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An assumption made in this paper and explored for its clinical implications is that an act of chronic drug use often marks or serves to implement an underlying omnipotent self-state. Psychoanalytic work with substance users, as compared with other approaches, trains attention on these omnipotent states and makes use of the transferential exchange as a therapeutic tool. States of omnipotence are particularly examined here in the context of recent attention to dissociation as an organizing force in the personality, and in the configuration of the transference – countertransference of the treatment relationship. A case illustration is used to apply current thinking on dissociative and projective processes, and their role in enactment in the therapeutic exchange, to illuminate the frequent interplay of omnipotence and helplessness in analytic work with substance-using and other patients.
Commentaries by Edward Khantzian and Henry Krystal allow me to elaborate the role of dissociation in addictive disorder, and its misguided place in the design of many therapeutic strategies to overcome it. Promising direction for the treatment of the characters and symptoms of drug-dependent patients lies in the application of developments in current analytic theory and technique. Such developments include familiarity with enactment, dissociative and projective processes, and work in a two-person frame to enable treatment to encompass and reach more of the patient.