You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
This book addresses the complex clinical and theoretical issues of analytic work with patients whose pathological dependency causes them to repeat self-defeating and destructive behavior patterns toward the analysis and the analyst. Work with this group of patients
taxes the analyst's skill and tolerance, and frequently includes impasses and less-than-satisfactory outcomes.
Coen writes from the perspective of traditional psychoanalytic conflict theory integrated with an object relations perspective, so that for him drive and object relations fit together as a single entity. He describes both an intrapsychic and interpersonal perspective, emphasizing also that “interpersonal is to be understood in relation to intrapsychic. To a degree they cannot be separated and must at the same time be separated; that is, what goes on within our minds and between ourselves and others are parts of a whole” (p. 11).
Coen defines pathological dependency as “the felt inability to manage on one's own and to be alone” (p. 13). Further:
The pathologically dependent person's fears of rage and destructiveness, in himself and in his vitally needed other, are so central to his conflicts … that multiple feelings and wishes are subsumed under rage and destructiveness including varying intensities of angry and hurtful wishes. The most frightening of these usually are those that most threaten to destroy the other or the relationship with the other. The more vitally one needs the other, the more dangerous rage and destructiveness become [p. 29].
He emphasizes that these wishes can take many forms, such as “cannibalism, evisceration, murder, robbery, castration, humiliation, rejection, disconnection, dehumanization, abandonment, contempt, belittling, spoiling, scorn, domination and so on” (p. 30).
“The patient needs to repeat such potentially dangerous and violent confrontations between self and other in the analytic transference to become convinced that his destructiveness can be felt, managed and c