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Impulsive action, such as binge eating or drinking, wrist-slashing, compulsive promiscuity or chronically explosive marital conflict, presents serious problems for psychoanalysis. Such action evokes explanations both from the analyst and from the patient. The analyst may be held captive by explanatory notions that emphasise one aspect of impulsive action rather than the whole process. These explanations are based on our notions of drive pressure, adaptation, control and attack of intimate persons, ‘acting out,’ and the ‘compulsion to repeat’. The patient's explanations may be either consciously stated or inferred by the analyst as unconscious ‘explanations’ from associative material. If the patient's explanations dovetail with or adapt to those of the analyst, the analyst may take them as confirmatory, and the whole process of breakdown and restitution may escape analytic scrutiny.
This process includes: (1) a precipitant that is narcissistically wounding; (2) a prodrome consisting of an experience of lack or absence which the patient feels as persecution, and a restitutive phantasy of the lack as fillable by a consummatory act; (3) the act itself; (4) character defences that ward off mortification on awareness of personal disintegration (shame) or the consequences of the act (guilt); explanations emphasising guilt often screen those giving rise to shame; (5) an attempt to regulate distance to protect against narcissistic injury by keeping intimates from getting too close or too far away.
The therapist's tendencies to overemphasise the precipitant, the meaning of the act, or its distance regulating may convey an attitude of blame rather than understanding. Therapeutic emphasis on the subjective experience in an unintegrated way is sympathy, not empathy; sympathy is collusive and fosters splitting and impedes working with the negative transference. Blame or sympathy may be buttressed by the type of explanation accepted by analyst and patient. Explanatory preconceptions must be transcended to do effective interpretive work. Interpretation should convey understanding of a preoccupied ego that manifests its disorganising and restitutive propensities in the process of impulsive action.