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Hedges has something important to say about some of the patients who cause us most anguish and anxiety. He is writing about a fundamental level of disturbance which results from a failure to establish bonding and connectedness with the primary
caregiver. The basic idea is that if the infant cannot ‘organize’ meaningfully around the attuned presence of the mother, then he/she resorts to attempts to organize around aspects of self, its own body, or inanimate objects. Although the wish to seek connection and to bond is still present, contact is now dreaded, threatening a repetition of the original trauma of misattunement. The transference resulting from this level of disturbance is psychotic, primitive, intense and extremely difficult to manage. Much of the analytic speaker's (Hedges's term for the ‘patient’) energies are directed towards avoiding real emotional contact. As contact is eventually established, the analytic listener is perceived as malevolent - as the ‘psychotic mother’.
Hedges draws upon some of the exciting analytic work that has developed in the last twenty years. He owes a particular debt to Kohut who, in the American context, did much to establish the importance of the analytic relationship in the healing process. Kohut observed that when the patient experiences the analyst as empathically attuned, he/she has a sense of well-being; when the analyst is experienced as not attuned, certain patients become temporarily (reversibly) psychotic, hypochondriacal, thoughtdisordered or paranoid. However, Kohut considered that, whilst patients with narcissistic disturbance could benefit from the analytic process, those with schizoid problems were beyond analytic help because the danger of uncontrolled and irreversible regression to psychosis was too great. Hedges, by contrast, believes it is possible to help these people to enter and work through the ‘organizing experience’ in relation to the therapist. In discussing this level of analytic work he also draws up