An Exquisite Corpse: The Strain Of Working In And Out Of Potential Space

Analysts working with patients who go in and out of psychotic states must handle a variety of potential strains. The most obvious strain is the management of the patient's self-destructiveness, both in the overt form of suicidality and the more subtle forms of disorganization, confusion, poor judgment, or intense anxiety states. Another source of strain is related to the analyst's awareness that working analytically with these patients is not supported by the wider mental health community. In fact, analytic work is generally perceived by nonanalysts as damaging to the patient. This social reality complicates the effective management of the more severe forms of self-destructiveness because most current hospital settings cannot easily be used, when necessary, as natural extensions of the analytic treatment process. A third source of strain is the absence of agreed upon technique among analysts for working with more “primitive” phenomena. The current passionate disagreements about such issues as developmental arrest and conflict, object relations and instincts, social and personal reality, confrontation and empathy, growth and safety, consensually validated experience and subjectivity are magnified in the context of treating more severely disturbed individuals.

In this article, however, I wish to emphasize an additional and unique kind of strain that the analyst must bear in working with these patients: the strain related to the precarious and cyclical way in which potential space is generated in the analytic encounter. The analyst's handling of this strain, the patient's experience of how the analyst handles the strain,