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Among Patients In Analysis Who have reached the level of emotional development that Melanie Klein called the “depressive position,” and Winnicott more aptly termed the “capacity for concern,” are those who are likely to negate, dissociate, or become selectively inattentive to experiences of the analyst's negative impact. To the extent that they become aware of negative thoughts and feelings, they are likely to withhold them in order to protect the analyst's self-esteem, and to protect themselves, as well, from possible retaliation. The sensitivity of these patients to the needs, feelings, desires, and vulnerabilities of others is such that it eclipses their awareness of their own needs, feelings, and desires. I think of them as being imprisoned in their empathy for others. They are given to automatic and unwitting self-abandonment. They tend to be hypercritical of themselves, self-hateful, and may be given to depressive mood swings and to suicidal thoughts and urges. The implosion of aggression may alternatively take the path of attacking the body or the immune system, increasing susceptibility to somatic disorders, illness, and disease.
The precursors to this complex of implosive defenses usually become clear in analysis. In most cases, the patient was very early recruited by one or both parents to serve as a selfobject and to meet the parent's need for tension-regulation and need-satisfaction. Sometimes the patient served as the target of projections, bad feelings, or feelings of badness, and at other times served to support the parent's need for feelings of goodness by never addressing the parent as the object of fault. This complex of security operations, by which one's negative emotional experience of the other is obscured and anger and hate are imploded, constitutes a powerful and sometimes lethal dynamism that is often intractable