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Presenter: The patient is an eighteen-year-old girl who has been in analysis with me for five years, four times a week.
She came in, lay on the couch, and was silent for a while. Then she said, “While I was silent I kept wondering whether I was going to speak or not. I thought the couch was hot. And I thought it would be very difficult for you to separate one person from another.”
Bion: Patients often do this. I find that it is important to draw their attention to the fact that they are putting distance between themselves and themselves. This patient says, “I wonder what I am going to say.” It might be useful to reply, “Well, what is the result of your wondering?”
P: She continued, “As a test I stayed silent to see what would happen.” I had the feeling that she was not sure if I could distinguish one patient from another.
B: You could say, “Well, I'll remain silent too, and then there will be two of us who can wait to see what happens.” This suggests that there are three people present – she, herself and somebody who is neither of these. So if any two of these could get together, they might hear what one of them alone could not.
P: Might that not imply, “I can also provoke and tease you”?
B: Possibly. That is why we have to be careful with the tone of voice, the inflection and so on. There is not only the difficulty of having to give an interpretation, but also how we give it, what musical accompaniment we put to the words.
P: I told her that I thought she was wanting to force me to speak. She answered, “I wanted to know if you were thinking of another patient.” I felt that she was afraid of being mixed up with all the other patients, like the children of a very big family who fear that the parents
won't be able to distinguish one child from another. I suggested that she was confused about her own identity. After a while she said, “I have never thought about it.” And then, in an anxious tone of voice, “I think I am afraid of losing myself from myself. It upsets me terri