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Originally presented at the Meeting of the Boyer House Foundation in Tribute to L. Bryce Boyer, at the Miyako Hotel, San Francisco, CA, May 15, 1999. (Condensed here for publication. Bibliography may be incomplete.)
In this paper I focus my attention on two main themes: the oscillation between paranoid-schizoid (PS) and depressive positions (D) (PS]D), and the related changes in the countertransference. Constant oscillations between the two positions demand a refined and sophisticated attunement to the patient's material on the part of the analyst. In my opinion, it is exactly when the patient is progressing from PS to D that the analyst is more prone to be caught off balance in his countertransference. In order to recognize the patient's evolution, the analyst must be able to resist his or her own internal impulses to attack psychoanalysis, and thus avoid resorting to massive projective identification. I want to convey that close attention should be paid to the difference between the countertransference proper and the analyst's transference towards the patient, and, more important, towards psychoanalysis as his or her most valuable possession.
This case presentation refers to the final stages of the analysis of a female patient whose psychotic self was encapsulated in very deep areas of her mind (for more on psychic retreat, see Steiner, 1993), causing great disturbances in her life. As a result of previous analytic work the psychotic self was becoming increasingly integrated and the first contacts with the depressive position became possible.
Two previous treatments were not able to address this area although both terminated with apparent success. In my view those earlier treatments resulted in internal rearrangements of the personality that resemble pathological organizations (Rosenfeld, 1971, 1987; Segal, 1972, 1983; Sohn, 1988; Steiner, 1988, 1990a, 1990b, 1992, among others). Hate and envy were scarcely, if ever, analyzed. Conversely, love, gratitude,