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The initial phase of psychoanalytic treatment can be quite difficult for both patient and analyst. For the patient, there is the conviction that the analyst will simply be another in the long line of repeat characters in their transference vision of the world, a place where the roles never change and the play never stops. This conviction forms the core conflict, the basic resistance to change, and the projective identification pattern.
For the analyst, there is the immediate confusion and anxiety of being partner to this transference confusion and a web of rigid psychic demands that have not yet been discovered. The analyst is simply the new surprise guest in the patient's internal world and has to feel his way through that unfamiliar darkness. Counter-transference is essential in this respect, and careful monitoring of the patient's responses to interpretation is important.
In this paper, I will share the clinical elements I encountered as I tried to understand the results of establishing — or trying to establish — a relationship with one new patient. I have now seen Paul for 15 sessions, so the nature of the analytic contact (Waska 2007, 2010a, 2010b) is frail and somewhat undefined. However, a transference profile has emerged and much progress has occurred regarding anxiety and phantasy conflict. How Paul is wanting closeness, change, power, learning, and the freedom to think and feel without dread or guilt is something I am just starting to understand. At the same time, he is preventing, numbing, or destroying those psychic possibilities in a deliberate unconscious manner. So, from the lens of counter-transference, I am noticing many ways Paul is making efforts to engage or disengage with me.
Paul is 22 years old. When he came to see me, he was very nervous that he was going to kill himself. He told me he would suddenly think, “You will jump off the bridge later this week.” Paul had a bottle of anti-anxiety medication and he heard himself think, “You will take an o