Missing the Analytic Connection: Some Perils of Therapeutic Ambition

Under present-day conditions the feeling that is most dangerous to a psycho-analyst is the therapeutic ambition to achieve by this novel and much disputed method something that will produce a convincing effect upon other people. This will not only put him into a state of mind which is unfavourable for his work, but will make him helpless against certain resistances of the patient, whose recovery, as we know, primarily depends on the interplay of forces in him.

A cartoon depicts a patient lying on the analytic couch, looking dismayed and disbelieving, as his analyst is storming out of the office with an expression of extreme disgust and exasperation. The analyst's pen and notebook are strewn on the floor, in front of the chair he has vacated. The analyst is exclaiming as he leaves, “This isn't doing me any good!” (Goldberg, 2013).

In this paper, I would like to discuss certain conscious and unconscious countertransference dynamics as we attempt to sustain an analytic frame of mind in our work. Specifically, I would like to explore the nature of the relational connection we desire as analysts and the emotional turbulence that arises when our patients do not provide this connection for us in the way we wish. My reflections began to crystallize when discussing a presentation by Otto Kernberg (Rather, 2013) in which he focused on the pathological narcissism of patients who ignore, devalue, and dismiss their therapists as a matter of course (see also Kernberg 1975, 1984). I was struck that the usual focus tends to be on the patient's psychodynamics, and therefore would like to focus on some common reactions of therapists on the receiving end of such dynamics.

As an analyst, a case consultant, and as a case conference leader, I have noticed that the experience of working with patients who do not exhibit a sense of being connected to us or having feelings of being shut out by a patient is among the most difficult states for therapists