A Special Variation of Technique1

In recent years the pathology of the ego and superego has increasingly become the centre of psycho-analytic interest. There exists as yet no systematic classification of the forms of ego pathology and character disturbances; hence there cannot be any systematic description of variations in technique or of parameters, to use Eissler's term, necessitated by this pathology.

Methods of giving initial support to a weak ego, so as to strengthen it for the task of facing instinctual conflicts, have been most frequently discussed. E.g., it has been described how the violence of anxiety in these cases often necessitates all sorts of supportive measures, such as to 'nurture' some positive transference by giving the patient the feeling that the analyst is always there for him and can be called in a situation of panic, etc. Sometimes his relation to the analyst may become the first really reliable object relationship in the patient's life, a contingency which of course entails the danger that it may seriously interfere with the possibility of the transference ever being analysed.

I shall concentrate on a special variation of technique dealing predominantly with a particular form of superego pathology in a certain group of patients who can be defined as impulse-ridden characters or acting-out hysterias. The ego disturbance in these cases appears to be a secondary effect of the defective superego. Such patients are a helpless prey to uncontrollable outbursts of libidinal and/or aggressive impulses, which cause violent anxiety and guilt reactions. Between these powerful drives and a relentless superego the ego seems weak, almost non-existent, so to speak; but it may manifest itself very forcefully in negative ways, i.e. as inhibitor of normally ego-syntonic, important gratifications and activities. Such an ego is of little help to the analysis. Repetitive acting out occurs outside and within the analysis, cannot be stopped, and threatens to make the treatment impossible.

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