The Body as a Stage for Criminal Acting out

In this paper I will present case material relating to a period of my analysis of a severely disturbed patient in an attempt to demonstrate my understanding of the patient and also the techniques and operating styles that shaped my attempts to establish contact with him.

I will attempt to centre this paper on our analytical dialogue, with special emphasis on my countertransference since this proved an invaluable aid in tackling this extremely difficult patient. Our analysis sessions were a constant struggle: he came to me four times a week and caused me such continual worry that it was very difficult for me not to think about him all the time. He aroused a whole range of very different emotions in me, including affection, fear, hostility, etc. Sometimes I even experienced periods of intense paranoia when I feared the patient was at the point of attacking me and losing control. This was offset on other occasions by my fondness for him. I felt a desire to help him when I was able to contact his more needy, defenceless 'patient side'—but this unfortunately happened only rarely.

I propose to follow a few explanatory notes relating to my material with a description of a certain period of analysis. This covers the vicissitudes experienced by my patient and myself as a result of a severe episode of acting out, which was expressed bodily and displayed disconcerting, plainly psychotic features. This and other forms of behaviour expressed by the patient affected me so deeply that at some moments—fortunately short-lived—I was led to question my identity and ability as an analyst.

I would like to run quickly through some important moments of the first stage (one and a half years) of this difficult process before concentrating my clinical discussion on the severe episode of acting out mentioned above—I will refer to this as the 'surgical operation episode'. This episode of acting out was no more or less severe than others that occurred during our analysis. I c