Pleasure in Phantasy and Reality

Pleasure, fantasy and reality are—in the words of Roy Schafer—the three axes of clinical psychoanalytic work. The work of analysis is concerned with stabilising and sharpening the patient's sense of reality. It is equally concerned with finding a way for a creative and imaginative fantasy life to become established. In each of these areas primitive defences such as splitting, denial, idealisation, projective and introjective identification play a dominant and pathological role in limiting the patient's ability to experience pleasure.

Defining and analysing emerging unconscious phantasies about the self and others often bring in their wake greater understanding of our patients’ basic assumptions, past and present, which limit their ability to find satisfaction in love and work. Through the analysis of the transference, the emotional reality of childhood can be refound and integrated by the now adult patient.

In his clinical presentation ‘Pleasure in fantasy and reality’, Schafer chose material from the analysis of a middle-aged, unmarried male patient, Anthony, whose presenting problems included depression and severely restricted sexual and social enjoyment and relationships.

His parents had fled political persecution in a Mediterranean country after their parents and other close family members had been imprisoned, abused and killed. Their devastating losses left them bereft and emotionally unavailable to their son, who in turn left them and their chosen country of refuge to study and eventually pursue his career in the United States.

Their depression and sense of guilt at surviving not only marked and subdued their lives, but also deprived and narcissistically damaged their son, curtailing his abilities to find pleasure in reality and fantasy and to relate to others with excitement or with passion.

‘Borrowed guilt’, i.e. his parents’ survivor guilt introjected by Anthony, exacted a heavy price in terms of Anthony's mental health. His outwardly pleasing, intelligent, cons