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In his clinical account Dr Cecilio Paniagua describes his work with a patient who presents a difficult technical problem. It is not simply an illustration of his usual technique. The clear and frank account of a portion of this analysis shows how sensitive the analyst has to be to hold his patient and how much internal dialogue the analyst needs with himself to preserve his analytic identity. The patient is having an analysis of the ‘third kind’ not just a third analysis. The first ‘intrusive’ analysis, we are told, produced a breakdown; the second, prior to the death of the analyst, looked interminable; and the third, with which we are presented, is hopefully leading to termination. With borderline patients, such as this, it is likely that with some analysts there is an abortive analysis, and with others an interminable analysis. Dr Paniagua is very aware of both possibilities and it is clear that his approach is shaped accordingly.
The analytic problem is familiar to anyone who has worked with those hyper-subjective, hypersensitive individuals whom Rosenfeld described as ‘thin-skinned narcissistic patients’. He contrasted them with those ‘whose narcissistic structure provides them with … such a thick skin that they have become insensitive to deeper feelings’, and he warned that ‘when the sensitive narcissistic patient is treated in analysis as if he is the thick-skinned patient he will be severely traumatised’ (1987, p. 274). I have suggested that
in these cases it is the attempted integration of subjective and objective ways of thinking in the patient, or the bringing together of empathic understanding and intellectual comprehension by the analyst, that is believed to cause a catastrophe … As it is an aim of psychoanalysis to integrate subjective experience and objective understanding, the very process of analysis is felt to be a threat to this group of patients. This makes for characteristic difficulties and raises considerable technical problems (1998, p. 43).
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