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The chairman opened the Panel by saying that even with acute psychotics we have to think as analysts and fight against the patient's resistance and our own countertransference. Freud said that there is a healthy corner in any patient's mind.
The first panellist, Barbara Stimmel, presented her paper ‘Analysis ends’, in which she said that the dividing line between necessary reality-based interventions and psychoanalytic ones is not so clear and that both were used in the treatment of the difficult case she was going to describe. When is the analyst acting out, and when is she setting the boundaries to help the patient respect and come to grips with reality?
The patient was described as presenting overt assaults and aggressive behaviour in the sessions—screaming, ripping her hair and slamming doors and menacing the analyst's equilibrium. Constantly ridding herself of unbearable aspects by making use of massive projective identification into the figure of the analyst, the patient felt threatened by that same figure. More than once the analyst refused to continue an impossible session. In so doing, the analyst was putting the patient in a quiet corner, holding her responsible for her actions and simultaneously defending the patient and her own self from disguised retaliatory responses. The analyst hoped with this attitude to bind the patient's uncontained fury, and also to highlight the line separating them. Only when it was clear that their minds were separated could analytic work be resumed, and some sense be made of the symbolic meaning of such disruptive behaviour.
The main point of the paper was that the creation of structure and boundaries are necessary for analysis to take place. The patient was able, at moments, to gain sufficient distance to reaffirm her trust in the analyst's helpfulness, while recognising at the same time her intense need to both reject and ruin what the analyst had to offer, in an almost perpetual see-saw movement.
The analyst became aware that