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From the exploration of so-called “difficult” patients Robert Grossmark has distilled a patient-centred psychoanalysis with new and innovative implications not only for a relational approach but also for all the diktats of the psychoanalytic training institutes, promoting a clear emancipation from the obsession with orthodoxy in favour of clinical evidence. As the author himself says,
The treatment belongs to the patient, and it is the analyst’s work to find and join with the register and wavelength that is the truest expression of the patient’s inner world and experience … The psychoanalyst can unobtrusively companion the patient into areas of non-developed, non-related, and non-represented inner life in the register that is organic to the patient at that time. (Ibid., 3–4, my italics)
He writes of exploring the most archaic areas of individual development which are often found in patients who are not clinically psychotic but have “defects of thinking” (Bion) such as we often find in the most seriously ill patients:
Often, psychoanalytic treatment eschewed patients who did not rely primary on language and consequently could not engage with both the structure and the spirit of the psychoanalytic endeavour, seeing them as too narcissistic, disorganized, or primitive. Action, motility, and pure sensation tended to be classed as acting out, resistances, or assault on the treatment. (…) However, many patients who present in this way also harbor self-states that contain earlier undeveloped, empty, unspeakable, and profoundly non-related parts of themselves that can find no expression in language. These areas of the self are much less likely to be reached by dialogical engagements and are often chased underground or shamed by a psychoanalytic treatment that puts a premium on relatedness, thought, and verbal exploration. (Grossmark, 2018, 1–3)
This centring on the patient which Grossmark introduces has the virtue of projecting psychoanalysis into the future, opening up the c