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The presentation and discussion of Dr. M's case, which follows, comprised the afternoon portion of an all day panel. In the morning, three papers were presented by Drs. Coen, Kantrowitz, and Rothstein. These papers are published elsewhere. We include here brief summaries of the papers, adapted from the authors' texts, as background to the clinical case presentation.
“How to Help Patients (and Analysts) Bear the Unbearable” by Stanley Coen, M.D.
It is suggested that absolute, “either/or” assessments of analyzability made in the course of analysis by analyst or patient may lead to
overconcern with apparent incapacity for analysis rather than to understanding of defenses and facilitation of psychoanalytic process. Analyst and patient can become trapped in narcissistic evaluations along the lines of “analyzable is special” and “unanalyzable is worthless.” Should the patient demonstrate affect intolerence, rather than attribute this to an incapacity for analysis, it might be tactfully challenged as generated by childhood attitudes, fantasies, and experiences that are no longer current. To bear the unbearable, patients need to gain the confidence that painful affects no longer will be as overwhelming as they once seemed.
“Difficulties in Analysis Due to the Patient's Characteristics Only Versus Difficulties in Analysis Due to Patient's Characteristics and the Fit with the Analyst's Characteristics” by Judy L. Kantrowitz, Ph.D.
Patients who are difficult in analysis are those who are on the cusp of freezing or flooding their affect. Their difficulties are manifested as impasses in the work—for one group mainly quiet, stubborn ones, for the other group often volatile and stormy. These patients are likely to be difficult for almost all analysts. The nature and organization of their defense systems prevent them from risking affective engagement; problems in trust and self-esteem make such involvement feel like a danger to their sense of intactness. These difficulties can be fur