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There have been many articles in the psychoanalytic literature describing the difficulties in working with very withdrawn and disengaged patients, with patients who seem cut off from the world and have ceased to process their experiences. Psychoanalysts have used terms like “psychic deadness” (Eigen 1996), state of “non-experience” (Ogden 1989), state of “foreclosure” (McDougall 1984) and “psychic retreat” (Steiner 1993) to describe adult patients who experience themselves in various degrees of isolation and disengagement in life. The withdrawal from life and disengagement that these patients experience is not temporary or transient, but is a more entrenched and stable feature in their way of being in the world. Their “deadness,” their “retreat” from contact, their nonexperiencing, all represent attempts to avoid internal and external pressures, to stay out of contact from a persecutory and fragmenting reality and to maintain a sense of safety, however fragile and ineffective.
According to Steiner (1993) the disengagement that patients experience can be expressed in multiple ways, depending on the patient's personality organization and history. Patients can seek safety either through a very aloof and schizoid type of distancing, through fleeing from contact due to intense anxiety, through contemptuous dismissal and narcissistic superiority, or even through a type of false and superficial engagement. Whatever the particular mode of disengagement, the bottom line is that such patients seek relief and safety in withdrawing and avoiding contact with reality.
In working with such patients, the therapist has to be able to tolerate and process the paralysis that is experienced in the room, the feeling that the treatment is unsuccessful, that he or she is failing as a therapist. The deadness, the paralysis that is enacted in the room often feels palpable, and in the countertransference the therapist is likely to feel intrusive and forceful