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The author reports on 22 patients with pre-verbal disturbances (12 seen as in-patients and 10 seen as out-patients), who were diagnosed as paranoid psychoses cases with hallucinatory phenomena (7), acute psychoses (2), borderline syndrome (6), narcissistic problems (7). The treatment went on for a minimum of six months and a maximum of three years. The frequency of the sessions varied from once to four
times a week. The series included seventeen women and five men ranging in age from twenty to thirty-eight. The paper reports experiences over a period of eight years.
The hypothesis is put forward that, in the treatment of conditions thought to be due to pre-verbal disturbances, the transformation of the dominant negative mother complex can be affected by accompanying the patient into the sphere of death and what this entails, and working through the constellation of the good/bad mother and the transference/countertransference. The author, who describes herself as a psychiatrist, psychotherapist and psychoanalyst, observed that the development of the work with these patients fell into four phases:
The initial phase dominated by the negative mother complex developing into thoughts of death. It is particularly during this phase that ambivalence towards the therapist is high and murderous feelings need to be contained.
Experience of unity in the initial relationship with mother and its rediscovery in the transference/countertransference. This phase requires a lot of courage in its management and much faith in the indestructibility of creative possibilities.
Phase of detachment from unitary reality and an approach to the good mother.
Phase of rapprochement crisis, feeling closer to the analyst and yet being able to separate.
A clinical example from each phase brilliantly illustrates this paper.
Following the work of Erich Neumann, the author maintains that accompanying the patient around discussions of death (coping for, being fascinated by, afraid of and having fantasies abo