The Patient Difficult to Reach: Omnipotence, projective identification, and the primary self

This paper is to do with the difficulties of reaching patients who are so heavily defended and resistant that I understand them as having an autistic core. This presents particular difficulties because we seem to be confronting primitive archetypal objects and defences which are experienced in the transference-countertransference phenomena.

To make a start about understanding these phenomena, I would like to consider the archetypal constellation of the Mother whose symbolic meanings are to do, on the one hand, with nourishment and care and, on the other, with devouring and death. In order to move towards individuation, these two aspects of the archetype have to be acknowledged and confronted, for if one is ignored or denied, the free flow of psychic energy between them is blocked and cut off. The tension between the positive and negative aspects of the Mother archetype needs to be held and contained well enough initially within the mother/infant relationship or later within the analytic experience. The roots of this tension are grounded in the instinctual life of the infant and, if the holding of this tension is, for whatever reason, too overwhelming for either infant or mother, particularly over a sustained period of time, the deintegrative/reintegrative processes from the original self may become distorted or in extreme cases cease altogether. Jung refers to the terrifying paradox of the primordial mother image, encompassing the withholding as well as the giving mother. If this duality is too terrifying to contemplate or experience, the unfoldings or deintegrates of the Self become paralysed or static and a rigid defence system is likely to develop, thus impoverishing the whole personality with a false or one-sided persona.

The alternative is the fear of disintegration and death. Hence the development of the defences of the Self, which are used in the first instance to ensure survival. These may include such defences as