Case Response II

I first wish to acknowledge the honesty and courage of the analyst and author of this case vignette for bringing such a personal and sensitive issue as the development of a potentially life-threatening symptom (breast cancer) during the therapy with Patricia into the wider analytical community for further reflection. The author brings a crucial issue, and one not often spoken about—the potential “dangers” inherent in an activated unconscious-to-unconscious link in the transference and countertransference relationship. As the author herself wonders about links between her diagnosis at this time and unconscious and “neglected” aspects of her own developmental history and subsequent identification with the all-loving “healer,” it is here that I wish to focus my response.

My experience of working with patients like Patricia is that it can be exceedingly painful because of the seeming “insistence” that we remain in a state of perpetual self-examination and self-doubt when with them. It can feel as if they are trying to “force” an unthinkable repudiated self-experience of existential shame and doubt out of one place (their psyche-soma) into another (the analyst's psyche-soma). But for any analyst, “thinking under fire” is not easy and we can be pushed to the limit of what we can bear. While reading this vignette, Jose Bleger's (1967) recognition that the body is also a part of the “setting” and frame of our analytic work came to mind along with a paper of my own (Dowd, 2012) which describes some early work with similarly disturbed patients and my recognition of the primitive agony I call “primal negation.” The description of Patricia and her background suggested to me that she had experienced the feeling of being denied entry into an imaginal space in mother's mind which left her feeling “locked out” of the potential space-of-becoming, existentially abandoned.

Such a foreclosure denies the infant what Grotstein (2007, p. 313) calls “an initializing experience of containment