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A major technical problem in treating paranoid patients is establishment of a working alliance. Most paranoids come to treatment with a monumental chip balanced precariously on their shoulders, and almost any remark of the analyst's may dislodge that chip. Every utterance is taken as a demonstration of the analyst's incapacity to treat the patient. I am emphasizing this opening phase of the treatment of paranoids, because unless one can keep these patients in treatment, it is impossible to help them.
Once the transferential glue has set and the analysis is ready to begin, one of the questions raised in this book by Auchincloss and Weiss becomes very valuable, how to understand the alternation, within patients, and even within a session, of persecuting ideation with blissful euphoria. Their explanation is particularly satisfying, since it does not offer a single answer, but rather indicates a strategy of questioning, the result of which will result in the patient doing a lot more talking, which, as w are beginning to understand, is what we want to happen in analysis.
Further on in the same chapter Auchincloss and Weiss make the point that:
… it was necessary to interpret derivatives of and defenses against primitive oral aggression and envy so that object constancy could be established and intimate relationships tolerated. Nevertheless, in this patient as in all paranoid patients, it was also necessary to interpret splitting between Ms C's feeling that she was either completely
Page 122connected to important others (as she put it, trapped and consumed) or totally ‘spaced out’ and disconnected.
Magical and concrete fantasies of connectedness that involve the sacrifice of self-object boundaries must also be interpreted before or along with the aggression…
… However, if the need to feel magically connected, the corresponding fear of utter indifference, and the high price paid for this split, are interpreted over time, particularly during periods of relative calmness, the possibili