Finding a Shape: The Creation of Psychic Structure in a Psychoanalytic Setting

This is a study of psychic movement, fluctuation, and change over a four year period in the treatment of a 41-year-old man fixated at a pre-object level of emotional development and exhibiting a range of psychotic symptoms including fragmentation of thought, obliteration of feeling, distortion of speech, confusion and loss of the boundaries of the self, and the destruction of his apparatus of awareness in the processing of stimuli. Transformations of the patient's representation of himself and of the analyst observed over the course of the first three years of treatment led to the research question, “How does the patient create psychic structure out of chaotic disorganization?” The methodology devised to study this question describes three comprehensive and overlapping axes of observation, whereby the functioning of the patient's apparatus of awareness, the evolution of his representation of himself, and his progressive construction of the analyst can be simultaneously tracked in either a progressive or regressive direction. The principal finding is that the patient creates psychic structure in the evolution and progression of transference states which the unconsciously enacts in the treatment. The uses the patient makes of the analyst and of the analytic setting constitute creative achievements in building psychic structure. Further, each such transformation of the analyst constitutes a transformation of the self in a progressive direction, structure being added by phases upon those that preceded. A sequence of four distinct phases describes the transformative movement from a fundamentally

objectless state to symbiosis to the construction of an externally situated transference object built out of fragments of the emerging self.