9. Projective Identification and the Problem of Containment in a Borderline Psychotic Patient

I drew attention in Chapter 8 to my view that projective identification, while sometimes taking the form of a violent and powerful expulsion of unbearable material, also provides the opportunity for communication between patient and analyst. If the analyst is functioning therapeutically, he should be able to contain the patient's communications (particularly in his counter-transference) and use them to increase his, and subsequently his patient's, understanding. On the other hand, projective identification is often confusing to the analyst and may prevent him from thinking and interfere with his capacity for judgement and assessment of the patient. From the beginning of treatment, especially with psychotic patients, powerful projective identification can take place and create an almost hypnotic atmosphere. In these circumstances the analyst's capacity to function therapeutically and to contain the situation depends upon his emotional resources and his theoretical understanding. It is important to realize that the two interact together, so that the analyst's emotional capacities can help him to empathize with what is happening, and his theoretical, conceptual capacity can help him to bear the emotions. The case I am now going to describe was first presented to me in a prolonged seminar lasting more than three hours. The patient, Clare, had been treated at that time by a psychotherapist, Mrs L., for four years.1 The case illustrates how delicate the balance can be in cases involving powerful projective identification and how it can go wrong – leading to a failure of containment and a long-lasting therapeutic impasse.2 I shall interpose Mrs L.'s report about the patient (in italic type) with my own comments in roman type).