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This paper was first published in P. L. Giovacchini (ed.) Tactics and Techniques in Psychoanalytic Therapy, vol. 2, Countertransference, New York: Jason Aronson (1975): 205-16; and appears in E. Bott Spillius (ed.) Melanie Klein Today, vol. 2, Mainly Practice, London: Routledge (1988), 48-60.
In this chapter I intend to concentrate on some problems of technique, focusing on a particular group of patients, very diverse in their psychopathology, but presenting in analysis one main point in common. It is very difficult to reach them with interpretations and therefore to give them real emotional understanding. My aim is to discuss some manifestations of the problem and some technical issues that arise in handling this type of case. I shall not attempt to make a study of the psychopathology of these patients.
In the treatment of such cases I believe we can observe a splitting within the personality, so that one part of the ego is kept at a distance from the analyst and the analytic work. Sometimes this is difficult to see since the patient may appear to be working and co-operating with the analyst, but the part of the personality that is available is actually keeping another more needy or potentially responsive and receptive part split off. Sometimes the split takes the form of one part of the ego standing aside as if observing all that is going on between the analyst and the other part of the patient and destructively preventing real contact being made, using various methods of avoidance and evasion. Sometimes large parts of the ego temporarily seem to disappear in the analysis with resultant apathy or extreme passivity — often associated with the powerful use of projective identification.
It follows from what I am discussing that for long periods in the treatment of these patients the main aim of the analysis is to find a way of getting into touch with the patient's needs and anxiety in such a way as to make more of the personality available and eventually to bring about