Introduction to Part Three

In the first chapter of this section, ‘Different types of anxiety and their handling in the analytic situation’ (1978), Joseph develops some of the themes introduced in the previous four papers. She is again primarily concerned with the factors which promote shifts within a given session back and forth from the use of defences belonging primarily to the paranoid-schizoid position to the experiences of ambivalence and guilt characteristic of the depressive position.

By careful attention to the immediacy of the transference situation rather than the ‘meaning’ of the patient's material, Joseph believes we can become aware of the current anxieties the patient is defending against and the mechanisms by which defence is achieved. She emphasizes the need to recognize and try to understand the patient's attempts to involve the analyst in a subtle form of acting out, the purpose of which is to avoid anxiety connected with conflict or guilt.

Thus she describes a patient who used projective identification for two different purposes — first, to disavow, for example, his own anger, cruelty, and guilt; and second, to try to draw the analyst into acting out a kind of sado-masochistic beating of him, which is another means of avoiding the experience of conflict, guilt, or depressive pain. Such patients use us to avoid anxiety rather than to understand it. The patient's use of primitive defence mechanisms (primarily projective identification) makes it imperative that the analyst recognize the extent to which he is being unconsciously involved and used in this very active fashion.

Joseph experienced the second patient she describes as bland and remote, successful in his work, but unable to be deeply involved with

anyone, especially women. He brought a dream which showed that he thought a woman, a thinly disguised version of his analyst, was grandiose and paranoid. Joseph makes an important technical point in relation to this patient, namely, that it is necessary first to interpret an