Chapter 3 Separation: A Clinical Problem

The problem of separation has long concerned the analyst who may observe marked changes in patients following weekend, holiday and day to day breaks. The analyst may also observe reactions to silences in the session, the quality of separateness and togetherness, normal and pathological, manifest in the daily work with the patient.

A relatively healthy patient faced with separation is ordinarily able to bear a certain amount of anxiety, frustration, greed, envy, jealousy and hatred. Such a patient has an internal picture of an analyst who is mindful of him, yet able to have mutually enjoyable intercourse with others. He experiences the analyst as someone concerned about the patient’s life outside the analysis. This is not too distorted by excessive intrusion and pathological projective identification.

If the core of a good enough relationship between the patient and his objects is sufficiently established, then the analyst is in a position gainfully to show the consequences of separation. The analyst can show how the real creative relationship becomes disrupted during separation by feelings of jealousy, envy, frustration, etc. The analyst needs to preserve what has been achieved and analyse the pain, grief, and the destructive and defensive devices employed by the patient which destroy the meaningful achievements of the relationship. Thus the analyst can help to reestablish the good achieving aspects of the relationship and provide the patient with the opportunity to see what the destructive and defensive elements have done during separation. The patient then can mourn the loss, face the guilt about damage, and work at the reparative reconstruction of the truth. To achieve this the patient needs to be relatively healthy. Sometimes, however, the severity of the illness militates against this understanding, either more or less, or virtually in toto. It is to this problem that I am addressing myself.

The problem becomes more taxing when the analyst witnesses repeated re