Chapter 9 Unbearable Pain

This case raises highly complex problems of technique. The patient is a borderline case, whose mother committed suicide when he was a child. His terror and the dramatization of his mental pain induce a countertransference response that tends to deny anxiety, which, precisely for that reason, becomes even more threatening.

Dr Brenman makes some important points about the capacity to tolerate psychic pain and about the tragedy of life when parents have lacked this capacity.

The need with this patient is to understand whether the drama serves the purpose of making the pain less intolerable or, conversely, of rendering the suffering so agonizing that it is unbearable. As a result, the patient wishes either to disappear himself (by numbing his mind) or to cause the disappearance of the person who speaks to him and who could provide him with an understanding of his pain.

Another complicating factor in the analytic relationship is that this patient seeks to erase the memory of good things, owing to his hatred of the object that also inflicts frustration and pain on him. This is what makes the experience of the relationship so painful for the patient and renders separation unbearable.

On account of this configuration, the transition to the oedipal experience becomes highly problematical, but without it the patient will be unable to develop and mature. The problem is not so much the introjection of objects as his difficulty in separating from a father or mother while preserving them as good objects inside.