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In the course of an analysis it is not uncommon to discern significant and meaningful changes that nevertheless cannot be pinned down and securely established. They may be inferred rather than discovered, they may only be hinted at by the patient, or they may be identifiable but so disguised or confused that their significance is ignored. A further step seems to be required to transform such developments into a more tangible and stable form. This step seems to require that the changes are made observable and explicit. Without this extra step they remain hidden and are sometimes felt as only potential, so that the patient is protected from needing to face the consequences. However, when they become observable the patient feels exposed and often threatened.
The anxiety about acknowledging new developments is particularly acute in those patients where a narcissistic organisation has created a hiding place that protects them from exposure and enables them to avoid the need to test achievements against reality. I have described how these psychic retreats initially evolve to protect the individual from catastrophic anxieties of persecution (Steiner, 1993). When these paranoid anxieties are at their height, the retreat is felt to be necessary for survival; fears of deadly attacks from powerful destructive objects lead to a terror of emerging. The development of a greater sense of integration leads to a shift in the nature of anxieties. Emergence from the retreat then gives rise to contact with depressive feelings such as guilt, remorse, and despair, which can be even more unbearable. This is the situation described by Riviere in her paper on negative therapeutic reactions where she writes about patients turning
to “a highly organised system of defences” to avoid unmasking despair, disbelief, and a sense of failure (Riviere, 1936, p. 315).
While the fears of persecution on the one hand and those of depressive anxiety on the other are never fully surmounted, I want to look a