Negative Hallucination

A patient who was in face-to-face therapy gave the analyst reasons to doubt for a long time, even though she herself had no doubts: she was enthusiastic, involved, persuaded as to the benefits of the work, whose effects she said she could distinctly measure and whose merits she bragged about to her friends and family. For her, it was “visible”, undebatable. She was constantly looking to her analyst for approval, and he was an interlocutor implicitly taken as a witness. He struggled with this inwardly because the patient's detailed account of daily life and her discussions with those around her generally left very little room for fantasy, for unforeseen thoughts, or for the emergence of an elaborated preconscious. Her accounts were reduced to circumscribed recollections that were immediately “interpreted” and hence equally quickly classified. Things were clear for her, but obscure for the analyst.

It was only when something went wrong that the analyst's confidence returned. For instance, if she arrived late for a session or seemed embarrassed to speak, the analyst considered that maybe she should lie down so that she would be better able to play with associations, which one could now suppose were suppressed. She would no longer need to cling to the physical presence of the interlocutor to whom she clinged to validate her conclusive affirmations. During one of the rare moments when she talked about a difficulty in saying what came to her mind, the analyst decided to ask her if she had ever thought about using the couch. She responded very quickly: “It's really funny that you're mentioning that today because yesterday evening I said to my sister that since you changed your office at the beginning of the year you no longer had a couch. Previously, when I came into the room, it was obvious.” It turned out later that she had noted, without paying attention, that a sofa had been replaced by an armchair in the waiting-room. An absence of perception was thus substituted with