You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Something that struck me about each of these remarkable responses is that they all, in one way or another, remark on my “strong” insistence that defense analysis must be a signal component of the treatment protocol for “pseudo-self” disorders. Anne Alvarez, Peter Goldberg, and Donnel Stern are some of my favorite thinkers on this topic, and I was struck by the fact that they all in different ways express some degree of curiosity, perhaps even mystification, about why I come out as strongly against “catalyzing transformations” as I do. Although they were each gracious about this in their own way, when I saw myself through their own eyes, I saw that I was unduly preoccupied with making a point about defense analysis that I no longer easily understood or identified with. To wit, rereading my own paper alongside these thoughtful and engaged responses, I began to wonder what I had against “catalyzing transformations?” I was especially perplexed because I was a firm believer in technical innovations that stretched and expanded the frame to meet patients where they were at, and I didn’t fully recognize myself as someone suddenly advocating for defense analysis or, god forbid, interpretation instead of “catalyzing transformations.”
In what follows, I want to revisit the question of how we treat patients with “pseudo-self” disorders by 1) reanimating the context in which defense analysis and non-interpretative interventions are continually counterposed, and 2) revisiting my clinical example to specify the range of work these conditions require.
Let me start with something that happened in my treatment with Casey. I have already mentioned that she was a talented music teacher in her mid-40s, but now I want to explore her relationship to music in greater depth because I think it tells us something important about the complex interrelationship between dissociation as a self-regulatory mechanism and the mind’s other defensive operations. A significant detail