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In a paper in 1958, I reported my experience that a phase of symbiotic relatedness between patient and analyst is necessary in treatment of either psychotic or neurotic patients, and in a succession of papers since then, I have discussed various aspects of this phase of “therapeutic symbiosis.”1
It is gratifying to see that Khan reports here his clinical experiences and theoretical concepts concerning essentially these same phenomena. His writing is, as always, memorably vivid and succinct, as when he refers to these “almost healthy borderline schizoid personalities” and when he says that “the children developed an early bias that they were special and cannot be understood and that communication is futile.”
He makes the valuable point that “the mother's selective sponsoring” fosters in the child “intensification of all libidinal stages of maturation and development with a corresponding failure to integrate aggression.” He presents the thought-provoking hypothesis, tying in both with Jacobson's and Winnicott's concepts, that “the self of the child functions as a transitional object between the child's ego and the mother.” His portrayal of the transformations of aggressive strivings, in the etiology of these patients' illnesses, forms one of the strongest aspects of his stimulating and instructive paper. In this particular regard, his emphasis is reminiscent of that of Jacobson's writings.
I wish here to point out more fully the nature of what I believe to be the depth of the analyst's actual feeling-participation in the symbiotic-transference phenomena which Khan describes.
Khan says that “the position the analyst takes up in relation to this externalization process is the factor that determines the fate of the clinical process.” I want to emphasize that this is not so much a position taken up as a deliberate technical device, but rather is one arrived at, and maintained, by the analyst primarily through the awareness of his own “countertransference” feelings.