Notes on Some Therapeutic Challenges in the Analysis of Severely Regressed Patients

One of the major problems of the analyst in the treatment of patients who regress deeply is how to respond to unusual and sometimes primitive expectations or behavior in ways that will not disrupt the effectiveness of the analytic process; that will not further stimulate insatiable cravings; and that will not render the treatment non-psychoanalytic (although no “sin” is involved if this “needs” to happen for the therapeutic benefit of the patient). In addition, we need to consider the possibility that severely regressed states may be utilized by the psychoanalytic process to gain some elements of emotional health for the patient. In this paper, I propose to review these issues from the point of view of early object relations, as elaborated primarily by Michael Balint (1937). His work in this area has been insufficiently understood and utilized. Balint's view provides illuminating insights on the nature of regression and the problems involved in the treatment of regressed patients. I will then attempt to show that the concept of the self-selfobject relationship, a critical construct in Kohut's theoretical framework,