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In the course of this presentation, I have attempted to convey something of a stance and conceptual framework for the treatment of adults who were sexually abused in childhood, which I believe are consistently, some of my patients might say “determinedly,” analytic. While the exact definition of all that this stance entails is subject to debate, at its core is an inexorable commitment to thoughtful and respectful inquiry into the experience of both participants in the therapeutic setting. Above all, I believe that the analytic stance is a way of looking at, exploring and trying to make sense of internal experience. It is an inherent component of how we, as analytic therapists, try to think and behave in the clinical situation. It encompasses an attempt at thinking, rather than acting, and is more closely allied to the realm of the symbolic, psychic reality, delay of gratification, and renunciation of and mourning for what was lost or what cannot be than to the realm of the concrete, material reality; immediate gratification; and the refusal and/or denial of the inevitability and necessity of renunciation and mourning.
In discussing the treatment situation, I have tried to show how all therapy mobilizes and even relies upon powerful forces that tend to move both patient and analyst away from an analytic stance. Adults who were sexually abused in childhood are no exception. Instead, the various forms of ego disturbance, to which their traumatic past may contribute, only make them more likely to relate via enactment and projective identification. This presents important implications, many of which I have attempted to discuss, for the treatment relationship—transference and countertransference—and for technique.