Negotiating Analytic Holding: Discussion of Patrick Casement's Learning from the Patient

WHEN I WAS A YOUNG GIRL, my mother took me to the burn unit in a hospital. Her friend's two-year-old son, Ben, had reached up to the stove and pulled the kettle of boiling water all over himself, scalding more than half of his little body. I had known Ben as an affectionate, cuddly boy, and what stood out for me was the sight of him now, totally encased in a protective see-through bubble—pleading blue eyes, a tentative smile, an arm reaching toward me with fingers outstretched but unable to touch the side of his plastic airfilled container. Ben was aching for contact but was too burned to be touched. Today, in my consulting room, when I sit with people who have been severely scalded by intrusive or withholding caregivers, when I witness persons deprived of sufficient recognition and self-affirming contact, I often use my memory of Ben as metaphor. I might say something like, “I sense that your body is aching, and I sense the pain in your eyes, and I'm reminded of a burn victim reaching out for contact but knowing it's too painful to be touched.” I have also come upon a related metaphor that seems to resonate with another kind of person—a person who has adapted to untenable neglect with counterphobic independence and the appearance of narcissistic retreat. As the two of us gradually become closer, I am reminded of