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.
Patients who are psychotic or borderline, or who have “pockets”— areas where organizing, pregenital structures predominate—present technical issues and countertransference dilemmas offering considerable challenges to both patient and analyst. Issues that arise are related to symbiosis, fusion, holding, security, mirroring, attaching, trusting, object representation, acting out, and the nature of the therapeutic alliance. Many emotional needs and traumas, along with development deficiencies, are evident and are likely to be complicated by concreteness in the patient's thoughts, needs, and object representations. Concreteness, of course, fluctuates according to the pervasiveness of the pregenital transference, along with the material that a patient is working on at a given hour.
Ordinarily, such patients will, in many ways, reveal longings for concrete connections with the therapist that may remain unconscious even as they are conveyed to the therapist. These longings may not be put into words, but in the countertransference they can be sensed by and resonate in the therapist. Such wishes or requests by the patient do not necessarily need to be verbally interpreted immediately. They may, in some instances, need to be simply sensed and accepted while they are being explored with extreme care and delicacy.
Under some conditions, patients' wishes may be represented in concrete enactments by the therapist and patient while or even before they are completely analyzed on the verbal level. What I am concerned with are those occasions when unconscious longings become crystallized in a patient's manipulation of a concrete object (or thing or phenomenon) in relation to the analyst, and