André Green on the Theory and Treatment of “Non-Neurotic” Patients

A pivotal turning point in contemporary psychoanalytic practice and conceptualization was the presentation by André Green at the 1975 meeting of the International Psychoanalytical Association. In his presentation Green opened new ways of thinking about non-neurotic patients based on a theory of psychosis that accounts for confusion of subject and object and a mode of symbolization derived from a dual organization of patient and analyst. Green proposed that analysts lend themselves to the fusional needs of their patients while the focus is on the force of the negative—destructive mental states where connection is superseded by disconnections that in turn lead to disorganization resulting in blank depression and negative hallucination. Green finds precedent for this viewpoint in his reading of Winnciott's work on transitional space as a developmental movement toward separation. Central to clinical work with non-neurotic patients is the analyst's use of their countertransference as a form of binding the inchoate into form built on interpreting in the transference as opposed to interpreting of the transference while titrating the degree of silence so as not to fuel the terror of too much absence.