A Contribution to the Metapsychology of the Preanalytic Patient

I have described a specific structural ego pathology that appears in a wide grouping of varied clinical syndromes. The ego deficiencies are found in patients who fall within "the widening scope of psychoanalysis" (Stone et al., 1954). They begin treatment in a chronic state of partial ego regression. The ego has attempted to stabilize at the ego organization of the separation-individuation phase and has failed, in part, to do so. Although the paper limits itself to a metapsychological study of this specific mental structure, some inferences

are drawn which also contribute to a theory of technique. The technique of therapy involves "preparation for analysis," in which adequate emotional separateness must first be laboriously achieved before controlled regression can occur "in the service of the ego." The ego pathology is correlated with an inability to sustain secondary autonomy, so that the ego is prone to regression and is overly dependent on environmental stimuli. It is theorized that paramount among these ego deficiencies are an unstable capacity for neutralization and for integration and a special sensitivity toward traumatic anxiety. Also depicted as defective are memory, signal function, frustration tolerance, emotional capacity, and the capacity to cathect objects. Genetic and dynamic distinctions are drawn between integration and synthesis, in presenting them as two separate ego functions.