Facilitative Analytic Interaction in a Case of Extreme Nihilism and Aversiveness

With new theoretical understandings and expansion of technical guidelines, psychoanalysis has, over the past three decades, become a therapeutic modality applicable to the entire range of human psychopathology. Essential to these new understandings is recognizing the variable co-contribution of analyst and patient to the analytic encounter (Stolorow, Brandchaft, and Atwood, 1987; Mitchell, 1988). This recognition emerges out of two ongoing paradigmatic shifts within psychoanalysis—the shift from positivistic to relativistic science and, for some, to hermeneutics, and the shift from intrapsychic to relational field or systems theory. Hence, our understandings of psychoanalytic treatment, involving the participation of the analyst as well as the patient, have become far more complex, requiring a substantial reformulation of theory and treatment guidelines.

The treatment to follow (C.A.M. was the analyst and J.L.F. was the consultant) concerns a man of deeply intractable nihilism and aversiveness (Lichtenberg, 1989; Lichtenberg, Lachmann, and Fosshage, 1992, 1996) and serves as an example of a person for whom, without new understandings and reformulation and expansion of traditional analytic technique, psychoanalytic treatment would not have been possible. Difficult treatments such as this often require