Waking the Dead Therapist

Abstract

The treatment of persons with dissociative adaptations is often filled with the stirring and emergence of intense affective states. Often bereft of words, these affective states remain to be articulated by either patient or analyst, as best they can tolerate. I present a case to illustrate the ongoing struggle in a countertransference analysis of unbidden and initially uncontrollable sleepiness in the analyst as a pathway toward greater understanding of intense affects in both patient and analyst. The benefits and risks of disclosing the analyst's subjective experience is explored.

Notes

A much earlier version of this paper was presented at the Massachusetts Institute for Psychoanalysis in May 2006, and a much shorter version at the meeting of Division 39 of the American Psychological Association in April 2008. At that latter meeting, a formal discussion of the paper by Wilma Bucci, Ph.D., opened an important avenue of inquiry. I have specifically, and gratefully, incorporated what I learned from Dr. Bucci's insight into this version of the April 2008 paper.

¹You are going to read case material where I speak to the patient's shifting subjective experience as if I am talking to another person. That is not what I am doing. But that is what you may experience if you have no experience of your own with these particular radical shifts in subjectivity in your own patients.

²I am quite aware of the movement back and forth between gender assignments in the way I refer to A as “her” and Joey as “he.” I go with the patient's own regard for their identity, and use male and female pronouns as is contextual for the name of different self-states. There are times where gender seems to hold particular meaning and becomes the subject of inquiry.