Analytic Enclaves and Analytic Outcome: A Clinical Mystery

Abstract

I describe a frustrating treatment relationship with a severely traumatized patient and consider what contributed to its successful outcome. Sexually and emotionally abused in childhood, traumatized in adulthood, Dani insistently kept associated memories and affect states sealed off and outside the treatment's scope. Dwelling with me in a deadened therapeutic space dominated by narcissistic imperiousness and apparent obliviousness to the other, Dani seemed unreachable. A single enactment broke into this deadened process and enlivened things, but this shift turned out to be temporary. Yet after years of flat, disengaged process, Dani changed dramatically. Querying the treatment's dynamics, I muse about what happened in our analytic enclave. Despite the clear therapeutic potential of both witnessing and intersubjective exchange in trauma work, there may be times when our tolerance for staying out—for not knowing—is clinically pivotal. By allowing our protected analytic enclave to remain nearly untouched and undisrupted—by keeping trauma out and in this sense un-bridged, this very fragile patient established a nontraumatic relational space within which an alive, hopeful, resilient experience of self imperceptibly coalesced.

Earlier versions of this paper were presented at the Winnicott Center, Jerusalem (2010), NYU PostDoctoral Program, New York, (2010), and Division 39 annual meeting, Chicago (2010). I am grateful to Stan Coen, Sue Grand, Adrienne Harris, Margerie Kalb, Stuart Pizer, Annee Ackerman, Leora Trub, and Dafna Fuchs for their very thoughtful feedback on earlier drafts of this essay.

Notes

Earlier versions of this paper were presented at the Winnicott Center, Jerusalem (2010), NYU PostDoctoral Program, New York, (2010), and Division 39 annual meeting, Chicago (2010). I am grateful to Stan Coen, Sue Grand, Adrienne Harris, Margerie Kalb, Stuart Pizer, Annee Ackerman, Leora Trub, and Dafna Fuchs for their very thoughtful feedback on earlier drafts of this essay.

¹ Rosenfeld (1971) described thin- and thick-skinned narcissism as alternative defensive styles, but Bateman (1998) viewed them both as alternating and interpenetrating:

In “thick-skinned” narcissists, the survival of an idealised self is paramount. The analyst is experienced as someone who wishes to dismantle the patient's self, to effect a cure and to engender dependence. As a result, analytic sessions become dominated by defensiveness, a devaluation of external relationships and a wish to destroy the analyst as an object who can be a source of goodness and personal growth … In contrast, the thin-skinned narcissist is more vulnerable. He is ashamed of himself, feels sensitive to rejection, and persistently judges himself as inferior to others. (pp. 14–15)