Brandchaft’s Pathological Accommodation—What It Is and What It Isn’t

Abstract

Pathological accommodation refers to ways of being that function unconsciously to preserve a needed attachment when that bond has been traumatically threatened. In this sense of the word, “accommodation” means that the individual unconsciously adopts the views and feelings of another at the expense of his or her own experience. The role of unconscious organizing principles and affective sequences is detailed, and the issue of pathological accommodation in therapists is briefly addressed. This defense—the dread not to repeat—is distinguished from Anna Ornstein’s description of the dread to repeat. An anecdote emphasizes the crucial role self-awareness and the capacity for self-reflection play in the emancipation from entangling remnants of pathological accommodation.

Keywords:

• Bernard Brandchaft
• dread not to repeat
• emancipatory psychoanalysis
• pathological accommodation
• relational trauma
• self-reflection
• systems of pathological accommodation
• unconscious organizing principles

Notes

¹ With Robert Stolorow and George Atwood, Bernard Brandchaft co-authored “Psychoanalytic Treatment: An Intersubjective Approach” (Analytic Press, 1987) and “The Intersubjective Perspective” (Jason Aronson, 1994) and was an important contributor to Atwood and Stolorow’s “Structures of Subjectivity” (1984).

² Kohut (1984) independently arrived at a similar sentiment: “Many times when I believed I was right and my patients were wrong, it turned out, though often only after a profound search, that my rightness was superficial whereas their rightness was profound” (pp. 93–94).

³ This section of Structures of Subjectivity was written in collaboration with Dr. Brandchaft.

⁴ There is increasing neuroscience evidence that this is so, though our focus is on the clinical level, not the neuroanatomical level.

⁵ This vignette appears in Doctors (2007).

⁶ Indeed, as Ferenczi (1926) taught, some forms of traumatic experience in childhood infiltrate the entire personality, fatefully recasting modes of thinking, feeling, and behaving.

⁷ The only other extensive case report of this kind of presentation of pathological accommodation known to us is the case of Mr. B (Jones, 2009). A briefer vignette (Evelyn) appears in Doctors (2009a).

⁸ The discussion of defensive structures that follows draws on Doctors (2009) and Brandchaft, Doctors, and Sorter (2010).

⁹ This dream is not reported in “A case of intractable depression” but comes from a previously unpublished paper, “Co-determination and change in psychoanalysis,” which appears in edited form as Chapter 8 in our book.