Analytic Adoption of the Psychically Homeless

Abstract

Some of our patients arrive in our practices as life-long emotional orphans—that is, in states of psychic homelessness. In such cases, long-term analytic treatment may offer the possibility of a process of mutual analytic adoption, and with it a deep sense of belonging. This idea connects with, but expands, Stolorow’s concept of “a relational home,” and is probably closest in spirit to Winnicott’s way of working with certain of his patients. I propose three principles for treating psychically homeless patients: (1) The analytic therapist must be not only an empathic responder but also an active agent who comes to feel a personal investment in the patient and, in a sense claims the patient as an analytic adoptee; (2) There is often a blurring or loosening of the boundary between the professional role relationship and a more personal relationship of authentic mutual investment and caring; (3) Because of the patient’s greater than usual need for the analyst’s availability, there may be alterations in the frame, especially with regard to the need for the analyst’s time and how the relationship exists in time. All three principles are grounded in paradox and involve an unconscious collaboration between patient and therapist wherein the real and the symbolic interact in complex, paradoxical ways. These processes are illustrated in the case of a patient who achieved such an experience of belonging in a transformative 40-year analytic treatment.

Keywords:

• analytic adoption
• psychically homeless
• relational home
• belonging
• expanded frame
• paradox

NOTES ON CONTRIBUTOR

Steven Stern, PsyD is a faculty member of the Massachusetts Institute for Psychoanalysis and Clinical Associate Professor of Psychiatry at Maine Medical Center and Tufts University School of Medicine. He is a member emeritus of the International Council of the International Association of Psychoanalytic Self Psychology and serves on the editorial board of Psychoanalysis, Self and Context. His book, Needed Relationships and Psychoanalytic Healing: A Holistic Relational Perspective on the Therapeutic Process was published in 2017 by Routledge in their Psychoanalysis in a New Key book series. Dr. Stern practices in Portland, ME.

Notes

¹ I am grateful to Peter Rudnytsky for bringing this quote to my attention after hearing me present an earlier version of this paper at the APsaA National Meeting in New York in Feb. 2019. Severn’s book, The Discovery of the Self: A Study in Psychological Cure, was first published in 1933, then went out of print until Peter rediscovered and edited it for the Relational Perspectives Book Series (New York: Routledge, 2017).

² By “mutual analytic adoption” I do not imply a symmetrical relation in which the patient adopts the analyst in the same sense that the analyst “adopts” the patient. I mean that the analytic adoption of the patient by the analyst is a development that both parties come to want and seek. One might say, loosely, that the patient comes to “adopt” the therapist as an adoptive parental (transference) figure, even as the therapist comes to analytically adopt the patient.

Additional information

Notes on contributors

Steven Stern

Steven Stern is a faculty member of the Massachusetts Institute for Psychoanalysis and Clinical Associate Professor of Psychiatry at Maine Medical Center and Tufts University School of Medicine. He is a member of the International Council of the International Association of Psychoanalytic Self Psychology and was Associate Editor of the International Journal of Psychoanalytic Self Psychology until 2015. He has been a frequent contributor to the contemporary psychoanalytic literature, with a particular interest in theoretical integration. His first book, Needed Relationships and Psychoanalytic Healing: A Holistic Relational Perspective on the Therapeutic Process (Routledge) was released in March 2017. Dr. Stern practices in Portland, ME with specializations in psychoanalysis, psychodynamic psychotherapy, couples therapy, and clinical supervision.