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Abstract
In this paper, I wish to illustrate how working with a patient who had a certain kind of narcissistic difficulty led me to develop particular clinical strategies to facilitate the development of a sturdier sense of self, greater affect tolerance and modulation, the diminution of harshness of her superego, and the ownership of projected parts of herself, and to decrease paranoid ideation. I call upon concepts from various theoretical schools of psychoanalysis to make sense of the dynamic intricacies of the patient’s psychological organization as they revealed themselves in the analytic process. These conceptualizations of the patient’s difficulties and of clinical interventions to address them result in a hybrid theory of both theory and technique. What transpired in the clinical work also led me to propose an additional way to understand this kind of patient’s difficulties with accepting interpretations or any view that differed from the patient’s subjectivity. I am proposing that ‘otherness’ itself, rather than only specific conflictual aspects of the self, is disowned. It is the analyst’s empathic stance toward all that is repudiated – the specific disowned aspects of the self and ‘otherness’ itself – along with empathy for the patient’s conscious state that will enable reinternalization and ultimately healing.
Notes
1. I later discovered that a similar formulation of technique had been already suggested by CitationBolognini (1997).
2. I realize that, when these authors write of failure of mentalization, they are referring to aspects of self and other which have never been given mental representation. I employ their idea here in reference to something once mentalized, however transiently and incompletely, and then extruded.