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26 Clinical example 19

Grotstein, James S. Karnac Books ePub

Antonino Ferro

Antonino Ferro has begun to emerge as one of the most significant contributors to the application of Wilfred Bion’s contributions to clinical technique, as well as the concept of the “psychoanalytic field” formulated by Madeleine and Willi Baranger (1961–62). The reader should look closely at his use of the connection between alpha-elements and narremes → narratives.

In this extract from “Marcella: the Transition from Explosive Sensoriality to the Ability to Think”, the author discusses an analytic case in which it was necessary to first address the patient’s need for containment of her protoemotions—her sensoriality—before the analysis could proceed along more standard lines, with interpretation of the transference, work on displacement and aspects of her childhood history, and so forth. Prior to treatment, the patient had resorted to a sort of affective autism in order not to experience dangerously overwhelming emotions, and her emotional lethargy in sessions at first engendered similar feelings in the analyst, making progress impossible until a container was established for her projective identifications.

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22 Clinical example 15

Grotstein, James S. Karnac Books ePub

Albert Mason

Clinical examples 15–18 constitute a “showcase” for the demonstration of comparative psychoanalytic techniques within the Kleinian → post-Kleinian →Bionian spectrum. I invite the reader to pay close attention, not just to these analysts’ interventions, but also to the subtlety of their thinking about their cases.

The brief case presentations in this and the following chapter illustrate how a classical Kleinian works. Albert Mason was trained in the British Institute of Psychoanalysis and was analysed by Hanna Segal, and the reader will quickly recognize that his work belongs in the classical Kleinian oeuvre. I personally have been very influenced by him. He was my first Kleinian supervisor and became, following Bion’s abrupt departure, my analyst. The following two cases are from his as yet unpublished work, “Transference”.]

A28-year-old woman walked rapidly into my consulting room early one Monday morning following a weekend break. She had been in analysis for six months and had come originally fearing a recurrence of a psychotic breakdown that had taken place seven years previously. She walked unusually briskly into the room and, after lying down, started to talk even before I had reached my chair. “It is nice and quiet and peaceful here, and you seem pleased to see me”, she said, “but you have put on weight!”

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21 Clinical example 14: dream analysis in an analytic session

Grotstein, James S. Karnac Books ePub

Brief past history

The patient is a 43-year-old married movie producer who had been in analysis for just over a year when this dream occurred (he has come up in some previous case studies). Of importance in the past history is that he recalls often having been beaten by his mother. The parents divorced when he was 10 years old. He had an endless series of torrid sexual affairs with various actresses and, at times, prostitutes. This behaviour ended rather quickly after he had begun his analysis and learned how much this behaviour represented his anger towards—as well as his hidden desire for—his mother.

ADAPTIVE CONTEXT: The patient’s wife has just become pregnant, and he will soon be absent for a week due to his business. He is being seen five times per week. This session is the second in the week.

[Each dream element and activity/action in the manifest content has been identified with a letter; these are explored subsequently.]

Analysand: I had a strange dream last night. I was making (a) a documentary about (b) water. I recall a (c) run-down industrial park with buildings or shacks with (d) corrugated roofs. (e) It began to rain. There was (f) an older woman therea (g) prostitute. I went to get my (h) camera, which, strangely, was in the shape of an (i) iron. (j) I couldn’t find it. (k) The prostitute was not the usual kind. She was (l) “exclusive”: she was like a (m) girlfriend: there only for me. I was fascinated by her (n) breasts. (o) I didn’t have enough money to pay her. (p) I had to go back and make the documentary.

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24 Clinical example 17

Grotstein, James S. Karnac Books ePub

Ronald Britton

Ron Britton is one the foremost representatives of the London Contemporary post-Kleinian School, as well as being unique in his views. He was one of the original members of Betty Joseph’s Workshop.

Clinical examples 17 and 18 have been extracted from Britton’s unpublished paper, “The Baby and the Bathwater”. The main theme of this paper is that of “models” of thinking in theory and in practice. One is aware of Bion’s (1962b) use of models as instruments of thinking that are analogues external to the object being studied. Britton uses the term “model” in that sense theoretically, but he also uses it clinically to indicate a patient’s personal belief system.

Models in clinical practice

A meeting ground for scientific models and personal models is the psychoanalytic consulting room, and I would like to illustrate that from two actual cases.

Clinical presentation

This case exemplifies how one might find a familiar clinical model in working with a patient. The case was one I supervised of “Peter”, a man with a severe stammer that had been treated to no avail by a variety of psychiatric methods and speech therapy and so had won his way to psychoanalytic psychotherapy in the NHS. He did not work; he was married but did not have sex, and he remained asocial most of the time. He avoided talking to his mother on the phone and wrote typewritten letters to her. The model that I describe emerged first in my mind, and I communicated it to the analyst, who kept it at the back of her mind, I think, but was only convinced when in his own terms the patient described just such a model of his own daily experience. It was that of Herbert Rosenfeld’s narcissistic organization in which the individual is forbidden to become deeply attached to or communicate freely with any external object by an internal figure, or gang, that meets out punishment and offers solipsistic solace [italics added; JSG].

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27 Clinical example 20: “The woman who couldn’t consider”

Grotstein, James S. Karnac Books ePub

Thomas Ogden

This fragment of an analysis focuses on three consecutive sessions at the beginning of the sixth year of an analysis conducted five times per week. I present it at greater length than the previous “showcase” contributions because of the way Ogden shows and then comments on how he uses his mind and body as unfailing analytic instruments.

My stomach muscles tensed and I experienced a faint sense of nausea as I heard the rapid footfalls of Ms B racing up the stairs leading to my office. It seemed to me that she was desperate not to miss a second of her session. I had felt for some time that the quantity of minutes she spent with me had to substitute for all of the ways in which she felt unable to be present while with me. Seconds later, I imagined the patient waiting in a state of chafing urgency to get to me. As she led the way from the waiting room into the consulting room, I could feel in my body the patient’s drinking in of every detail of the hallway. I noticed several small flecks of paper from my writing pad on the carpet. I knew that the patient was taking them in and hoarding them “inside” her to silently dissect mentally during and after the session. I felt in a very concrete way that those bits of paper were parts of me that were being taken hostage. (The “fantasies” that I am describing were at this point almost entirely physical sensations as opposed to verbal narratives.)

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