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9 Clinical example 2

James S. Grotstein Karnac Books ePub

This analysis took place many years after Clinical example 1. The reader may see some changes in my technical approach. The analysis I am presenting is a good example of the negative therapeutic reaction (psychic equilibrium).

Session

ADAPTIVE CONTEXT: Monday session, one of five sessions per week.

Analysand: You know, I was kind of down most of the weekend, but not terribly so, just a little bit, and then in the evening, after we’d put all three kids to bed, I went out to the store to get some milk. As I was driving back, I realized that I was hungry and that I had been hungry all weekend. It was hard to stay on the diet. Then I had a memory of saying that I was hungry for the wrong things, or of you saying that I am hungry for the wrong things.

My private feelings: I recognized feelings of guilt and defensiveness in me while the analysand was speaking. Noting that this was the first session following a weekend break, I recognized that the patient was dramatizing how he neglected himself the way he felt I had neglected him. In other words, I thought I heard the depressive defence: he was attacking me by projecting guilt into me by his suffering neglect—not caring properly for himself in my absence. In other words, I felt that he wanted me to feel guilty and responsible for his distress. I also had the gut feeling that he was trying to pull me into believing that he was conducting the analysis on his own: first presenting typical weekend complaints and then affecting to proffer the interpretations he would have expected me to give.

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19 Clinical example 12: psychoanalytically informed psychotherapy

James S. Grotstein Karnac Books ePub

presented by a supervisee supervised by JSG

ADAPTIVE CONTEXT: (a) Christmas/New Year’s holidays coming. (b) Prior session discussion regarding twice-week therapy. (c) Soon to graduate from university.

FRAME: Once a week.

Patient: I had a weird reaction just now. I don’t know what to make of it. It must have been the caffeine. My arms were shaking, and I was light-headed. Maybe I drank it too fast. This has never happened before. I don’t know what to make of it. (Pause.) I’m not sure what to talk about. Oh, yeah, there is one thing! I wanted to ask—if we could meet Monday instead of Tuesday next week.

JSG’s impressions: I suddenly (spontaneously) remember from past sessions with this patient that she frequently asks for changes in sessions. I then formed the opinion that she may have been demonstrating claustrophobic anxiety.

Therapist: Tell me why you would like this change.

Patient: I wanted to do the following stuff Tuesday: Christmas shopping, spend time with a friend from high school, and I want to do some decorating with my mother.

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Klein's view of the death instinct

James S. Grotstein Karnac Books ePub

Freud (1920g) conceived of the death instinct as an antagonistic counterpart to the life instinct, which included (a) the aggressive aspects of his older concept of the libidinal instinct and (b) the repetition compulsion.1 His biological conception of it may have been partially defensive, according to Segal (1993, p. 55). He conceptualized that its raison d'être was the achievement of constancy with regard to the pleasure-pain principle (Nirvana principle)-that is, to achieve biological constancy, for which death is the analogue. He associated it further with the experience of the aggression of the severe superego (Freud, 1930a) and suggested that all guilt feelings come from it. He also postulated that one aspect of it remained with the individual to cause primary masochism and that another aspect was projected outward into the primary object. Klein out-Freuded Freud in virtually concretizing his concept of the death instinct. She believed that the infant clinically suffers from an anxiety whose inchoate roots sprang from its peremptory emergence. From a practical standpoint the death instinct was considered by her to be the culprit in virtually all defence operations. It can be personified (after it becomes projected into objects and then re-introjected) as a primitive, peremptory, severe, hateful, destructive superego. She also believed that the infant's inchoate anxiety was due to the quantity of the death instinct that it was constrained to absorb. Klein (1933) states:

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19 Bion’s studies in psychosis

James S. Grotstein Karnac Books ePub

In Second Thoughts (1967c), Bion brought together eight papers that represented an ongoing chronicle of his psychoanalytic work with psychotic patients, which he had either presented or published between 1950 and 1962. At the end of the work there is a “Commentary” that represents a significant caesura in his thinking about his work with those patients and the conclusions he had derived from it. The “Commentary” must have been written between 1962 and 1967, and in that time Bion apparently went from being a “Kleinian” to a “Bionian post-post-Kleinian. He moved from the logical positivism and certainty of modern Freudian and Kleinian thinking, which was ultimately based on the drives as first cause, to a position of uncertainty, O. He had already formulated the tools of his new metatheory which included such concepts as the container and the contained, α-function, α-elements, β-elements, the theory of transformations, the reassignment of the drives to L, H, and K emotional linkages between objects, the notion that a coeval, dialectical, rather than a hierarchical and chronological relationship existed between the paranoid-schizoid and depressive positions, P-S ↔ D, not P-S D, and the transformations in and from (and to) O.

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1 The consultative interview: initial session

James S. Grotstein Karnac Books ePub

When interviewing the prospective analysand for the first time, experience seems to suggest that it may be better for the analyst not to confuse the consultation with psychoanalysis itself. Etchegoyen (1991) believes that a marked distinction should be made between the realistic, face-to-face consultation and the future analysis so as to allow the prospective analysand to develop a semblance of the reality of the analyst’s presence—at least as much as he can glean during the consultation. Klein and her followers, including Bion, seem often to do otherwise. They consider that the analysis has already begun with the beginning of the consultative interview and, while interested in past history, do not especially ask for it but allow for it to emerge of its own accord. In other words, they follow the prospective analysand’s free associations and interpret transference from the beginning. The latter was my experience in my Kleinian (Albert Mason) and Kleinian/Bionian (Bion) analyses. Yet Mason (personal communication) has made the point that he likes to take some history of the analysand’s past so as not to be surprised by the emergence of psychosis, addictions, and other disorders of this kind.

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