Jane Bunster - Flexibility in Treating the Difficult to Reach Patient

Editors Note: In this passage, Bunster summarizes her treatment of a patient whose psyche was organized around an autistic core. Bunster emphasizes the flexibility she needed to maintain in her analytic activity - moving back and forth between relatedness/ containing while also consistently interpreting what was happening in the analytic dyad.

"First, I tried to use what could be considered as ‘maternal reverie’, where I did my best to get in tune with her so that any deintegrative moves she might have made towards me were met with good-enough understanding and response. I thought in terms of the infantile transference. What she was furiously defending against was the pain of the loss of the mother/breast, which, in turn, she saw as attacking, retaliatory, and unforgiving. Any interpretation I might make needed two parts: first, the direct content and, then, analysis of the defence she used to prevent the interpretation/food being taken in and digested.

This was particularly apparent at times of holiday breaks and weekends. The sessions became more quiet and silent. Any feelings of loss had to be denied. If she denied my existence, no loss need be experienced and so she wiped me out of her mind, in the way she experienced I was doing to her whenever we separated from each other. Although she realized intellectually how cut off she was, she could make no link between thought and feelings.

My task was to try to stay patiently with her disconnectedness and annihilation and gradually make sense of it, always remembering that, underneath the withholdingness and locked-in-ness which may manifest itself as obstinacy, omnipotence, and manipulation, lay very great anxiety and perhaps fear of falling to bits.

In confronting and experiencing such primitive archetypal material, flexibility of approach seems essential. I have tried to show how useful the concept and the process of projective identification are in helping such a cut-off patient get more in touch with her feelings, thus modifying the intense conflicted areas and ameliorating the terror. If I can talk and make sense of these feelings, confidence can be gained that unconscious impulses need not be overwhelmingly destructive and imagination may then flow more freely." (pp. 43-44)

Jane Bunster (1993). The Patient Difficult to Reach: Omnipotence, projective identification and the primary self. Journal of Analytical Psychology, Vol. 38, pp. 37-44