Clinical illustration

On the night before his initial consultation with me, a patient had the following dream. He arrived at my office for his consultation, only to find the waiting room full of people. I was nowhere in sight. He went into the consulting room, and discovered me showing another crowd of admiring people some fabrics I had designed. He felt obliged to admire them as well, but at the same time felt cheated out of his consultation. I was evidently so much in need of his praise for my work, however, that he couldn’t complain.

Among his associations were the feelings that he had to serve other people, which he resented but could not complain to them about; that he felt he was never doing enough for them; and that he somehow was inadvertently always messing this obligation up. I said that the dream suggested that, although he hoped to get some help from me, he feared he would end up instead having to help me in some way. He agreed that he had dreamt of me as one more in the endless line of people who demanded his help when he needed help from them.

He was surprised and embarrassed at this portrayal of me, and added, by way of explanation and apology, that his mother had been a depressed, fragile and easily overwhelmed woman whom he had apparently “transferred” onto me.

This dream was the initial communique about a relationship that was to remain virtually unwavering between us for two and a half years, until a session several weeks before a long summer break, in which the patient began to worry' that I had become overwhelmed by my work with him. He explained this in the same way as he had explained the dream, as well as a number of similar episodes that had occurred since his dream, by saying that he knew it was probably a “transference” from past experiences with his mother.

Although I had never really' felt satisfied with these interpretations, I also had not been able to see why, and had more or less fallen into the habit of silently' assenting to them. But this time I was struck by the lifeless manner with which he spoke, and by the fact that he afterward lapsed into a torpid silence. When he did speak again, I noticed that it was in a cautious and tentative way, being careful (I felt) not to say anything that might cause me any distress or make me feel there was any work I had to do for him. I reflected to myself that, although he had meant by his interpretation that he realized that his state of mind reflected a past reality now dead and inappropriate to the present, he was acting as though I were indeed quite fragile in present reality. His analysis of his state of mind did not seem to meet or affect his actual experience of it; it seemed, rather, to be a half-hearted attempt to talk himself out of his present experience of me by labelling it transference.

I then began to feel an unexpected sense of irritation at the patient’s concern about me. If my job was indeed to help him understand what he was experiencing, then his attempt at making my work easier was having the opposite effect: working with such a reticent patient was much harder than with a candid one.

I told him, with some trepidation, that, while he was aware of feeling that I was overwhelmed, and wanted to help me, I thought he was unaware that his reticence was helping to make me helpless. The patient, as I feared, at once felt angry and hurt.4

His reaction confirmed a suspicion that was just beginning to dawn on me: despite his interpretation about the past, he still took it as an unquestionable present fact that I was exhausted. From his point of view, his attempts to lighten my burden were then the only' possible way that he could hope to help me. My comment could therefore only represent to him my ingratitude for his efforts. Hence his feeling wounded. The unconscious beliefs about my exhaustion on which his reaction rested suggested that he was not just confusing me with a past figure, or having a fantasy (in the ordinary sense of the word) about me in the present, but actually' experiencing me in the present as exhausted and overwhelmed by him. I now realized that what had been irritating me was that this experience carried with it a sense of conviction so strong that it seemed to admit literally' no doubt. Any interpretation I might make about it was therefore impotent.

He seemed unable, then—despite his evident desire to think about what made him see me as so incapable—to overcome an emotional certainty about my exhausted state that was so fundamental and undoubted that it made serious consideration of any alternative impossible. When I told him this, he again fell silent. But this silence, unlike his previous reticence, had a thoughtful quality to it. When he broke it, he said very soberly that he now realized his analysis had been governed by a profound belief—an unwavering certainty immune to the experience of the analysis—that I was indeed too fragile to bear the burden of him as a patient. He was astonished to find how it had persisted despite the many times he had tried to convince himself it was merely a carry-over from the past. But he now saw, as if for the first time, that it had been both present since the first day and the first dream, and, up until now, completely untouched by interpretation.

I believe that what had happened was that I had managed to convey to him that his “helpful” circumspection and reticence were actually hindering me as an analyst, and turning me into the feckless mother he feared I was. In doing so, I had departed definitively (perhaps for the first time in his 214 years of analysis with me) from his unshakeable, unconscious belief in my impotence, and thereby established myself as someone separate from what existed in his mind—what we might call a proper object. I had, in other words, broken away from his fantasy and thereby become and object with a mind of its own, separate from his: a whole object.

Over the next few weeks the analysis took on a seriousness and a hopefulness that I had not seen previously. The patient now experienced his listless and oft-repeated formula about his mother not merely as a kind of “analysis” that he didn’t really believe in, but as a way of actively wasting his time and life. He felt genuinely guilty (not the false guilt connected to the feeling that he was failing to meet the supposedly unreasonable, infantile demands of his objects), and at the same time began to recognize for the first time the burden he was placing on me, and to appreciate my efforts to help him with himself.

As a consequence of his mourning the waste, his analysis had now come to life, and was not just an exercise in admiring me for producing what he believed on a deeper level be worthless interpretations. He began to experience real love and gratitude for the now rehabilitated analysis. His recognition of me as different from his enduring fantasy about me, along with the recognition of how his fantasy had wasted his analysis, enabled him to see the analysis as something worth loving. This allowed him to begin to contain himself, which is what was manifested as the new seriousness and soberness in his attitude.

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