Psychotic distortions of the good object
analytic work with the more disturbed patient
DOI:
https://doi.org/10.60106/rsbppa.v14i1.414Keywords:
Countertransference, Death instinct, Life instinct, Projective identificationAbstract
Extensive case material is used to explore the difficulties in working analytically with psychotic patients who are prone to excessive splitting, manic idealization, and projective identification. Clinical issues of transference acting out are addressed and the importance of utilizing counter-transference information (Segal 1977; Spillius 1983) is explored. The conflicts between life and death instincts (Rosenfeld 1971; Grotstein 1985; Segal 1993) are quite common with the more disturbed patient and the way these dynamics play out in the transference and create intense impasse states are illustrated in the material. Specifically, the pathological distortions of the good object is identified as the core conflict in work with certain more primitive patients. The Kleinian approach is demonstrated and case material illustrates the need for clinical patience, faith in the analyst process, and the ability to accept slow progress or even no progress at all.
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