What's a Good Object to Do? - PsyBC

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12 Neil J. Skolnick ⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ of the disturbance the analyst experiences. We must be prepared to roll up our sleeves and enter the patient’s inner world, as well as our own. We need, as Pick (1985) prescribes, to become greatly disturbed as we are made to experience, through concordant and complementary transferences (Racker, 1968), the object relationships inhabiting the patient’s inner world. On the way, we are called to reexperience the painful disturbances of our own inner object relationships. As we do, both consciously and unconsciously, so does the patient, who begins to identify with the struggles, failures, and successes of our own self– other dilemmas and how we negotiate them. The more we have resolved our own issues, or are at least able to tolerate them, the further the patient can safely venture. The further we have ventured ourselves, the further the patient will feel safe to go. Let me illustrate. A patient of mine, Marianna, an attorney in her 40s, was successful in her work world. By contrast, her romantic life was in shambles. She was haunted by the shadows of a mother who in many respects was loving and providing but who was enormously anxious and would, at times, become impulsively and physically abusive. Marianna remembers episodes when her mother would smash her (the patient’s) head against a wall, at times drawing blood. Marianna, in a long-term relationship with a man, would luxuriate in comforting thoughts about the hoped-for possibilities of a life together. These hopes stood in marked contrast to the couple’s actual experience with each other. Inevitably, when they were together, their interactions would rapidly deteriorate into verbally abusive fights that were repaired, not by resolution, but only by being tucked into the passage of time. On one occasion, she entered my office following her vacation only to discover that I had replaced the old, worn patient chair with a new one. Complaining that I had not forewarned her about the change, she instantaneously entered into an enraged state, one I had not theretofore observed. She pelted me with virulent abusive language. She attacked my ability as an analyst and threatened to bring me up on ethical charges. At some point I became visibly addled, sputtering lame interpretations, while feeling a fine blend of helplessness and exasperated rage. My response only fueled her sadism as she upped her attacks while simultaneously announcing that, actually, she was getting great pleasure out of bashing me. In fact, she exclaimed, she had not had this much fun in years. I was thrust into that paralyzing place, familiar to most analysts at one time or another, of feeling that any intervention would meet with utter futility.
What’s a Good Object to Do 13 ⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯⎯ So, what’s a good object to do First we must, as I am sure most would agree, survive the attack. Whether the patient’s outburst is seen as a ruthless attack by a Winnicottian, a dip into the paranoid/schizoid position by a Kleinian, or the result of empathic failure by a self psychologist, survival of the analyst is a must—it is a prime requisite of a good object. Let’s examine this process more closely. What do I mean by survival Allowing for nuanced differences by analysts of different theoretical creeds, I am referring to the analyst’s not succumbing to the patient’s omnipotence, not disappearing either consciously or unconsciously in the face of the patient’s conscious or unconscious fantasy of having wiped me out. We do not abandon, retaliate, or fall apart. That we survive ensures that the patient’s subjective omnipotence is challenged so that gradually he or she can tolerate the ongoing tension of surviving and tolerating an existence in which he or she must share the stage with others, while being allowed some measure of prime time as well. But it is not only by virtue of the experience that we survive that helps our patients. As important, if not more so, how we survive ultimately enables the expansion of the patient’s ego and, by implication, therapeutic change. Surviving is not enough. To rephrase Winnicott (1965), we can fob off a patient with a good survival. Survivals can be as staged and lifeless as a formulaic interpretation. When confronted with a murderous attack, we can manage to maintain a calm veneer while internally we fume, struggle, disorganize, become massively ashamed, sadistically attack, or settle into a lifeless remove, to name a few possibilities. While technically we have visibly survived, the patient does not get to experience or identify with how we survived. Patients, of course, can usually detect a storm underneath our best attempts to display calm. We need to straddle an impossible line between maintaining professional control and experiencing emotional upset. While maintaining a relative professional calm, we try not to affect a false remove, an aloof “nothing you say can affect me” attitude. Whether we are working with a more disturbed patient or a patient who is experiencing temporary paranoid/schizoid disorganization, we need to get stuck in our own psychic mud and experience our own painful disruption. To do otherwise (i.e., avoid, deny, etc.) we risk missing an empathic understanding of the underside of our patient’s skin. We also can appear inauthentic, typically signaling to a patient that it is not safe to venture further.
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