hiden gift of love, object relations

8/13/2019 Hiden Gift of Love, Object Relations

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Hidden gifts of love: A clinical application of objectrelations theory

Naomi Steinberg

2066 NW Irving St., Suite 3, Portland, OR 97209, USA [email protected]

(Final version accepted 2 November 2009)

Using an extended clinical example, the author applies aspects of Kleinian, Fairb-airnian, and Bionian theory to demonstrate how individuals may come to hideaway feelings of both love and aggression. In the clinical material presented, a ver-sion of a schizoid retreat was understood as a pervasive response to trauma. Theauthor attempts to explore more specifically the nature of a traumatizing outerworld (Guntrip, 1969) and how these experiences cause an individual to retreatand undermine movement toward healthy adult dependency. An understanding ofthese dynamics helps inform the psychoanalytic treatment process and can serveas a type of roadmap in navigating through challenging transferencecountertrans-

ference enactments.

Keywords: countertransference, depressive position, enactment, psychoanalyticpsychotherapy, trauma

A mysterious cardboard box appeared outside my office on a rainy Febru-

ary day. Inside was a colorful flowering plant. No delivery company slip orpersonal note was attached but my name was handwritten on the box. Whohad left this anonymous gift? I embarked on an investigation of sorts tosolve the mystery. After some cross-referencing, I traced the handwriting toL, a 38 year-old female patient in four times per week psychoanalysis withme.

The gift arrived during my first week back after leaving the office for oneweek to attend my fathers funeral. Prior to leaving town, I had shared withL the reason for my sudden cancellation of sessions. She shared her condo-lences and I noted the great anxiety she seemed to experience in communi-

cating her feelings of concern with me. Upon my return, she struggled in asimilar manner; the sharing of these sentiments seemed related to some formof hiding, I thought. I wondered about Ls hidden gift as connected toaspects of fear and danger and how she might sabotage this capacity toexperience her love instead of her hate.

As I will further describe, my patient grew up in a traumatized familyand, while able to function in a highly competent manner, was sociallyanxious and withdrawn, having never married and maintaining a type ofschizoid retreat.

I had observed a pattern over time in which L would begin to share more

of her thoughts and feelings and subsequently retreat from more intimatecontact with me. The hopefulness of sharing more of her giftswith me wasthus followed by feelings of despair and threats to either leave treatment or

Int J Psychoanal(2010) 91:839 858 doi: 10.1111/j.1745-8315.2010.00281.x

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threats proved to be part of a powerful enactment in which we came tounderstand aspects of her retreat from intimacy and her repetitious capacityto undermine her movement toward appropriate adult dependency andattachments.

A brief theoretical backdrop: Klein, Fairbairn, and Guntrip

Utilizing concepts from Klein, Fairbairn and Bion, I will attempt to showhow an ongoing and pervasive response to trauma results in a type of schi-zoid retreat. In so doing, I hope to illustrate, at least in the work with mypatient, how these aspects of trauma and their enactments in the transfer-ence constituted a more specific example of what has gone wrong, oraspects of a schizoid individuals experience of a traumatizing outer world(Guntrip, 1969). Put more simply, I will attempt to explore the reasons whymy patient felt that she had no choice but to hide away her love. In thechallenging analytic work that I will describe, an understanding of whathad gone wrongwas invaluable to me in living through difficult enactmentsand in providing a direction from which we could identify and analyze theobstacles in the way of self-expression.

Following the work of Fairbairn (1944) in regards to the dynamics of schi-zoid functioning, I will attempt to illustrate through a clinical example theway in which the analytic process can be seen as an opportunity to bringback into the interpersonal realm that which is internalized and hiddeninside. Drawing from Klein (1937, 1946) I will also attempt to show how,for my patient, the analytic work allowed her the chance to move from areliance on omnipotent defences in a paranoidschizoid realm to a gradualletting go of these defences on the way to more depressive position function-ing. In these shifts she was more able to more fully acknowledge andtolerate both her loving and aggressive feelings.

I will also attempt to elaborate upon aspects of trauma which are, as I seeit, implicated in Fairbairns and Guntrips conceptualizations of the schizoidpersonality but not fully elaborated upon. Here I will draw from the workof Bion, specifically his notion of the negative container or obstructiveobject.

Klein

According to Klein (1946b), object relations exist from the beginning of lifewith the first object, mothers breast, being split into good and baddepending upon the experience of gratification or frustration. The result ofthis split is a severance of love and hate (p. 2). The infants destructiveimpulses are turned against the object and experienced as phantasiedoral-sadistic impulses to rob the mothers body of its good contents (p. 2).Anxiety results from phantasies that the object will become persecutory andoverwhelm or destroy the ideal object and the self (Segal, 1964). This

anxiety is a central aspect of the paranoidschizoid position. If the infantcannot work through these anxieties, heshe is impeded in reaching thedepressive position and persecutory fears are reinforced. In the depressive

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the loved and hated aspects of the complete object (p. 100) and leading tofeelings of mourning and guilt. In normal development, an internal goodobject counteracts splitting and dispersal processes and allows for develop-ment of cohesiveness and integration (Klein, 1946a).

The object relations common to schizoid patients, says Klein (1946b),includes a violent splitting of the self and excessive projection(p. 12) suchthat the other is experienced as the persecutor. In addition, the destructivepart of the self is split off and projected and felt as a danger to the lovedobject and therefore gives rise to guilt (p. 12). The individual may thenretreat from relationships with others in order to avoid a destructive intru-sion into them and the danger of retaliation by them(p. 13). The fear thata loved person may die because of phantasied destructive attacks makes itunbearable to be dependent upon this person(Klein, 1937, p. 321) and theonly way out of this predicament may be to deny, suppress ones capacity

for love or to avoid strong feelings in general.

Fairnbairn and Guntrip on the schizoid personality

As Guntrip (1969) and Sutherland (1989) point out, Fairbairn developed hisobject-relations theory out of his study of schizoid problems. In his theoryof basic endopsychic structure, Fairbairn contends that libido is object-seeking versus pleasure seeking such that: The real libidinal aim is theestablishment of satisfactory relationships with objects (Fairbairn, 1946,p. 30). The stage of infantile dependence includes the development of an

emotionally-determined splitting of the external object into good and badobjects. Bad objects are needed external objects (i.e. parents) that are inter-nalized because they cannot be dealt with in the external relationship. Forexample, aspects of the relationship with a parent marked by excessive dan-ger, frustration, or threat of loss are likely to be internalized as bad objects.As Grotstein (1994) writes: The patient suffering from introjective identifi-cation has unconsciously absorbed the intolerable aspects of the mother andfather and identifies with them in order to preserve the illusion of worth-whileness of the external object(p. 723). The worse the experience with theobject, the deeper and more terrifying is the unconscious internalization.

In Fairbairn

s model of basic endopsychic structure, the bad object, afterit has been internalized, is split into an exciting object and rejectingobject, both of which are repressed. Also split off and repressed are a libid-inal ego and an internal saboteur (later referred to as the anti-libidinalego). The anti-libidinal ego is attached to a rejecting object and destroyslibidinal needs. Fairbairn, through his model of endopsychic structure, viewsthe primary function of the ego as adaptation to outer, social reality, and hedescribes to some extent how individuals develop and cope in situations ofdeprivation, emotional frustration, andor trauma.

In Fairbairns (1941) earlier theory of the development of the schizoid

personality, the breast, in the oral phase of development, assumes the roleof libidinal object, and the libidinal attitude is characterized by an aspect oftaking and also incorporating and internalizing. In a situation of depriva-

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child feels empty and concludes that heshe has emptied the mother. Thus,says Fairbairn, deprivation has the effect not only of intensifying (thechilds) oral need, but also of imparting an aggressive quality to it (1941,p. 10). This anxiety occurs out of the belief that, in emptying the breast,

heshe has destroyed the libidinal object. For this reason, love made hun-gry is the schizoid problem and it rouses the terrible fear that ones love hasbecome so devouring and incorporative that love has become destructive(Guntrip, 1969, p. 27).

Fairbairn (1944) later posited that the difficulties in a childs ability toexpress emotion, both libidinal and aggressive, arose from experiences ofemotional rejection by the parents, resulting in a precariousness of emo-tional expression. Love which is expressed into an emotional vacuuminvolves an experience of intense humiliation over the depreciation ofhis love (or) shame over the display of needs which are disregarded or

belittled

(1944, p. 84). The intensity of the childs need leads himher tofeel that heshe is overly demanding. Worse yet, says Fairbairn, is the

childs experience ofexploding ineffectively and being completely emptiedof libido an experience of disintegration and of imminent psychicaldeath (p. 84). The precariousness of the childs situation derives from aposition in which, if he expresses aggression, he is threatened with the lossof his good object, and if, on the other hand, he expresses libidinal need, heis threatened with the loss of his libido (which for him constitutes his owngoodness) and ultimately with the loss of the ego structure which constituteshimself (p. 84). The child, says Fairbairn, avoids the dangers of emotional

expression by using a maximum of his aggression to subdue a maximumof his libidinal need (p. 84) and this process is carried out through anattack on the libidinal ego by the anti-libidinal ego.

The schizoid individual finds hisher relationships to be emptied by amassive withdrawal of the real libidinal self (Guntrip, 1969, p. 18) withschizoid aloofness including the fear of loving lest ones love or need oflove should destroy(p. 27). Because of the deep-seated fear of hisher ownlove, such individuals learn to transfer relationships with external objects toinner reality and to work out emotional problems in an intellectual mannerin their internal worlds (Fairbairn, 1944). Safe expression of feeling and

emotional contact are terrifying and thereby thwarted. The schizoid individ-ual may feel cut off, shut off, out of touch, feeling apart or strange, ofthings being out of focus or unreal, of not feeling one with people, or of thepoint having gone out of life (Guntrip, 1969, p. 17).

According to Guntrip (1969), the withdrawal of the innermost self occursas a result of fear. He believes that this impulse to withdraw may stem fromexperiences of deprivation in the parentchild relationship or from animpingement of a hostile aggressive object or situation (which) arousesdirect fear of an overpowering outer world(p. 75).

Both Fairbairn and Guntrip, in describing schizoid individuals, are

describing the effects of parental relationships in which something has goneterribly wrong. In thinking about my patients anonymous gift, I wonderedabout the particular traumatic circumstances and object relationships behind

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Clinical material

In the Monday session upon my return from my fathers funeral, L sharedthe following dream: Im in a house in a big room. Then I walk into a smaller

room and there is someone sitting on a couch. I try to sit down but a police-man comes in and arrests me for trespassing. I have to go to jail.In her associations, L wondered if the house could have been my house

and she considered that I might have been the person sitting on the couch.She wanted to sit down next to me but felt that it was wrong for her toenter my house without permission. She did not want to make me feeluncomfortable but worried that she did. L reported the dream on a daywhere she anxiously and self-consciously shared her condolences with me. Inthe dream, her visit to my house represented, I thought, a desire to comeinto my personal space and experience the intimacy that accompanies this.But this move toward me results in her arrest and she is taken to jail. I won-dered why she had to be taken away upon venturing closer to me. Consistentwith the interplay of Fairbairns libidinal and anti-libidinal egos, her desirefor greater intimacy and her expression of caring and concern for meseemed to result in a policeman part of herself removing her from the pos-sibility of more intimate contact in the analysis.

To some extent, Ls struggle was not surprising to me. She began treat-ment several weeks after a man she had been dating for four months endedtheir relationship. On the heels of this break-up she began to have suicidalthoughts and a friend suggested that she seek therapy. In past relationshipsshe had been the one to end things; in contrast, this man was someone shewas falling in love withand she thought that the relationship could lead tomarriage. She had been depressed in the past, she told me, but never sui-cidal. She was frightened by her feelings. This intensity reminded her of thefeelings she experienced ten years earlier when her father committed suicide.

The eldest of three children, she was born two years after her fatherreturned from serving in the Vietnam War. As her mother would share withher years later, he returned home a different man; prone to fits of rage,physical violence, unpredictable moods, and paranoia, Ls father apparentlystruggled with the psychological trauma of his war experiences. Her brotherwas born when she was 4 years old, with her sister arriving two years later.While L experienced many blanks in her childhood memories, she remem-bers a constant tension at home no one knew when her father would betriggered into a state of anger. We had to walk around on eggshells, shesaid, We were all afraid of making Dad upset. Her fathers physical vio-lence was directed mainly at Ls mother and many of their conflicts involveddisagreements around parenting. L remembers trying to interrupt theseconflicts by attempting to distract her parents or to assist them in problem-solving. She also recalled an incident at age 10 of grabbing her fathers armto keep him from hitting her mother. Her father wrestled her off, leavingbruises, and telling her to get lost. Living in fear of her father, L generally

kept herself at a distance from him. Her relationship with her mother,however, was more confusing to her; at times her mother sought her outf d i d i h hil h i h j i d h



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husband in scapegoating L, blaming her for a variety of family difficulties.Between the uncertainties of her parentsbehavior and the pressure of keep-ing her younger siblings in place, L found it frightening and overwhelmingto be at home. Not surprisingly, she experienced a good deal of anxiety in

relationships outside her family, tending to feel awkward and out of placeand worrying that others were upset with her.

With the stress of her fathers emotional difficulties and the ongoing mari-tal conflict at home, L was relieved to leave home for college, where, notsurprisingly, she studied nursing. Upon graduation, she worked as a criticalcare nurse where she relied upon her competent and efficient manner ofproblem-solving skills that she developed over years of having to take careof her parents and her siblings.

The therapy process

Upon beginning treatment, L, with great anxiety and hesitation, talked abouther disappointment and feelings of loss in her failed relationship. In addition,she had been struggling in her hospital job; she chastised herself for certainorganizational struggles at work. She often felt that her co-workers wereangry or upset with her and she was afraid to address her concerns withthem directly, imagining that her efforts in communicating her concernswould only worsen the situation. She experienced a similar anxiety in comingto treatment and she struggled in communicating her concerns. Gradually,however, she began to feel more comfortable in the sessions and she moreeasily shared thoughts about her history and her current situation.

I was alerted to Ls fragility after my return from a summer vacation inthe ninth month of her treatment. During my absence, she informed me thatshe had stockpiled a number of medications from the hospital pharmacy,and I suspected that she was well aware of which combinations and quanti-ties of the medications would be lethal. I suggested more frequent contactand L, with some relief, agreed. We began to meet four times per week. Shetried using the couch but became quite anxious and returned to her usualsitting position.

Clearly struggling, but also highly motivated, L explored a variety of con-flicts and central themes. For instance, she experienced a sense of chaos and

confusion in dealing with others in an affective manner. Her struggles in thisarea stood in contrast to her competent and efficient manner of problem-solving. In affectively intense interpersonal situations, she said, she stepsback from the heat of the situation, offering up practical solutions whilehoping that others intense feelings will cool off. She actively attempts tocool off her own feelings, experiencing herself as a volcano ready toexplode.

Her anxiety in venturing closer to others became, of course, evident in thetransference. L worried that she will screw up and cause problems for me.Things can go wrong fast, she said, and I wont know how to fix it. Itll

be a mess and youll be stuck with me. I will be a problem for you. Shedescribed a sense of something being wrong with her, deficits that others do

t il b t th t h k th S thi i ith

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me like Im a volcano. Its fine to look at volcanoes from a distance butyou dont want to get too close. If it explodes, everyone will die. If she killsherself, she said, her volcano self will no longer pose a threat to me or toothers.

She observed, however, on a recent vacation to Hawaii, the transforma-tions over time of the massive lava flows. The more recent flows, sheexplained to me, appear as endless black rock with no plant life in sight.The older sites, however, have soil and plants growing in between the lavarock. Alongside her phantasy of explosion followed by devastation, I under-stood that, in spite of her feelings of alienation and despair, she could imag-ine the possibility of new life emerging from within herself. We wereopening up these possibilities in the analytic work.

In the second year of treatment, it was clear that the analysis was deepen-ing and progressing. L seemed more able to verbalize her concerns and

tolerate more intense affect. She expressed a sense of hopefulness of feelingmore like herself and more able to live her own life. She explored the pain-fulness of her failed relationship alongside emerging thoughts and feelingsrelated to her fathers suicide, identifying feelings of guilt and self-blameand a voice within herself who chastised her, threatened her with suicidalthoughts and cruelly reminded her of her perceived failures and shortcom-ings. Her desire to draw closer to others and to be goodfor others and forme was being attacked by this critical and angry part of her. Frightened bythese internal attacks, she threatened to leave treatment and only with muchdifficulty and anxiety was she able to return the next day and begin to ver-

balize her experiences. Supporting her efforts, I commented: Even thoughyou felt overwhelmed with terrifying feelings the other day and believed thatyou would have to stop your analysis, we are able to talk about it now andmake some sense of what is unfolding for you. She seemed moderatelyrelieved.

Yet, as the work progressed, I found myself on an anxiety-filled roller-coaster ride with L and her episodic but ominous suicidality. I had everyreason to believe that L might act upon her suicidal thinking. She continuedto accrue a lethal collection of medications. Often, these episodes occurredon a Thursday afternoon or on the weekends and began with a voicemail

message. There would be vague-sounding complaint that encompassed feel-ings of failure, futility, and resignation. Upon returning her call, I felt asthough I spoke directly to Ls critical voice. This voice was filled with self-loathing, anger, and despair, and she shared with me her disturbing conclu-sion, a harsh and irrefutable judgment that she brings hardship to othersand is guilty of all wrongs.

I observed myself working hard to convince her otherwise or, at the veryleast, to suggest a more open-minded exploration. My efforts to discussthese issues with her, however, were futile. In my countertransference, I feltfrustratingly inert and ineffective as L steadfastly held to her grim conclu-

sions. With the threat of suicide looming alongside L

s apparent lack ofresponsiveness, my anxiety rose. Ls comments became increasingly vagueand cryptic as she backed away from me further. And then the phone call



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those moments, I hated her. As hard as I tried to make contact, my effortswere being thrown back in my face. In the abrupt end to the phone call, Iwas left with a terrible dread wondering if L would survive the weekend.There was nothing further to do in a practical sense. She would not consider

a hospital stay and I believed that she would deny her suicidality to emer-gency personnel. I understood the necessity of living through the feelingsthat had been deposited in me.

Three weeks later, after a week-long vacation break, L stated: I wouldlike to get more from you and more for myself in life. Later in the session,however, she became agitated and explained that she was once again experi-encing her volcano feelings. When I start to feel more alive, she said, Ialso begin to feel like I will explode. Im dangerous to you and to othersand I really should stay away! I pointed out to her that, as she got intouch with wanting more for herself, particularly more from me, a part of

her rears up and tries to sabotage her desires. I also raised the possibilitythat an aspect of her volcano experience could be related to some angertoward me over the recent vacation break. She agreed with my interpreta-tion, noting that: These issues are challenging and scary. I had an imme-diate association to a challenging and scary child, a child whom a mothermight distance herself from or reject.

The next week she reported the following: Things seem to be changing.I am able to feel my feelings more easily. Im not as worried about the vol-cano exploding. Maybe there are steam vents on the side that will let someof the pressure out. I think that Im feeling more confident these days.She

then went on to say that she is contemplating placing a personal ad in thelocal newspaper. She would like to begin dating but doesnt feel ready yet tobe in a new relationship and offer her interest and care to another person.She imagines, though, that she might be ready sometime in the near future.I interpreted: In sharing your condolences with me several weeks ago, youfound yourself offering your interest and concern to me. Perhaps you arepracticing in here. Also,I said, you have some experience of me tolerat-ing your volcano feelings without either of us exploding.

I made this interpretation to emphasize Fairbairns point that she foundher love to be destructive but that she was challenging this notion in herself.

At first, she seemed surprised by my comment but a dream followed twodays later which demonstrated that I had hit a chord.Soon after, during a Friday session, she shared this dream: Im at work. A

patient has stopped breathing. Someone calls a Code Blue but it is not broad-cast on the PA system. It is called out in a normal speaking voice. The regularstaff dont notice, only me and the nursing students do. I hear it, though, andrush to the patients room. The nursing students are panicking in the hall,bumping into each other and not knowing what to do and where to go. Im try-ing to get an IV started and Im waiting for the doctor to arrive. It takes along time.

L explained that, in a non-emergency situation, a doctor is paged andhisher response time is variable. When a Code Blue is called, everyone hasan assigned role and specific procedures to follow. Typically, she explained,

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be asked to observe the emergency situation. In the dream, it seemed likethey were responding independently to the Code Blue and they were ill-prepared to do so. It appeared, she said, that their panicky response couldonly lead to further problems and confusion in the emergency situation.

L then related details around her fathers death that she had never beforeshared. She had received a call from her father, who complained of worsen-ing depression. Ls parents had divorced two years prior and her fatherrelied upon L for emotional support. She decided to make the three-hourdrive to check in on him. Upon her arrival, she found him unkempt, barelyable to take care of himself. As she returned to her hotel that night, sheconsidered possible options and she decided to call her brother and sisterfor their input. All agreed that their father should be evaluated for inpatientpsychiatric treatment. With a plan in place, she returned to her fathershome the next day to find him lying in a pool of blood. Emergency person-

nel seemed to take forever to arrive. Unfortunately, it was too late. Herfather had died of a self-inflicted gunshot wound to his chest. She blamed

herself for his death. I shouldnt have waited until the next day, she said,I wasted time calling my brother and sister; I should have known to takeaction sooner.I interpreted: You felt then, as you felt as a child, that yourofferings of care and concern caused others to suffer. In this case, you feelthat your love caused your father to die. In fact, his suicide was quite a slapin the face for you; as you reached out to him, he rejected your help, leavingyou with overwhelming grief, confusion, and guilt.

I considered the fact that L had always felt that more had been asked of

her than she was able to handle. She, like the nursing students, felt com-pelled to respond but was ill-equipped to do so. In the association to herfathers suicide, she expressed both the phantasy as well as the reality of atragic outcome. Further, the actions of the novice responders only serve toworsen matters.

The dream, I thought, reflected a shift occurring in Ls inner world; thereis a doctor who is called, representing the potential for receiving help indealing with her own emergencysituation. She was experiencing this possi-bility with me in the transference. She reported the dream and the associa-tions around her fathers suicide at the end of a hard week; it would be long

wait over the weekend. She had made it through the week but would soonbe left on her own. Perhaps, in anticipating the weekend, she imagines thather Code Blue emergency feelings would fail to be seen or heard by me.Thus, the long wait occurs in the context of an impending internal catastro-phe, one which she must cope with by herself.

The next week, feelings of anger quickly surfaced along with an awfuldread of something terrible happening. In a voicemail message followingan affectively intense session in the ensuing Tuesday hour, L alluded againto killing herself because, as she complained: I cant seem to do thingsright and I will cause problems for you.I called her back, aware both dur-

ing and after the phone call that I felt anxious, attacked, and tired. In strug-gling with my own feelings, I stepped back to think about my experiencewith L, attempting to generate meaning from our recent phone interaction.



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At one level, the idea of L causing problems for me, of being too difficult,suggested a configuration where I am the overwhelmed and non-containingmother, offering little if any help to her desperate and struggling child. She,as the challenging and scary child, anticipates being left with her difficulties

and confusions, to do things right by herself, and, further, she anticipatesbeing rejected by her motheranalyst.

At another level, though, my countertransference alerted me to her posi-tion as the recipient of her fathers out-of-control and chaotic affects. I wasexperiencing with her the ominous threat of the others questionable sur-vival. I could now see that the phone call after Tuesdays hour representedboth a cry for help and a terrifying threat. The next day, I interpreted thisformulation to her. I said: You are letting me know how desperate you feelin needing my help and wondering if I will hear you. Also, you are commu-nicating to me how afraid and helpless you must have felt knowing that

your father was always on the brink of his own internal collapse. As only astudent nurse as a little girl, you repeatedly bore witness to a Code Bluebut felt unable to provide the rescue your father needed. How frustratingand agonizing for the child who needed both a father and an availablemother, the doctorin your associations.

I remembered the details of her fathers suicide which she had recentlyshared with me, entertaining the idea that the threat, communicated to methrough her suicidal thinking, was part of a sadomasochistic enactment inwhich the one offering help and care is shot down with a punishing and vio-lent response from the recipient. I interpreted: You are letting me know

about the painfulness of reaching out with your care and concern only to bemet with a response that seems to undo what you offer and also leaves youfeeling that the gifts you offer are worthless or even dangerous to the other.

I continued: You have been terribly worried about bringing these disturb-ing feelings to me, fearing that you are a problemfor me. Maybe your ideaof being a problem could be seen as you bringing a problem to be dealtwith. She listened and seemed deeply relieved. Thank you for not leavingme,she said. With this comment, L conveyed her belief that at least a littlebit of her love was tolerable. At the same time, she communicated her loveand appreciation to me for tolerating her volcano feelings; I had taken the

heat

and had not left her. Perhaps, she, too, does not need to leave. At thispoint in the session, L stretched out, took a deep breath and seemed torelax into the couch. I feel calm and peaceful inside, she said, and Iwant to take that in.

Frightening attachment: Love embedded in trauma

My patient experienced a chronic sense of fear and impending disaster asshown in her image of herself as an exploding volcano and in her anxietyaround communicating her concerns to me. These fears became especiallystrong at times when she came in touch with her libidinal needs and her

desire to depend more upon me. I speculated that she felt the very act ofcommunication to be dangerous alongside the dangerousness of intimacy

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In Kleins (1937) view of normal development, objects are initially splitinto good and bad with destructive impulses stirred up by feelings of hatredand aggression when the infants desires are not satisfied. Feelings of secu-rity result when the mother is able to satisfy these desires, yet, the mother

infant relationship is already disturbed at its roots by destructive impulses.Love and hate are struggling together in the babys mind (Klein, 1937, p.308).

Fairbairns more environmental and interpersonal theory points toaggression as a derivative of disappointing and troubling object relation-ships. Actual trauma andor problematic relationships with externalobjects are internalized in order to manage them. Bad parenting, in otherwords, resulted in the types of frightening and explosive difficulties experi-enced by my patient, who had internalized the chaos and explosiveness ofher familys traumas. She then felt herself to be dangerous and was terri-

fied to draw closer to me at the time of my loss, fearing that the intensityof her feelings would endanger me as she imagined she had harmed herfather.

Fairbairns model of endopsychic structure (in particular, the harsh work-ings of the anti-libidinal ego in stifling libidinal and aggressive affects) andGuntrips (1969) elaboration of Fairbairns theory, both point to situationswhere parentchild attachment and communication have gone horriblywrong. Both theorists describe serious lasting effects on their patients, forexample, Guntrips observations of the schizoid individual being afraid ofwearing out, of draining, or exhausting (his) love object (1969, p. 30) or

Fairbairns description of the precarious

relationship between parent andchild. What is not as clear is how these situations of problematic attachment

and communication come to be.In noting my patients overwhelming anxiety in sharing her care and con-

cern with me following my fathers death alongside her need to maintain adistance from her gift to me, I of course considered Fairbairns notion ofthe schizoid individual feeling hisher love to be bad. I was struck however,by the quality of immense fear and dangerousness that accompanied herhiddenness. There appeared to be a backdrop of trauma and catastrophe toher retreat and her hiding. It was here that I considered aspects of Bionian

theory.Bion, who suffered through a difficult childhood and horrific traumas inWorld War I, experienced a tormented inner life (Bleandonu, 1994). Stem-ming from his own traumatic experiences, his writings account for theinterweavings of destruction of personality and affective intensity, withdeadness and aliveness of self(Eigen, 1998, p. 61).

Bion extends Kleins notion of projective identification from an exclu-sively unconscious intrapsychic phantasy to a normal, realistic, intersubjec-tive form of communication (Grotstein, 2007, p. 41). In normaldevelopment, the infant projects hisher beta elements, sense impressions

devoid of meaning, into the mind of the mother, who, through her own pro-cess of reverie or alpha function, transforms these elements and returnsthem to her infant in a tolerable form. The data of experience are thus



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The concept of containercontained adds an interpersonal, adaptive,attachment dimension to Kleinian thinking (Grotstein, 2007, p. 41). Whena mother is able to serve as container for her childs beta elements, weexpect a process which includes development of thought and growth of per-

sonality. Because beta elements are aspects of personality linked by a senseof catastrophe (Bion, 1963, p. 40) which must be metabolized by alphafunction into psychically soluable events(Eigen, 1985, p. 324), the absenceof adequate maternal containment results in beta elements remaining ascatastrophic globs of experience (Eigen, 1985, p. 324), and the infant isleft with a nameless dread and a sense of internal catastrophe. This processoccurs in situations of a negative container or describes a process Bion callsminus containercontained. Inherent in this scenario is a gross failure ofcommunication in which the infants fear of dying is either not received oris projected back to himher.

The mother who serves as a negative container (generally lacking a con-taining mother of her own), rather than take in and metabolize her infant sprojections, projects in reverse such that the infant is left with hisher ownterrors as well as the mothers violent hatred of himher for bringing suchdisturbing affects to her awareness. For the infant, the mother is trans-formed into what Bion calls an obstructive object. This internalized objectnot only refuses to accept hisher projections, but is believed to attack himor her when there is any communicative attempt, internally or externally(Grotstein, 1980, p. 485). The obstructive object attacks attachment links aswell as attacking the infants capacity to link thoughts together (Grotstein,

1995). In addition, the infants hatred of the mother for rejecting himher isprojected into the image of her (Grotstein, 2007), adding to this powerful

package of hate and rejection. In this way, the development of thought(which for Bion is emotional thought and experience) is stifled, replaced byhate and malevolence which fill the gap where thinking might have been(Eigen, 1998, p. 98).

I hypothesized that my patient, in growing up in a chaotic and trauma-tized family, had felt her strong affects, both loving and aggressive, as beingshoved back at her with hate and malevolence. She would then have inter-nalized a hateful mother who chastises her for not just holding strong feel-

ings, but also for seeking attention for herself at times of need. In thetransference, as she approached feelings and confusions requiring help andattention, the voices reared up to shoot her down, bringing with theiradmonishments a lifetime of self-loathing and avoidance of dependency, vul-nerability and intimacy. In Bions terms, this would be an example of theobstructive object, which seeks to sever links with the other when any com-municative attempt is undertaken. I see this pattern as consistent with Fairb-airns description of the interplay between the libidinal and anti-libidinalegos. However, I find Bions notion of the obstructive object or negativecontainer to more specifically elucidate the manner in which hate and

destructiveness are established (and passed down intergenerationally) in theparentchild relationship and, of course, how these relationships are inter-nalized by the child.

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L imagined that I, like her parents, would not only reject her love butwould experience her reaching out as troublesome. Here, I would point tothe confusion in differentiating a loving embrace from physically holdingdown a violent father. I believe that she saw her efforts as dangerous or dan-

gerously evocative. In this clinical material, I am highlighting the way inwhich my patient tested out whether I could manage my own affectiveexperience with her. She must necessarily test out the effects of both heraggressive and loving feelings.

Transferring back the volume of hate and aggression

In addition to using mechanisms of internalization and splitting, says Fairb-airn (1944), the child avoids the dangers of emotional expression by usinga maximum of his aggression to subdue a maximum of his libidinal need(and) in this way he reduces the volume of affect, both libidinal and aggres-sive, demanding outward expression (p. 84). Thus, the libidinal ego isattacked internally for its libidinal needs, with this attack also representinga persistence of hatred which the child comes to feel towards himself forthe dependence dictated by his need(p. 85).

Prior to beginning treatment, my patient silenced the volume of heraggression and also her love. Her anonymously-presented gift to me is anexample of such a retreat. And yet, as I have shown in the clinical material,the analytic process was characterized by a type of raised volume, experi-enced internally by my patient and expressed in the transference. How dothese volume controlsplay out in the treatment? Guntrip (1969), in extend-ing Fairbairns work and looking at therapy process, notes that: The flightback to objects is at first a return to the bad objects from whom escape wasoriginally sought (p. 82). He also emphasizes the importance of analyzing(noisy) anti-libidinal opposition. Similarly, Sutherland (1989), in referencingKleinian theory, suggests that a severe split between good and destructiveaspects of self can only be undone with the analyst providing a relationshipin which the hate can be expressed with acceptance and without retalia-tion(p. 54).

Fairbairns volume can perhaps be seen as uncontained elements oftrauma such that a scream, or, as in Ls dream, a Code Blue announcement,

is a type of alarm or siren, alerting the parentanalyst to an urgent need orto an emergency situation. Maintaining a low volume or no volume is,I think, one and the same with a schizoid retreat in which both libidinaland aggressive feelings are avoided, and the individual retreats to the quietsafety of hisher inner world.

In the analysis, my patients raised volume, experienced by her as noisyvoices rearing up to threaten and chastise her, followed her getting more intouch with libidinal and aggressive affects in the transference. She felt theraised volume as dangerous inside of herself and also dangerous to me,describing this ominous threat as a ready-to-explode volcano. The initial

transfer of dangerous affect into internal reality, says Fairbairn, is under-taken in an environment in which trauma cannot be felt and workedth h I th l i ti t t f i h l f h t



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and aggression back into the outerinterpersonal reality of the transference.In her analysis, communication for L remained dangerous (as evidenced byher great anxiety in sharing difficult thoughts and feelings with me) yet shebegan to entertain the possibility that I might tolerate her volume,

responding to her emergency calls rather than devolve into further catastro-phe with her. Over the course of the work, she sensed with me the possibil-ity of a relationship of, in Bionian terms, containercontained in which herpersecutory and aggressive internal objects might emerge and be workedthrough. In this regard, she had no choice but to enact the threats, violence,and sadism in the analytic relationship. In working through these transfer-ence enactments, she was on her way to internalizing this containing func-tion such that she could gradually tolerate her own internal volume.

Britton (2004) elaborates upon Bions concept of a non-containing motherin his use of the idea of chaos monsters, ancient mythical creatures existing

in darkness and chaos, capable only of screaming. As in the case of Bionsobstructive object, the mothers perceived hostility and aggression in regards

to linkage and communication is split and repressed as a hostile force. Thechaos monsters threaten the female personification of order in the world(with) mother as the source of goodness now precarious and dependingon the childs restricting his or her knowledge of her(Britton, 2004, p. 50).

I see an interesting link between Fairbairn and Bion inherent in Brittonsideas. The chaos monsters scream, as I understand it, drives from the dark-ness of uncontained traumatic elements and the meaninglessness and futilityof communication. Is Fairbairns notion of the schizoid individual reducing

affective volume akin to an unconscious avoidance of such monsters? Thefunctioning of the anti-libidinal ego could be seen as a desperate attempt toestablish order in the context of chaos and trauma. In the clinical materialI am presenting, the transfer of volume (at first no volume and later lowvolumeand high volume) into the analytic realm can be seen as an uncov-ering of the chaos monsters in both their noisy communication of terrorand trauma alongside the opportunity to establish linkages based uponpatience, affective experiencing, and the development of thought and mean-ing, Bions notion of containercontained.

The omnipotent bind of the junior nurseFairbairns (1944) theory of endopsychic structure is predicated on a strat-egy of omnipotence as the individual transfers the traumatic factor in thesituation to the field of inner reality, within which he feels situations to bemore under his control (p. 83). He also refers to the moral defence inwhich an individual sees himherself as conditionally or morally bad ratherthan see the parents as unconditionally or libidinally bad. My patient, forexample, blamed herself rather than her parents for the explosiveness andchaos in the family, and her taking on of responsibility and blame extendedinto her adult life. Set up as a junior nurse, my patient operated under the

unconscious belief that if she tried hard enough or worked hard enough shecould make things right, hoping that the damage that she believed she had

d ld fi ll b d d h t bl d f il b ld

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get better. From both intrapsychic and interpersonal perspectives, she wasplaced in a predicament not unlike that of the little Dutch boy who plugs aleaking dike with his finger. In this story-within-a-story found in Dodge s(1865) story, Hans Brinker or the Silver Skates, the boy saves his country by

his heroic action. He stays at the dike all night until found by adults in thevillage who make the necessary repairs. My patient, unfortunately, did notreceive adult assistance and, to make matters worse, she (unlike the Dutchboy) believed that she caused the leak. In the absence of any help, mypatient was doomed to fail; she had omnipotently taken on overwhelmingand untenable responsibilities. Her Code Blue dream points to the terrorand futility of student nursesfeeling compelled to respond to an emergencyfor which they are ill-prepared.

The trap of this omnipotent bind resulted in my patient needing tohide her love from others as well as from herself. To the extent that she

felt compelled to fix

things and keep disaster at bay, she experiencedcritical and attacking voices within herself pushing her to do more andpreventing her from engaging in relationships marked by healthy depen-dency. In the analysis, she struggled in asking for help with her confu-sions and anxieties, believing that she should manage the difficult affecton her own. Here, she limits herself in accepting the love and care ofimportant others.

In addition, she cannot engage her true self in interactions with othersbecause she is stuck in a savior role. It would be impossible, as in the storyof the Dutch boy, to both keep ones finger in the leaking dike and to be

somewhere in the company of others; and in my patients role of savior, arefusal to manage the task will result in catastrophe for all. Because she is

doomed to fail in her task, her failure leads her to conclude that her lovingofferings are bad. Of course, her gifts could not be accepted by the recipi-ents in her family but, in utilizing the moral defence, she concludes that sheis bad. A vicious circle results in which her guilt and self-blame lead her toredouble her efforts and with further failureshe becomes even more hatefulof herself and feels increasingly lost.

In the frightening enactments of suicidal threats, I came to understandsomething of Ls lonely position of omnipotence. I had, of course, taken on

the responsibility of treating her and was terribly concerned for her safety.As described in the clinical material, the suicidal threats were marked by mypatient backing away from me either by hanging up the telephone or insist-ing that nothing could be done. My initial approach to this countertransfer-ence experience was stoic in nature; I would patiently, albeit with muchdifficulty and anxiety, tolerate the feelings and attempt to make sense ofwhat was being projected into me. Somewhat later, however, I was able torecognize a second level to these enactments; I found myself, like mypatient, standing alone in the terror. I had been pulled into the Dutch boy

junior nurses omnipotent stance of I can do it.

It was now up to me to find a way out of my own omnipotent trap. Thefirst step involved acknowledging that, ultimately, I could not keep her alive.I would offer what I could offer as analyst and it was her decision whether



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From another standpoint, I observed that she and I had slid into a typeof shaky dyad; we were missing a father. We were lacking the assistanceand added stability of a third. In the oedipal configuration, as Britton(2004) points out: The closure of the oedipal triangle by the recognition of

the link joining the parents provides a limiting boundary for the internalworld (which) creates triangular space(p. 47). In the enactments I havedescribed, my patients attempts to back away or sever the link with me canbe seen as a closing down of space, experienced by her as having nowhereto go (except to end her own life) and no way of tolerating her powerfulaffects and thinking through her predicament. In the countertransference,I felt similarly stifled, particularly in the heat of the moment; I felt drawninto the experience of threat and danger in a manner which seemed to pre-clude more involved thinking. My patient was communicating to me herexperience of having no father inside her and of being lost in her internal

world with no way of stepping back and considering her experience.In the absence of a third object, I found that turning toward theory, seek-ing out informal and formal consultation, and drawing from my ownanalytic experience was essential. I also believe that the writing of this paperwas a type of reaching for a third.

PSD

At times of greatest desperation, despair, and confusion, my patient trans-ferred her difficult affects to me via projective identification. I was thuspulled into her world of terror, uncertainty, and futility, a world in whichpersecutory anxieties prevail and hate, aggression, and envy destroy all thatis good. Here, there was little opportunity for thought or understanding.My patient could not fully experience or work through her feelings ofaggression, disappointment, and grief. The conclusion that my love is badfalls into the paranoidschizoid realm where love and hate are split off; sheis all bad and others are good and there was no way of considering themore nuanced aspects of her experiences.

According to Klein (1946), loving and destructive aspects of self cometogether in the depressive position. The splitting of good and bad objectsand predominance of persecutory fears common to the paranoidschizoid

position are worked through, allowing the introjection of the object as awhole and, through the coming together of loved and hated aspects of theobject, the individual can then experience feelings of mourning and guilt.She highlights the importance of the first internalized good object whichcounteracts the processes of splitting and dispersal (and) makes for cohe-siveness and integration and is instrumental in building up the ego (Klein,1946, p. 101).

In moving toward the depressive position, L became more in touch withpreviously disowned affects and came up against her fears of harming meandor losing me. In uncovering the troubling affects in herself, she was

faced with a version of the original traumatic set-up in which feelings, needs,and contact lead to some type of explosive or chaotic outcome. In her phan-t h ill d t ith h f l f li ti l l i

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approaching weekend and vacation breaks, as she resents me for abandoningher and worries, perhaps, that I will retaliate.

Within this mix of persecutory and depressive anxieties, my patient thenlooped back into more of paranoidschizoid place. As she experienced the

terror of her persecutory anxieties, she encountered in herself the absence ofan internalized good object or, in Bions terms, the absence of a container.In spite of my obvious presence and availability, she experienced internally afrightening absence of help alongside the harsh and condemning voices,threatening her from within. As Klein (1946a) states:

If development during the paranoidschizoid position has not proceeded normallyand the infant cannot for internal or external reasons cope with the impact ofdepressive anxieties a vicious circle arises. For if persecutory fear and correspondingschizoid mechanisms are too strong, the ego is not capable of working through thedepressive position. This forces the ego to regress to the paranoidschizoid position

and reinforces the earlier persecutory fears and schizoid phenomenon.

(p. 105)

In Bions (1963) extension of the paranoidschizoid and depressive posi-tions, Ps and D are in constant oscillation. Both are important; Ps breaksup and D is integrative (Eigen, 1985). Bions version of PSD alsoexpresses a kind of dying or going to pieces and coming back as an invari-ant of psychic processes (Eigen 1985, p. 329). In the episodes of raisedvolume and suicidal threats, I imagined that my patient felt herself to begoing to pieces. Her internal version of falling apart was expressed in her

ideas of dying or of quitting her analysis. And yet, she inevitably, albeit withsome difficulty, came back to the analysis and she found that I, too, cameback to her. In spite of the frightening enactments, I had not left her andshe found that we were able to make meaning of these episodes upon herreturn. She was taking in good object experience in these moves towardthe depressive position, finding that she could increasingly tolerate strongfeelings and that the disparate and confusing experience that she had splitoff could, slowly and over time, be made sense of.

Reparation and the acceptance of love and hate

In Ls analysis, she demonstrated her fear and terror of her love. Yet, thehidden longing to experience her love as precious and valuable peeked outthrough her gift-giving. The hiddenness was set alongside a desire to be dis-covered; she had, after all, addressed the package in her own handwriting.Through her anonymous gift and her new-found capacity for concern,she signaled an initial, albeit tentative, capacity to feel her love as non-destructive.

For Klein (1937), the struggle between love and hate and ones fear ofhurting or destroying the loved one may cause an individual to deny orsuppress loving feelings. Alongside destructive impulses, she says, is a pro-found urge to make sacrifices, in order to help and to put right loved peoplewho in phantasy have been harmed or destroyed (p. 311). This process of



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It seems to me that the possibility of reparation allows one to carry on; achild who is able to express aggressive feelings with hisher subsequentreparative efforts accepted by a parent is able to trust that both aggressiveand loving feelings can be dealt with and are valuable. For my patient, her

parents could not receive her love and she was left feeling empty anddespairing, or, as Fairbairn (1944) puts it, reduced to a state of worthless-ness, destitution or beggardom (p. 84). On one hand, her loving offeringsto her family were attacked and responded to, at the very least, as unhelp-ful. At an internal level, however, we would imagine that these efforts had areparative function attached; in her phantasy she has harmed her familymembers and she then tries to make it right. Her efforts at reparation, then,were not acknowledged or taken in.

Guntrip (1969) proposes that schizoid suicide represents a longing toescape from a situation that one does not feel strong enough to cope with

alongside a longing to be reborn with a second chance to live, that it mayspring out of a deep unconscious secret wish that death should prove to bea pathway to rebirth(p. 217). In my opinion, Guntrip is getting at the needto escape from an untenable situation involving some sort of omnipotentbind. It is not that the individual is inherently weak; rather, heshe istrapped in an environment in which expression of feeling cannot be workedthrough. To be able to live is to have ones mistakes and missteps as well asones gifts taken in and responded to. I believe that my patient, in her anal-ysis, was working toward rebirthin this way.

In taking in me as a good object, she found that her cries for help, rather

than resulting in chaos, destructiveness, and disconnection, could be met byboth of us with tolerance, patience, and understanding. In spite of her terri-fying and ongoing concerns that she would destroy me, her persistenceallowed her to continue in the work. In moving toward the depressive posi-tion, she could increasingly share both her aggressive and loving feelings.She continued to offer the giftof her presence; in spite of numerous threatsto the contrary she continued to show up.

The aspect of new life emerging from that which is dead is, at once, bothtragic and hopeful. Ls poignant example, which I alluded to earlier, is thatof new growth peeking out through a vast expanse of volcanic rock. Earlier

in the analytic work, it was difficult for L to elaborate upon this image. Asthe work progressed, however, she shared more specific images and phanta-sies of the Hawaiian lava fields. She imagined, for example, seeds fromnative plants that are carried in the wind to the older lava fields, those areaswhere a layer of soil has begun to develop. The seeds that are blown intothis area can then grow in their new environment. Of course, L understoodthat this process occurred over hundreds of years, yet it captured for her afeeling of hopefulness in her work with me. My association here was to linkthe idea of soil to the world of others and the possibility of becomingrooted there. Not all forms of new growth survive, she said. But over time a

variety of plant life can be established and can thrive.She found in the analytic relationship a seed of possibility, a seed withinherself from which she might allow more of her true self to grow and flour-

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where the rubble could be seen as lava rock, the byproduct of others volca-nic explosions. After numerous fiery and explosive enactments of her own,expressing her own terror and trauma, she was able to take in my ability tocontain her volcanic self alongside my desire to find her. In sharing the

aggressive and loving aspects of herself, she was able move from the barrenlandscape of the lava fields to a place where soil could develop and growthcould occur. She began to discover that she was good enough, good for meand for others without having to be perfect. We would continue to workthrough difficult and anxiety-laced enactments, yet L increasingly felt herselfto be more alive within herself and more firmly rooted in the world ofothers.

Conclusion

In applying Kleinian, Fairbairnian, and Bionian theoretical concepts to thisextended case example, I have attempted to show how the ubiquitous natureof schizoid phenomena can be seen more specifically, at least with mypatient, as a response to highly traumatic relationships beginning with herparental relationships. Thus, in Fairbairn and Guntrips work, the notionsof something having gone wrong in parenting and of the schizoid individ-uals experience of a traumatizing outer world can be viewed in more detail.I am highlighting Bions concept of the obstructive object or negative con-tainer, the utilization of omnipotent defences, and the struggle in movingtoward depressive position functioning as important aspects in understand-ing how this version of a schizoid retreat is set up alongside the usefulnessof these concepts as a type of roadmapin navigating through the challeng-ing enactments that are encountered and must be worked through. AlthoughI am describing work with a patient who approached her hidden love andaggression in, at times, life-threatening ways, I would propose that thesetypes of struggles in uncovering hidden affects and hidden aspects of selfcan be readily found in, and applied to, less traumatized patients.

Translations of summary

Verborgene Geschenke der Liebe: eine klinische Anwendung der Objektbeziehungstheorie. Aneinem umfangreichen klinischen Beispiel wendet der Autor bestimmte Aspekte der Theorien Kleins,

Fairbairns und Bions an, um zu zeigen, wie ein Mensch dazu kommen kann, seine Gefhle von Liebewie auch Aggression zu verbergen. In dem hier prsentierten klinischen Material wird die Varianteeines schizoiden Rckzugs verstanden als eine tiefgreifende Reaktion auf Traumata. Der Autorversucht, das Wesen einer ,,traumatisierenden Auenwelt (Guntrip, 1969) genauer zu untersuchen undwie solche Erfahrungen einen Menschen veranlassen, sich zurckzuziehen und die Bewegung hin zurgesunden Abhngigkeit eines Erwachsenen zu untergraben. Das Verstndnis fr diese Dynamik hilft,den psychoanalytischen Behandlungsprozess anzuregen und kann als eine Art Leitplan dienen, umdurch die Herausforderungen der bertragungs-Gegenbertragungs-Inszenierungen hindurch zunavigieren.

Regalos de amor ocultos. Una aplicacion clnica de la teora de las relaciones objetales Medi-ante el uso de un ejemplo clnico extenso, la autora aplica aspectos de las teoras de Klein, Fairbairn yBion para mostrar cmo los individuos pueden esconder sentimientos tanto amorosos como agresivos.

En el material clnico presentado, una versin de retiro esquizoide fue entendida como una respuestaonmipresente al trauma. La autora intenta explorar ms especficamente la naturaleza del mundoexterno traumatizante (Guntrip, 1969), as como la manera en la que estas vivencias hacen que uni di id t i b t li l i i t h i d d i d lt C d t



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dinmicas ayuda a orientar el proceso del tratamiento psicoanaltico. Adems, puede servir como unasuerte de mapa para atravesar difciles puestas en acto transferencialescontratransferenciales.

Cadeaux damour caches: une application clinique de la theorie des relations a` lobjet. En utili-sant un exemple clinique de longue dure, lauteur applique des aspects des thories de Klein, Fairbairn

et Bion afin de dmontrer comment des individus peuvent cacher des sentiments d

amour et d

agressivit.Dans le matriel clinique prsent, une version dune retraite schizode a t comprise comme unerponse envahissante au traumatisme. Plus spcifiquement, lauteur cherche explorer la nature dunmonde extrieur traumatisant (Guntrip, 1969) et comment ces expriences font quun individu se retireet sape un mouvement vers une dpendance adulte saine. Une comprhension de ces dynamiques aide avertir le processus de traitement psychanalytique et peut servir comme une sorte de carte routire dansla navigation travers des acting-out de transfertcontretransfert provocateurs.

I doni nascosti dellamore: unapplicazione clinica della teoria delle relazioni oggettuali. Conlausilio di un esempio clinico ampliato, lautrice applica gli elementi delle teorie di Klein, Fairbarnian eBion per dimostrare in che modo gli individui possano arrivare a nascondere sia sentimenti d amore chedaggressione. Nel caso clinico in oggetto, un tipo di ritiro schizoide fu considerato una risposta pervasi-va a un trauma. Lautrice tenta di esplorare in modo pi specifico la natura di un mondo esterno trau-matizzante (Guntrip, 1969) e come queste esperienze inducano un adulto a ritirarsi indebolendo il suo

progredire verso una dipendenza adulta sana. Una comprensione di queste dinamiche d aiuto nel for-mare il processo di trattamento psicanalitico e pu fungere da roadmap per farsi strada tra i difficili agitidi transfer e controtransfer.

References

Bion WR (1962). Learning from experience. London: Heinemann.Bion WR (1963). Elements of psychoanalysis. London: Heineman.Bleandonu G (1994).Wilfred Bion: His life and works 18971979. New York, NY: Other Books.Britton R (2004). Subjectivity, objectivity, and triangular space.Psychoanal Q 73:4761.Dodge MM (1865). Hans Brinker or the silver skates: A story of life in Holland. New York: Charles

Scribner.Eigen M (1985). Toward Bions starting point: Between catastrophe and faith. Int J Psychoanal66

:321330.Eigen M (1998). The psychoanalytic mystic. London: Free Association Books.Fairbairn WRD (1941). A revised psychopathology of the psychoses and psychoneuroses. Int J

Psychoanal22:250279.Fairbairn WRD (1944). Endopsychic structure considered in terms of object-relationships. Int J

Psychoanal25:7092.Fairbairn WRD (1946). Object-relationships and dynamic structure. Int J Psychoanal27:3037.Grotstein JS (1980). A proposed revision of the psychoanalytic concept of primitive mental states.

Part I: Introduction to a newer psychoanalytic metapsychology. Contemp Psychoanal16:479546.Grotstein JS (1994). Projective identification reappraised. Part I: Projective identification, introjective

identification, the transferencecountertransference neurosispsychosis, and their consummateexpression in the crucifixion, the Pieta, and therapeutic exorcism. Contemp Psychoanal30:70846.

Grotstein JS (1995). Projective identification reappraised. Part II: Projective identification, Introjectiveidentification, the transferencecountertransference neurosispsychosis, and their consummate

expression in the crucifixion, the Pieta, and therapeutic exorcism. Contemp Psychoanal 31:479511.

Grotstein JS (2007). A beam of intense darkness: Wilfred Bions legacy to psychoanalysis. London:Karnac.

Guntrip H (1969). Schizoid phenomena, object relations and the self. New York, NY: International UP.Klein M (1937). Love, guilt and reparation. In: Love, guilt and reparation and other works 19211945,

30643. New York, NY: Free Press.Klein M (1946a). Notes on some schizoid mechanisms. Int J Psychoanal27:99110.Klein M (1946b). Notes on some schizoid mechanisms. In: Envy and gratitude and other works,

19461963, 124. New York, NY: Delacorte.Segal M (1964). Introduction to the work of Melanie Klein. London: Karnac.Sutherland JD (1989).Fairbairns journey into the interior. London: Free Association Books.

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hiden gift of love, object relations

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