chapter  9
22 Pages

SPECIFIC TREATMENT ISSUES AND THE VERTICAL SPLIT

Our psychotherapeutic and psychoanalytic literature is filled with descriptions of patients whose major defensive mechanism is disavowal, those who present with a "rift in the ego" or a vertical split. Almost all of these case reports are presented with the picture of the therapist or analyst observing the patient from the outside and thereupon pointing out to the patient what is seen by the therapist as a break with reality, or a denial of a bit of reality, or perhaps a refusal to acknowledge some information conveyed to the patient by the analyst. More often than not, a certain recalcitrance on the part of the patient to agree with this appraisal leads to a frustrated and resentful therapist who seems called on to explain the unhappy state of affairs and may do so by an alteration of a theory of treatment.