ABSTRACT
In this chapter, the author discusses a clinical situation in which analytic work impacts on a pathological organisation of the mind, only to uncover psychotic and confusional thinking at its core. The development of a narcissistic organisation as part of a system of defences against severe psychic disturbance is well known, and is difficult to treat because of the very rigidity which it confers to thought processes. The author focuses on a patient, Ms A, who came into analysis after she had experienced several breakdowns. With pathological projective identification, aspects of the patient's self are projected into her objects, which then take on the identity of the aspect that has been projected. The author presents some material from Ms A's session, five years into her analysis. The internal migrations that occurred within sessions were not so much from paranoid-schizoid to depressive positions, but more from pathological organisations to primitive, preconscious states of mind.
