chapter  9
41 Pages

Treatment of Psychotic States

Searles (1963), whose clinical accounts vividly demonstrate the role of intersubjective reality and concrete symbolization in the psychotic process, candidly describes his own experience of this threat to per, sonal selfhood encountered in his work with two psychotic patients:

We have previously reported one of our own cases in which the ana~ lyst's interpretive approach eventuated in such a persecutory spiral (Atwood and Stolorow, 1984, chapter 2). In this case, the analyst's in~ terpretations of the patient's fears of women, which were well docu~

mentedintheanalyticmaterial,repeatedlyconfirmedthepatient's beliefthatthetherapist'ssolemotivationinofferinginterpretations wastohumiliatehim,lorditoverhim,andultimatelydestroyhim.In, terpretationsofprojectivemechanismsonlyconfirmedfurtherandin, flamedthepatient'spersecutoryvisionoftheanalyst,whicheventual, lybecameentrenchedintheformofafull,fledgedtransference psychosis.Itwasgraduallyunderstoodthatthepatienthadbeendes, peratelyattemptingtosolidifyhiscrumblingse[f,experiencebyestab, lishinganarchaictransferencebondinwhichhelongedforhisbrittle grandiositytobeaffirmedandsustainedbythetherapist'sadmiring gleam(Kohut,1971,1977).Inthisspecifictransferencecontext,the analyst'sinterpretationsofthepatient'sfearsofwomenwereexperi, encedbythepatientasmortifyingrejectionsofhisyearningforthead, mirationthathefeltwasnecessaryforhispsychologicalsurvival.Itwas essentialfortheprogressofthetreatmentthattheanalystwasableto recognizethekernelofsubjectivetruthencodedinthepatient's persecutorytransferencedelusions.Inthecontextofthetransference revivalofthepatient'sarchaiclongingforunconditionaladmiration, theinterpretationsofhisfearswerepersecutory,becausetheythreat, enedhimwithself,obliteration.Whentheanalyst,overthecourseof severalsessions,wasabletoclarifyhow,inthecontextofthepatient's desperateneedtofeeladmiredandesteemedbyhim,theinterpreta, tionsoffearswereexperiencedasdeadlyassaultsonthepatient'ssense ofpsychologicalintactness,thismadepossiblebothadissolutionof thetransferencepsychosisandabeginningconsolidationofthear, chaicselfobjecttransferencebond.