ABSTRACT
Working with Brandchaft on this project has been a gift, giving us the chance to draw him out on many issues. The most memorable conversation was about “primitive anxieties.” We asked what that meant to him, specifically. In a wide-ranging talk, he spoke of the many ways such experience had been described-“disintegration anxiety,” “fragmentation anxiety,” “falling apart,” “disappearing,” “shrinking.” He emphasized that the most important thing to remember was that the quality of the therapeutic alliance, on which all else rested, was dependent on how specific the analyst could be in grasping and articulating the patient’s experience and how successful the analyst could be in finding the right language to communicate his or her understanding, so the patient might feel really understood. In the face of even terrible anxiety, the most important factor, he stressed, was to continue to investigate the patient’s experience, to encourage the patient to articulate his or her experience. “If the patient says, ‘I’m falling apart,’ none of your knowledge will inform you a priori as to what the patient means. It’s always a matter for further investigation: ‘Can you tell me a little more about that … what that means … how that feels. … Is there some feeling you’ve had in other circumstances that is like it?’ ”
—Shelley Doctors
One of the things I heard often from Bernie, and I’m not sure how it would fit in, would occur just after I might say something like I just did: “I’m not sure how it would fit in.” Bernie might hear the doubt in my voice and with a little chuckle would say, “Maybe you suffer a bit from it, too,” meaning pathological accommodation. His comments always had the effect of reminding me to think about my own contribution to the ongoing process. It was in this way that I learned to attend to microshifts in affect in my patients. Now I say it frequently to a patient.
“After you said … I noticed a slight pause, a slight drop in the sound of your voice, did you notice that?”
