ABSTRACT
I would like to refer to several additional aspects of the treatment described in this book:
The analyst’s “survival”. Salvaging my analytic ego and continuing to function as an analyst—especially when confronted with extraordinary and outrageous intrusions into my analytic space— was vital for the patient’s development and eventual well-being. I believe that my survival helped the patient achieve a victory over the forces of Thanatos.
Holding relationship. Providing the patient with a nurturing, confiding, and reflecting relationship, which included faith in his capabilities to grow as a result of the treatment, enabled him to feel some security in analysis and subsequently in life. This holding relationship facilitated the strengthening of the patient’s psychic forces and the stabilization of his psychic boundaries.
Hope. Hope, which was clearly lacking in this patient, is the activation of an internalized relationship with a good object—a benign, reflective presence that makes thinking about the vicissitudes of emotional life possible, however frightening, disturbing, or unacceptable emotional responses might feel. Hope grows from 86the repeated experience of being able to overcome or to manage painful states of mind in oneself whether triggered by the actions of others towards the self or by the actions of the self through aggressive acts (Lemma, 2004).
Hope is different from manic repression of feelings of loss and despair in that it is grounded in an acknowledgement of loss. It denotes a state of mind that allows the individual to approach externally and internally difficult scenarios with a sense that the difficulty can probably be overcome, even if this is painful and the process involves relinquishing past hopes. Lemma regards hope as “a profoundly moving and sobering appreciation of ‘the possible’, or of reality, reminiscent of Kierkegaard’s (2000) definition of hope as ‘passion for the possible’” (Lemma, 2004, p. 109).
Elie Wiesel (1977) makes reference to hope with regard to the Holocaust: “How do you unveil horrors without offering at the same time some measure of hope?” (p. 6). One of my psychoanalytic goals was to bring some hope into this treatment, particularly because the patient had to deal with the horrors of the present superimposed on those of the past. I attempted to achieve this goal through my interpretations, which, in addition to conveying an understanding of the patient’s deepest anxieties, were intended to provide a kind of “mutative support” (De Jonghe, Rijnierse, & Janssen, 1992). Through interpretation, but also by my presence, I became a new kind of introject (Pollock, 1964), which, in contrast to the earlier one, provided hope.
