ABSTRACT
This chapter is a reflection on the need to adapt therapeutic intervention with the type of patients described, particularly during the more acute initial phases. The author starts out by outlining the phases of psychotherapy proposed by Anne Alvarez based on the different levels of integration of the Self: the first vitalizing level, the second descriptive level and the third explanatory level.
In this work, the analyst will need to overcome feelings of impotence, solitude and hopelessness, and find new ways of establishing affective contact and sharing symbolic meanings. She can do this by referring back to her feelings, experiences, memories and associations to connect with the patient’s suffering and on her own past to find a personal way that can be of help to the patient. This links to Resnik’s concept of double transference and the theory of the gift illustrated by anthropologists.
The author then goes on to reflect on the implications of discussing the ending with the patient, which brings back early experiences of mourning an absent object.
A final reflection remarks on the patients who ‘remain in our minds’, perhaps because the long and arduous analytic trajectory allowed them to express an affective bond that had previously been non-existent, and in time they maintain an appreciative memory, full of new hope for life.
