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Regression to Malignant Relations

Hayuta Gurevich, MA

Her face freezes. I know now that I have said something totally wrong. I feel a pang

of fear in my body. She begins to scream, to hit me with her words. I tell her to stop

but to no avail. I am to be exterminated because I was not accurate, because I did not

match her expectation to say exactly what she wished me to say. Her rage is imbued

with the strict belief that only a perfect fit would save her from her miseries. Her

words become harsher, her lips spit anger and cold rage and cruelty creeps into her

voice.

I feel a heavy brick on my chest, I can't think. I stare at her with disbelief, beaten by

her words and overwhelmed by their sound. She then gets up in a majestic disgust and

leaves in yet another 'grande sortie', as we already call it. She slams the door so

loudly that although expected, it sends a horrible jolt through my body and mind: I

am shocked, beaten, ashamed of my impotence and failure, responsible and guilty

again for a catastrophe beyond my comprehension. I become mad. After all the

working through, can't she control herself? No, she cannot, and does not want to. This

patient, when in need - hates herself and whoever hurts her, becomes cruel and

violent, breaking furniture, dishes, and of course – me, the therapy, just as she was

endlessly mentally 'broken' as a child. No matter how much I adjust myself to her,

talk to her on the phone between sessions, add sessions, meet her daily when she is

suicidal, being empathic to the violent impact of my failures - each rupture evokes
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this turmoil. The roles between us are reversed (1): she is just as sadistic as her

mother and brother were to her in her childhood.

But she is dissociated, both from her violence and from her rage: although she acts

violently, she does not feel angry, but rather overwhelmed, shocked, and that she

must flee to save herself from my cruelty, my indifference, my distance, my living in a

whole different world, - envious of me for having all that she does not, protesting

against this profound injustice and feeling helplessly entitled to have me merged with

her and provide all her needs. She is desperately devastated because I can't even

imagine what it is like to be such an outcast, almost a bag lady. Finally, she feels that

I gloat at her, happy not to be in her situation.

And me? Though I manage to say the right words, how come I am always bit by a

painful sting of guilt that I do, actually, neglect her? She is right; I am the therapist,

it's my responsibility. I am her present 'undertaker' (2), the neglecting and cruel

mother, enjoying her only when she is nice and bright and funny. And haven't I

learned to expect these outbursts? I did, to a point, but never enough.

We both regress to our individual malignant relations, and are stuck there again and

again. I know that these attacks annihilate not only me, but first and foremost her

dread of falling into a gap which is, for her, an abyss. Her demand for clinging to me

and for my absolute and total provision and adaptation to her are the only way to

annihilate her own annihilation anxiety. As for myself, I am paralyzed when

screamed at, just as I had been long, long ago, and I can't change this, although I am

aware of the fact that when I cringe into myself I immediately become her depressed
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and deserting mother, enraging her even more. This whole drama is enacted and lived

out in the present. Is this 'malignant regression'?

The vignette is an illustration of what I would like to explore today – a portrayal of

the so called 'malignant regression' as a mutual enactment of dissociated self states,

which originate in early traumatic environmental failures of primary malignant

relations.

Before the ego and its functions are established, (what Ferenczi called) the tender

psyche is dependent on the environment for its survival and realization of its inborn

potentials. Excessive environmental failures at this early stage of dependence arouse

annihilation anxiety, which automatically evokes fragmentation and dissociation that

are imprinted upon the tender psyche. The only way to survive and to maintain the

crucial connection to the caretaker entails cutting itself off from its spontaneous

subjectivity.

I consider any early environment as malignant if it is imbued with excessive absence

of a good enough adaptation to the infant's psychic needs. Ferenczi's concept of

Identification with the Aggressor sheds light on this idea. He postulated, as did

Winnicott later on, that before developing ego functions, the tender psyche reacts to

external threatening absence by coercively identifying with the aggressor's denial of

its subjectivity and dissociating from its impact. The anxiety-ridden identification (or

incorporation) is with the annihilation of the authentic and subjective self, and not as

Anna Freud understood it – identification with the aggressiveness of the aggressor.

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Such early absence is violent and aggressive. It forces the tender psyche to distort

itself intra-psychically while adapting to the environment in order to survive the

annihilation anxiety that is aroused. The dear price of such survival is fragmentation

and dissociation of the authentic self.

I would like to underscore the intra-psychic rupture as the psychic trauma. What is

traumatic is not the external event, which may be very subtle, but the deep inevitable

impact of rupture and annihilation anxiety and consequently - fear of breakdown. The

psyche develops around this core. Survival modes are repeated compulsively in actual

relations, not as 'malignant regression', but, as I suggest, as enactments of early

malignant relations.

At this point, let me go back to Michael Balint's concept of 'malignant regression', (3)

which has bothered me for years: what is it that is malignant?

Malignant is not 'benign', and essentially different from benign regression, where,

according to Balint, the basic fault (the psychic trauma) can be activated and healed

by the analyst's participation. This may be attained by recognizing the patient's

internal life and unique individuality without the patient's expectation for actual

change in the environment. In a quiet state of 'arglos' (4)– as Balint named this

satisfactory situation, a new beginning occurs: a guileless, innocent, unsophisticated,

and unsuspecting attitude, which offers significant opportunities for therapeutic work

(arglos is a German word with no English equivalent).

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The above vignette is definitely not 'benign.' It fits Balint's description of patients in

'malignant regression', as those who "can never have enough" (5), and "if the

expectations are not or cannot be met, what follows is unending suffering or unending

vituperation" (6) and actual gratification of instinctual wishes must occur. The

mutually trusting relationship breaks down repeatedly - there develops an addiction-

like state, a constant demand for concrete gratification by the analyst. This, according

to Balint, is malignant. But is it? And why does this happen?

Balint, an analysand and follower of Ferenczi, cautions us from malignant regression,

alarmed by Ferenczi's relations with his most difficult patients, by his mutuality and

deep involvement. Balint sought a way out by making this distinction, releasing the

analyst from plunging into such 'messy' and seemingly 'non-analytic' technique. What

he saw as benign regression can happen, but so often and with so many patients we

do find ourselves entangled in stifling impasses and enactments where no 'new

beginning' is seen in the horizon, just as Ferenczi described it in his clinical diary.

The analyst inevitably becomes 'the undertaker', the retraumatizing other, by

committing the same failure that the patient had barely survived in the past.

Even if the analyst is unaware of it, there is always a grain of truth in any delusion of

the patient about him. In Winnicott's view, the analyst cannot avoid failing in the way

that for the patient repeats early environmental failure. These failures in the actual

analytic relations compulsively repeat past survival modes, protecting the dissociated

traumatized parts from a return of the initial breakdown.

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The malignant failures are also repeated intra-psychically: I go back here to Ferenczi's

bold assumption, that if an early aggressor is incorporated into the tender psyche, it

keeps its annihilating work internally, annihilating any arousal of the dissociated

authentic self, which relentlessly seeks reparation. The analytic situation activates and

'invites' the dissociated parts by raising the never lost hope that some Other will

safely revive them. There is, therefore, a crucial importance to actual failures in

analysis: not only are they inevitable, but they are essential for the process of

reviving, via enactment, the dissociated states of early malignant relations.

Contrary to Balint, both Ferenczi and Winnicott highlight these failures in analysis as

the main opportunity for reparation, assuming that the analyst does take responsibility

for them in recognition of their traumatizing impact on the patient. Ferenczi wrote: "It

is this confidence that establishes the contrast between the present and the

unbearable traumatogenic past, the contrast which is absolutely necessary for the

patient in order to enable him to re-experience the past no longer as hallucinatory

reproduction but as an objective memory" (7). In other words, the past will be

experienced in the present, the past is occurring in the present, but free of coerced

survival dissociation.

This road is not followed easily: if pathological dissociation is an intersubjective

phenomenon (8), matters become complex, since the analyst is drawn into these

enactments with his own inevitable dissociated states. Patient and analyst repeatedly

get stuck in those mutual enactments, both subjugated to a malignant 'analytic third'

(rephrasing Ogden's concept), with no 'arglos' to envelope any of them.

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I suggest that what is called malignant regression is an enactment of psychic modes of

surviving the absence of conditions that facilitate the initial continuity of being. The

unending demands of the patient are manifestations of the dissociated suffering

instigated by the refusal of the analyst to actually change the environment, a

gratification seen by the patient as his only salvation.

For instance, the need to concretely cling to the analyst is a reaction to a trauma, an

expression of and a defense against the fear of being dropped or abandoned – that had

already happened. It is therefore a secondary phenomenon, whose aim is to

restore, by proximity and touch, the original absent primary object (9). Incessant and

desperate clinging (10) is a defense against an earlier traumatic breakdown. It

expresses simultaneously what is still needed and what was traumatically absent, i.e. -

an environment that enables primary clinging (11) and a normal developmental

course of 'weaning' from it. Any recurrence of such threat arouses a vehement and

forceful demand to diminish the recurrence of this catastrophic absence by clinging.

For the traumatized patient the analyst is responsible for those enactments. His

attitude determines whether what develops will be benign regression or the repetition

of malignant relations (12). According to Balint, Ferenczi's and Winnicott's theory of

regression to dependence – a regressed patient needs the analyst to be with him in a

state of at-one-ment, as he regresses to a stage where he is incapable of differentiating

internal from external reality. The other is perceived only as a subjective object, as a

function that either adapts to his needs or doesn't.

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If the analyst does not realize this he literally is a traumatizing object, whose

separateness would be beyond the patient's capacity to contain; the patient regressed

to dependence cannot contain too much 'not me' which initially breached his

continuity of being. If the analyst does not understand and recognize this regression

and tries to 'organize' or explain it - the greater is the danger of the analyst becoming

an actual aggressor, arousing in the patient fear of breakdown and repeating early

malignant relations. The analyst must recognize such situations as his own failures, to

be repaired by reconnecting with the patient (13). Only this adaptation by the analyst

will enable the patient to experience the failure without surviving it by dissociation.

Such adaptation does not mean total adjustment, but rather a recognition of the impact

of its absence. These are actual reparations of the analyst as an adaptive environment

that acknowledges contained failures, and can transform them into 'benign traumas'

(14), in which experiencing the failure revitalizes spontaneous reactions such as pain,

anger and protest. Otherwise, the patient is retraumatized by the analyst and

immediately casts him as part and parcel of his repeated malignant relations.

The imprint of early malignant relations is profound and resists change for any of the

following reasons:

1. Imprinted fragmentation and dissociation: Before the ego is established, early

excessive environmental failures are imprinted and dissociated without any mental

apparatus to regulate, contain and represent it. Ferenczi wrote: "Individuals at the

beginning of their existence still have totally different ways of reacting from those in

later life…in infants…protective devices are not yet developed, so that infants

communicate with the environment on a much broader surface… (it) has been
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insufficiently appreciated that identification (is) a stage preceding object relations…a

state in which any act of self-protection or defense is excluded and all external

influence remains an impression without any internal anti-cathexis…people at the

beginning their of lives have as yet no individuality…this kind of mimicry, this being

subject to impressions without any self-protection, is the original form of life…" (15).

The tender permeable psyche is suggestible to external influence and cannot assert

itself without a good-enough adaptation of the environment to its own needs.

Furthermore, to realize itself, it depends on the environment. An environmental fault

ruptures the psyche, and is imprinted in the psyche as a basic fault, a negative imprint

of the external traumatic absence of adaptation. When annihilation anxiety is aroused,

these primary identification and mimicry operating at this stage of dependence,

automatically enhance the incorporation of the caretaker's attitude or absence of

attitude, forcing internal distortions in order to maintain and preserve the crucial

dependence on the object. This is an anxiety-ridden incorporation which results in

coerced identification with the external environment's annihilation of the tender

psyche's subjective existence, which is automatically fragmented and dissociated

(16).

This, again, according to Ferenczi (17), is the Identification with the Aggressor.

Psychic trauma is not the external event or absence, but rather its automatic intra-

psychic impact of a dissociated rupture of the continuity of being. This rupture does

not cease to exist at the core of the psyche. Moreover, being imprinted, the

traumatizing impingements are manifested by the survival modes which are thus a
 10

negative of the traumatic occurrence. (This does not mean negation or negativity, but

rather what occurred as a consequence of it).

2. Compulsion to repeat: The tender psyche survival modes of fragmentation and

dissociation are ruled not by the pleasure principle, but by the compulsion to repeat

and act-out dissociated parts (18).

These dissociated states are unrepresented (19), inaccessible to any mental

association. Yet they are in a relentless struggle to be revived and are acted out and

manifested in mutual enactments in the inter-subjective field and intra-psychically.

Fear of breakdown rules this 'psychic equilibrium' and overshadows and forbids any

tapping of the unbearable annihilating anxiety. Even when the analyst provides a safe

environment for the dissociated parts to revive, the internal incorporated aggressor

threatens the psyche by fear of recurrent return of the past trauma, and the analyst is

inevitably regarded as a potential aggressor who will repeat the initial breakdown.

The past is alive in the present.

The analyst must be alert to this paradoxical attitude of the patient, and attend to its

manifestations in the actual analytic relations, thus providing him with a good enough

adaptation, which facilitates a continuity of being. This does not mean incessant

satisfaction, but rather a good enough adaptation which creates basic trust and

attachment that can contain and experience failures without dissociation, and thus –

growth and development.

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3. Dissociated 'me-states' that are sensed as 'not-me': The incorporated malignant

relations (or identification with the aggressor) continuously threaten the authentic self

with the return of breakdown, keeping authentic 'me-states' dissociated in a

pathological state and regarded as 'not me states'. This is a self mutilation that runs

along a continuum beginning with self reproaches – not for doing something bad or

wrong, but for being defective, sensing oneself as flawed and faulty, annihilation of

any authentic self state, up to physical self mutilation, and even suicide. Shame and

guilt for having a self are mingled with the fear of breakdown if revived. This is the

incorporated external annulment of the self, which is repeatedly and compulsively

activated when dissociated spontaneous states of the true self are aroused. Then they

may be sensed as 'being mad'. Furthermore, "feelings of hatred are thereupon directed

against all emotions including hate itself, and against external reality which stimulates

them. It is a short step from hatred of the emotions to hatred of life itself" (20).

4. 'Alien transplants' - 'not-me' states experienced as 'me': Any use of the parent

of the child's psyche for his own needs, any extensive dissociation of the caretaker of

the child's needs, any projection of unbearable states by the parent to the child, any

accusation of the child for the caretaker's emotional difficulties – they all infiltrate

into the gaps created by dissociation. The tender psyche has no defense against them.

The more the caretaker uses the child, the more suggestible and permeable he

becomes. In identification with the other's attitude towards him, he accepts any

misconceptions and misrepresentations. These 'not-me' states of invasive objects (21),

interjects (22), projections and projective identifications of the parent, are sensed as

part of the self, of 'me', though they are not.

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In Ferenczi's words, this is the fate of children whose parents use them for their own

psychic needs (23): “[…in cases] that adults forcibly inject their will, particularly

psychic contents of an unpleasurable nature, into the childish personality…these split-

off, alien transplants vegetate in the other person during the whole of life…". Any

attempt to protect the self arouses confusion and an incomprehensible fear of having

killed or a wish to kill, to get rid of, without understanding what and why. Evacuating

these alien transplants cause "a tremendous void in the person who has become

accustomed to having the alien will as a skeleton of his own person…up to a state of

complete dissolution". These alien transplants are infused with one's own drives -

one's own psyche intertwined with the other's.

These parts, unwillingly incorporated, are "forcible introjections and embodiment of

pathological internal part-objects that disrupt ego functioning and the evolution of a

sense of self…" (24), which may collude with the incorporated aggressor. There may

also be an overwhelming identification with an invasive rejecting object that

colonizes the psyche as internal 'mafia', and repeatedly annihilates the self, arousing

extreme self-reproaches and self-mutilation. Furthermore, the invaded psyche also

identifies with the invasiveness itself and tends to expel these interjects invasively and

forcefully into the analyst, who becomes overwhelmed and confused, reversing the

malignant relations.

5. Unrealized authentic self and spontaneous gestures: Early malignant relations

are immanent with excessive absence of a good-enough-environment. This absence

has a traumatic impact on the tender psyche: An adequate response to early

spontaneous gestures is crucial for the development of a sense of being, of being real,
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of being a subject. Inborn potentials that have not been adequately responded to and

have not been materialized stay frozen, yet strive for a providing environment in

order to revive. The question, at this point, is what happens to spontaneous gestures if

they do not meet an adequate response? Do they 'simply' stay frozen?

The breakdown of the mother's reverie or holding floods the psyche with unbearable

primary agonies or nameless dread, and automatically raise a need to 'short-circuit'

(25) these breaches. They are embedded in an absence of attachment of the caretaker

and in his dissociation of its internal catastrophe for the child. This external

dissociation from the intra-psychic impact of the impingement on the tender psyche is

imprinted as an internal dissociation. I call this state "absence within absence". What

we meet is its negative, that is – the mode that the psyche survived this crucial

absence. What does that mean?

The establishment of a sense of real depends on the actual realization of finding in

reality what was created in the psyche. The inborn expectations need to actually to be

met in order to experience, imagine, and transform them into a representation (26).

The unmet spontaneous gesture (27) actually ruptures and hinders the development of

a sense of real and of transition from relating to objects as subjectively perceived to

recognizing them as external and objective. As a result, the striving for realness never

stops. It is felt as deadness, de-realization, de-personalization and the like, which are

actually the negative manifestations of this initial failure and embody its residues and

consequences (28).
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When absence occurs and lasts beyond the capacity to contain it, and the mother is

dissociated from the threat to the tender psyche – it is overcome by nameless dread,

with no representation. When revived in analysis by the analyst's reverie, the

unrepresented absence is experienced as more real than any external or internal

object or fact. Winnicott quotes a patient who was separated from her parents at an

early age (29), while referring to a former analyst; the analyst's presencing of the

absence, both external and internal, allowed the patient to experience that: 'The

negative of him is more real than the positive of you'. To this he adds, that she

managed never to call by name those who were caring for her the whole of those

years, and that this was the negative of the dissociated memory of her father and

mother.

6. Survival modes of nameless dread: What all of this means is that when the

mother's reverie is absent, there can be no representation of a bad or absent object or

experience. Absence of representation is filled with unbearable nameless dread which

activates other psychic survival functions; this internal absence is not empty. Bion

suggests that it is transformed into other reparative hallucinations such as clinging to

an 'unceasing breast' as the only way to survive.

The psyche needs 'do' something about this unrepresented absence, and will employ

various mental 'tools' to deal with this missing function: Sexualization, somatization,

perversion, psychosis are also possibilities for surviving these tensions (30). These

are alternatives for patterns of deficient attachment (31), and are all psychic

phenomena alluding to a dissociated primary trauma.

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These survival modes offer a pathological solution, a concreteness devoid of

symbolization and of normal representations (32). They are negative manifestation

which 'stich' (33) and 'cover' the scars of absence and are an attempt to fill this

dreaded gap or rupture while actually leaving the original wound inaccessible.

7. Hallucinatory salvation as a reverse of malignant relations: Although

dissociated, the dissociated psychic retreats keep activating the psyche. Ferenczi

describes in his diary (p.19) that they also evoke "protest against violence and

injustice, contemptuous, perhaps sarcastic and ironic obedience displayed in the face

of domination; but inward knowledge that the violence has in fact achieved nothing;

it has altered only something objective (meaning external behavior), the decision-

making process, but not the ego (true self here) as such. Contentment with oneself for

this accomplishment, a feeling of being bigger and cleverer than the brutal force;

suddenly insight into the greater coherence of world order, the treatment of brute

force as a kind of mental disorder, even when this power is successful".

This sense of omnipotence may or may not be dissociated, yet it is always oblivious

to the reality that the very fragmentation of the psyche and the need to survive it has

already occurred and that these survival means are sealed in psychic retreats and have

no means for realization. They may keep sanity and true self protected, but have no

ability to revive them in real and actual intersubjective relations (34). Had there been

a mother's reverie, anxiety would have been relieved not by an incessant breast but

rather by adaptive feeding and soothing the anxiety.

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When this function is traumatically absent, the internal absence may also be filled

with reparative hallucinations such as clinging to an 'unceasing breast'. These

hallucinatory salvations aim to annihilate annihilating anxiety, and promote a sense of

omnipotence, oblivious of the fragmented psyche's painful reality.

These are "permanent enclaves ...that unconsciously commemorate traumatic

episodes in the patient's earlier history"(34, p.146). These phenomena propose to

reverse (36) the conditions that caused the psychic catastrophe: If it were a result of

not enough holding, the only fantasyed (35) cure can be that of incessant clinging; if

an absence of holding aroused feelings of emptiness, then one has to constantly fill it

up by an 'unceasing breast', etc.

In this situation, the excessive absence of a good breast is used by the tender psyche

to regard the anxiety arousing from it as incessant hunger for which an incessant

breast would be the only relief. This psychic state "seems to be the mirror image (a

negative) of the sane one…sanity in reverse, "topsy-turvy, "a mock-up of it, a sinister,

eerie, bizarre imitation of it. This imitation… is actually transformations in

hallucinosis (Bion 1962)" (37). Such hallucinations, which are dissociated from the

psycho-somatic matrix, have no access to materializing in reality. Nevertheless, they

contain a grain of the initial absence and the wish to repair it by avoiding

annihilation anxiety, and they seem and feel totally concrete and real. While Grotstein

emphasizes the fictitious quality of those hallucinations (37), I suggest that they

always contain and express a dissociated acknowledgement of the traumatically

initial absence in the early external environment.

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8. Enactments in analysis: These intertwined and complex qualities of surviving

early malignant relations are inevitably enacted in analysis. The dissociated states

seek their revival via these survival modes, in need for an other who will provide

what had been absent but never given up. Basic trust in the analyst depends on the

sense that he actually provides adaptation to the patient. This does not mean incessant

satisfaction but rather adaptation to the patient's needs according to the analyst's

ability. Needed adaptive changes in the environment do not indicate 'malignant

regression' but rather the recognition of the patient's level of regression to

dependence.

Failures are inevitable and crucial for making a difference between the traumatic

occurrence in the past and its experience in the actual present, without dissociation.

These enactments enable the potential cure for a ruptured self. Experiencing psychic

pain may be frightening and terrible, but it is alive, not dissociated and psychically

dead. Survival-invulnerability is transformed to human suffering. In analysis, the

analyst is expected to recognize these pleas for sanity. Survival modes should not be

regarded as resistance but as a path for reconstruction of dissociated schemas (38).

An analyst, threatened by the patient's regressive needs, will strive to avert them; in

order to analyze a patient's regressive longings, the analyst must be comfortable with

them (39), and know his own traumas. Furthermore, "the more the analyst can reduce

the inequality between the patient and himself, and the more unobtrusive and ordinary

he can remain in his patient's eyes, the better are chances of a benign form of

regression" (40). This means that the analyst lets the patient to lead him (41), allows

for the analysis to occur 'in the way of the patient' (42), and adheres to a 'technique'
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that allows the patient to experience him as a subjective object without impinging on

him an objective external reality that is beyond his ability to contain; This means

"abandoning any attempt at 'organizing' the material produced by the patient….and

tolerating it so that it may remain incoherent, nonsensical, unorganized, till the

patient… will be able to give the analyst the key to understand it" (43); 'acting-out'

and enactment are valid means of communication, and in these cases – the only

access to dissociated parts.

The analyst needs also to offer 'something' to the patient which will fulfill functions

that were not available by the primary object. What is this 'something' that functions

as a primary object? In recent theories, several clinical suggestions are made

concerning these states of unrepresented unconscious. They all highlight the analyst's

actual role and involvement in fulfilling the absent crucial environmental functions

that promote symbolization and representation.

A crucial function for reviving dissociated states is to enable to experience them and

sense them as real. Ferenczi suggested (44) that "one cannot believe that an event

took place if the analyst does not take really seriously the role one assumes, of the

benevolent helpful observer, that is, actually to transport oneself into that period of

the past (a practice Freud reproached me for, as being not permissible), with the result

that we ourselves and the patient believe in its reality, that is, a present reality, which

has not been momentarily transposed into the past". In Winnocott's terms – to

experience together renders a sense of real to what has occurred but not experienced.
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To attain this, the analyst must relinquish his 'language of passion' – his theory, his

technique - and realize that his subjective responses to the patient are not necessarily

projected into him but may rather be his own transference, due to his subjectivity,

limitations and failures. He should agree to be receptive and honestly involved, able

to see his failures in the way of the patient (their subjective impact on the patient),

and understand and make contact with the patient at the present level of development

of his psyche. This last point meaning, that when the patient is in a level of

dependence, he can perceive the object only in a subjective way, so the analyst must

acknowledge the fact that the patient is yet incapable of containing him as an external

object. Interpretations about what is happening can be understood by the False Self,

without touching the emotionally dissociated states. The analyst needs to see what is

happening to the patient 'in the way of the patient', living with him the past as a

present occurrence. This has 'a healing effect…the traumatized psyche feels love,

cleansed of all ambivalence, flowing toward it and enveloping it, as if with a kind of

glue: fragments come together into larger units; the entire personality may succeed in

again becoming united' (45).

9. Mutual dissociation in enactments: Theoretical literature concerning these issues

acknowledge the intersubjective quality and mutuality of dissociated states (46), the

irrelevance of verbal interpretation and the need for the analyst to meet, be with,

regress mutually, be receptive etc, and to be able, through his own experience to

provide a reverie function for the patient's dissociated states. These ideas introduce

the importance of the analyst's attitude as crucial for determining whether traumatic

environment will be enacted as a retraumatizing event - or worked through. It is the

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analyst's countertransference and transference that determines the patient's

transference, and not the other way around.

This entails being involved with total immersion and opening up in a way that the

analyst can detect his own dissociated states after they are activated in enactments.

Contrary to Balint, and somewhat to Winnicott but less so, Ferenczi knew this and

was not afraid to plunge into any messy relationships that evolved in analyses of

deeply traumatized patients.

What happens to the analyst when drawn into the turmoil, in which his own

dissociated states will inevitably come to the fore? Ferenczi is the first analyst who

dared to deal theoretically and clinically with the fact that the analyst's psyche is not

different from that of his patient, and that no matter how well analyzed he may be, his

own dissociated states will be enacted and impinge the patient, thus repeating

mutually early malignant relations.

My point here is that early malignant relations have specific attributes that enhance

their hold on the mental functioning of both analyst and patient. The analyst needs to

struggle through his own personal capacities, psychic pains and dissociations as well

as with the patient, and 'live through' those regressions to malignant relations.

Recognition of his failures and their impact on the patient is crucial, and so is his

ability to transform the uncontained to an experienced failure. Explaining the patient's

states as a survival reaction to an external impingement enables the patient to

experience himself as reacting to external traumatizing environment and to intra-

psychic annihilation anxiety. This includes a 'negative capability' of the analyst

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combined with an ability to experience the patient's feelings and to help him

understand the uncontained quality of the analyst as an object objectively perceived.

These explanations seem similar to self-disclosures but are different – in the sense

that they are not aimed at revealing the analyst's subjectivity as such, but rather to

provide an alpha-function for the patient about the analyst as an objective object

which has been uncontained by the patient. This function is crucial for disentangling

malignant enactments; the analyst functions for the patient as a primary object who

recognizes that a rupture has occurred, and gives the patient a meaning for it,

accompanied by the empathy and adaptation that have been absent in the initial

trauma. The analyst thus transforms traumatic events in the present into experienced

suffering, allowing for pain, protest and rage to be alive and not dissociated. In

Winnicott's concepts – this is a transformation to benign trauma which is embedded

in a sense of real, with differentiation between internal and external reality,

representation and psychic growth.

Back to the vignette: For many years we have understood together that she has been

abused, incorporated invasive objects and that they explode out of her with no control

and regulation, that her dissociated protest and rage in the past were reviving, that she

survived in her fantasies of grandeur which compensated for her extreme loneliness

and her vulnerability, and that this fantasying (47) expressed a crucial claim for her

born right and need to be special and loved. We also understood that she could not

bear my own exposed vulnerability which also evoked her own rage, and in role

reversal - the way her own vulnerability was cruelly treated as a child. All of this

helped, but still something was missing: she kept feeling that I intentionally rejected
 22

her neediness because it was repulsive for me, and that she deserved to be expelled

and cut off because of her faulty self. My cringing and emotional paralysis when

screamed at, were experienced by her as repulsion and disgust, from which she fled in

total despair and rage in order to save herself.

At a certain point, the assault became unbearable for both of us. I told her that I know

that my response drove her mad and aroused her rage, but that I can't do anything

about my reaction, that my reaction has to do with my own abusive past, and that I

repeatedly close myself, even though I know that had I put a limit to her tantrum - it

would help her. I have thus let her know that I recognize my impact on her when I

cringe and that I understand that she senses it as hatred and repulsion towards her. Of

course, all of this was also correct and later addressed openly. But still, my initial

response had personal origins that she could not have known. It was beyond her

subjective capacity to know and beyond my ability to control, and it had to actually

occur between us in order to be experienced by both of us.

I had not heard from her until our next meeting. She came in calm, smiling at me

shyly and said: “I had the most extraordinary experience after I left. It occurred to me

gradually that I had an extreme pleasure in beating you up. I feel strong. No one can

beat me. No one ever will.”

Once she could experience my vulnerability and her own violence, she could

paradoxically begin to comprehend her own fragility and her wish to reverse it. It

took many more years of painful work for her to be able to better contain her

vulnerability and violence without 'breaking' relations and "not to burn the club if it
 23

does not suit me perfectly"; but since that session the 'grandes sorties' stopped and she

never screamed at me again.

References and notes:

1. Borgogno, F. (2008). The relevance of "role reversal" in today's psychoanalytic work. International
Forum of Psychoanalysis, 17(4):213-220
2. Dupond, J. (ed.), 1988. Ferenczi, S. Clinical Diary. Harvard Univ. Press. P. 51 (8.3.32)

3. Balint, M. 1968. The Basic Fault. Tavistock Pub. London&NY. Part 4, pp.119-156

4. Balint, Ibid, p. 138

5. Balint, Ibid, p. 138

6. Balint, ibid. p. 140

7. Ferenczi, S. 1933. Confusion of tongues between adults and the child. In Balint, M. (ed). 1955.
Final contributions to the problems and methods of psyco-analysis. Basic Books, NY.
8. Phillip Bromberg is the main theorist that underscores this quality of pathological dissociation. It is
an underlying assumption also for Ferenczi and Winnicott - see also Gurevich, H. 2014. The return of
dissociation as absence within absence. AJP, 74(4), pp. 313-321.
For mutual dissociation of analyst and patient – see Stern, D.B. 2010. Partners in thought. Routlege,
NY&London.

8. Bromberg is the main theorist that underscores this quality of pathological dissociation. It is an
underlying assumption also for Ferenczi and Winnicott - see o Gurevich, H. 2014. The return of
dissociation as absence within absence. AJP, 74(4), pp. 313-321.
For mutual dissociation of analyst and patient – see Stern, D.B. 2010. Partners in thought. Routlege,
NY&London

9. Balint, Ibid. p. 145

10. Balint, M. Ibid. p. 145

11. It is only appropriate at this point to remind us of Imre Herman's theory of clinging: Herman was
Ferenczi's student and a prominent analyst in Hungary. The essence of his theory was that 'the
instinctive behavior of the ape infant, that is, its clinging to the mother, is an existing but inhibited
instinctive drive in human infants as well… an that it can be triggered in the 3 month old infant… the
clinging instinct is frustrated …since the mother's body is not hairy, and as a latent drive, it is effective
throughout a human's life. It provides the biological background to the mother-infant relationship. ..and
will later be a source of loving relationships, but also a source of aggressive tendencies…, particularly
after a disappointment or loss of a loved one. ' he adds that the opposite of this instinct is going-in-
search, 'that becomes active when the instinct of clinging is left without object of clinging. The
aspirations to separate and hide oneself are…a manifestation on the instinct of clinging. These are
considered to be reaction formations used by the ego as a means if defence…clinging, going-in-search,
separation and hiding, including self-destruction (p141), are closely connected phenomena; Herman
called them 'the clinging syndrome' (p140) which is a reaction to traumatic separation (141). In
Szekacs-Weisz, J. and Keve, T. (eds). 2012. Ferenczi and his world. Karnac, London.

12. Balint, M.Ibid. P. 173

 24

13. Ferenczi, S., 1931. Child analysis in the analysis of adults. In Balint, M. (ed). 1955. Final
contributions to the problems and methods of psyco-analysis. Basic Books, NY. P. 126

14. Winnicott, D.W., 1965. The concept of trauma in relation to the development of the individual
within the family. In Winnicott, C. et.al. (eds). 1989. Psychoanalytic Explorations. Karnac, London.
Ch. 22

15. Dupond, Ibid. Pp. 147-148.

16. Gurevich, H. 2014. The return of dissociation as absence within absence. AJP, 74(4), pp. 313-321.

17. It is interesting to compare the concept of identification with the aggressor with Bion's obstructive
object and Winnicott's good enough environment.

18. Roussillon, R. 2011. Primitive Agony and symbolization. Karnac, London. Introduction, pp. 1-26.

19. Levine, H.2014. Beyond neurosis: Unrepresented states and the construction of the mind. Revista
Psicoanal., 60(2):277-294

20. In “Attacks on Linking” (1993) Bion writes:

Projective identification makes it possible for him to investigate his own feelings in
a personality powerful enough to contain them. Denial of the use of this mechanism, either by
the refusal of the mother to serve as a repository for the infant's feelings, or by the hatred and
envy of the patient who cannot allow the mother to exercise this function, leads to a destruction
of the link between infant and breast and consequently to a severe disorder of the impulse to be
curious on which all learning depends [emphasis added]. The way is therefore prepared for a
severe arrest of development. Furthermore, thanks to a denial of the main method open to the
infant for dealing with his too powerful emotions, the conduct of emotional life, in any case a
severe problem, becomes intolerable. Feelings of hatred are thereupon directed against all
emotions including hate itself, and against external reality which stimulates them. It is a short
step from hatred of the emotions to hatred of life itself. (pp. 106-107)

21. Williams, P. 2010. Invasive objects. Routledge, NY&London.

22. Bollas, C. 1999. The mystery of things. Routledge, NY&London. P.113

23. Dupont, Ibid. 7.4.32

24. Williams, P., Ibid. pp. 13-17.

25. Ogden, T. 2014. Fear of breakdown and the unlived life. IJPA, 95 (205-223)

26. Winnicott, D.W. 1988. Human Nature, pp. 100-8. Otherwise, writes Winnicott, this is what may
happen: 'Let us imagine a theoretical first feed…. There develops an expectancy, a state of affairs in
which the infant is prepared to find something somewhere, not knowing what…. (if) at about the right
moment the mother offers her breast. .. if the first feed goes well, contact is established… (when) the
baby is ready to create, and the mother makes it possible for the baby to have the illusion that the
breast…has been created by impulse out of need…the baby can begin to hallucinate the nipple
(represent it) …thus starts the infant's concept of external reality… the basis for the infant's gradual
recognition of a lack of magical control over external reality lies in the initial omnipotence that is made
a fact by the mother's adaptive technique". This situation enables a gradual process of normal
development and possibility of gradual weaning that enhances differentiation between internal and
external reality.
"Per contra, if the first feed is mishandled, a great deal of trouble may be caused…a failure at this point
exaggerates instead of healing a split in the person of the infant. Instead of relationship with external
reality softened by the temporary use of an illusory state of omnipotence there develop two separate
kinds of object-relationship…on the one hand there is the infant's capacity to create (true self)…and on
the other hand there is a false self …which is passive to the demands of external reality. It is very easy
 25

to be deceived and to see a baby responding to skilful feeding, and to fail to notice that this infant, who
takes in an entirely passive way, has never created the world, and has no capacity for external
relationships, and has no future as an individual".
27. Stern, D. et al. (1998. Non- interpretive mechanisms in psychoanalytic therapy: The
'something more' than interpretation. International Journal of Psycho-Analysis, 79:903-921) refer to
the same issue in case of a failed moment: If the failure is left unrepaired, the two gravest
consequences are that either a part of the intersubjective terrain gets closed off to the therapy, as if one
had said ‘we cannot go there’, or even worse, a basic sense of the fundamental nature of the therapeutic
relationship is put into such serious question that therapy can no longer continue (whether or not they
actually stop).

28. Bion, W. 1962. The psychoanalytic theory of thinking. Int. J. Psycho-Anal., 43:306-310: In Bion's
terms - the psyche's pre-conceptions expect their realization, so that they can become conceptions. He
discerns between a representation of absence and the absence of representation. The normal course is
to experience absence and represent it: a representation of absence occurs if the tender psyche's can
experience and contain it, that is – if there is a mother's reverie of the absence, for instance – of a
breast, and if there is a good breast to be compared with. A bad breast is a good breast that is absent.

29. Winnicott, D.W. 1971. Transitional objects and transitional phenomena. In playing and reality, p
26

30. Roussillon, R., Ibid.

31. See also Liotti, G. 1999. Understanding the Dissociative Processes: The Contribution of
Attachment Theory. Psychoan. Inq. 19:757-783.
Liotti, G. 2004. Trauma, Dissociation, and Disorganized Attachment: Three Strands of a Single Braid.
Psychotherapy: Theory, research, practice, training Vol. 41, pp. 472-486.
Liotti, G. 2012. Disorganized attachment and the therapeutic relationship with people in shattered
states. In Yellin, J. & White, K. (eds) Shattered States:Disorganized Attachment and its Repair.
Karnac, London. Pp. 127-156.

32. Roussillon, R. Ibid. p. 22

33. Jacques-Alain Miller. 2007. The Symptom. Issue 8.

34. These phenomena are conceptualized in different theories as fantasying, primary dissociation,
psychic equilibrium of pathological organization, psychic retreats, etc. Grotstein refers to them as 'a
third area' of the psyche which is dominated by primitive and concrete survival hallucinations. See
Grotstein, S.J. 2002. Endopsychic structures, psychic retreats, and 'fantasying': the pathological 'third
area' of the psyche. In Pereira, F.& Scharff, D.E. (eds), Fairbairn and Relational Theory. Karnac,
London &NY.

35. Winnicot, D.W. 1971. Playing and reality. Pp 31-43.

36. Bion's concept of “alpha function in reverse" may shed some more light on phenomena:: "Reversal
of alpha-function means the dispersal of the contact-barrier and is quite compatible with the
establishment of objects with the characteristics I once ascribed to bizarre objects. …the reversal
of alpha-function did in fact affect the ego and therefore did not produce a simple return to beta-
elements, but objects which differ in important respects from the original beta-elements which had no
tincture of the personality adhering to them. The beta-element differs from the bizarre object in that the
bizarre object is beta-element plus ego and superego traces. The reversal of alpha-function does
violence to the structure associated with alpha-function. … The distinction indicates the limitation of
any treatment effecting changes in the personality to secondary factors for primary factors will not be
altered." Bion, W. 1962. Learning from experience (p 103).
This concept refers to changes which are associated with the replacement of alpha-function by what
may be described as a reversal of direction of the function. Instead of sense impressions being changed
into alpha-elements for use in dream thoughts and unconscious waking thinking. In the absence of
maternal alpha function psychic elements may be transformed into elements that seem like alpha
elements (having representations), yet they are not: they resemble a transformation of beta elements
but they loose the possibility to return to real beta-elements which have the ability to be transformed
 26

back into alpha elements. This concept refers to changes which are associated with the replacement
of alpha-function by what may be described as a reversal of direction of the function. Instead of sense
impressions being changed into alpha-elements for use in dream thoughts
and unconscious waking thinking, in the absence of maternal alpha function psychic elements may be
transformed into elements that seem like alpha elements (having representations), yet they are not: they
resemble a transformation of beta elements but they loose the possibility to return to real beta-elements
which have the ability to be transformed back into alpha elements.
See also Civirarese, G. 2015. Transformations in Hallucinosis and the receptivity of the analyst. IJPA
96(4):1091-116

37. Grotstein 1990. Nothingness, Meaninglessness, Chaos, and the Black Hole. Contemporary
Psychoanalysis, 26:257-290.

38. Bucci, W. (2002). The Referential Process, Consciousness, and the Sense of Self. Psychoanal. Inq.,
22:766-793

39. Coen, S.J. (2000). The Wish to Regress in Patient and Analyst. J. Amer. Psychoanal. Assn.,
48:785-810.

40. Balint, Ibid. p173

41. Purcell, S. 2018 Dissociation and Duets: Aspects of Technique in the Analysis of Developmental
Trauma

42. Winnicott, D.W. 1963. Dependence in infant-care, in child-care and in the psychoanalytic setting.
Inter. J. Psychoan. 44, p339

43. Balint, Ibid. pp 177-179

44. Dupont, Ibid. p. 24

45. Dupont, Ibid. p 12

46. Phillip Bromberg and Donnel Stern elaborate on these ideas.

47. Winnicott, D.W. 1971. Playing and reality. In ch. 2 "Dreaming, Fantasying, and Living". Winnicott
uses this concept to describe hallucinatory fantasying which is a sort of psychic retreat, a survival self-
holding which attempts to avoid fear of breakdown.