“By compiling and editing this superb volume, David Scharff has made an

important contribution to our field. Each of the original and informative essays
in the book enhances our understanding and appreciation of the various uses of
the object, a topic of great importance and one that has been much neglected in
the literature. This landmark work not only corrects that deficiency, but provides
a valuable educational experience for students and practitioners alike. This is a
book that belongs in the library of every analytic therapist.”
—Theodore Jacobs, MD, member of the New York Psychoanalytic
Association, Author, The Use of the Self and
The Possible Profession.

“This highly original book hugely extends the study of the variety of ways in
which we may use our objects, and for that matter, misuse them or be misused
by them. Disturbing interactions between internal and powerful external objects
are examined, and careful distinctions between oedipal and pre-oedipal matters
always carefully observed. There is deep and moving analytic work and thinking
being carried out here. Prepare to be edified and surprised!”
—Anne Alvarez, PhD, MACP. Consultant Child and Adolescent
Psychotherapist. Author, Live Company
and The Thinking Heart.
The Use of the Object
in Psychoanalysis

Using Winnicott’s classic paper as its starting point, this fascinating collection
explores a range of clinical and theoretical psychoanalytic perspectives around
relating to “the object.” Each author approaches the topic from a different angle,
switching among the patient’s use of others in their internal and external lives,
their use of their therapist, and the therapist’s own use of their patients.
The use of objects is susceptible to wide interpretation and elaboration; it is
both a normal phenomenon and a marker for certain personal difficulties, or even
psychopathologies, seen in clinical practice. While it is normal for people to relate
to others through the lens of their internal objects in ways that give added meaning
to aspects of their lives, it becomes problematic when people live as if devoid
of a self and instead live almost exclusively through the others who form their
internal worlds, often leading them to feel that they cannot be happy until and
unless others change.
Assessing the significance of objects among adult and child patients, groups
and the group-as-object, and exploring Freud’s own use of objects, The Use of
the Object in Psychoanalysis will be of significant interest both to experienced
psychoanalysts and psychotherapists and to trainees exploring important
theoretical questions.

David E. Scharff, MD, is Co-Founder and Chair Emeritus of the Board,

International Psychotherapy Institute, Chair of the International Psychoanalytic
Association’s Committee on Couple and Family Psychoanalysis, and Editor of the
journal Psychoanalysis and Psychotherapy in China.
The Use of the Object
in Psychoanalysis
An Object Relations Perspective
on the Other

Edited by David E. Scharff

First published 2020
by Routledge
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chapters, the contributors
The right of David E. Scharff to be identified as the author of the editorial
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Contents ContentsContents

List of contributorsix

Introduction: how do we use others? 1

DAVID E. SCHARFF

1 Living in the object 4

DAVID E. SCHARFF

2 What does the object (in our patients’ lives) have to do with it? 17
JAMES L. POULTON

3 Dreaming up, re-finding, and grieving lost objects: a case study 31

CARL BAGNINI

4 Creating a new relationship in child analysis: revisiting

theoretical ideas of developmental and transference objects 42
CAROLINE SEHON

5 Analysis interminable: the analyst’s self as object for the patient 67

NANCY L. BAKALAR

6 Can an ingroup be an internal object?: a case for a new construct 89

RON B. AVIRAM

7 Beyond subject and object, or why object-usage is not a good idea 101
JUAN TUBERT-OKLANDER

8 The use of the object: personal and clinical reflections 118

JILL SAVEGE SCHARFF
viii Contents
Epilogue 129
DAVID E. SCHARFF

Index 130
Contributors ContributorsContributors

Ron B. Aviram, PhD, is an Adjunct Associate Professor at Ferkauf Graduate

School of Psychology at Yeshiva University. He is author of The Relational
Origins of Prejudice: A convergence of psychoanalytic and social cognitive
psychology. He is in private practice in New York City. ronaviram@msn.com
Carl Bagnini, LCSW, BCD, is founding and senior faculty, The International
Psychotherapy Institute; Faculty, The Gordon Derner Post-Graduate Psycho-
analytic Institute and The Training Institute for Mental Health. Author, Keep-
ing Couples in Treatment – Working from Surface to Depth, and is in private
practice in Port Washington, NY. edre54@aol.com
Nancy L. Bakalar, MD, is a graduate of The International Institute for Psychoa-
nalysis (IIPT), where she is a supervising analyst and teaching faculty member.
She is also a faculty member of The Denver Institute for Psychoanalysis. She
developed and taught in the Infant Observation Program at The International
Psychotherapy Institute (IPI) for ten years. She is a Distinguished Fellow of the
American Psychiatric Association and practices psychoanalysis and individ-
ual, couple, and family psychodynamic psychotherapy in person and by video-
teleconference in a suburb of Denver, Colorado. nlbakalar@comcast.net
James L. Poulton, PhD, is a psychologist in private practice in Salt Lake City,
Utah, an Adjunct Assistant Professor in Psychology at the University of Utah,
and a member of the national faculty of the International Psychotherapy Insti-
tute. He has written numerous articles and chapters on psychoanalytic theory
and treatment and is the author of Object Relations and Relationality in Couple
Therapy: Exploring the Middle Ground and co-author of Internalization: The
Origin and Construction of Internal Reality. jlpoulton@mac.com
David E. Scharff, MD, is Emeritus Chair of the Board, Co-Founder, and For-
mer Director, International Psychotherapy Institute; Chair, The International
Psychoanalytic Association’s Committee on Family and Couple Psychoa-
nalysis; Clinical Professor of Psychiatry, Uniformed Services University of
the Health Sciences and Georgetown University; Supervising Analyst, Inter-
national Institute for Psychoanalytic Training; Teaching Analyst, Washington
Psychoanalytic Institute; Honorary Fellow, Tavistock Relationships, London;
x Contributors
Former President, American Association of Sex Educators, Counselors and
Therapists, and former Vice President, International Association for Couple
and Family Psychoanalysis. He is a child and adult analyst in private practice
with children, adults, couples, and families in Chevy Chase, Maryland. He is
the author and editor of more than 30 books, with foundational texts on family,
couple, and individual psychoanalytic therapy, the work of Ronald Fairbairn
and of Enrique Pichon Riviѐre, sexual difficulty, and innovative training of
psychotherapists and psychoanalysts. His recent initiatives involve organizing
training programs in Russia and in China, where he has founded an innovative
training program for students from across China. To this end he is founder of a
journal devoted to the newly emergent field of psychoanalysis in China, called
Psychoanalysis and Psychotherapy in China. As Chair of the Couple and Fam-
ily Psychoanalysis Committee of the International Psychoanalytic Association,
he has, together with members of the group, organized meetings of the com-
mittee and international congresses that further the study of family and couple
psychoanalysis around the world. davidscharff@theipi.org
Jill Savege Scharff is an internationally known psychoanalyst for children and
adults, couples and families. She is the co-founder and former co-director of
the International Psychotherapy Institute. She was the founding Chair of the
International Institute for Psychoanalytic Training, the analytic training pro-
gram at the International Psychotherapy Institute, where she also developed
an analytic supervision training program, a child therapy and child analytic
curriculum. She is a teaching analyst at the Washington Center for Psychoa-
nalysis and a clinical professor of psychiatry at Georgetown University. Her
private practice is in Chevy Chase, Maryland. She is the author of Projective
and Introjective Identification and the Use of the Therapist’s Self (1992) and
senior co-author with David E. Scharff of The Primer of Object Relations:
Second Edition (2005), Tuning the Therapeutic Instrument: Affective Learn-
ing of Psychotherapy (2000), Object Relations Individual Therapy (1998), and
Object Relations Therapy of Physical and Sexual Trauma (1996). With David
E. Scharff as the senior author, Jill Savege Scharff co-wrote many books on
object relations: Object Relations Family Therapy (1987), Object Relations
Couple Therapy (1991), and The Interpersonal Unconscious (2012). She is co-
series editor with David E. Scharff of the Library of Object Relations at Jason
Aronson (now at Rowman and Littlefield) and series editor of the Library of
Technology and Mental Health at Routledge. She has edited four books in the
Psychoanalysis Online series (Routledge, 2013, 2015, 2017, and 2019). jills-
charff@theipi.org
Caroline Sehon, MD, FABP, Chair and Supervising Analyst, International institute
for Psychoanalytic Training (IIPT) at the International Psychotherapy Institute
(IPI); Teaching and Supervising Faculty in IPI’s child and adult psychotherapy
training programs; Clinical Associate Professor of Psychiatry at Georgetown
University. Adult and child psychoanalyst and psychiatrist in private practice
 Contributors xi
in Bethesda, Maryland. Author of papers and chapters on object relations indi-
vidual, couple and family therapy. carolinesehon@gmail.com
Juan Tubert-Oklander, MD, PhD, is a psychoanalyst and group analyst, living
and practicing in Mexico City. Full Member of the Argentine Psychoanalytic
Association and the International Psychoanalytical Association, Honorary
Member of the Group-Analytic Society International, Founding Member of
the International Field Theory Association, and Member of the International
Association of Relational Psychoanalysis and Psychotherapy. Professor in
the Master´s Degree Course of Psychoanalytic Psychotherapy at the Marista
University of Merida. Author of numerous papers and book chapters, pub-
lished in Spanish, English, Italian, French, Portuguese, Czech, and Hebrew.
Co-author, with Reyna Hernández-Tubert, of Operative Groups: The Latin-
American Approach to Group Analysis (Jessica Kingsley, 2004) and author of
Theory of Psychoanalytical Practice: A Relational Process Approach (IPA/
Karnac, 2013) and The One and the Many: Relational Psychoanalysis and
Group Analysis (London: Karnac, 2014), as well as several books in Spanish.
jtubertoklander@gmail.com
Introduction David E. ScharffIntroduction

How do we use others?

David E. Scharff

The question of how we relate to important people in our lives is a different ques-
tion from how we use them. Winnicott wrote that object relating preceded object
using – a statement that seemed so counterintuitive to me that I have puzzled over
it on and off for the many years since I first read Playing and Reality soon after it
was published.
I did not meet Winnicott, although I had planned a year’s sabbatical in London
partially with the hope of learning directly from him and from John Bowlby. Win-
nicott had died at a relatively early an age not long before I arrived. Nevertheless,
there were others interested in his work who had known him well and with whom
I was able to interact, allowing me to learn from them. There was the whole world
of British psychoanalysis – Klein, Fairbairn, Bowlby, and Bion – to reckon with.
Of the group, Bowlby was in the middle of writing his landmark three-volume
study, Attachment and Loss, and very present at the Tavistock Clinic. There were
enigmas embedded in the work of each. Fairbairn and Bowlby seemed the most
logical and coherent; Klein, passionate but difficult to muddle through. Bion was
not yet in the forefront of my London teachers’ minds but became more so when
he returned to London from California and taught them directly a few years later.
So, later, I was able to learn from those whom he had mentored himself when they
came to Washington, DC, to work with my colleagues and me.
There are other notable schools of thought about how we use others. In the
United States, the intersubjective and relational schools have contributed greatly
to our ideas about shared unconscious processes, and in South America, from
Pichon-Rivière on and including the work of such eminent analysts as Jose Bleger,
Isidoro Berenstein, Janine Puget, and Julio Moreno, with elaboration in Europe
by Rene Kaës and Antonino Ferro, ideas of the interactive links (or el vinculo)
between people have recently come to feature more prominently in the English-
language analytic dialogue.
In the United States, I have had the particular pleasure of learning from Theo-
dore Jacobs, whose landmark articles and presentations, published in his book The
Use of the Object, have explored the ways countertransference and all subjective
experience with patients informs our work. I conceived the idea for this book
while thinking of his work. I think of “the use of the object” as a counterpoint to
2 David E. Scharff
Jacobs’s conception of “the use of the self,” although, of course, the two concepts
overlap and intermingle greatly.
Each of these theorist/clinicians has informed me, occupied a part of my mind,
for considerable periods. In this way, each has been an object whom I have used
ruthlessly, if with a large measure of awe for what they were able to discover and
formulate. But there are continuing ways that I and many of us keep coming back
to Winnicott and his enigmatic way of thinking that so often leads to a depth of
exploration.
This book is a series of essays formed around the attempt to explore and intuit
“uses of the object.” Precisely because this theme is susceptible to wide interpre-
tation and elaboration, each essay starts from the author’s personal and sometimes
idiosyncratic take on the question.
From the beginning, I realized that the question of the use of the object – and
the larger theme of uses of others – is subject to multiple explorations and multi-
ple meanings. While I had a rough idea of what I had in mind even before writing
my own chapter, I knew that no one essay could exhaust the vectors that could be
usefully applied to looking at how people use both their external objects or the
people in their lives or how they relate to the internal objects that are part of their
own psychic structure. I realized that using objects was both a normal phenom-
enon and marker for a particular kind of personal difficulty or even psychopathol-
ogy that I experience in clinical practice. It is normal for people to have internal
objects whom they treasure and who give a kind of meaning to aspects of their
life that they would not otherwise experience. But it becomes problematic when
people live almost exclusively through the others who form their internal world,
then often coming to feel that they cannot be happy until and unless their others
change. In the clinical situation, they often come with the aim of changing the
other person, whether they say so directly or only behave as though this is their
goal without saying so.
Having formulated this problem, I then went about enlisting colleagues who
I thought would be particularly interested in and qualified to explore this area with
me. Ultimately, this formed the basis of a year-long series of seminars and led to
fruitful exchange. The chapters in this book come directly from those presenta-
tions and discussions, rewritten in the light of the discussions among our group
of colleagues.
In Chapter 1, I discuss patients who taught me about this concept, ending with a
patient whose growth allowed her to begin to surrender the organization of living
in and through her bad objects. In Chapter 2, James L. Poulton asks the funda-
mental question of psychic organization, “What does the other have to do with
our inner lives?” Chapter 3, by Carl Bagnini, explores the often painful process
of dreaming our internal objects during therapy, finding them again, and grieving
for lost objects. Caroline Sehon explores shadows of inner object worlds in Chap-
ter 4, and Nancy L. Bakalar looks at an analysis through the long lens of “The
analyst’s self as object for the patient” in Chapter 5. Chapters 6 and 7 are each
different in focus from the ones that have come before. In Chapter 6, Ron B. Avi-
ram explores a concept he has described as the “social object,” a group object that
 Introduction 3
inhabits us. Juan Tubert-Oklander’s Chapter 7 is the most theoretical, as he traces
the history of analytic ideas about humankind’s social nature. Finally, Jill Savege
Scharff’s concluding Chapter 8 is the most personal. Her discussion ranges from
her own experience with patients to the fact that she, as both my colleague and my
wife, is writing such a chapter that explores the ultimately personal issue of the
internal object in self and other.
From all these perspectives, it is my hope that this volume of explorations will
open a previously neglected area for analytic discourse. In this way, living with
and often in our analytic objects – as all analytic therapists do – we can use them
in a benign and growth-promoting way in order to come to understand our work
and ourselves anew.
1 Living in the object David E. ScharffLiving in the object

David E. Scharff

To discuss patients who live their emotional lives by what I have come to call “liv-
ing in the objects,” I began by re-reading Winnicott’s (1971) article from Playing
and Reality, “The use of an object and relating through identifications.” This is
not an easy article, because what he says is that object relating comes first and
begins when the infant is in a merged state with the mother. Then it is through
the destruction of the object and yet having the object survive that destructive
set of acts toward the object that the other person becomes real for the infant. It
then becomes possible for the infant to use the object in a set of real relationships
between two subjects. In this way, Winnicott puts destruction at the center of the
growth of a capacity to form emotional relationships between two people, each
of whom has his or her own autonomous inner lives and who then relate to each
other across what he defined a potential or transitional space through the use of
transitional phenomena.
Destruction of the merged object is therefore at the center of his postulation of
a developmental sequence toward mutual relating. This growth in capacity to use
the object is at the center of a maturational line that has to do with the capacity
to relate to somebody else with what Winnicott called a capacity for concern, his
language for Melanie Klein’s depressive position.
In thinking about the idea of “the use of the object,” I realized that I had some-
thing else in mind, an elaboration of one part of Winnicott’s paradigm. I want
to explore the way in which our patients, and people in general, use the idea of
another person for their own purposes. Of course, everybody does this in health
and illness, but some of our patients come to us through the particular mental
mechanism of using the image of another person as a long-term substitute for a
sense of having an inner life of their own.
This idea came to me many years ago through experience with a patient who
I came to feel had a sense of being alive only when talking about his wife. His
wife was a wealthy woman, whose wealth was inherited and not the fruit of her
own work or of his, and who lived in a world of excess. She shopped tirelessly
and spent excessively. She used the sense of whether he was willing to indulge
her, as her father had indulged her before him, as the sign of whether he loved her
and obeyed her – or not.
Notice that I have introduced this man mainly by talking about his wife. I’ll
call him Mikey because that’s like the kind of infantilizing name by which the
 Living in the object 5
family called him. Talking about his wife is exactly what he did. He talked only
about his wife. It was the damnedest thing. I could not get him to talk about
himself except through focusing on what his wife wanted of him and the travails
she exposed him to. He explained to me, actually he complained to me, that she
would buy things, get tired of them, and ask him to resell them for her, usually at
some fraction of the original cost. Nevertheless, although he could sell them only
for, let’s say, half of what they originally cost, the income from these resales was
substantial enough that it was crucial to supporting their current lifestyle, which
was otherwise constrained by what the family trust money would allow them.
Mikey was exasperated by her getting and spending, her selling and spending
again. He talked about it all the time. He would have to arrange to return or resell
the things, call the stores to manage their credit points (on which they also relied
for buying yet more things), and attempt to rein her in because his mother-in-law
was constantly on him to manage his wife’s overspending. And he had to manage
the family business for the whole coterie of the three daughters and a slightly no-
account son, a business inherited from his deceased father-in-law and on which
they were all dependent.
Mikey’s wife was in therapy, too, but she complained that the therapy put
uncomfortable pressure on her to examine her life. Because we had permission
to speak, her therapist was able to confirm to me that Mikey’s description of his
wife’s life and her constant complaints about any constraints he put on her was
pretty much the way Mikey described it. Although my understanding was that
her therapist worked hard about putting even gentle pressure on her toward self-
examination, just the pressure of being in therapy and the invitation to look into
her own behavior and way of living at all was more than she could stand. Soon she
chafed at the prospect of continuing therapy and then began to feel that my work
with Mikey threatened to unravel his compliance with her wishes. She began to
lobby him to stop therapy. Mikey said to me, “I like coming here. I feel you are
the only person I can talk to about the life I lead. But I’m going to have to stop
because, if I don’t, everything in my life will fall apart.” So, he complied with his
wife’s pressure and stopped.
In the middle of treating Mikey, it had occurred to me that, inside his mind,
he had no independent life. His only way of feeling alive was to be inside his
wife. His inner object of her served as substitute for an inner sense of self.
Metaphorically, and unconsciously, he lived inside his wife. I formulated this to
myself: that “he lived in his object.” It was as though he had no life outside his
thoughts about her.
My formulation of Mikey’s problem also stemmed from my countertransfer-
ence. Gradually, I came to realize that when I was with him, I would be longing
for him to “get a life” outside his complaints about his wife. That was my crude
formulation of a longing for him to develop a self, to develop a masculine capac-
ity to confront her and actually to confront himself. My countertransference was
my early guide to the specifics of what seemed to be missing in his inner world.
Once I had formulated the idea for myself that Mikey lived in his object, I real-
ized that to a certain extent everybody does this. The people who are important
to us define who we are. Our struggles with them are the struggles of ourselves in
6 David E. Scharff
action, in relationship to the most important people in our lives. To a large extent,
we all live through our objects.
How different is this dyadic formulation from an Oedipal version of the same
problem? A three-year-old girl who had quite a lovely relationship with her mother
said to her, “You’re a bad mommy.” “Who isn’t bad?” asked her mother. “Daddy
is a good daddy!” the girl said. From having a previously good overall relation-
ship with her mother, she was facing her developmental challenge by formulating
the Oedipal version of inhabiting a bad object, splitting it off from the idealized
object. We all know this psychic formula, but my point here is that this leads to a
familiar pattern of patients (and other people) who live in this formulation, who
cannot forgive their mothers or fathers, and who live in and through grievances
with or idealizations of them.
This is a very different from the way Winnicott formulated the situation. For
him, object relating came first. He dated the capacity for creative destruction of
the object, with the aim of being able to create a new object, as the beginning of
mutuality. It is in this paper that he states that the object was there before the infant
created it, but the mother must not challenge the infant’s sense that the infant cre-
ated the new object. It is the creative act, founded in creative destructiveness,
that opens a place for discovery of the real world of relationships. Mikey would
have had to be able to destroy the image of his self-centered wife as all-powerful
and displacing all room for him to have an independently operating mind. He
could not bear to carry out that act of destruction. It was not her refusal to allow
him independence that was the problem – although she certainly did forbid it. It
was his own act of forbidding himself to challenge her and risk losing her in the
attempt to spur her growth and his own. That he could not face.
In the ordinary process of development, we hope that our children will destroy
the image of us as all-powerful and as constituting their sole universe, so that they
can develop new relationships with each of us as they grow up and so they can
develop the capacity to relate to others with mutual give-and-take. We hope they
will not simply live inside these other people as their inner objects.
So, what is the process of doing this in a way that is beyond the enigma of
Winnicott’s description? And, in a parallel way, what is the pathology of failure to
accomplish this developmental task?
Thinking through this line becomes easier once we include the conception
of the link as formulated by Pichon-Rivière (Scharff, Losso and Setton, 2017;
Losso, de Setton and Scharff, 2017). Conceptually the link is formed as an exter-
nal structure in the space between two people or between members of a group. Its
organization is developed by these people interacting, and, in turn, it organizes the
individuals themselves who make up the link. A link is an interactional structure
formed by a combination of individuals’ unconscious and conscious interactions,
the movements of their bodies and their speech. It represents an organization in
the space between the people and between their minds; that is, the totality of their
interacting relationship. Then, in turn, this link pattern contributes to their con-
tinuing re-organization.
 Living in the object 7
Then the link itself is represented in the mind of each of the individuals. Pichon-
Rivière followed Fairbairn’s description of the psyche as formed by a series of
self-and-object links (1952). These internal linked organizations are themselves
in constant dynamic interaction inside the mind. The organization of mind is a
fractal of the external link between emotional partners. The minds of each partner
are constantly reformed by their dynamic link, and they constantly contribute to
ongoing links with the social world.
Therefore, when we talk about somebody living in the object, we are describ-
ing a person who lives psychically at one pole of a bipolar internal organization.
In ordinary life, people live with an oscillation between aspects of their organ-
ized self and aspects of their internal object organizations. Internal objects are, as
Fairbairn described, parts of the mind. Both self and object are parts of the ego
capable of generating activity. Our internal objects can be the organizers through
which we speak, just as our self-organizations are.
For instance, an adolescent patient berates her therapist. On examination it
turns out that she is treating the therapist the way she feels her mother treats her.
At this moment in therapy, it is irrelevant whether the mother actually treats her
so badly or whether this is a construction she makes of a mother who is simply
setting limits. While we understand that such a teenager is more likely to feel that
she has an actually cruel mother and that the degree of cruelty will feel worse if
mother is actually behaving cruelly to her, at the moment in the therapy that is not
the point. The point at that moment is that our teenage patient is speaking from
her internal object rather than from the aspect of herself, who, in this exchange,
feels mistreated. Instead, it is the therapist in her countertransference who feels
mistreated just now. At other times such an adolescent speaks for herself, com-
plaining about how she suffers at the hands of her mother or, even on a good day,
saying, “My mother’s not really so bad, but sometimes she just gives me a pain.”
That is to say, a patient who is relatively healthy is capable of speaking from her
self-organization and less often speaks from the sense that she is living inside the
bad internal object. Of course, an internal object can also be good-enough. In this
position, the girl would be saying kind things about a world that otherwise she
might be inclined to speak ill of. Or the internal object can be idealized, as when
somebody speaks from the position of living in the idealized or exciting internal
object, as happens in the passion of young romance.
So, it seems to me that Mikey was embodying a particular kind of pathology
of the use of an object. He was living in his indispensable bad object. His is the
pathology of someone who is trapped in the world of his internal object, with no
perspective other than that of the internal object or, at least, no perspective other
than the focus on and sense of living inside a constraining relationship with that
internal object. There is no feeling of mutuality in this sense of being trapped.
Unconsciously, such patients are organized by the sense that “I need to do some-
thing either to be obedient to the internal object or to be constantly in a battle with
it because it defines who I am, who I am allowed to be.” This sense is unconscious,
although there are always important conscious derivatives of it. That is, one can
8 David E. Scharff
be entirely conscious of a feeling that the world is dominated by this figure. From
our perspective, it is an internal object, but to the person the other is a constant
presence in his or her mind that determines almost everything that the person does
or feels – mood, organization, and orientation toward the world. But the reasons
for living this way psychically are centered in the person’s sense of being trapped
and are principally unconscious fantasies. More important, these are unconscious
axioms about how the person must live. Therefore, such patients are often rather
unavailable to therapists, as these axioms are held to be unquestioned truths about
the only way they can relate to the important people in their lives. If there are
people in these patients’ lives who would like to have a more mutual relationship,
that mutuality has to be denied.
Here is an example that will be familiar to child and family therapists.
Quentin came to me because his wife, Samantha, could not let go of the idea
that her 14-year-old son, Adam, was up to no good in one way or another. She
worried incessantly about Adam and could not let go of her preoccupation with
him. According to Quentin’s description, she was living in her son-as-object. This
man thought that his son was doing fine. “He’s a little laconic, it’s true. He doesn’t
seem to have any great ambitions, but he has cottoned on to the art program at
school with great enthusiasm. And he generally gets As, with the exception of
history, which he doesn’t like but in which he still gets a B. It’s true he spends a
lot of time in his room, that he wanders around the neighborhood with a chang-
ing combination of friends, and that we don’t really know who the friends are.”
This preoccupation of Samantha’s meant that there was a great deal of strain in
the couple’s relationship, too, since Quentin got along better with Adam than with
his wife, sharing activities like tennis, which occasionally he and his son played
together. Adam actually did seem to work on his tennis fairly actively. He refused
to take lessons but had taught himself fairly well.
We could say that this man was partly living in the middle of his wife’s distress,
living in her as an object. Certainly, he presented the situation as constraining his
relationship with her, and that is the problem he brought to me. He presented this
as more of a problem than the fact that he drank more than she wished and that
drinking had been a constant factor in the evenings at home. He traveled a great
deal for work, something he no longer enjoyed, and he felt pretty washed out
when he got home from a job that had become a burden. However, what distin-
guishes Quentin from the example of Mikey is that Quentin had another life in the
sense that he talked about other relationships – his life at work, his own aspira-
tions and interests. So, he was living in his internal constrained object only to the
extent that this was a problem in his life.
Later on, Samantha became obsessed with the idea that Adam was on drugs.
As a result, she searched his room and his backpack and found a small vial of a
powdery substance. They sent it for testing, and it turned out it was a synthetic
of marijuana. This confirmed her darkest suspicions, while for the husband this
was the kind of ordinary problem that parents face these days, something to be
taken seriously but not a calamity. What Quentin regretted most was the fear
that this confirmation of his wife’s preoccupation not just would become the
 Living in the object 9
defining element of her relationship with her son, which was impaired by her
suspicions of him, but also would also come to totally define Quentin’s relation-
ship with his wife.
This woman was living in the worrisome object of her son, a part of herself that
she was terribly worried about as going bad, being out of control and going down
a path of destruction. And her living in the worrisome object-son then affected
her marital relationship so that her husband was living in her – or, perhaps more
accurately, in the worrisome mother-son pair as a combined inner object – in
a parallel preoccupation. (I did have confirmation of this formulation about her
from Samantha’s therapist since we were authorized to talk.)
I suggested that we have a family session. Adam had refused to have treatment
earlier when he had been so apparently lacking in motivation, but now, with this
discovery, Quentin was able to make the case that Adam no longer had a choice.
In the session Quentin and Samantha were able to confront Adam about what
he had done. He understood that he had been caught red-handed. Taking advan-
tage of this crisis in their family, we were able to discuss Adam’s feeling that his
mother did not trust him and that this distrust colored their entire relationship.
When I asked Samantha about the possible origins of her fear about Adam, she
connected it to her schizophrenic brother. In his late teen years, he had suddenly
become psychotic. He had never recovered, never been able to have a productive
life. She had spent her life after her parents’ death taking care of him. She con-
nected her preoccupation with Adam with her constant fear. She was afraid that
there might be some sign that she would miss that Adam would come to the same
fate, and so any hint of a misstep on his part brought out her tremendous fears for
his development. In the session, she was able to say that she felt he communicated
so little to her about his life that the gap between them fueled her fear and sus-
piciousness, while admitting that her position of being suspicious of him all the
time amounted to what Samantha called a “paranoid position.” She owned up to
the idea that she carried this preoccupation in excess of anything that he had done
to provoke it, and that this had informed a malignant element in their relationship.
She said to Adam, “But If you would only talk to me more, just to tell me ordinary
things about your life, it would help me in my own attempts to control this so it
would not contaminate our relationship.”
Adam said that he wanted more freedom than he had in the past, because he was
getting older and he thought he behaved generally in a responsible way. He main-
tained the story that this synthetic marijuana was put in his backpack by a friend
and that he had nothing to do with it, but he agreed that its discovery justified his
parents’ suspiciousness. Nevertheless, he said, he would like more sense of trust
from them, more independence, although he still wanted to be connected to them.
In his turn, Quentin was able to say to his wife that her unrelenting suspicious-
ness about their son had a negative impact on their relationship, too. He wanted
a return of the sense of freedom from constraint that had characterized their early
relationship. He experienced her having a child as something that provoked her
worries in a way that impinged on the sense of a more loving mutuality through-
out the family. Samantha was able to say to her husband that his unavailability
10 David E. Scharff
through travel and through his excessive drinking in the evenings left her alone
and more focused on Adam, and that if he could improve those things, it would
help her own attempt to be less suspiciously focused on Adam.
In this case, all three members of the family were able to own something about
their own roles in provoking a breakdown of mutuality in the family. What they
were discussing was the way that their link was contaminated from inside each of
their minds and that this contaminated link then soured each of them psychically,
so that they became more isolated, more depressed, more anxious internally, and
more dissatisfied with one another – and more prone to live in their feared bad
objects. Their capacity to improve by owning things themselves, by taking clear
steps to improve their overt communication, and by sharing the mutuality of their
disappointment and their wish to do better with each other led in a fairly easy way
to dramatic improvement in the family.
The gains in the family were challenged six months later when Quentin dis-
covered Adam smoking a joint one late night. In a return to family therapy, Adam
insisted that this was only his second joint ever. He insisted that he had never
smoked until that week. Quentin said that Adam looked pretty experienced and
that he, Quentin, was not buying Adam’s story. Samantha said that this, of course,
set her back. What she wanted from the situation was that they not return to the
“paranoid position” that she had previously brought to the family. I asked Quentin
and Samantha about their own experience of smoking marijuana, which they then
shared. Neither of their experiences was particularly remarkable in that neither
of them had liked it, but they had both experimented in their adolescence. The
three of them reviewed the improvement in their relationship that had previously
ensued, and the parents were able to say that they were not so fixed now on stop-
ping Adam from ever smoking marijuana, but much more on maintaining the
restored trust that they had achieved. Adam agreed, and with implicit understand-
ing that he would be likely to experiment further with marijuana, they were able
to emerge from these sessions with regained trust.
Before giving a more extensive example, I want to add another central point
about the way that the concept of the link helps with the concept of living in the
object. So far, I have talked about the way our patients act as though they are liv-
ing in an object inside themselves. They then externalize that psychic experience
onto and into the people that they relate to.
But the concept of the link holds that there is an organization in the space
between members of any emotional relationship that is unique to that couple,
family or group. We can say that there are three organizations that make up any
couple organization: (1) the psychic self-and-object organization of the first per-
son; (2) the link between the two people or between members of the family; and
(3) the introjection of the experience by the second person in resonance with the
first person. In this third part, the first person is living inside the second subject
as an indwelling internal object. These three organizations are each fractals of
the totality of a complex dynamic pattern. In health the link between two peo-
ple has dynamic resonance with the psychic self-and-object experience of each
of the individuals. Inside each individual, a dynamic psychic structure oscillates
 Living in the object 11
among various self-and-object positions. It is only in the stasis of a fixed psychic
structure that our patients come to act as though they are living almost literally
within their inner objects. Then they project that sense of being inhabited onto
the relationship the actual other person. In contrast, we consider it normal when
parents live as though inside the mind of their children for periods of time. But in
health, the parents can extricate themselves from that sense, can pull back to be
external actual parents.
So, it is a matter of where the emotional emphasis is unconsciously assigned by
the people involved, because each of us spends some time feeling as though we
live in our internal objects. When we imagine ourselves inside the experience of
our objects but then extricate ourselves to regain perspective so that we can expe-
rience the other person in the actual interaction, this is ordinary in-depth interac-
tion with our important others. But when someone gets fixed and stuck, then we
see a pathological situation. Therefore, it is a matter of where, in a person’s fan-
tasy, the person assigns the center of his or her psychic life and what flexibility the
person has in moving from one position to another: In the self, in the link between
the person and the other, or in the other person’s mind.
My final example comes from an analysis carried out some years ago.
Audrey, a 40-year-old woman, had been in analysis for three years. She said
that she had been cruelly treated by her parents, and most of her early material was
about how she hated her mother. She also hated her father and wished that her par-
ents would get on with dying even though they were nowhere near doing so. She
organized her life unconsciously around taking revenge on them, which she had
done by moving away, at their expense, and, over the first two years of treatment,
not speaking to them. “Not speaking to them” is a relative matter in that she joined
in the family chat, talked badly about them to her brother with whom she was on
close terms, took money from them on occasion, and read her mother’s occasional
letters describing her mother’s life and wishes for Audrey to be in active contact
with her. She said that she did not talk much about her father because things were
even worse with him. She said, “He sexualized his relationship with me when
I was little. He didn’t do anything frankly abusive, but there was a leer in his eye
whenever he looked at me. I could feel him sizing me up sexually, getting off on
anything sexual that he thought he saw. And he was emotionally abusive.” Her
most intensely ambivalent relationship, with alternating excitement and punish-
ment, was with her grandfather, with whom she used to have sadomasochistic
childhood games. She would taunt him and run away. He would give chase and
spank her in a way that was simultaneously excitingly playful and sadistic. Never-
theless, he was the only figure she felt she had a positive relationship with.
On the day I am reporting from Audrey’s analysis, we discussed her being stuck
with anger and despair. All she could do was complain about her mother, and
intersperse her hatred with saying to me, “You just don’t get it!” This frequent
complaint that I did not get it about how cruel her parents were to her led to her
conviction that until and unless I did, nothing was going to change. She was not
going to be able to give up her way of treating people cruelly herself that inevi-
tably led to the feeling that nobody liked her. This was also true of her husband,
12 David E. Scharff
who she felt was not a person she could ever feel passionately about, despite the
fact that he treated her well, was endlessly loving, and stayed with her no matter
how aggressively or dismissively she treated him.
In the session, I said to her that she had decided that her mother, too, had to
“get it” before Audrey could ever change. She put control over her ability to effect
change in another person: her mother, her husband, me. She said, “Do you think
you can ever get it? That you can ever understand? Because you keep telling me
that I shouldn’t be so angry and mean.” I said, “What I have said is, ‘How long are
you going to hold onto your anger?’ ” I said that in the past that she tried an end-
less number of maneuvers not to change: for instance, having a giddy approach
to me at the beginning of the hours by turning onto her stomach to stare at me
in a teasing way, knowing it annoyed me. She also tried being furious at me for
not “getting it.” But when these maneuvers did not work, she was slowly backed
into having to face her anger. I said that she maintained her feeling that “no one
gets it,” and meanwhile she was nasty to all the important people in her life – her
parents, colleagues and friends, husband, and me.
I said, “There is a stubborn clinging to your idea that the other person has to get
it.” She said, “I agree and I want my mother to get it because nothing can change
until then.” I said, “So the control of your happiness is in your mother’s hands.
It’s a question of when will she ever get it, and you will never be able to change
until she does.”
“Never!” she said. “She’ll never get it because she just doesn’t understand how
she was to me for all those years after she came back from abandoning me so she
could go away to school.”
I said, “So you have defined these things as impossible. Nothing will change
because you put the control in her hands, or, now, in my hands.” As I said this,
I remembered that she had also taken her husband to me as a couple therapist in
order to get me to change him. She had said in that first session that she thought
I was the only person who could change him. He was not particularly interested
in changing, and I soon realized that her effort to get me to change him was a
substitute for any idea that she could change herself. When I had made this inter-
pretation, it eventually led to her coming into analysis, but it had not ended her
hopes of changing him.
She was now sobbing loudly. I said, “This is the sound of impossibility. No one
will ever understand you. They will never change and therefore you can never
change.”
“It hurts so much. Why does it never go away no matter how much I cry? It’s
still there. I want to cut it out surgically. I cry every day. My grandfather killed
himself because of it.”
I said, “Tell me about that.”
“He was angry, drinking and depressed. It got in his stomach. They cut his
stomach out and I saw it. This big, round part was all green with mold on it. He
was so angry. When they cleaned up our place, when we finally moved, I saw a
picture of my grandfather and my grandmother in the ’50s with my father and his
brothers. I gave him the picture. He tore it up. I told my mother, and she said, ‘I
told you not to do that.’ She meant I shouldn’t have shown him the picture.”
 Living in the object 13
I said, “Now you wish that I wouldn’t show you the pictures of what is happen-
ing inside yourself.”
She said, “I don’t care. What I care about is that you see these things. If I’m
teasing you, it’s that I’m only teasing you, and it’s nothing else. You told me you
didn’t like that.”
I said, “No. I said you were trying to avoid this kind of pain.”
Audrey turned over on her back, in the position she had been in at the begin-
ning of the hour. She pulled her coat to cover herself. I had always thought of this
particular coat as being uncharacteristically masculine and stylistically harsh. She
said, “I always cover myself with this coat because I can’t stand being exposed.
And my mother used to cover my belly button with a blanket because she thought
cold air gets into you through your belly button. I just want to have some friends.
There’s no fun anywhere in my life.”
Audrey lived in her bad objects. Her parents, grandparents, aunts, and uncles
were nothing but bad objects to her. One of her brothers was a good object, the
only one she was in close contact with, but his wife was another bad object because
Audrey felt her to be in the way between Audrey and her idealized brother.
When a woman who lives so much in the world of her bad objects and inside
the constraint of constant battle with these objects, we have to ask the question
whether there are any good objects, and, if so, where are they? The answer is
right there in front of me every day. Audrey had researched my life before seek-
ing me out and continuing into treatment, more extensively than any patient I can
remember. I was seeing her early in the days when everything about everybody
first became discoverable through the Internet. She had looked up elements of my
life and found pictures of me I did not know existed. Her fantasy life involved me
in her sexual excitement with fantasies both of being included with me and being
excluded by me in the painful replay of exclusion from her mother and from her
parents’ relationship. This intense daily focus on a fantasy ideal and idealized
relationship with me supplanted any pleasure in the relationship with her husband.
She had never had an actual boyfriend, even before marriage, with whom she
could have a tangible romantic adolescent passion, the kind that could organize an
idealized relationship that would contribute to the destruction of the ideal parental
relationship and therefore to ordinary resolution of Oedipal idealization. Instead,
she had a lifelong search for an unobtainable idealized figure who would save
her. By offering her analysis, I had offered to take on the role of that savior – and
therefore to become inevitably guilty of failing to save her and thereby of failing
her idealization. In these times I became the object of her rage, the same disap-
pointment afforded by her mother and, in the more painfully unspeakable ways,
her father. All of this boiled down to her formula that “You just don’t get it.” So,
when the idealization failed, her ability to live in the idealized fantasy object
crashed to the earth. She was not only let down; she was furious.
On the following day, Audrey described how, since the beginning of their rela-
tionship, she had not been able to feel excited sexually with her husband, because
when he would touch her, she would connect the experience to being molested
and would feel molestation was occurring now. But last evening, she had felt some
small sexual excitement for the first time with him. She had an accompanying
14 David E. Scharff
fantasy: “I was being tied down and couldn’t move. I was being stimulated by
an ugly, disgusting old man, against my will and I found it exciting. Then I had a
fantasy about wanting revenge, which I also found exciting.”
A few days later she discussed more about something she had never told me
that she found exciting. “I thought about a fantasy of you and my couple therapist
sexually. My family is so violent. My husband needs for me to offer him softness
and gentleness, which I can’t give him. My fantasy about our couple therapist is
that she’s just so soft and gentle. That gives me a lot of sexual excitement, just her
talking, not actually being sexual herself. There are so many things that she likes
that I like. [She had extensively researched the couple therapist as well.] She’s
curious and intelligent. My mother was contemptuous about me wanting to read
interesting things like philosophy. She said to me ‘Why would you want to read
that? Are you going to make money from it? It’s useless.’ But I can see that my
couple therapist is a widely read woman.”
I said, “You feel critical of me for not wanting to hear how bored you are with
your husband.”
She said, “That’s true. You want me to discuss my role in the boring relation-
ship.” She went on to describe how her mother was boring, too. Well maybe not
that boring, because her mother had encouraged her to dance, which she likes very
much. But then her mother would want to discuss only how she should compete.
At this point she went back to talking about her husband being boring. I pointed
out that she’d settled back into talking about him being boring instead of the idea
of having to develop herself in order to keep herself from being boring. During
this discussion she finally was able to talk about how she had offloaded the need
to change herself onto him instead of considering the possibility she could change
herself. I said that this was because she was convinced it was a hopeless project
to think of changing herself.
She said, “That’s right. I blame him for not having a social life when I don’t.
I blame him for things I can’t do myself either. I know I have to do that for myself
instead of compelling him to change. I have to leave him alone.”
I said, “That’s a change, from blaming him and hoping to change him because
you can’t change, to saying you know that’s what you have to do yourself.”
“Yes, but I still don’t think you get how boring he is. Really, really boring!
Which he has been from the beginning. But it’s okay. I have to stop looking out-
side and start working on myself.”
I said, “Do you think you picked him because, since he wasn’t exciting sexu-
ally, he made you feel safe? Because in that case, he would never threaten to sexu-
alize you like your father or grandfather or look at you with your father’s leer?
That way he would be safe, at the price of being sexually exciting.”
She turned on her stomach, giggling, and said, looking at me, “It’s so funny
how boring he is.” But then she said she had pulled back from wanting to divorce
him, to now realizing how good he had been to her. That realization was forcing
her to look into herself. It was a realization that put pressure on her to grow.
I said, “Do you think you feel anyone can ever love you?”
 Living in the object 15
“No,” she said. “I don’t feel I’m lovable. But he loves me anyway. But then
I can’t love him, partly because I feel he doesn’t see how bad I am, so he actually
doesn’t get me.”
A few minutes later, she said, “I hate you! No! I don’t really hate you, but
you’re too strict. You make me do things I don’t want to do.”
In this segment Audrey moved from a position of hopelessness about whether
she could ever change, as expressed over many months of living in her intractably
boring, hopelessly unchanging husband-object, to now beginning to consider the
possibility of changing herself. This led me to ask, and her to say, that she felt
fundamentally unlovable. In this process, we can see that she had been inhabit-
ing people who expressed her ideal fantasy, but in more realistic ways than her
habitual fantasy way of living in her idealized object in order to offset how she
lived so much in hated internal objects. And, in the transference, she began to
develop a fantasy couple that is connected to her fantasy idealized woman. There
was now an oscillation between her sadomasochistic fantasy that had been part
of the hated objects she lived in, the fantasy objects she was now creating, and a
slight hint of a move toward a more realistic ideal object that might guide her to a
different way of living. Finally, we hear that at the bottom of her need to live in her
objects was the feeling that she was fundamentally unlovable and was hopeless
about ever being able to love or be loved. This realization presaged later stages
for us in her analysis.

Conclusion
Living in the object is a common part of everyday life in which we imagine our-
selves inside the mind of people who are important to us. We do so inside our
own minds. But in health, we are able to pull back, to extricate ourselves, to form
a link of mutual give-and-take, to repair periods of misunderstanding. The repair
of understanding between people who can see themselves as separate persons
and who communicate aspects of their inner world to each other through their
interpersonal links can then inform the development of each of them (Scharff and
Scharff, 2011). In the form of illness that I have been describing, persons get stuck
in their own minds inside their inner objects, whether it be an object of idealiza-
tion and excessive love, or an object of hatred and mutual attack. In these cases, it
is as though nothing we do could help unless we agree to help them change their
objects. These patients think it is not helpful to change their own perspective, their
own minds. We are pressed to change their actual object.
I should have picked up on this more than 30 years ago when one of my patients
said to me, “I have finally realized that I’m here to have you cure my parents.”
This is a common position for many patients, but fortunately most of them are
eventually willing to move on to examination of the organization of their own
minds. Only after the realization that their own growth cannot be contingent on
changing the people in their lives can they be free them to do difficult work on
themselves.
16 David E. Scharff
References
Fairbairn, W. R. D. (1952). Psychoanalytic Studies of the Personality. London: Routledge
and Kegan Paul.
Losso, R., de Setton, L. and Scharff, D. E. (Eds.) (2017). The Linked Self in Psychoanaly-
sis: The Pioneering Work of Enrique Pichon Rivière. London & New York: Karnac.
Scharff, D. E., Losso, R. and Setton, L. (2017). Pichon-Rivière’s psychoanalytic contribu-
tions: Some comparisons with object relations and modern developments in psychoa-
nalysis. International Journal of Psychoanalysis, 98(1): 129–143.
Scharff, D. E. and Scharff, J. S. (2011). The Interpersonal Unconscious. Lanham, MD:
Jason Aronson.
Winnicott, D. W. (1971). The use of an object and relating through identifications. In Play-
ing and Reality. London: Tavistock, pp. 86–94.
2 What does the object
(in our patients’ lives)
have to do with it? James L. PoultonWhat does the object have to do with it?

James L. Poulton

To set the stage

I begin by quoting the Bodhidharma from the sixth century CE:

Then for the first time I dwelled upright in dark quiescence and settled exter-
nal objects in the kingdom of mind. . . . For the first time I realized that within
the square inch of my own mind there is nothing that does not exist.
(Broughton, 1999, p. 12)

I would like to approach psychoanalytic objects by considering the role of

external objects in our patient’s lives and even in our patient’s minds. Let me start
with a seemingly unrelated observation.
One of the central events that led to the capture of Ted Kaczynski (a serial
killer, nicknamed the Unabomber, who was at large for 17 years) was a psycho-
linguistic analysis of the 35,000-word manifesto he mailed to the New York Times.
The analysis concluded that because the manifesto contained terms used by news-
papers from Chicago in the 1930s, ’40s, and ’50s, the Unabomber was most likely
raised in that area. Because of the analysis, the FBI decided to publish the mani-
festo, with the hope that someone would be able to link its language to its author.
Shortly thereafter, Kaczynski’s brother and sister-in-law contacted the FBI and
provided additional letters and documents they had received from him, which
ultimately led to his capture (Davies, 2017).
The interesting part of this story, for our purposes, is that the Unabomber’s
actions could not help but reveal the traces of the social/interpersonal envi-
ronments in which he had developed and which had inscribed in him specific
characteristics that he thereafter exhibited as evidence of their influence. In an
important sense, this story reveals that external objects are in some way inher-
ent in us.
The question, however, is this: In what way is the object inherent in us? What
does it mean to say that we bear the traces of the object within us? And then,
depending on what we decide about the role of the object in our lives, what impli-
cations does it have for how we treat our patients?
18 James L. Poulton
Psychoanalysis and the external object
For many years, psychoanalysis has had a lot to say about internal objects and the
role they play in shaping everything about us. Recently, however, psychoanalytic
theorists have begun to focus more on external objects and to explore whether
they influence our experience and behavior in ways that are different from the
influence of the internal objects with which we are more familiar.
The question I would like to consider, then, pertains to the role the real, exter-
nal object may play in our patients’ lives, apart from how they have internalized
those objects. I have in mind a particular situation in which a patient attends ses-
sions with us but then returns to a relationship with another person who has been
instrumental in generating some or most of our patient’s pathological adaptations.
A characteristic example is the case of a young man, Damien, whom I will intro-
duce in more detail later, who developed a pattern of extremely harsh treatment of
himself as a way to calm his harsh and judgmental mother. Following some of my
meetings with this patient, he would call his mother to discuss our session. When
I would meet him for the next session, I would feel that we had lost the ground
we had gained and that we had to cover again the same territory we had already
traversed. Although this phase did not last through all of the treatment, while it
was occurring I felt as if I was in a tug of war over the patient: I and my views
were on one side, and his mother and her pathological influence over her son were
on the other.
Before I get to the case, though, I propose a quick tour of some of the theories
that have led to a re-examination of the external object and its place in the life of
the individual. I merely wish to get a few basic ideas under our belts, enough to
help us frame the discussion of how to deal with Damien and his mother.

The intersubjective vs. the intrapsychic

With the rise of such theories as intersubjectivity, relationality, the analytic
third, the analytic field, and the vínculo or Link, analysts have explored two pri-
mary dimensions of psychic experience: the intrapsychic and the interactive or
“interpsychic” (Bolognini, 2004). The chief concerns of most of these writers
have been, first, to illuminate the differences between these two dimensions, and,
second, to describe the ways in which the two interact and jointly or mutually
influence each other.
Pichon-Rivière, for example, suggested these two dimensions jointly interact
to create what he called the Link. Through the idea of the Link, Pichon-Rivière
“attempted to explore the complex relationship between the way that external
object relations influence internal organization throughout life, and in turn, how
internal object relations organize external interaction” (Scharff, 2009, p. 69; see
also Losso, de Setton and Scharff, 2017).
Berenstein (2001, 2009, 2012) and Kaës (1995, 2007) were also concerned
with developing the concept of the Link. Berenstein (2009), for example, fol-
lowed Pichon-Rivière in suggesting that a Link is produced by two different
 What does the object have to do with it? 19
mechanisms: “a predominantly individual mechanism” based on each participant’s
internal object relationships that function in interactions “by means of projective
identification” and an “in-between” mechanism in which the real-time interaction
between the participants exerts its own pressure – outside the participants’ inter-
nal object relations – on the course of the interaction. This second “in-between”
mechanism is the result of what Berenstein calls “interference” (2009, p. 86).
Berenstein believed that who we are is the result of two kinds of investments
by others in our development. The first is through the process of identification, in
which the other serves as a model for what we want to be. Through this process
we establish internalized, symbolizable aspects of the object that thereafter guide
our experience and behavior. The second process, in contrast, occurs through
acts of interference, according to which we have to adapt to the other because we
have encountered something in them “which resists and cannot be incorporated”
(2001, p. 145). This process is distinct from object relations (2009, p. 86) and
is something that we cannot represent to ourselves (2012, p. 574). A possible
example of interference: you have just finished an evaluative interview with a
prospective patient who has, unbeknownst to you, a repressed history of trauma
in relationship with her father, and you realize afterward that you forgot to ask
about the father. In this case, an unrepresented part of the patient may have inter-
fered with your capacity to think, without your knowing how or why the interfer-
ence occurred.
Berenstein refers to the aspect of the other that “resists and cannot be incorpo-
rated” as alien or foreign (2012) and emphasizes that its impact on us is a con-
sequence of being in the here-and-now presence of the other. When we interact
with another, there will be part of the person with which we can identify and that
fits easily into our internal object world. But there will be another, alien part that
will not fit easily into our internal world because we will have no way of repre-
senting it. It is this part of the other that interferes with the ordinary flow of our
experience.
When Berenstein turns his attention to the interactions between therapist and
patient, he again speaks of two dimensions or “modalities” (2009). The first is the
modality of transference, in which the patient’s internal object world is repeated
or reproduced in relationship to the therapist. The key aspect of this modality is
that the experiences that generated the patient’s internal world can be worked
through via careful attention to the here-and-now of the session and the there-
and-then of the patient’s past. For the second modality Berenstein again uses the
term “interference,” but in this case interference – especially that imposed on the
patient by the therapist – can be used for positive gain, since through it therapist
and patient can generate new and potentially healthier experiences by making “a
space for the otherness of the other subject” (2009, p. 88). In Janine Puget’s terms,
interference can make room “for surprise, for a form of belonging that does not
fit into the set of problems tied to identity” (2012, p. 786). Because of its growth-
enhancing potential, Berenstein regarded interference as equal to transference, in
terms of its efficacy in bringing about change, and repeatedly stated that “we need
to work therapeutically with both of them” (2009, p. 87).
20 James L. Poulton
The French psychoanalyst Rene Kaës is another writer who has made sub-
stantial contributions to the theory of the Link (1993, 1995, 1998, 2007; Kirsh-
ner, 2006). Like Pichon-Rivière and Berenstein, Kaës recognizes that the other
influences us either through the internalization of representable aspects of the
other (which become bound “to our own private ends” Kirshner, 2006, p. 1006)
or through the transmission of something foreign, “an obscure and unknown pres-
ence of another . . . inside [the self],” which functions as “a kind of unassimilated
other dwelling as a permanent guest, unwelcome or unknown, within the psyche”
(Kaës, 1993, p. 5, translated by and quoted in Kirshner, 2006, p. 1006).
For Kaës, this “indwelling” of the other as an unassimilated, unknown guest in
our psyche is a significant source of psychopathology. Kaës speaks of the “require-
ment of psychic work imposed by the subjectivity of the object” (1995, p. 2) on
the self and says that the content or meaning of these requirements may never
be represented – either by ourselves or by the object. When they are imposed on
us, however, they lead to what Kaës terms “diseases of intersubjective contracts”
(p. 2), which include “agreements” to participate in mutual acts of repression,
erasure, denial, splitting, and misunderstanding or refusals to know and which
result in areas of non-signifiability and non-transformability, “zones of silence,”
“pockets of intoxication,” “garbage spaces,” and “lines of flight that keep the sub-
ject a stranger to her own history” (1995, p. 13). From Kaës’s perspective, these
requirements “inscribe” themselves on us, and our experience and behavior are
thereafter modified or conditioned by the presence of those inscriptions, whether
or not we remain in the presence of the original object.
Some of you might have noticed a point of disagreement between Berenstein
and Kaës in what I have written. Berenstein says that the alien parts of the other
influence a person only when the two are actually interacting in the here and now,
but Kaës says that “diseases of intersubjective contracts” can modify a person’s
psychic activity even after the original interactions have ceased. In this respect,
Kaës’s position is similar to that of Gabbard, who says he believes, contrary to
Berenstein, that Links and their pathological effects “persist in spite of physical
separation” (2012, p. 585). This is an issue we will return to when we consider
the case of Damien.
Kaës’s language may be new to us, but I would suggest that diseases of inter-
subjective contracts are quite common in our patients and have been identified
by other theorists under a variety of names, including “schemas of being-with”
(Stern, 1995), “implicit relational knowing” (Lyons-Ruth, 1999; Stern et al.,
1998), “relational scripts” (Trevarthen, 1993), and “the haunting of the phantom”
(Abraham and Torok, 1994). A good example of these diseases can be found in
Abraham and Torok’s description of a family in which a traumatized mother has
so deeply repressed her trauma that she is unaware of its nature or its distorting
effects on her emotional and behavioral functioning. In such a family, the growing
child adapts to her mother’s distortions, participates in them, and even supports
her mother in the exercise of such distortions, but without understanding their
purpose or origin. This process, in turn, saddles the child with fears that have no
images to ground them, behavioral patterns with no apparent meaning, and “blank
 What does the object have to do with it? 21
spots” in her mind where thoughts cannot be thought, emotions cannot be felt, and
desires cannot be acknowledged. Abraham and Torok call this process the haunt-
ing of the phantom, the hallmark of which is that the child becomes invaded by
an alien presence whose meaning lies not in the child’s own experience but in the
details of the mother’s trauma (cf. Poulton, 2013).

Therapeutic strategies for diseases of intersubjective

contracts
The theories I have just reviewed raise some vexing questions about psychoana-
lytic technique. Suppose a patient enters therapy and you discover that aspects of
his experience and behavior are, as Kaës and Berenstein describe, unassimilated
into his internal object world and are therefore neither signifiable nor represent-
able. Suppose further that you suspect these characteristics in the patient are the
result of diseases of intersubjective contracts that have taken hold in the patient
because he is still in thrall to a close relationship, such as with a mother or spouse.
What kinds of interventions will help to dislodge these contracts and free the
patient from the limitations imposed on him? What interventions are useful when
working with unrepresented influences over the patient?
One thing theorists of the Link agree upon is that traditional transference analy-
sis, while still centrally important, is not sufficient when the patient’s problems
arise from Links with others. Berenstein, for example, believed that because
transference analysis is primarily focused on representable aspects of the patient’s
internal world, it overlooks mechanisms of interference and their consequences.
Similarly, Kaës has written that intersubjective contracts “cannot be reduced to a
taking into consideration of the place and function of the Other and the others in
intrapsychic space” (1998, p. 4; quoted by Kirshner, 2006, p. 1012). José Bleger,
another theorist of the Link, wrote that an exclusive focus on here-and-now trans-
ference “may lead to blind spots about external vínculos [Links] that are problem-
atic in other domains of the patient’s daily life” (Gabbard, 2012, p. 583).
Gabbard elaborates on Bleger’s point, saying that most patients “at some point
recognize that they have lived their lives to please” or to “avoid the wrath, criti-
cism, or humiliation of someone else” and that “the very essence of analytic work-
ing through is to identify these linkages as they emerge in the transference and
outside the transference in order to shed light on who we actually are in light of
these linkages and in spite of them” (2012, p. 584, emphasis added).
Helping a patient understand who he is “in light of these linkages and in spite
of them” requires, of course, that the therapist investigate how and why the rela-
tionships in his life function the way they do. And this, in turn, requires that the
treatment sometimes focus not so much on the patient but on the motives, needs,
and pathologies of the external objects surrounding him that have played a role in
binding the patient in his diseases of intersubjective contracts. Indeed, it is only
through such a focus on external objects that the therapist can follow Gabbard’s
recommendation or those of Thomä and Kächele, who said the therapist “must,
in collaboration with the patient, provide him insights into his situation in life”
22 James L. Poulton
(1992, p. 482) or those of Lemma and Target, who said the therapist “takes the
many opportunities provided by the patient’s description of real-life interpersonal
incidents to help the patient to exercise flexible understanding of the possible
feelings and thoughts (of the different individuals involved), getting the patient
to elaborate different internal scenarios perhaps underlying these incidents, ques-
tioning habitual assumptions” (2011, p. 156). The danger, of course, is that focus-
ing on the patient’s external objects can potentially imbalance the treatment to the
point of losing sight of the patient’s own contributions to creating and maintaining
problematic patterns. Consideration of the case of Damien will help us explore the
reasonable limits to the effectiveness of such interventions.
Before we get to Damien, though, two other intervention strategies that address
diseases of intersubjective contracts deserve mention. First, it is of utmost impor-
tance that we recognize that transference analysis should not automatically be
ejected when working with such “diseases.” Stern and colleagues have made this
important point in an article on non-interpretive mechanisms in analytic therapy.
They suggest that a patient’s “implicit relational” patterns that are “not symboli-
cally represented but are not necessarily dynamically unconscious” (1998, p. 905)
can be brought to light in treatment through transference interpretations of the
way the patient behaves with the therapist. Stern et al. are making a subtle but
important point. Not all transference arises from identifiable or symbolizable
internal objects in the patient’s internal world. Instead, some transferences will
consist in a non-represented, non-symbolized repetition of behaviors and patterns
of experience the patient has come to embody in the intersubjective contracts the
patient has with others. This, I believe, is especially the case when those behav-
iors and patterns of experience are held in place by a current relationship in the
patient’s daily life.
The final intervention strategy refers us back to Berenstein’s and Puget’s idea
that the therapist can function as a source of interference for the patient in a way
that helps the patient not only in “making room for the other as a different sub-
ject” (Berenstein, 2012, p. 576) but also in allowing him- or herself to participate
in the therapeutic relationship “in so far as it has the potential to create and shape
both a subject and new ideas” (Puget, 2006, p. 1697). This point is emphasized by
Scharff, who says that the therapist, by his or her presence, can work as a “desta-
bilizing force” (2009, p. 82) in the patient’s basic patterns of interaction. This is
to say that the therapist’s presence, as a (one hopes) non-pathological participant
in a growing Link with the patient, exerts a form of unsymbolized and perhaps
unsymbolizable pressure on the patient that helps the patient disengage from the
constraints imposed by relationships with external objects. Certainly, much more
can be said about this particular form of intervention with our patients, but it is
time now to turn to Damien.

Damien
I met Damien three and a half years ago. He was 29 years old and in his third
year of a very demanding graduate program. Because of his schedule, we could
not meet on a consistent basis: sometimes we were unable to meet for two or
 What does the object have to do with it? 23
three weeks in a row, followed by one or two weeks when we would meet up to
three times per week. This pattern persisted throughout our two and a half years
together. Our work ended when he finished his degree, got married, and took a
job in another state.
Damien was the second oldest of four children, all born within one or two
years of each other. Although he didn’t talk often of his three sisters, the one he
spoke most about was his next younger sister, who had been bulimic and anorexic
from the age of 18 and had spent “many months” in various institutions for what
he called “borderline” behaviors. Damien described his parents as very religious
and devoted to their religious community. Despite their devotion, they would not
infrequently get into violent fights in which they “lost control” and which “abso-
lutely terrified” him. His mother, he said, was rigid, judgmental, and unforgiving:
“She says what she thinks as she thinks it. She has a strong personality.” Damien
attributed his mother’s rigid religiosity to a “history of mental health issues,”
including bulimia in her teens, extreme anxiety throughout her life, and enduring
guilt about an abortion she had in her twenties before marrying his father. Damien
blamed most of the difficulties of his childhood on his mother and saw his father
as calmer and more forgiving. His father, he said, was “passive” “thoughtful,”
“hard on himself,” someone who “takes care of other people first.” When Damien
was young, he and his father went on fishing trips together, but as Damien got
older their relationship became more distant as his father spent more time at work.
Damien was home-schooled until high school because his parents objected to
public schools for religious reasons. Between the ages of about four and ten, he
said, he “at least” had a group of friends who understood and accepted him. When
he was ten, however, his parents moved the family to a new city, and from then
on he felt isolated and ostracized by other children because of his family’s beliefs.
This was the reason, he believed, that he “wasn’t a socially comfortable kid.”
From the age of ten, he said, he hated his parents, both because of the move and
because he “got the shit kicked out of me a lot” by his mother while his father
did little to intervene. His mother, he said, was extremely critical of him, would
often beat him with a belt, and rarely attempted to understand his perspective. He
believed his mother hated males and that she took her wrath out on him because
his father was often absent.
For a “significant portion” of his adolescence, Damien had a suicide plan, and
he came close to attempting suicide on multiple occasions. He said the main theme
of his suicidal thoughts was “the conviction that nobody loves me and nobody can
love me.” When he left home to go to college, he immediately stopped attending
church, and in our second session he said, “I have this visceral reaction to religion
now that’s a function of my growing up.”
Before his move to Salt Lake City, where I met him, Damien was in treatment
with a psychoanalyst who helped him explore “traumas that gave me a poor self-
concept. He said as my brain matured it looked for ways to justify my negative
self-perception.” As he and I began treatment, Damien described multiple symp-
toms of depression and anxiety, including severe and persistent self-negation and
devaluation, social isolation, and avoidance of any situation in which he might be
judged. For example, he refused to open letters of evaluation from his graduate
24 James L. Poulton
supervisors for six months, and he delayed writing an assigned report for more
than a year. Given that his program was quite prestigious, and given that his over-
all presentation was one of a capable and intelligent young man, the unrealistic
nature of the attacks he launched against himself was all the more disturbing.
As treatment progressed, we linked his self-devaluation – his certainty about his
badness – both to his enduring anger at his mother (being not-good-enough, we
agreed, was a way of being angry with his mother without being aware of his
anger) and to the pressure he felt from her to accept her attacks without complaint,
even agree with them, as the price he had to pay to minimize their intensity.
I would like to briefly describe four sessions I had with Damien. The first three
are contiguous and occurred near the end of the second year of treatment. In these
sessions, we discussed the nature of the unacknowledged agreements, à la Kaës,
he had reached with his mother that led to his pattern of harsh self-judgment. It
was during this time that Damien was in fairly steady contact with his mother.
The fourth session, which occurred several months later, near the end of treat-
ment, focused on his transferential attempts to enlist me in his self-attacks and
his difficulty doing so because he found me to be an “uncooperative” partner.
When viewed from the perspective of Berenstein, Puget, and Scharff, Damien’s
difficulty with me stemmed from my having presented an intersubjective pressure
(i.e., interference) on him that pressured him to disengage from the self-limiting
patterns imposed by his relationship with his mother.

Three sessions at end of second year

Damien began the first of these sessions saying he was frustrated with his progress
and thought he should be working faster. He added that he was not working faster
because he was a “lazy-ass procrastinator” who never did anything he should.
I commented that the spontaneity and forcefulness of his attack on himself sug-
gested there was something he was afraid of. He agreed and said that throughout
his life he had been afraid he wouldn’t be loved or valued or esteemed. “I feel my
fear was fairly evidence based,” he said. “My mother was mad at me so often.
And when I did incur her wrath, I felt I had done bad on a fundamental level.
When her punishment was physical, I didn’t feel it as discipline – it felt like
an attack. . . . When I erred, it was in terms of biblical and godly standards –
I had sinned and fallen short of the glory of god.” “Your badness was biblical,”
I said, “because your mother needed goodness to be biblical as well?” Damien
then talked of a phone call with his mother a few days earlier. She had talked
about her father – how he had been extremely demanding and unstinting in his
criticisms if she failed to live up to his standards. “My mother had the idea,” he
said, “that we had to match up to a standard, to rise above her upbringing. She
had a need for achievement, for looking good for her father. For her father, value
was earned, not given.” “And she brought the same pattern to you?” I asked. “For
me,” Damien said, “my mother’s unhappiness was linked to some form of doom –
something that would lead to her anger, which for me was a disaster. So, we kids
 What does the object have to do with it? 25
started to monitor her unhappiness. We got good at it.” “You monitored it in order
to try to repair it?” I asked. Damien said, “In my childhood, nothing was ever
done enough – the house was never clean enough, the garden was never weeded
enough, I never did anything fast enough. It wasn’t so much terrifying as it was
depressing. I remember feeling, all the time, this will never get any better.” At
this, Damien began to cry, which embarrassed him and led him to say something
about how stupid he was to be crying. I said, “I think what has just happened is
important. You’ve covered up your pain – about the fear and hopelessness you felt
as a child – with yet another self-attack. I imagine that’s what you did as a child,
and I imagine it worked, not just for you, but for your mother too.” Damien said,
“You mean it’s okay to cry? I’m not being stupid?” I was struck by how young
this question made Damien sound, but I only shook my head to say, no, it wasn’t
stupid. He said, “When I was three or four, I would be devastated if I colored
outside the lines. Being ashamed of myself feels like the natural order of things.
If at three I was anxious because my mother was, then conformity was the solu-
tion to both our anxieties.” “All of these brutal and harsh things you say about
yourself,” I said, “function as a way of not thinking about something else – how
injured, sad, and hopeless you felt. And it sounds like that not-thinking worked
both for you and your mother. I wonder if that’s what you mean by the ‘natural
order of things.’ ”
Damien began our next session, five days later, by telling me he hadn’t been
doing well. “I had some evenings off,” he said, “and I didn’t do anything. I didn’t
study, I didn’t write, I didn’t even go out with friends. I just sat around beating
myself up for being such a lazy bastard.” He then talked about how he had dis-
appointed a program supervisor because he was “too stupid to answer a basic
question,” and how he was too fat because he is “so lazy I won’t even do what
I know is good for me.” I said, “The part of you that needs to berate you is out
in full force today. I wonder why.” After some back and forth about whether his
self-contempt was overstating its case, Damien grew silent. After a long moment,
he said, “I called my mother last night. I was telling her I was lonely. She said
‘You need an attitude of gratitude.’ It’s from a f***ing kid’s song! She throws
a f***ing kid’s song at me! I’ve been lonely since I was ten.” I said, “I sus-
pect there’s a connection between your phone call and the intensity in your self-
contempt as you began today.” Damien said, “You mean she devalued me by
quoting the kid’s song, and I then devalued myself?” I said, “Yes, there’s that.
But it feels to me like there’s something else. Something like: you were hurt by
your mother’s inability to respond to your real feelings of loneliness, but then
forgot about being hurt by putting extra energy into attacking yourself.” Damien
said, “Now I’m feeling guilty about being angry at her. She’s done the best she
could. She’s even apologized to me for how she treated me as a kid. Why can’t
I get over it and accept her apology?” I said, “There it is again. You’re using self-
devaluation to beat back anger and pain. The self-devaluation essentially says
‘Get over it already – I don’t want to hear about it.’ ” Damien: “I guess my mom’s
response to pain was to say ‘get over it’ in a lot of different ways – ‘attitude of
26 James L. Poulton
gratitude,’ ‘God will take care of it’ – I guess that was somewhat difficult, given
that she was also the source of the pain.”
Because of Damien’s schedule, the next session occurred two weeks later. Dam-
ien began by saying that after our prior session, he had been depressed and found
himself obsessing about his “failures.” “But then I pulled myself together and did
a reasonable job of telling myself I’m not as bad as I think I am.” He then said,
“I talked to my mom. I told her I’m trying to reconcile her with the ‘old’ mom. She
understood. I said I was still angry at the old mom. I was whining a bit. She said
something about, ‘That’s where grace comes in,’ and I just blew up. I don’t need
that ‘attitude of gratitude’ shit.” I said, “It’s difficult for your mom to be present to
your pain.” Damien said, “I was saying I don’t know if this will ever get better or
if this will ever get fixed, and God comes along!” I said, “You mean your mother
turned to God instead of you when she made the comment about grace?” Damien:
“I think I wanted something from her and what she offered instead was something
that has hurt me in the past. Between the ages of 10 and about 14, I was probably
hoping God would intervene in my hating myself. But by 15 I was in a ‘f***
God’ mood. F*** that shit, it wasn’t f***ing real. I truly detest the church. It’s
about looking good, a keeping-up-with-appearances attitude.” I said, “Your anger
at the church is rooted in how injured you are by a move your mother continues
to make. It’s a move that lifts your conversation with her out of the human level
and into an abstract level – where the interaction is about God and no longer about
your injury, or how you feel or how you are doing. It’s a move that places her out
of your reach.” Damien then told me that his mother had been raised Catholic
but later got involved in the evangelical Christian tradition. He said he thought
evangelism offered his mother a chance at her own redemption from the “terrible
guilt” she felt over her past. He then said, “The 14-year-old me was an ashamed,
depressed, suicidal, angry, lonely person. So, my parents turned me over to God
and all I got there was judgment for nonconformity.” I said, “The 14-year-old you
was in a lot of pain.” As Damien took some time to respond, I watched his face
harden. Where there had been sadness, there was now contempt. He said, “The
14-year-old me: what I think is that he’s a little bitch. I’m embarrassed at a lot of
his behavior.” I said, “And there’s another repetition of the sequence from anger
and pain to self-attack.” Damien said, “If I stop blaming the 14-year-old, all that’s
left is feeling sad about all this. I’d be overwhelmed by a sea of sadness.” At this
he began crying again, although he tried to hide it by wiping tears away as quickly
as they appeared. After a pause, I said, “This is the sadness you hide from yourself
by covering it with self-blame.” Damien: “If I go into that sea of sadness I don’t
know if I’ll come up. If I go into it, I’ll feel contempt for myself. Maybe I can tell
myself, ‘the grief you have is reasonable, understandable, real. There’s nothing
aberrant about having it.’ ” I nodded. The session was over.
When working with a patient whose behavior has been influenced by an uns-
ymbolized and unacknowledged “contract” with another person, particularly one
who is still active in the patient’s life, the therapist’s role must shift in some sig-
nificant ways. In the sessions described earlier, my intent was to weave together
 What does the object have to do with it? 27
the patterns I witnessed in Damien during our sessions with the real-life dynam-
ics of his relationship with his mother. To that end, my focus alternated between
the here-and-now of the session, the there-and-then of his past relationship with
his mother, and the “there-and-now” of his current interactions with her that had
immediate effects on his behavior and attitudes toward himself. By doing so,
I was trying to symbolize what had never been symbolized by or for Damien:
the real parameters of his unconscious agreement with his mother that both par-
ties remain unaware of the pain, sadness, and anger he felt through much of his
life. Those parameters included his mother’s fear and guilt, her need to deny her
contributions to her children’s distress, and Damien’s complementary need to res-
cue her from her anxieties. If Damien was going to emerge from the “disease”
this unconscious agreement had induced in him, it would be through his explicit
understanding of these parameters and through his subsequent working through of
the painful realities of both his past and his present.
In the following session, which occurred near the end of treatment, our focus
had shifted. Instead of illuminating the foundations of his agreement with his
mother (as in the three sessions already described), we turned to exploring
how that agreement had influenced Damien’s relationship with me. Our con-
versations at this point occurred in the two different modalities I have already
described. First, we explicitly discussed Damien’s assumptions about himself
and about me that led him to attempt to perpetuate, in the transference, the basic
structures of his agreement with his mother. These interactions fell within the
boundaries of traditional analysis of transference, since they focused on what
was, by this point, representable and symbolizable in Damien’s psyche. The
second modality conformed to Berenstein’s concept of therapeutic interference,
in the sense that I resisted the (countertransferential) pressure on me to play the
same role as Damien’s mother and instead presented him with an alternative
way of being with another person – one in which he did not have to replace his
self-awareness with self-attack. By the end of this session, as a result of my
refusal to conform to past patterns, Damien was experiencing some confusion
as to what role he might play with me. This state, which has been described by
Beier and Young as an experience of “beneficial uncertainty” (1998, p. 65), is
a precursor to therapeutic change because it implies that the pressures underly-
ing old patterns have weakened to the point that new arrangements are now
possible.

Fourth session
Over the next several months, Damien and I continued our irregular meeting
schedule. During this time, I saw significant progress: he attacked himself less
frequently, and when he did he was increasingly able to question his motives for
doing so. He began dating a woman he met at school, and he began talking about
his growing affection for her. The following session occurred after I had been on a
two-week break when he otherwise would have been able to meet with me.
28 James L. Poulton
Damien began by saying, “While you were gone, I did get a few things done,
but none without dragging myself to it. Basically, I was lazy.” “You were lazy,”
I said, in a tone that said I was aware he was devaluing himself again. He said,
“I can’t tell you how many hours I wasted saying to myself, ‘What are you doing,
you lazy piece of shit?’ ” I said, “It sounds like you’re comforting yourself by
reminding yourself of your badness. As you’ve said many times, it’s how you
guarantee your place in the order of things.” Damien thought for a moment and
said, “Almost what I’m doing is affirming my avoidance – recognizing that it’s a
valid strategy that I’ve used in the past.” I said, “I guess the question is, avoidance
of what?” He said, “I don’t really know.” I paused, then said, “I suspect you do.”
He said, “What do you mean?” I said, “Well, for one thing, I’ve been away for
two weeks when we might have met, and we’re coming up on the time that you’ll
be done with your training and leaving Salt Lake. Maybe you have some feelings
about it.” Damien was silent for at least a couple of minutes. He then said, “I’m not
sure I have a right to miss you.” “You missed me,” I said. Damien nodded almost
imperceptibly and became interested in his hands. He was wearing a sweatshirt
and he pulled the hoodie over his head. I said, “I see that it feels like something
needs to be hidden – something like sadness?” Damien said, after another pause,
“I am sad. I’m sad that we’re going to stop meeting.” I said, “I wonder if you’re
also angry with me because I arranged my break so we couldn’t meet these past
two weeks.” Damien: “If I don’t have a right to miss you. I definitely don’t have a
right to be angry with you.” I said, “I think the old sequence has kicked in between
you and me. I hurt you. . . .” At this, Damien shook his head but didn’t say any-
thing. I said, “Okay, I know it’s hard to acknowledge it, but . . . I hurt you, and
you’re sad and angry about it. But the old sequence between you and your mother
told you it was part of the order of things to hide those feelings, from me and
from yourself. So, you accomplished that by telling me you’ve been a lazy piece
of shit.” Damien said, “It’s how I’ve always defined myself.” I said, “Defined and
protected yourself. And I think you’re trying to protect me, too.” Damien said,
“I suppose it could be that I’m not certain how to define myself beyond that.”
I said, “I think you’re saying that it hasn’t been in your basic repertoire how to talk
with someone who has hurt you, and still expect them to want to listen.” Damien
said, “I talked with my mother last week. She told me that when she was 21, she
had an epiphany that ‘God does not make junk.’ I took it to mean that she felt sud-
denly valuable – absolutely valuable – and that was a solution to the conditional
value she felt in the eyes of her father. But then I thought: If she was suddenly
valuable in the eyes of God, then where did all her guilt go? I think she needed us
kids to be perfect so she could prove to God that she was. And when we weren’t,
she blamed us.” I said, “Accepting that blame was a way of saving your mother
from her fears. And because those fears were so strong, you couldn’t talk about
how the whole arrangement was hurting you. This morning, by beginning with an
attack on yourself, you were doing the same thing with me.” Damien said, “Yeah,
but it’s harder to do it with you – you don’t give me any of that God shit.” I said,
“And you don’t quite know what to do with that.” Damien said, “Right, I don’t
know what to do with it.”
 What does the object have to do with it? 29
Conclusion
I would like to make a few observations about the nature of intersubjective con-
tracts and the methods by which they can be treated:

1 As I mentioned earlier, there is a fairly clear divergence between the way

Kaës and Berenstein understand the kinds of pathological influence the
“alien” parts of one person can have on another. Their divergence centers
around whether such influence can persist even when the two are separated.
The case of Damien seems to help settle this debate: Although Damien’s
mother was never physically present in our sessions, her influence over his
experience and behavior was substantial and undeniable.
2 The influence Damian’s mother had over him was sustained and reinforced
by the frequent telephone contact between the two. From one perspective,
their conversations can be viewed as analogous to mutual hypnotic induc-
tions, in which each reminded the other, without knowing they were doing so,
of the nature and parameters of their basic agreement.
3 It is important to recognize that the unconscious agreement Damien reached
with his mother was most likely instigated, initially, by her relationship trauma
with her father, whose “unstinting criticisms” seem to have been instrumental
in the development of rigid, black-and-white defenses that found their full
expression in the fervor of her religious beliefs. This observation, in turn,
raises two additional points. First, a pathological relationship between two
people will always be embedded within and supported by a matrix of other
relationships – with past generations, with current familial and social groups,
and even with broader societal and cultural institutions. This point was force-
fully made by Pichon-Rivière (Losso, de Setton and Scharff, 2017). Second,
it is possible to regard some diseases of intersubjective contracts as special
cases of the intergenerational transmission of trauma. This is especially the
case when a parent’s defenses against trauma are both rigidly oriented toward
denial and when the child is enlisted early in life to participate in the parent’s
will to not know about his or her own trauma in order to rescue the parent
from overwhelming anxiety.
4 The case of Damien illustrates that treatment of a patient constrained by an
intersubjective contract may require the therapist to go beyond the therapeu-
tic modes of interference and transference analysis in order to interpret the
motives and background of the other, “alien” partner to the contract, even
though that person is not physically present in the consulting room. Of course,
such interpretations should be employed only insofar as they illuminate who
the patient is in light of those contracts and help him gain access to the pain –
and its necessary grieving – that motivated their formation in the first place.

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3  reaming up, re-finding,
D
and grieving lost objects Carl BagniniDreaming up, re-finding, and grieving objects

A case study
Carl Bagnini

This chapter describes a discovery process that fostered a change in the treatment
of a very difficult case. Dream work on the therapist’s part occurred at a cru-
cial juncture of the treatment that transformed a difficult impasse into a creative
encounter.
When the therapist dreams during analytic treatment, the dream has a dual
function: the patient that is blocked prefers to remain asleep (unconscious), while
the treatment situation stirs powerful countertransference images in the therapist’s
unconscious, whose dream can uncover subjective truths (evidence) crucial to
opening up a new pathway for grieving lost objects in cases of trauma.

Theory and the evolution of technique in challenging cases

Contemporary psychoanalytic theory has expanded the study of internal and
external objects and recognized that object relations are fluctuating ordinary rela-
tional phenomena occurring between therapist and patient. Traditional thinking
had focused mainly on the object relations of the patient, with the therapist’s posi-
tion one of relative abstinence or neutrality. The material considered most relevant
to therapeutic process consisted of the patient’s utterances, dreams, associations,
and transferences. As long as the therapist reflected on his or her countertransfer-
ence as the product of and not the cause of patient transferences, patient-centered
interpretations allowed the therapist a semblance of detached and benign objectiv-
ity. In this approach, patient personal history was the hidden treasure to be mined
by the ready mind of the therapist.
The evolutionary world of psychoanalysis has expanded the study of object
relations to the field of multiple psyches. Relational meanings of enactments,
mental process, and attachment issues recast object relations as a system with
new paradigms for treatment of deeply disturbed, dissociative, or otherwise stuck
patients. We re-frame the frame in search of technical options with the most dif-
ficult cases. One of these options is to resist the temptation to quickly jump into
transference interpretations before bearing the unknown and suffering with the
unmetabolized beta elements of traumatic exposure. How do our psyches bear the
experience of pain associated with patient trauma, and how does our traumatic
past become the pathway for finding a transformative potential?
32 Carl Bagnini
While we do not yet have sufficient research to empirically compare psycho-
analytic models, we can study and consider what occurs that makes a difference
one case at a time. In practice we cling to a preferred approach, while undergoing
a seismic tilt that shakes our beliefs in what we are doing when reaching a limit
in holding and containment. In the undertow of becoming personally disturbed,
a discovery surfaces that makes a difference in the clinical situation. Was the
change a product of theory, intuition, a mistake, or catastrophic acting out? Or was
there a co-constructed image, perception, bodily sensation, thought, or intuition
that created a new “gestalt”? Such a gestalt of complex properties and emotions
has a re-organizing effect on the relationship, adding new meanings for use.
In the case presentation that follows I feature the importance of therapist’s
dreaming for retrieving and grieving lost objects as central to therapeutic progress.
The dreamscape offers pathways to their access, but the process of discovery is
arduous, personally upsetting, and indirectly discovered. In David E. Scharff’s
well-crafted book Re-finding the Object and Reclaiming the Self (1992), we are
treated to a relational exploration of discovery and loss by examining what lies
between and within ourselves and our patients in individual, couple, and family
psychotherapy and psychoanalysis. In such explorations we are asked to probe the
mutual shaping of patient and therapist object relations, in order to ground our-
selves in a parallel process of discovering and grieving lost objects. I conjecture
that we fall prey to, ignore, and escape opportunities and defend against affects
that are central to retrieving lost objects.
Our historicized vulnerabilities interfere at first with re-finding our personal
traumas, and locating patient defenses that parallel our unconscious fears and
partially metabolized personal histories in avoiding theirs. We collude in having
similar avoidances that require attentiveness and a willingness to suffer through
“not knowing” (Bion, 1974). Gradually, if we are able to summon the courage
and persist in locating the uncanny in us, a transformative potential can result that
enhances the therapeutic relationship.
As we can see, the I-thou has grown to the I-thou-and-them – the unconscious
relational others in the setting that make object relations more complex than we
might be comfortable with. Evolving theory prompts the central question: Whose
object relations are the focus of treatment? Relational models focus less on patient
autonomy and more on the intersubjective matrix of the treatment dyad. While
acknowledging that patient and therapist are individuals, the technical issues for
relational analysts involve what to work on within a “co-constructed” environ-
ment. In current practice, therapists from other schools, including contemporary
Freudians, modern Kleinians, ego psychologists, self-psychologists, Bionians,
and others, variously conceptualize the individual mind as connected to a larger
psychic world or field.
Let us now apply these observations to practice. When a therapist dreams dur-
ing a treatment, this is a phenomenological event and requires a generous consid-
eration of the multiple effects of interactive elements occurring between treatment
participants. Dreaming can increase awareness in a therapist whose patient
remains deeply unaware. When patient and therapist are locked into concrete
 Dreaming up, re-finding, and grieving objects 33
transactions, the therapist can experience a “near” psychic death exposure; it is
the impasse that forecloses availability for working in the symbolic realm. The
therapist’s dream can be influenced by the patient’s ruthless shutting down of
the therapist’s emotional range, by numbing and repetition. Can we reduce the
therapist’s dream to a countertransference enactment, traceable to the therapist’s
all-too-willing emotional receptivity? Or might the dream function as a healing or
contact point with self-objects for the therapist’s personal benefit? Are we permit-
ted to gain narcissistic supplies from our work?
What meaning, if any, does this all have with respect to the way I relate as
a clinician and person? Although I respond to the existentialist in me, such a
response privileges the here-and-now experience of patient-therapist encoun-
ters. I am deeply affected by various ways the therapeutic comes into being from
surprises, mistakes, dreams, and associated somatic and painful stuck-ness. The
psyche-soma of the therapist-patient relationship is an important dimension of the
treatment.
In clinical practice we discover a unique unconscious sharing of mutually
resonating self-parts, resulting in an expanded conceptualization of treatment, in
which the contextual make up of human interaction is more important than patient
internalizations alone. In this interface, there is an opportunity to be in touch with
therapist and patient internal object worlds as they interact. These interactions
produce a more inclusive, if not complete, experience. Exposure to each other’s
humanity in here-and-now relating has a profound impact on psychological
process and outcome. Objects and part-objects press into the relationship, seek
expression and then recognition. If they are not available in the patient’s con-
sciousness, they emerge in the therapist’s subjective associations, crazy thoughts,
dreams, and psychosomatic reactions in or between sessions.
Case studies are one means to empirically determine whether clinical theory
works in practice. I have found that in certain clinical situations, we can draw
inspiration and technical assistance from a flexible partaking from other models,
in order to address particular difficulties when feeling limited in moving the treat-
ment forward. Once we identify gaps in our own theory or technique, we can
borrow from other models. Altering our analytic approach comes from practice
over time; we are not the same therapist now as we were during or soon after
completing training. Learning always implies change and a degree of suffering.
I want to turn to one of Bion’s contributions to practice that assisted me in the
case I describe later in this essay. The specific clinical idea is that patients express
meanings without emotions and emotions without meanings (Bion, 1965, p. 183).
The density of the patient-therapist exchanges becomes concrete, with fluctua-
tions between two types of disturbances that reduce analytic work. Co-generated
problems occur, as the field becomes laden with action-discharge or linguistic
paralysis. The patient’s symbols are conscious but have no transforming value;
their emotions erupt without thought. Are we reduced to “pruners,” reducing the
patient’s options out of sadistic reactivity, when caught up in our defenses against
their ruthlessness (Bolognini, 2006, p. 114) or to being “dreamers,” connoting a
capacity to play? Our fantasies must remain hidden until something ripens, and
34 Carl Bagnini
if discovered and communicated. Then unrepresented objects may emerge and
become newly represented.
I now explore a case that illustrates how an expanded cast of shadowy charac-
ters fostered dream work and tapped into unrepressed, unforgotten meanings that
had not been thought by the patient or myself. The process of discovery caused
turbulence. A seismic shift occurred first in the therapist and then in the patient
as new meanings came to have an impact. I describe the emergence of the thera-
pist’s dream and how it opened a new space for moving the work forward. Self-
discovery came with the therapist’s dream work that accessed traumatic elements
in both patient and therapist, freeing up the therapist to gain access to the patient’s
childhood trauma.

The case of Lanie

I am in my office with Lanie, 40, married, smart, and a beautiful, tall, blond for-
mer model, mother of two boys, 3 and 5. Very high strung, volatile, and disturbed,
Lanie has been with me for two years in twice-a-week therapy. Her fluctuating
moods and taste for marijuana and alcohol are my constant concern. Her difficult
history involves anorexia-bulimia, beginning in her teens, then under control dur-
ing her first pregnancy after in-patient treatment, and a masochistic attachment to
a depressed, forced-into-retirement, and once very capable surgeon father, long
divorced from mother, compulsively involved with two women. The women pre-
sumably do not know of the other lover.
Lanie has two brothers, one older, the other younger, each by two years. Younger
brother is long-term dependent on father for financial survival and is a pot and
cocaine user, unemployed and very volatile. Lanie tries to help by listening to him
and ignoring his attacks on her “well-to-do life.” Older brother is easier to talk to
but blames father for everything wrong in his life. He loses jobs, cannot get along
with bosses, and was estranged from father for four years after father left mother
for another woman when Lanie was 18. Lanie is the “glue,” as she puts it. Mother
is the only family member in the nuclear group that all of the siblings have contact
with. Mother is reported to be intellectual and cannot make decisions without the
input of her second husband, a nice man who, unlike Lanie’s father, takes care of
mother. Mother was an elementary schoolteacher, retired, and has been remarried
since Lanie was 25. Lanie has a cordial relationship with the stepfather. As she
puts it: “As long as mother is happy I’m okay.” Another issue with mother is that
Lanie could never feel close to her, due to mother’s aloofness and intellectualized
attitude. In this sense Lanie feels quite deprived and has sought out her philander-
ing father, to whom she often gives more than she receives.
We have been working with Lanie’s many issues. An interior designer, she is
terrified of getting work because she will be unable to deliver an adequate job
or on time due to a lack of confidence. Since treatment began she has taken on a
few jobs and done well, but she continues to undermine her talent. She is bored at
home as a full-time mother. She has a few women friends who drink and smoke
 Dreaming up, re-finding, and grieving objects 35
pot every afternoon, between 3 and 5 a.m. before their husbands return home from
work. Lanie reports pot helps her zone out, with less anxiety about her life, which
seems boring and unproductive. She used to live in the city and partied regularly,
drinking and smoking pot in the glitzy world of fashion modeling, with her then
boyfriend, now husband of seven years. He works in his family business for less
money than he is worth.
Three years ago I saw them as a couple during their second pregnancy for six
months before their child was born. They were fighting over the unplanned second
pregnancy, blaming each other, while both knowing they were having unprotected
sex. They admitted that neither paid attention to the consequences. The couple had
moved to town after the birth of their first son, and Lanie had not adapted, pre-
ferring the fast-lane life of New York. Lanie is a borderline personality, volatile,
depressive, self-indulgent, masochistic in family relations with male members,
and lacking in boundary setting. She regularly gets high with girl friends when
the children are playing in other rooms with the babysitter in charge. She has
more conscious awareness lately that the pot is capable of affecting the children.
She doesn’t pass out but needs it for stimulation and says it prevents depression
at the end of the day. She uses pot to be alert when her husband comes home. She
reports the pot is a reward for being able to do the chores. There is no evidence
of child neglect or overt aggression with the children. Her psychiatrist is trying
Naltrexone 50 mg to reduce and structure alcohol consumption and as a substitute
for rehabilitation, AA, or other treatments that would require exposure to addic-
tion environments. Lanie refuses the other options out of shame. She cries when
we discuss other approaches should the medication not work. She was drinking
less wine by taking the medication, saying she has to drink for the medication to
be effective. She also takes Xanax, Klonopin, and Prozac to stabilize her.
Recently (after two months) she is drinking more again, mostly wine at dinner
that helps her relax, while insisting that Naltrexone can take six months to be
effective. I believe this is pure rationalization, and I am expecting failure because
Lanie is denying the extent of the dependency. Her husband is getting more upset
with her. They still drink together, although he does not get incapacitated.
The marriage was based on early adolescent sexual excitement and partying, a
mutual addictive fixation with youthful boundary testing, and later an adjustment
to family life in suburbia, which brought responsibilities for children with Lanie
hemmed in to a small-town life, isolation, and no career. The couple bickers over
money, child rearing (she feels he’s the calmer parent but dictates how she should
do better), and extended family (Lanie cannot stand one of his sisters, whom he
is close to. They gang up on her when they drink, pointing out Lanie’s faults.).
Lanie appears for sessions dressed in tight stretch pants and loosely lay-
ered tops that move when she shifts in her chair. She is well groomed and uses
makeup and has not come to sessions either high or sedated. She relates to me
as safe to talk to, is often not sure where to begin, and at other times is worked
up over extended family relations, her lack of happiness, and her inability to
find her way in life.
36 Carl Bagnini
Course of treatment
The first treatment was couple therapy for six month that stabilized the couple.
They made adjustments in their expectations of each other after a period of angry
blaming over the pregnancy, which we traced to insecurities and fears about tak-
ing on responsibilities for the changes.
Lanie called two years later for individual therapy, with symptoms of anxiety,
depression, and malaise about life passing her by, with further disillusionment
about marriage and motherhood. While she professed love for her husband and
two boys, she claimed her husband’s job gave his life meaning, while she missed
city life. Marijuana and alcohol were always part of her life, and occasional black-
outs had occurred in the city as well as in the suburbs, but she insisted it was when
her husband became more worried that she had decided to try therapy. She feels
responsible for her brothers’ and father’s dysfunctional life and relationships, but
it is all she has to hold onto.
A major difficulty has been that Lanie appears to take in only shared observa-
tions or interpretive comments; these may come from my enlarging her narra-
tive of early childhood neglect when I connect that to bad choices of exploitive
males in late adolescence or college. She cries, then becomes very surprised to
be feeling so strongly, as though her factual portrayal is more emotionally signifi-
cant to me than to her. Then her retention of what occurred disappears and in the
next session she asks me what we discussed in the previous one, saying that was
probably important. I usually leave room for her to work with situations rather
than coaching her. The going has been tough, given the powerful defenses against
remembering and new emotional connections to the material and to me, the per-
son responding in this unusual way. It is unlike any experience she has had before.
Gradually Lanie grew to tolerate my way of working, showing intellectual curi-
osity, but emotionally she hung onto what she knew – unprocessed, unmetabolized
connections to her symptoms or personality difficulties. Attempts to discuss the
overall influences of being tied to a masochistic-sadistic (I don’t use these words)
merry-go-round, family inheritance, and the way these keep her from detaching
and individuating (including the addictive aspects) produces the same blockade
of interest for a while. She questions my motives for bringing the patterns up but
rationalizes that everything has to be what it is, lest her family be angry at her
and she have no one. The neglect of herself and the self-defeating obligation to
save others holds me hostage. I want to help her break free, but I feel I’m in the
presence of a perversion of thought. The unrepressed fixed belief is that the bad is
acceptable, and what is painful is the unmetabolized truth that I am holding. This
is the scaffolding for undiscovered trauma.

A session
L. Not a good week. I spoke to my father yesterday (begins to weep) and he has
Parkinson’s you know. He was complaining about Eric again (the younger, finan-
cially dependent brother). He got a DUI and wants my dad to take care of it.
 Dreaming up, re-finding, and grieving objects 37
TH. And the tears?
L. I don’t know, it makes me sad that father is always pressured to bail out my
brothers. He can’t ever do enough to satisfy them.
TH. Are there other feelings or thoughts along with the tears when you listen to
father?
L. I talk to my brothers and try to be understanding. I give them advice, asking
them to give Dad a break. Eric turns on me, says that I should mind my own
business, that Dad owes him. Dad wasn’t around when we were kids. He was
out working or having affairs (I’m not sure if Lanie is reporting what Eric
said or having a recollection). My father complains on the phone, then asks
me out to dinner and I hear it all again. I tell him to take better care of himself,
to enjoy life, but I know he isn’t listening.
TH. And then?
L. (Crying again more intensely.) It’s so frustrating I just want to run away, but
he needs me. The alternating bimbos he brings to the house don’t relate to
me or the boys. Dad comes for an hour and disappears for weeks with the
bimbos. He wants to talk about them to me because they want to marry him.
TH. You keep trying and nothing works. Let’s consider the result! He runs away
from your efforts to advise, then you want to run away from the rejection of
your worried love for him. I wonder what’s happening here between us!
L. What do you mean between us?
TH. Do you see a parallel?
L. Like I’m repeating the running away with you? That can’t be. You’re not like
my father, you listen and try to help me.
TH. Lanie, the story you’re re-telling has to do with you not feeling influential in
your father’s depressing life or your brother’s, and you keep trying. There’s
no anger coming up when your efforts go in the toilet. I wonder if my efforts
are following suit, because you are always sad and upset that your words
don’t improve things; I am feeling that here. Neither one of us is getting
through to the other, so we’re in the stuck place together.
L. No, Carl, that doesn’t make sense. I am stuck, that’s true, but I want your
help. I don’t want to give up drinking and pot though, which I believe you
think would be good for me.
TH. And?
L. It would, but they give me peace and calm me down.
TH. Yes, that’s all true. And you need their calming effects because that prevents
other emotions from emerging that you are very fearful of – like anger. And
yet you remain miserable and know it well.
L. I have to think about that. I can’t follow that kind of logic.
TH. We have to stop now.

The therapist’s dream followed this session:

I’m in a cab, driving through a vaguely familiar Brooklyn neighborhood. The

driver is a Jamaican woman, lighthearted, with an infectious lyrical accent
38 Carl Bagnini
that makes me want to listen, not caring what she says because the music
of her voice is so enthralling. In the dream, I’m much younger, in my early
30s, having worked in mostly minority neighborhoods, one in particular
in which I was the only Caucasian social worker/child therapist. As is the
local custom, the cab stops to pick up additional passengers while taking
me on my journey to – I have no idea where. Three children enter the cab.
The first is a black girl, about 9. A 7-year-old black girl pushes in behind;
she doesn’t look much like the first child, but I sense they are sisters, and
after her, a white boy, about 12. To accommodate the three children, I shift
as far to the right side of the back seat to make room. Being white, I am
partly apprehensive I am going to have my wallet stolen by three hungry
children. The driver is quiet. The girl closest to me says: “Do you have a
father?” I reply, “I did, but he died a long time ago.” She gazes left at the
younger girl, pensive, leans closer to me, head almost touching my shoul-
der. “Lucy has no father, and she cries a lot, but I can deal.” She speaks in
a detached intellectual tone, then puts her head on my shoulder and begins
weeping deeply.
I sit silently, quietly weeping, trying not to disturb her, and gently put my left
arm around her shoulder. We are still now, both quiet, emotionally con-
nected in grief, strangers in a cab, coming from and traveling together but
in different directions. As she pulls over, the Jamaican cab driver, with her
upbeat, musical voice, announces, “We’re here.” The dream ends.

Discussion
My dream suggests a powerful merged unconscious grief experience with Lanie,
signaled by means of the cab ride with the three children. The eldest, a girl, nine,
conveys her sister’s father loss, after which she seeks comfort from me. My ini-
tial fear of having my wallet stolen by the hungry children connects to the fear
that Lanie is depleting me, robbing me of my analytic resourcefulness. Lanie’s
primary family represents the core traumatic exposures of Lanie to resourceless
dependency, which she projects onto me. The nine-year-old’s intellectual telling
of father loss reminds me of Lanie’s mother, who intellectualizes most emotions,
while relying extensively on a man to make her decisions. However, the nine-
year-old girl transitions to weeping deeply, representing my conscious wish for
Lanie, who I believe needs an emotional breakdown to retrieve lost objects. I am
the shoulder she weeps on. While weeping myself, we share father loss, quietly,
without conversation. The driver and the location (Brooklyn) are familiar figures
from my own childhood. I imagine the driver is the arms-around Winnicottian
figure, one that makes for a tight back seat but provides a sing-song container for
a chance encounter on a journey that will takes us passengers to different destina-
tions. The 12-year-old silent white boy represents me at that age, observing and
fearful of experiencing female losses of fathers – a parallel tragic loss I could not
share with the females in my family of origin.
 Dreaming up, re-finding, and grieving objects 39
The dream, therefore, represents a bridgeable moment between us as a therapy
pair, at a time when Lanie’s clinging to a life of numbness, isolation, and sacrifice
is depleting my capacity to feel I am meaningful to her. In the sessions, we share
the experience of trying and failing to engage, each feeling isolated and lost. I feel
rejected and inadequate because my words fail to touch her, while she insists
she needs me. Lanie strives but cannot rescue anyone, especially herself. Parts
of myself and parts of Lanie’s self are joined: Lanie insists she wants my help, a
belief she relies on masochistically when relating to her own nuclear family that
uses her. I feel used in a similar way: we talk, but she promptly forgets. I reflect on
how I am engaging. My approach has been to link fears of her repressed aggres-
sion to her suffering and her escape into numbness through pot and alcohol. I am
not getting to the traumatic elements in her life, however, or the depressed aspects
she denies in favor of boredom.

Next session later that week

I’m feeling the dream’s effects as I wait for the session to begin. I’m sad and
burdened.

L. We were in an important place, right? Do you remember where we were last

time (embarrassed and blushing)?
TH. What’s it feeling like now, not being able to remember?
L. I don’t know. It was very emotional, I think.
TH. I want to shift the subject. Can you recall what it was like between 3 p.m. and
5 p.m. weekdays as a child with Mom and Dad at work? (The hours 3 to 5
p.m. surfaced in relation to the hours Lanie and her friends regularly partied.
The numbing and the hours somehow resonated in me as having potential to
shut out traumatic memories.)
L. (Sits forward and grips the sides of the chair.) Nothing happened. My broth-
ers and I carpooled with the neighbor’s kids and their nanny, Felicia.
TH. (I don’t know why I shifted, but I am going with it because of the dream.) And
when you got home?
L. I did homework and had a snack.
TH. (Feels intense and scary here.) And your brothers? They were there?
L. No, I can’t seem to find them. Maybe they were outside playing. (Becom-
ing increasingly uncomfortable, staring at me leaning forward.) My brothers
were playing. . . . (Suddenly begins to sob! Covers her face with both hands.)
I told them to play inside, it was getting dark. I wanted to be included. Peter
(older) said: “You’re not my mother,” and he and Eric were mad at me. I was
scared when Peter got mad because he threw things, and my mother couldn’t
control him. I am feeling something bad happened.
(Lanie squeezes her legs together and turns away but keeps talking.) We
played a game Peter said we could play together. He called it Explorer.
TH. Lanie, I’m here with you. How old were you at the time?
40 Carl Bagnini
L. I was eight. Peter was big! He hurt me! I did what he said. He told me to
undress, but he didn’t. He said he got the first turn. Then he (more sobbing but
talking) . . . pushed his finger inside me and in my backside too, and it hurt
and he made Eric watch. He made me touch his penis. He said it felt good. . . .
Should I tell you everything?
TH. Tell me what you’ve been holding inside all these years. And if you don’t feel
safe we can stop.
L. He was laughing. It hurt and he pushed harder. He wanted to use a wooden
kitchen spoon, but Eric cried, so Peter put it away. I got dressed and ran to my
room and cried. (Lanie is crying, but I sense some relief because she can run
to her room.) I can’t say anymore. It’s terrible. My brother did this, and then
I try to help him all these years. (Lanie is crying, looking at me with sorrowful
eyes).
L. Is this supposed to help me, Carl?
TH. You seem angry with me now because we released a terrible memory. The
anger at Peter for causing you pain was never expressed because of fear. We
need to consider where the anger belongs. How about your parents?
L. I never told anyone. I tried to forget.
TH. And you became the dutiful child obligated to keep men from losing control
or falling apart.

End of session.

Discussion and conclusion

In this session, Lanie was able to connect emotionally to the therapist by means of
the shift to his association that seemed to appear out of nowhere. The affect that
was revealed had been blocked throughout Lanie’s life. The issue of mourning
losses might have been accomplished gradually if Lanie had felt safe enough to
remember how the losses occurred: Her brothers’ sadism, Lanie’s shame, terror,
loneliness, being left unprotected, secrecy, lack of safety and mistrust – all miss-
ing fundamental requirements for healthy development.
The emergence of the therapist’s dream at a critical point in treatment expanded
the possibilities in a stuck situation. Theory about treatment expands the study
of therapist-patient object relations when there is a blurring of boundaries that
occurs with deeply wounded patients that challenges analytic neutrality. Objectiv-
ity becomes useless and potentially results in the therapist’s defensive counter-
resistance. A patient’s dream in a “waking” state within the holding environment
may be too close to annihilative anxieties, because it has the potential to elicit the
panic of going “mad.” Because of the defenses that numb madness, a patient’s life
has been lived without concern for consequences. The patient in this case was less
re-traumatized because she did not know that the therapist, as proxy and guardian
of the patient’s waking and sleeping life, had a co-created dream that led to an
opportunity to move beyond the impasse and salvage treatment. The location and
 Dreaming up, re-finding, and grieving objects 41
retrieving of lost objects and the opportunity to mourn in instances like this can
aid the creation and application of a therapist’s dream.

References
Bion, W. R. (1965). Transformations: Change from Learning to Growth. London:
Heinemann.
Bion, W. R. (1974). Experiences in Groups and Other Papers. London. Tavistock.
Bolognini, S. (2006). Like Wind, Like Wave: Fables from the Land of the Repressed. New
York: Other Press.
Scharff, D. E. (1992). Re-Finding the Object and Reclaiming the Self. Northvale, NJ: Jason
Aronson.
4 Creating a new relationship
in child analysis Caroline SehonCreating a new relationship in analysis

Revisiting theoretical ideas

of developmental and
transference objects
Caroline Sehon

Introduction
I had the privilege to meet “Ella” when she was four years nine months old. An
only child, Ella was born to parents in their late 30s who wrestled for several years
about whether to conceive, frightened of recapitulating their own traumatic family
histories. The mother worked from home as an entrepreneur of a small start-up
company, and the father traveled often as a salesman.
Ella’s parents consulted me at the recommendation of her preschool teacher.
A bright, creative, and determined little girl, Ella was hampered by severe
emotional, social, and academic delays. She was further challenged by a seri-
ous speech articulation problem – she became extremely frustrated and prone
to meltdowns when people made clumsy efforts to decode her unrecognizable
words. Her mother reported that Ella had a “latching problem” at birth, such that
“I didn’t produce enough milk, and she didn’t naturally take milk.” At one week
of life, breastfeeding was quickly halted when her mother noticed that “the nurses
were shoving the nipple into her mouth and it was really invasive.” Subsequently,
Ella expressed strong food preferences and resistance to eating solids. Apparently
unable to sense her need to relieve her full bladder or bowel, she also faced the
occasional embarrassment of enuretic or encopretic episodes.
At the start of our journey, Ella suffered also with profound separation anxiety,
especially from her mother. She was frequently required to play alone when her
mother teleworked from home and conducted daily business calls in private. Time
and time again, she tried to enter her mother’s office, only to be ushered away.
Although her mother was otherwise involved in her life, these moments occurred
consistently, leaving Ella feeling dropped. Similarly, her father was absent for
long workdays or on travel; upon his reentry, he was often asleep or too tired to
play with her. A similar dynamic therefore unfolded between Ella and each parent
in which she would meet a seemingly present parent who was actually unavail-
able. These contrasting settings set the stage, in my view, for anxiety within Ella,
between Ella and her parents, and between Ella and me in the transference sur-
rounding recurrent fears of separation and rejection on one hand and her desperate
longing for closeness and merger on the other.
 Creating a new relationship in analysis 43
Many parents feel paralyzed about crossing the therapeutic threshold because
of guilt about their contributions to their child’s problems. Ella’s parents were no
exception. They openly expressed deep pain at having to revisit their own sense of
childhood trauma and at exposing their misgivings about their perceived parent-
ing failures. Yet they were able to secure a strong therapeutic alliance with me,
and they became unwaveringly devoted to Ella’s treatment.
Favorable results were achieved with a one-year course of twice-weekly ana-
lytic therapy, once-weekly parent work, and speech therapy (provisioned pri-
vately), but Ella still had fierce trouble handling her intense feelings, conflicts,
and separation anxieties and representing her aggressive feelings and affectionate
longings through play or words. The parents therefore accepted my offer of a four-
times-weekly analysis along with once-weekly parent work.
This essay focuses specifically on Ella’s use of various therapeutic “objects”
at successive and ever-deepening moments along the analytic journey. Over the
course of the analysis, she and I embarked upon a spiral process (Scharff, Losso
and Setton, 2017) in which Ella became gradually more capable of employing
me as a transference object and relatively less as a developmental object (Neely,
2020, in press). In one sense, therapeutic action is regarded as occurring within
an analytic field, in which the heart of the action occurs within the setting of el
vinculo or “links” that represent numerous relational patterns, affects, transfer-
ence and countertransference manifestations, and traumatic experiences transmit-
ted both intergenerationally and within the here-and-now of the child’s family and
surrounding communities (Scharff and Scharff, 2011; Sehon, 2013).
The emerging development of transference and countertransference requires
the child to find and employ the analyst as a transference object in progressive
ways. In a complementary manner, it is necessary for the analyst to be used and
created by the child as a transference object and for the analyst to welcome the
child patient as a “countertransference object.” This interpenetration of subject
and object within the shared mind of the analytic pair takes time and patience
before the analyst can glean hints of the transference. Then, proper tact and tim-
ing are needed for the analyst to offer a transference interpretation as a hypoth-
esis, delivered into the displacement of the play or directly to the child. Many
factors determine a child’s capacity to use such transference interpretations, not
the least of which is the child’s developmental readiness. If all goes well, the
analytic couple will leverage such work in the transference-countertransference
field to collaborate on behalf of the child resolving her conflicts and advancing
her development.
But how would the child patient make optimal use of the analyst as a transfer-
ence object if she were severely developmentally delayed and subject to ongoing
family strain or traumatic links? The term “developmental object” was coined by
Tähkä to describe the analyst’s capacity to identify the patient’s developmental
needs and potentials and to facilitate a transformation in the child’s difficulties
as they will be repeated within the analytic relationship (Tähkä, 1993). This con-
struct was subsequently elaborated by Anne Hurry, Jill Miller, Carla Neely, and
others to capture something of the deeply moving and often memorable moments
44 Caroline Sehon
of intimate interaction between the child and the analyst that support the child’s
development. When the analyst is receptive to being found and used by the child
as a developmental object, she resonates with those developmental needs trans-
mitted by the child through play or words.
Winnicott described the analyst as functioning in this context as the environ-
ment mother, hopefully as a “good-enough mother (parent)” (Winnicott, 1965).
David E. Scharff and Jill Savege Scharff elaborated on Winnicott’s notion by
introducing the term “contextual transference” to represent the child’s experience
of the analyst and the setting as either safe and welcoming – expressed as a posi-
tive contextual transference – or threatening and rejecting when it manifests as a
negative contextual transference (Scharff and Scharff, 1998). Usually both ele-
ments co-occur, but the hope is that the positive contextual dimension will super-
sede the negative aspects. In this way, a sturdy therapeutic alliance forms between
the child and the analyst, and in turn, the child marshals the analyst’s capacity to
serve as a developmental object.
Furthermore, the Scharffs conceptualized the focused transference as analo-
gous to Winnicott’s object mother and described the patient’s use of the therapist
as an object upon whom to project the exciting and rejecting object relationships
(or aggressive and libidinal object relations). Through the analyst’s availability as
a developmental object, a focused transference eventually emerges in the form of
a veritable transference neurosis when the child finds and creates the analyst as a
transference object (Chused, 1988; Scharff and Scharff, 1998).
The concepts of the developmental object and the transference object are dis-
tinguishable from each other, yet they inherently operate at one and the same time.
The use of one facilitates the improved use of the other. The clinical case material
that follows provide examples to illustrate Ella’s eager search for a developmental
object to foster her progressive movement through her developmental impasse
within the arms-around holding of the therapeutic relationship. As the analysis
progressed, the analyst was able to make more transference interpretations both
in the displacement and directly, in ways that were possible only because of the
child’s development and the growth of the analytic partnership. Over time, Ella’s
predominant use of the analyst as a developmental object receded, thus paving the
way for the transference object to take center stage.

Description of child and setting

Ella was a pretty, highly intelligent, creative, inquisitive, engaging, and energetic
little girl. At times, she appeared friendly and excited to meet with me, but on the
turn of a dime she could become tearful, dramatic, angry, and commanding, or
solemn, sad, and in retreat. From the beginning, she demonstrated a high capacity
for symbolic play and prided herself on being able to distinguish between pretend
play and reality. She had an innovative ability to create props at will – for exam-
ple, she created an imaginative garden scene by lifting up toy flowers to combine
with tree silhouettes that cast a shadow on the upper wall of my office.
 Creating a new relationship in analysis 45
At the start of our work, Ella often wore leggings under an oversized dress.
Her hair was often uncombed as if she had just come running in from a storm; her
straggly bangs often obscured her vision and kept me from seeing her eyes. Grad-
ually her attire shifted to wearing more fitted skirts and pants, paired with decora-
tive t-shirts that displayed hearts, ice cream cones, and various Disney characters.
As the analysis progressed, she showed a more consistently pulled-together look,
as signaled by her braided or neatly combed hair, pulled back from her face, and
often adorned with colorful hair bands or barrettes.
Ella always impressed me as having the capacity to engage collaboratively. She
seemed to enjoy the close-in attentiveness and understanding. Curious to listen
and consider the meaning of my interpretative comments, she often demonstrated
a short while thereafter that she had taken onboard a word or an idea from an
earlier moment together. She was not at all shy to communicate her strong feel-
ings, including her upset and her criticism of me. Sometimes, Ella was quick to
take on the role of a pretend schoolteacher who told me the rules or scolded me
for my “misbehaviors.” For example, she would say sternly: “Shh! Shh! Leave
me alone!” Or she would alternate a play sequence, one moment by working with
me at the child table, then suddenly taking the toy characters to the floor where
I could no longer see what she was doing or hear what she was saying.
Ella’s communicative disturbances were a formidable hurdle for me to man-
age at the beginning of the therapy. At first, her words tumbled out, rapid-fire, in
a jumbled, condensed manner. I found myself trying even harder to decipher her
messages. I wondered: Was she beckoning me, or creating a barrier to what she
had to say? Perhaps both hypotheses were true, as I reflected that she was prob-
ably expressing conflict for me both to hear and not to hear her. I suspected that
my feelings of confusion and helplessness were at times reflective of her diso-
rientation in a complex world that overwhelmed her. Fierce confrontations had
developed with her mother whenever Ella grew frustrated by her mother’s dif-
ficulty making sense of her words. Therefore, I refrained from having Ella repeat
what she said and simply tried to immerse myself in the feeling of “not-knowing”
(Bion, 1962) and in the profound symbolic richness of her play. Over time, I came
to understand her words most of the time. Looking back, I think this situation
resulted, in part, from an actual growth in her language ability (as noted objec-
tively by the speech therapist and by her parents), from my learning to decode
her “language” over time, and from her symptomatic relief as we slowly worked
through some of her conflicts.
Ella’s creativity and hunger for a relationship knew no bounds. She regarded
each and every element of the physical setting as a potential vehicle through which
to convey her conflicts and internal psychic life. From the get-go, she redesigned
the office setting into an “open-floor” plan that included the sparsely furnished
waiting room. One of the functions of this enlarged play space was to reveal her
rejecting object relationship (Fairbairn, 1952). By claiming the waiting room as
her private territory, in effect, she banished her mother from her space to symboli-
cally retaliate against her mother, who turned her away from her business calls, or
46 Caroline Sehon
against her father, who traveled or retreated to bed. Once I realized that Ella was
occupying the waiting room, in part, as a way to exclude her parents, I secured
an alternate waiting room from one of my colleagues for the parents’ use. In no
uncertain terms, Ella was also asserting her agency and control in relation to me
and the setting as transference objects.
Initially, the sessions took place entirely in the waiting room. Later, she moved
to and fro between the office and the waiting room. As Ella conquered her separa-
tion anxieties and worked through various conflicts and traumas, she relied less on
the waiting room, transitioned more easily from the waiting room into the office,
and allowed me eventually to close the door for “our privacy.” I provisioned Ella
with her own box for her drawings that she chose to keep at the office, and I took
a photographic record of drawings she wished to take home.

Vignettes over the course of the analysis

To illustrate Ella’s use of diverse therapeutic objects, I selected several vignettes
from the initial session and the early to middle phases of the analysis, between
when she was four years nine months old until when she was six years four months
old. I highlight how I understood my role in advancing Ella’s development and
the rationale for why I intervened in the way I did at particular points of urgency
(Baranger, 1993).

Vignette no. 1 (our first encounter)

My first meeting with Ella, when she was four years nine months old, etched an
indelible mark in my mind. I was drawn to her way of relating to me, to the office
toys, and to the analytic setting as both transference and developmental objects.
I felt her willful desire to be seen and known by me and her fierce determina-
tion to convey the troubled and resilient areas of her inner world. Although her
words were sparse and her articulation distorted, her narrative was compelling
nonetheless.
With eager anticipation, I expected to discover an involved mother-child
pair given her extreme separation anxiety. On the contrary, Ella unhesitatingly
parted from her mother and walked stoically into the office. A complex scene
unfolded. Without making eye contact or uttering a word, she collapsed to the
floor and examined the toys from a safe distance. I knelt next to her, watched,
waited, and followed her lead. Hedging her bets, she glared at the toy animals
and crawled on all fours, as if mimicking an animal in the wild facing a crowd
of ominous predators that she would have to either fight or flee. Throughout the
first 20 minutes, she remained mute. In tandem with her hypervigilant stance,
I noticed ways that I felt gripped by this unusually dramatic entrée into our
work together. She seemed to regard the toys as a potential danger. In contrast,
she appeared to feel safe, as she crawled next to me on the floor, as if inviting
me to join her as a co-investigator into this novel environment and into her
inner world.
 Creating a new relationship in analysis 47
Then the atmosphere shifted to become soft and calm. Ever so slowly, she
warmed to my offer to explore objects within her view. She tentatively reached
out to pick up a tiny baby doll. I responded in a quiet, gentle, whispering voice:
“Oh! A baby!” In turn, she picked up a miniature sleeping bag and then repeatedly
tried to force a larger baby doll into the unyielding small space of the sleeping
bag. When I commented, “Oh, the baby doesn’t seem to fit in that small space,”
she persisted energetically until finally surrendering from fatigue. Although
I uttered a few words, she held hers back as if to minimize the chance of feeling
dropped by me. As I had learned that her garbled words often “fell on deaf ears,”
I suspected that she would need time before she could entrust me with her words.
In resonance with her mute stance, I also felt lost for words amid intense feelings
of curiosity and concern. A short while later, she picked up the wheelchair in the
dollhouse and then, suddenly, a small girl doll fell over.

ANALYST: Oh!
ELLA: (Uttering her very first words)
She fell over!!
ANALYST: Oh! Ouch! Is she hurting?
ELLA: (Emphatically)
No!! She’s okay.
ANALYST: Oh, maybe it hurt her, at first. We can pretend.
ELLA: (Louder and insistently)
No!! She’s okay.
ANALYST: Oh, okay.
ELLA: (She pretended to fly a butterfly and suddenly dropped it.)
(Flatly, she said) It died.
ANALYST: Oh, it died! Oh, that’s sad!
ELLA: (She smiled and laughed.)
ANALYST: Oh?! You’re laughing, but the butterfly died.
ELLA:  (She picked up another butterfly on the bookcase and lifted it up in
the air.)
(With excitement) Look! Look! A purple butterfly!
ANALYST: Yes, it’s so pretty.
ELLA:  (She pretended it was flying, stopped it in flight, and then looked at
me while continuing to hold it airborne.)
ANALYST: Oh! What’s happening?!
ELLA: It’s thinking.
(I was utterly amazed by her remark and the sense that we had just
ANALYST: 
taken a quantum leap forward.)
Oh, okay! Let’s give it time to think.

[There was a timeless quality to the atmosphere as she continued to hold the
butterfly in the air, shifting her gaze back and forth between me and the butterfly.
We both waited, looking together at the butterfly and at each other. I was fasci-
nated by Ella’s play. A short while later, I spoke softly, again with curiosity.]
48 Caroline Sehon
I wonder what the butterfly is thinking. I’m going to ask the butterfly. What are
you thinking, Butterfly?

ELLA: (Gazing seriously at me)

Are you pretending?
ANALYST: Yes, I’m pretending. We can do that together. . . .
 (Near the end of the session, as I returned the dollhouse to its usual
location, suddenly Ella pled her case.)
ELLA: I want you to keep all the same.
ANALYST: Okay, I will try hard to keep the toys in the same place.

*****
In a certain sense, we can regard this first encounter as representing a fractal that fore-
shadows and summarizes the entire story of the analysis. What are the anchor points
of this narrative (Bernardi, 2014)? Ella conveyed an image of a child who moved
about the world as a baby, unable to support her weight as expected by her age and
developmental stage. She made tireless efforts to push a baby doll into the “crawl
space” of the toy sleeping bag, as if to convey her sense that earlier developmental
needs had gone unheeded. She picked up a wheelchair, perhaps symbolically suggest-
ing her need for holding and repair of her broken self. The first butterfly dropped to
the floor and died, suggesting Ella’s meltdowns when she became overwhelmed in the
absence of holding and containment. Was she conveying her unconscious hope for a
second chance, in which she and I would help her grow thinking capacity, just as the
second butterfly could do? Defensively, she expressed an illusion of infantile omnipo-
tence, declaring emphatically that the baby was numb to the pain of being “dropped.”
At the same time, she expressed the desire to find a “good-enough,” accepting, new
object relationship to afford her a sense of safety, where things are “(kept) all the
same” and where thinking (and a mind) could develop at long last.
In summary, this first vignette spoke to her wish for a secure base and for her
use of me as a developmental object that would allow her to unveil earlier selves
that longed to speak and be heard. This inaugural scene displayed images of a
split, contextual transference to me as both a benevolent and a malignant object.
Although I was in role both as a transference object and as a developmental
object, my hope at this stage was merely to take my first baby steps forward as
Ella’s analyst. I aimed to earn her trust as a developmental object, as someone
who would listen to her, mirror her initial utterances, and encourage a gradually
deepening conversation with me through play and language. On the basis of her
early powerful impact on me that would eventually develop into a complex coun-
tertransference, I was beginning to form hypotheses for how Ella might discover
and employ me as a transference object, as her internal mother, father, and other
important attachment figures. In the meantime, I needed to remain in a state of
suspended animation and of “not knowing” (Bion, 1962) and to enjoy the intrigue
and mystery of the here-and-now with Ella.
 Creating a new relationship in analysis 49
Early phase of psychoanalytic therapy
Ella readily settled into the twice-weekly analytic therapy. At the start of each
session, I usually discovered her at the child table in the waiting room, immersed
in her drawing, while her mother read nearby. Ella conveyed her need for me to
witness her first drawing of the day while we sat silently together in the waiting
room. Sometimes she enjoyed commanding me to bring her markers from inside
the office. I found this request to be particularly compelling given that she already
had access to an identical set of markers in the waiting room. I surmised that Ella
needed to use me as a developmental object in this way so as to create a symbolic
bridge between the waiting room and my office. I thought she was partnering with
me to bolster her nascent self-regulating function as she struggled to transition
from her life at school, to her commute to my office with her mother, and finally
to our play space.
Using me as a transference object, Ella kept me waiting at the start of ses-
sions by demanding “Privacy! Privacy!” She insisted that I not look at or speak
to her as she collected her thoughts and feelings represented through pictures
or play. This resounding phrase, “Privacy! Privacy!,” seemed highly precocious
for a child of this age, and all the more so for Ella given her language delays.
I wondered if she was repeating this command to re-enact a dynamic with me
that echoed her mother’s use of that phrase. At times, if I simply said, “Hmm,”
or, “I see many hearts on your drawing,” she would say in a pseudo-adult voice,
“Wait! I am working! . . . I need to do this! . . . I need my privacy!” Although she
appeared anxious when her mother left, it was not unusual for Ella to later press
up against the time boundaries at the end of the sessions so as to keep both her
mother and me waiting.
In the early phase of our work, Ella spoke in a strident, demanding, urgent
tone, lest I not take her seriously or question whether she was in charge. She
would decide when she was ready to leave the waiting room, and she seemed
pleased at being able to reject my invitation into the office. She hurled her
directives like projectiles, putting me on notice to stay out of her play, regard-
less of whether I briefly commented or intervened in a careful and sensitive
way. At times, she would yell, “Stop! Stop! My brain hurts!” or she would cry
or collapse onto the floor. As she settled into the sessions, her affect usually
became calmer and she could engage in symbolically rich play. She seemed
to derive pleasure at making eye contact, at my tracking her play, and at our
shared engagement that nonetheless emphasized her lead role. During this
early phase, she occasionally allowed me to make brief comments about our
interaction.
Although the transference became clearer over time, she often blocked me from
making any direct transference interpretations. For example, she might say, “Now,
now! Let’s not talk about that right now!” Instead, I gathered the transference to
me or made transference interpretations in the displacement, while serving pri-
marily as a developmental object.
50 Caroline Sehon

Figure 4.1 Baby

Early to middle phases of the psychoanalysis

Vignette no. 2
Although Ella showed no separation anxiety in the initial meeting, this quickly
gave way to her becoming extremely anxious when her mother would depart.
The parent work helped the mother hold firm as she assured Ella of her return
45 minutes later. During the first few months of the analysis, I often discovered
a gripping image of Ella sobbing in the waiting room with her mother sitting
nearby. This phenomenon initially surprised me given Ella’s insistence that her
mother not occupy the waiting room and given her frequent reluctance to leave
the office at the end of the hour. Later I came to appreciate that this dramatic dis-
play of anxiety partly seemed aimed at reassuring her mother of her importance
and value in Ella’s mind.
After the mother departed, Ella often collapsed on the floor of the waiting
room into a formless heap and soothed herself by twirling her fingers atop the
white noise machine with my silent presence nearby. Or she would lean her spine
against the legs of adjacent chairs as if to collect herself by means of a hard,
autistic object (Tustin, 1980). Through these moments that lasted usually 10 or
 Creating a new relationship in analysis 51
15 minutes, I labored with feelings of helplessness as I witnessed her annihilation
anxiety. As I discovered that my words caused her more distress, I learned that
my quiet presence offered her the salve to recover more of her collaborative self.
On this occasion, it had been a few months since she had exhibited such extreme
separation anxiety, so I was perplexed that we were revisiting this situation. As
her mother got up to leave, Ella clung to her mother’s leg and wailed and whined.
The mother reported that Ella had just become extremely upset after getting water
on her dress and that Ella’s distress had escalated when the mother comforted her.
Shortly thereafter, her mother left.

ELLA: (Yelling loudly and angrily) Privacy!! Privacy!!

ANALYST: Oh, okay. I’m going to sit here now. I will not look at you, Ella, to
give you the privacy you are asking for. (I was reminded of the gaze
aversion to which infants resort as a way of self-soothing in the face
of a depressed or overexciting object.)
ELLA:  (A short while later, she slowly crawled down from the adult chair to her
usual place at the child table in the waiting room and began drawing.)
I don’t want to talk! I need my privacy!
ANALYST: Yes, I’m going to draw here next to you. I’m not going to talk right
now to give you your privacy.

For about ten minutes, we drew side by side. I noticed she would look up at me
in a seemingly purposeful way as if communicating nonverbally that she valued
my calm and quiet presence and my availability to speak or engage with her when
she felt ready. I followed her lead and returned her gaze from time to time. She
seemed to calm down further when our gaze met.

ANALYST: When you feel calmer, I would like to have a chat with you.
ELLA: I’m not calm. I need to draw until I’m calm.
ANALYST: Yes, drawing can sometimes help you feel calm when you’re upset.
ELLA:  (Looking at me affectionately, she scribbled in the heart.) Baby.
Baby.
ANALYST: Baby.
ELLA:  (She completed the drawing, gathered herself, and looked up at me
with self-composure.)
Okay! I am ready now.
ANALYST: Okay. (We entered the office together, and I closed the door to the
waiting room behind us.) . . .

As the session neared its end, she reverted to hurling “Privacy!” and tried to pro-
long the session rather than reunite with her mother. The following exchange cap-
tures a common pattern at this phase of our work.

ANALYST: It’s time now for us to stop for today.

ELLA: No! I’m still working! Privacy! Privacy! (She opened the door to
glance at her mother and then slammed the door and remained
52 Caroline Sehon
with me. She repeated this sequence a few times while smiling and
giggling.)
ANALYST: Oh! You’re in charge!
ELLA:  (She transformed into a calm and collected little girl and seemed
interested in my comment.)
I’m not in charge!! Why am I in charge?!
ANALYST: At the moment, you’re in charge about when you will go out to see
your mom.
ELLA:  (With mild pleasure, she repeated this sequence an additional few
times, seemingly enjoying that she held the power and control. On
the turn of a dime, as if commanding a Broadway performance, she
looked at me, morphing into an extraordinarily pleasant child as if
interested only in complying with my authority. In a charming way,
she looked at me while wearing a half-smile, and asked in a coquet-
tish voice)
Can I leave now?
ANALYST: Yes.

After gently opening the door and leaving it slightly ajar, she reunited with her
mother. In an unprecedented manner, she hurried back a few moments later,
peeked inside the office, smiled at me, and then promptly slammed the door
behind her. Effectively she had trapped me in the office. I was gripped by this
unusual sequence that erupted beyond my control and by her crafty way of defy-
ing the time boundaries until she would emphatically decide when the session was
over. Then I opened the door, looked at her attentively and with a partial smile,
as a way of signaling that her aggression had not “killed me” off and of marking
these moments that would need to be unpacked and understood on another day.

*****
At the start of the session, Ella became unmoored when she accidentally wet
her dress. I suspected she was angry at her mother for not protecting her from
her own mishap. In all probability, her aggression disorganized and frightened
her, especially given that her mother left shortly thereafter. Perhaps this sequence
confirmed Ella’s unconscious fear that her aggression could be “deadly.” As
I slowly became the recipient of Ella’s anger, she found comfort in knowing that
I would remain with her without retaliating and without leaving. In other words,
Ella needed to use me and the setting as developmental objects to gather herself.
Her fear and annihilation anxiety were at an all-time high, and her capacity for
thinking was at an all-time low. It seemed to me that she could not use direct
transference interpretations at moments when her sense of self was so fragile.
Although I continued to listen to the transference, I aimed mainly to support her
self-soothing through use of me as a developmental object.
This elaborately enacted narrative signaled also how Ella had used the temporal
and physical dimensions of the setting as a proxy for me in role as a transference
 Creating a new relationship in analysis 53
object. She seemed intent on my momentarily experiencing her hatred of the fact
that I controlled the time boundaries. During these early days, her aggression
came into the room mainly at such moments of separation, probably when she
felt safe. In this exchange, there was no disputing that she had effectively used
me as a transference object. I had become the internal mother. Ella thus marked a
transformative moment in the analytic journey, signaling that she was now ready
to work directly in the transference.

Vignette no. 3
This vignette marked another important shift in the work, as Ella seemed capable
of using me more as a transference object than as a developmental object. At par-
ent meetings, I had learned that Ella had become frightened by heated verbal alter-
cations between her parents. During this phase of our work, Ella seemed to draw

Figure 4.2 Flower petals

54 Caroline Sehon
comfort from my welcoming her aggression toward me by “wearing the negative
attributes,” so she, in turn, could withstand her own aggression. We also had been
working on her disappointment that I could not read her mind, which would have
relieved her of having to verbalize her feelings and thoughts. That would have
proved that I perfectly understood her. I suspected she longed to become at one
with me as her internal mother, while she feared such intense closeness would
threaten her sense of self. Over previous weeks, Ella and I had been working on
distinguishing those times when she needed my assistance from moments when
she could exercise her independence. Occasionally, she summoned the courage to
express her helplessness and neediness by hurling a command for “Help!,” albeit
with an angry tone.

(She asked
ELLA:  for help by asking me to place a silver pipe cleaner to
form the petals of a flower without giving me specific instructions.)
(sternly) “No!! Not like that!”
ANALYST: Oh! I got that wrong! You seem upset with me.
ELLA:  (Immediately, she tried to do it in her own way but was terribly dis-
appointed by the results.)
Ughh!
ANALYST: Oh! Now you seem upset with yourself!
ELLA: (She darted several feet away to take refuge under the child table.)
ANALYST: Oh! You have leaped away, almost as if you are giving yourself a
time out.
ELLA:  (From under the table, she faced me, and smiled. Then she reached
for a light switch, turning it on and off repeatedly.)
(Excitedly) Look!
ANALYST: Yes! I see the light is going on and off, on and off. One moment it
is on, and the next moment it is off. That’s like what happened here,
one moment you’re not upset, and another moment you are upset.
ELLA: (In a sing-song voice, she made up the following song.)

You’re my best friend ever

You can be my best friend forever
You can be my best friend forever
I love to say
You are the best thing for me
I know you can be my best friend forever
So you can see
You’re my best friend ever

*****
On this occasion, Ella flew into a rage because I incorrectly shaped the flower
petal. Then, she turned her aggression back on herself, after painfully realizing
that she was unable to rely upon me as a mind reader. Her sense of pseudo-
omnipotence began to crumble, and her aggression toward me threatened her
 Creating a new relationship in analysis 55
sense of safety. She risked losing me as a developmentally “good-enough” object,
only to feel in the hands of a negative transference object that could reject her by
abandoning or turning against her. She exclaimed “Ughh!” in self-disgust, as if
she had turned herself into a “bad object” in order to rescue me as a good mother
in the transference (Fairbairn, 1952). Frightened, she sought refuge under the
child table, as if the physical setting were a proxy for a positive developmental
object that could reliably offer her safety and comfort.
By this point in the analysis, Ella was able to utilize the language and under-
standing I provided as a container, rather than relying principally upon me in
more primitive ways. Ella’s playful use of the light switch seemed to reflect her
capacity to work in the transference. We could now engage in an elaborate nar-
rative where distorted beliefs about herself and about me could be transformed
(between “on” and “off”), rather than her simply holding both of us to a fixed
position in which she was in charge and I was embattled. Near the end of the ses-
sion, she gifted me with her song that celebrated our valued partnership and her
creation of me as a “new object” with whom she had fallen in love and toward
whom she could express rage without her world collapsing.
During this session, it seemed clear to me that she had found and used me as her
internal mother. While I listened to the transference, it still felt premature for me to
interpret her aggression as an attack upon her sense of neediness. Therefore, I con-
tinued primarily to serve as a developmental object by supporting her capacities
to self-regulate; to assert her agency; to tolerate ambivalent feelings; and to grow
her confidence in the analytic relationship. Nevertheless, the heat of the action still
seemed more centered on her creating and using me as a transference object.

Vignette no. 4

Figure 4.3a Constellation of stars

56 Caroline Sehon

Figure 4.3b Heart

The following vignette occurred amid growing parental conflict about diver-
gent views of Ella’s bedtime routine. Mother was concerned that Father would
rile Ella with excited, over-stimulating play or at the very least oppose her efforts
to help calm Ella. Ella’s mother would then try to establish a boundary with Ella’s
father and with Ella.
As I opened the door to the waiting room, I noticed that Ella seemed to be in
a relatively upbeat mood. As her mother rose to depart, they interacted playfully.
Ella protested her mother’s leave-taking by hugging her leg, but it seemed entirely
playful as she cajoled her mother to stay.

MOTHER: I need my leg back. No! No!

ELLA: (Ella released her grip and darted into the office. Mischievously, she
tried to close the door to block me, as if wanting to lock me in the
waiting room. Although I had my keys in hand, I worried that this
scene could quickly get out of control. This sequence was a first, so
I felt completely unprepared. I slipped into the office, while she gen-
tly pressed the door against me.)
ANALYST: (In a firm and steady voice) No, No! We don’t do that.
ELLA:  (She gently resisted a couple times, but then quickly gave up. She
tossed off her shoes and leaped onto the couch.)
Mamma! Mamma!
(She climbed on to the top of the seat cushions, plunged into the
couch head-first, and then began kicking her feet against the back of
the couch.)
 Creating a new relationship in analysis 57
ANALYST: 
(Uncharacteristically, I sat down at my desk chair, momentarily
catching my breath to think. I felt de-authorized. I realized that my
retreat to my grown-up chair would not serve us well. Hoping to
inspire potential engagement, I repositioned myself quickly to one
of the small chairs next to the child table, while she remained on the
couch several feet away.)
I think you don’t like when I say No. I’m not mad at you when I say
no, but . . .
ELLA:  (Talking over me, she spoke quickly and angrily. Her words had
decayed so I could not understand them but there was no mistaking
that she was upset with me.)
ANALYST: Oh, I guess you’re not ready to hear what I have to say.
ELLA: (She paused as if trying to listen.)
ANALYST: I think when I say, “No!” you might think I’m mad at you, or that
I don’t like you anymore, which is scary.
ELLA: (She stomped her feet on the couch.) No! That’s not it!
ANALYST: That’s not it?
ELLA:  (She jumped off the couch angrily, stomped over to where I was
seated, and turned her back to me. She fiercely shook her body from
side to side.)
Grrr! Grrr!
ANALYST: You’re really showing me your angry feelings. There is room in here
for those parts of you too.
ELLA: Grrr! Grrr!
ANALYST: Grrr! Grrr! Use your words to say what you feel.
ELLA: Stop!
ANALYST: Stop?! You want me to stop talking? Oh.
ELLA: (A very short while thereafter, she became much calmer.)

She began to draw a heart. Respecting that she probably wanted quiet, I decided to
draw an illustration next to her – a constellation of three stars with her name writ-
ten above the stars. (The pseudonym “Ella” was inserted to protect confidentiality.)
From time to time, she looked over at my picture as I showed interest in her image
of a heart. Then she asked if she could color in the stars, added a yellow star between
and underneath the large stars, and asked me to write my name above her star.

(I recognized that she still seemed immersed in the joint construction

ANALYST: 
between us as we approached the end of the session.)
Ella, I am thinking that we could use this box for projects that we
are still working on and that aren’t yet complete. We can keep all the
supplies you and I are using in here.
ELLA: (She smiled.) You read my mind!
ANALYST: Oh! Sometimes you and I come up with great ideas together.
ELLA: (She continued to cut out the heart she had drawn.)
ANALYST: I notice you seem much calmer now than you were at the start of the
session. Sometimes you’re mad at me, and sometimes you’re happy.
58 Caroline Sehon
And today we can see how one feeling turned into another, and now
you seem to be very calm.
ELLA: (She started coloring in the heart, in red.)
ANALYST: Okay, it is time for us to start cleaning up. (I began putting away the
markers.)
ELLA: Keep the red pastel out! Now, tape this! (She helped herself to cotton
balls, positioning them behind the heart, which she then placed on
the back of the co-constructed illustration. A short while later, the
session ended.)

*****
Many noticeable firsts occurred at this point because language and symboliza-
tion could increasingly enable her to use me in an advancing transference object
role. In the waiting room, Ella hugged her mother’s leg as she was accustomed to
rough-housing with her father before bedtime. Then she pushed the door frame
against me in a show of unprecedented force to press up against my boundaries.
Perhaps her mother and I had swapped roles – she related to her mother as if to her
father, while Ella challenged me as her internal mother.
Looking back, I thought my illustration unconsciously expressed the family
constellation. She had employed me as a symbolic family member. I had placed
a small star between two “grown-up” stars, perhaps unknowingly conveying a
wish that Ella (as the little star) would feel held by her parental couple (shown
by the large stars). I Iined the letters of her name directly along the border of the
stars as if I were wishing to provide her with my internal analytic setting as a new
foundation for her self-development. I wondered: Might Ella have come to feel
more secure as the session progressed because we were able to recover from our
earlier confrontation, evidenced by her locating herself (by her little star) front
and center on the page (or in my mind)? I inferred that she was relying upon me
to carry both positive and negative transference dimensions. She chose to add the
heart to the underside of our shared drawing, transforming it with the cotton balls
into a more fully embodied and enlivened heart. Perhaps she was conveying that
our work was gaining momentum, founded by our heart-filled moments together.
These drawings represented the first time that she had allowed us to share art-
work, reflecting the deepening of the analysis and the growth in her use of me as
both developmental and transference objects. This vignette captures the way that
she was learning to tolerate loving and hating feelings toward the same object,
as she moved back and forth between paranoid-schizoid and depressive forms
of relating (Klein, 1935). She was developing a capacity for ambivalence as she
gathered more sense of a self that would allow her to recover from distress and
disappointment. Spoken communication was now serving as a container (Bion,
1962) for her aggression, so we could make psychological sense of her experi-
ence to enable further developmental steps. My drawing revealed countertransfer-
ence attempts to make sense of the transference, recognizing that Ella desperately
needed a sense of security that would come from my maintaining the firm bounda-
ries of the analytic setting.
 Creating a new relationship in analysis 59
Vignette no. 5
In contrast with the previous vignette, the following session called for me to serve
more in role as a developmental object, hearkening back to an earlier phase of
analysis. By this time, Ella knew well that it was paramount to use words to
express her affectionate longings, and yet she still periodically pressed against the
boundaries by flying toward me with a hug or wishing to touch my necklace. In
this session, I was helpless to resist her impulsive demand to gratify her wish to
penetrate my body and mind.
We began by collaborating nicely. As she drew, we sat next to each other at the
coffee table on the floor. She allowed me to comment without forbidding me to
speak or look at her drawings, also a sign of progress in the analysis as her transfer-
ence to me as a rejecting object began to soften. Suddenly, she moved over from
where she was sitting to rest her face against my leg. Immediately, I pulled my leg
away. As I did so, she made brief but forceful contact with me by bumping her body
against my leg. She commanded, “Scoot over!” Before I could apprehend what was
coming next, she tried to slither under my legs that formed a triangle with the floor.
Was she relating to my body as a make-believe bridge that she could crawl under?
I tried to reiterate again the importance for us to find words or toys to express her
desires and imagined stories rather than using my body as a prop.

ANALYST: Oh, you’re wanting to pretend my legs are a bridge. (I began to stand
up.) No, we need to try to find toys to make a bridge. (Unbeknownst
to me, the palm of her hand was positioned near the heel of my shoe.
As I moved forward, she let out a loud cry, followed by a whim-
per. Shocked, I apologized and expressed concern about her injury.
I refrained from speaking again to her misuse of my body so as not to
shame her, while locating the responsibility solely within me at this
stage.)
ELLA:  (In a heartbeat, she ran away from me and retreated to the arm of the
couch with her back to me. After a brief silence, she reached for the
sand tray and brought it back, reclaiming her former seated position
next to me. Ever so slowly, she kneaded the sand, looking up at me
from time to time with a half-smile.)
(As she turned over the sand and self-soothed, I reflected on what
ANALYST: 
I might say. I wondered what she would be able to take in and imag-
ined a complex set of ways that she might have experienced this
injury. Had she disowned her aggression by projecting it onto me,
only to then experience me as intentionally hurting her? Was she
upset at herself for trespassing on my body in ways she knew were
not allowed? I spoke slowly, measuring my words and trying to use a
gentle, caring tone as I ventured forward in the role as a containing
developmental object.)
  Earlier in the session, you and I were playing nicely together, and
it seemed as if we were enjoying talking to each other. Then I acci-
dently hurt you. I am very sorry that I hurt you by mistake with the
60 Caroline Sehon
heel of my shoe, but maybe it is not necessary for the good feelings
between us to be washed away by that unfortunate event.
ELLA:  (She continued to knead the sand and seemed to be listening intently.
We sat together in silence for a few brief moments. Outside my
awareness and ever so quickly, she rose and hugged me by gently
encircling her hands around my neck from behind.)
(As the end of the session neared, she seemed unable to use words to
ANALYST: 
seek reparation for our shared faux pas.)
 Oh, I think maybe you are trying to tell me that you forgive me
for what I did and that you like it that we can talk about these things
together.
ELLA:  (She resumed her sand play in silence amid a calm atmosphere
between us.)

*****

In this session, Ella was unable to restrain her impulse to express her longing to
use my body as a bridge or to hug me, and I felt impotent to protect her from her
own urges. As I tried to re-establish the firmness of the boundaries by moving my
body away and by invoking the importance of words, I caused her to experience
an “injury” that shocked us both. Retreating, she used the sand as a self-soothing
device that was a creative and resourceful way to rely upon the setting as a stand-
in for me as a developmental object that could comfort her even in the face of her
hurt and the wedge between us.
I opted against interpreting the transference in that moment as I thought that
it would overwhelm her and complicate her anger at me for rejecting her loving
feelings, her guilt for her own contribution in producing her hurt, and her ambiva-
lence. It was only near the end of the session that she seemed to gather herself, so
I thought she could not make use of a transference interpretation.
At later stages of the analysis, Ella was able to contain her impulse to using my
body. For example, she would come running toward me as if about to give me a
hug but come to a screeching halt a foot away from me. She became more ame-
nable to directing her affection or aggression into play or to using her words and
powerful imagination to communicate her affects.

Vignette no. 6
At earlier phases of the analysis, Ella was unable to verbalize her feelings directly
to me as we anticipated separations. We used a calendar to prepare her for such
absences and to mark the continuity of our work. On this occasion, in contrast, she
was able to create a highly imaginative play narrative that not only conveyed her
feelings of longing and sadness but also showed her growth at representing her
affection for me through the play rather than through my body.
Ella was about to leave with her family on an atypically long five-day vacation.
As I opened the door to the waiting room, she was seated at the child table, quietly
Figure 4.4 Lego project before a separation

Figure 4.5 Child between two trees

62 Caroline Sehon
drawing. She remained seated briefly with her head down, neither acknowledging
me nor bidding her mother farewell. She finished her drawing quickly, then made
her way into the office with her drawing in hand.

ANALYST: (I closed the door after she entered.)

ELLA:  (Inside the office, she stood against the child table looking at the toys
in a deeply reflective stance. Then she sat down and began tossing
the Legos back and forth between her hands without using them to
make something at that moment.)
ANALYST:  (At a recent session, I had assembled the Legos in a sequenced for-
mat to represent the sessions progressing through the week as one
way to prepare for the upcoming separation. I positioned a Lego tree
on a brick to identify the current day and moved it along the bricks
to mark the days intervening during the separation.) This is Tuesday,
then we will meet on Wednesday, Thursday, Friday, and then we will
be apart from each other for five days.
ELLA:  (She looked at me attentively. Then she showed me her drawing that
she had been working on in the waiting room. Ella typically did not
wish to discuss her drawings, so I came to regard them much like
a dream in a session, where all subsequent commentary could be
regarded as associations to the picture or dream.)
ANALYST: Hmm, you are between two really big trees. Oh! I didn’t mean to say
that was you. I don’t actually know that is you. And there are music
notes.
ELLA: (She nodded her head without uttering any sounds or words.)
ANALYST: Oh, it is! Yes, you are between two really big trees. And there are
music notes too.
ELLA:  (She started to sing.) La, la, la, la. (She went to the corner of the office
and descended upon a basket that was filled with stuffed animals.)
ANALYST: It looks like you’re giving all the animals a really big hug, but it
seems also that you have very strong feelings as you stay there in the
corner.
ELLA:  (Ever so slowly, she picked herself up, then caressed and touched the
stuffed animals with affection. Slowly fingering the otter’s whiskers,
she looked over at me. Our gaze met. I was moved by her expres-
sion of deep sadness, sensing also that she wanted me to notice her
sorrow.)
ANALYST: As I watched you giving the animals such a big hug, it reminded me
of a day when you used to want to give me a hug. Now you’re able to
do what you couldn’t do before, to give the animals a hug and show
us your feelings with the toys as I’ve asked you to.
ELLA: That was what I did when it was a new way (meaning when we had
just started meeting), and now I do what is an old way, because now
I come here every day (which was not actually true, as we met Mon-
day through Thursday, for four days each week).
 Creating a new relationship in analysis 63
ANALYST: Yes, we’ve come a long way since those early days, when it was a
new way, and we still have a long way to go. Now we meet almost
every day, and so it can be hard to be apart from one another.
ELLA:  (She returned to the child table while I remained seated a little
longer at the couch. She picked up a Lego character.) This is a police
officer.
ANALYST: (I began to move from the couch to approach her at the child table.)
ELLA: This is what a police officer does. (She pointed to the officer’s shack-
les in hand.) This is what he uses to put a leash on someone, so he
doesn’t go anywhere.
ANALYST: Oh, so he doesn’t go away!
ELLA: Yeah, so he’s trapped!
ANALYST: Oh!
ELLA: (She then motioned aggressively for me to return to the couch.)
ANALYST: (I followed her command.) Oh, you want me to sit here.
ELLA:  (She nodded and sat down on the floor mid-way between the table
and the couch, playing with the Legos, while intermittently looking
up at me.)
ANALYST: Oh, now we are further apart (as she had directed me away from the
table to the couch), but I can still see you. I can still think about you,
and I can wonder about you.
ELLA:  (She proceeded to play quietly, then got up and moved to look out the
window.) Stay there for 155 billion, million days.
ANALYST: 155 billion, million days? Wow! That is a really long time. That
would mean that I surely wouldn’t move from this couch for the
entire time you’re gone.

*****
This vignette demonstrates Ella’s capacity to use me as a developmental object.
Feelings about separation could be verbalized rather than merely enacted. When
we anticipated separations at earlier phases of the work, her play would typically
become quite impoverished. For example, she would count the days on the cal-
endar in a rote way as if she were trying to grasp an unimaginable reality. On this
occasion, in contrast, she directed me playfully to return to the couch and to stay
for “155 billion, million days.” She spoke in a playful tone that lacked the earlier
stridency. As we worked through the negative transference to me as a rejecting
object and as she seemed to internalize me as a “good-enough” developmental
object, she anticipated separations with much less anxiety and engaged in more
imaginative and collaborative play.

Vignette no. 7
As the analysis progressed, not only was Ella more able to use me more effec-
tively as a transference object, but also she was able to receive direct transference
64 Caroline Sehon
interpretations. She built on the work done previously in the displacement of play
and as an example of her readiness to receive in-depth transference interpretation.
I said: “Oh, I think I get something now. . . . (She listened very attentively.) At
home, sometimes your mom is in a meeting with someone, and the door to her
room is closed. At those times, you’re on the other side of the room, all alone, and
maybe you feel lonely and hurt that you can’t be with her. In here, sometimes you
want me to be all alone while you are playing with the toys and the dolls so I know
how you feel at home with your mom.”
Ella seemed able to take this idea on board, as she immediately engaged her
dolls. She disappeared beneath the table to whisper their dialogue between them
outside my view. My direct interpretation would not have been received earlier in
the treatment, even when she could relate to me primarily as a transference object.
By this later stage, we had made major forays into many of her conflicts, and the
analytic relationship had become strong enough to support deepening of the work.

Conclusion
Ella presented originally with profound developmental delays and a high level
of distress. She suffered heightened vulnerability to separation and rejection; she
was prone to outbursts with empathic failures; and she was delayed academi-
cally due to socio-emotional difficulties. Throughout the treatment, she longed
for me to recognize her capacity for growth and resilience, even though her dis-
organized self leaked out in the form of jumbled words, meltdowns, and enuretic
and encopretic episodes. Insecurely and anxiously attached to her parents, Ella
contended with a post-traumatic stress syndrome in which she reenacted experi-
ences of rejection toward me in the transference that reflected traumatic family
links (Scharff, Losso and Setton, 2017). She expressed conflict about dependency,
often stating she was okay when she was hurting or that she could do things all
by herself. At times, she aimed to control me by prolonging sessions, or, in reac-
tion formation, she would say, “Oh, good! It’s time to go home!” At times, Ella’s
emotional lability resembled a disorganized style of relating, expressing contra-
dictory feeling, for instance longing for my help while angrily rejecting my offers.
Although that feature did not appear frequently, when it did, these discordant
wishes were extremely distressing to her.
These challenges were augmented by her speech disturbance, a severe consti-
tutional phonological disorder. For years, Ella felt people could not make sense
of her spoken words, despite her efforts to enunciate clearly. She seemed to think
people ought to know what she was trying to say, if only people would listen. She
was filled with impotence and frustration and often felt unheld and uncontained.
Without being able to communicate reliably, she was deprived of this powerful
way to regulate strong affects. Ill equipped to interact competently, her sense of
self was buffeted by experiencing countless empathic failures. As her commu-
nicative efforts were in vain, it was no wonder that she felt pressured to rely
only upon herself. Perhaps holding her urine and stool were ways to preserve her
internal psychic contents in an external world that often seemed frightening and
unresponsive.
 Creating a new relationship in analysis 65
Fortunately, Ella was endowed with considerable strengths – her eagerness to
relate, her intellect, her symbolic capacities, her determination to communicate
strong affects, and her perseverance in the face of misattunement or misunder-
standing. All these factors contributed to her resilience in the face of adversity.
I have endeavored to illustrate the highly creative ways in which Ella used me,
the office toys, and the analytic setting as developmental and transference objects.
Our work enabled her to advance her development by installing and relating to
me as a “good-enough” object (Winnicott, 1965). By redesigning my office into
her own open-floor plan, she reconfigured the analytic setting as a potent way to
retaliate symbolically against her parents for ways she felt wounded by her sense
of their abandonment. In an analogous way, she would repeatedly say to me, “I’m
busy now, so I can’t talk now!” – turning the transference tables on me. It would
be a long time, however, before Ella and I could begin to work directly in the
transference in relation to my role as a rejecting object.
My first encounter with Ella offered an initial window into her potential use of
me as both transference and developmental objects. That session represented a
harbinger of many salient conflicts and dynamics that subsequently were replayed
throughout the analysis. I have provided several vignettes to demonstrate the
progression over the course of the analysis from her preferential use of me as
a developmental object at earlier phases of the analysis to her growing use me
as transference objects expressed in the displacement of the play or by working
with direct transference interpretations. At regressive moments in the analysis,
I noticed how she reverted to relying on me as a developmental object when she
became overexcited or overwhelmed by affects that collapsed her thinking. Over
time, she became more capable of utilizing her internal resources to recover from
those regressed moments. Gradually, she was able to develop a sturdier psychic
organization, working through traumatic experiences by her use of me as both
developmental and transference objects.
Although it was evident that the analytic journey would take still more time,
at the stage of these examples, I felt hopeful that she could achieve a significant
transformation because of her constitutional strengths, her parents’ commitment
to the work, and the robustness of the analytic relationship. Ella made these sub-
stantive gains largely because of her talented ways of using and creating me, and
all possible objects, within the analytic setting. I am grateful to Ella and her fam-
ily for giving me an intimate sense of her inner world, as she entered my mind en
route to finding her own.

References
Baranger, M. (1993). The mind of the analyst: From listening to interpretation. Interna-
tional Journal Psychoanalysis, 74: 15–24.
Bernardi, R. (2014). The three-level model (3L-M) for observing patient transformations.
In M. Altmann de Litvan (Ed.), Time for Change: Tracking Transformations in Psychoa-
nalysis – The Three-Level Model. London: Karnac.
Bion, W. R. (1962). Learning from Experience. London: Tavistock.
Chused, J. F. (1988). The transference neurosis in child analysis. Psychoanalytic Study of
the Child, 43: 51–81.
66 Caroline Sehon
Fairbairn, W. R. D. (1952). Psychoanalytic Studies of the Personality. London: Routledge.
Klein, M. (1935). A contribution to the psychogenesis of manic-depressive states. Interna-
tional Journal of Psychoanalysis, 16: 145–174.
Neely, C. (2020, in press). The Developmental Object and Therapeutic Action. Psychoana-
lytic Study of the Child.
Scharff, D. E., Losso, R. and Setton, L. (2017). Pichon Rivière’s psychoanalytic contribu-
tions: Some comparisons with object relations and modern developments in psychoa-
nalysis. International Journal of Psychoanalysis, 98(1): 129–143.
Scharff, D. E. and Scharff, J. S. (1998). Object Relations Individual Therapy. Northvale,
NJ: Jason Aronson.
Scharff, D. E. and Scharff, J. S. (2011). The Interpersonal Unconscious. Lanham, MD:
Jason Aronson.
Sehon, C. (2013). The synergy of concurrent couple and child therapies viewed through the
lens of link and field theories. Couple and Family Psychoanalysis, 3(1): 61–71.
Tähkä, V. (1993). Mind and Its Treatment. Madison, CT: International University Press.
Tustin, F. (1980). Autistic objects. International Review of Psychoanalysis, 7: 27–39.
Winnicott, D. W. (1965). The maturational processes and the facilitating environment:
Studies in the theory of emotional development. The Hogarth Press and the Institute of
Psycho-Analysis.
5 Analysis interminable Nancy L. BakalarAnalysis interminable

The analyst’s self as object

for the patient
Nancy L. Bakalar

Over the past four or five years I have developed a particular interest in patients
whose treatments seem to have dragged on too long. I am referring to patients
who have been in therapy for more than five years, made appreciable gains in
their relationships and in work, but then seemed to be stuck. Quinodoz termed
these patients “heterogeneous” (Quinodoz, 2001) in that they are capable of sec-
ondary process thinking but suffer from unconscious splitting and private periods
of misery. Another way to think about them is that they have both pre-Oedipal
and Oedipal dynamic issues. In several of my cases, the treatment was at a cross-
roads: I needed to help each patient move toward termination or to institute a
more intensive treatment of psychoanalysis to try to get at the root of the apparent
impasse. After many years of practicing, I now offer these patients analysis ear-
lier in their treatment. These are patients whose character structures have at least
minimal permeability, so that I have a sense that I can be taken in and used as an
object, but who seem unable to let themselves fall into close relationships because
they are guarded and lack trust. Patients who cannot attach to the therapist or the
therapeutic work or whose character structures are so narcissistic and rigid that in
the countertransference I feel dehumanized, I have not tried to treat. The patients
I describe here are in a category between those who are depressed and/or anxious
and those who are unreachable because of severe narcissism or psychosis. These
are patients who relate to others socially but suffer internally in that they are not
able to love or feel loved, suffer from severe affective distress, and are blocked in
their development.

Freud’s ideas about interminable cases

Freud wrote about the limitations of psychoanalysis in several major papers. In
Lecture XXVIII of the Introductory Lectures on Psychoanalysis (Freud, 1917)
and in Lecture XXXIV of the New Introductory Lectures on Psychoanalysis
(Freud, 1933), he seemed to be more optimistic about what might be achieved by
psychoanalysis than in his widely read paper Analysis Terminable and Intermina-
ble (Freud, 1937).
In the later paper, Freud (1937) is more pessimistic about an analytic com-
plete cure. Freud declares, “psycho-analytic therapy – the freeing of someone
68 Nancy L. Bakalar
from his neurotic symptoms, inhibitions and abnormalities of character – is a
time-consuming business” (p. 214). He didn’t believe all patients could be cured
and accepted that failures were inevitable (p. 155). Barriers to cure include what
he identified as underlying biological or physiological causes; the constitutional
strengths of the (id) instincts; weaknesses of the ego; masochism, meaning the
presence of guilt and need or, more specifically, taking pleasure in self-punish-
ment – this latter factor a part of the death instinct.
Hopes for cure vary with whether the psychic conflict arose because of a trau-
matic experience or was constitutional; the severity of trauma – what Freud termed
the quantitative factor; and, finally, the role of the analyst, by which he meant that the
analyst “pulls” for the transference. In modern thinking, we pull especially for the
negative transference, which is then analyzed and “frees” the patient of his conflicts.
In providing the conditions for transference to develop and take hold, the patient’s
conflicts are de-repressed, that is, come into consciousness, where they can be worked
through and, it is hoped, mastered in relation to the analyst.
In this same paper (Analysis Terminable and Interminable) Freud (1937) dis-
cusses in detail the many limitations of psychoanalysis. Describing the ideal
conditions for a successful analysis, he says that the patient’s ego has not been
“noticeably altered” (damaged) and that the cause of the disturbance was an exter-
nal factor, that is, traumatic. Presciently, Freud also noted that if an individual
sustained trauma at a very young age, when the ego was immature, the patient
would be unable to master the trauma; that is, an analysis would likely be unsuc-
cessful or only partially successful. The goal of Freud’s analysis was to make the
unconscious conscious. That is, repressed conflict is brought into consciousness
through the vehicle of the transference, where it can be noted, discussed, worked
through, and then repressed again with less conflict. In sum, the goal was to make
the unconscious conscious.
More modern analytic theorists have taken up the challenges of treating patients
with early, pre-verbal trauma, those who Freud felt were largely untreatable –
patients whose trauma occurred at the very beginning of life or before the age of
language development, when the child had little or no symbolic thinking. (Only
that which can be symbolized can be repressed.) The trauma may have been phys-
ical, sexual, psychological, or simply emotional neglect, a chronic or rather sud-
den cessation of responding to the child emotionally, as in Andre Green’s (1972)
“Dead Mother Complex,” which I will speak to shortly. Patients whose trauma
was pre-verbal may present with dread, angst, confusion, rage, or untamed or
uncontained affects, now often called Bionian beta bits. In contrast to Freudian
analysis, the task in these treatments is to make the conscious unconscious. This
is achieved by allowing the patient to express these strong emotional states in
sessions, with the analyst naming them, not retaliating, and allowing the patient
to “go on being” with the analyst in the wake of affective breakdown and severe
attacks on the analyst. The analyst assists the patient in developing alpha func-
tion by taking in the patient’s raw emotions, or beta bits, inside herself, convert-
ing them to alpha bits, symbolized affects, and returning them to the patient in a
mentally digested form. This helps structure the patient’s mind and brings relief.
 Analysis interminable 69
Master Speaker Series
The theme of the 2016–2017 Master Speaker Seminar Series at The International
Psychotherapy Institute was “The Use of the Self.” I presented a paper titled, “The
Use of the Self: When the Patient Is Stuck, the Therapist Digs Deeper.” In that
paper, I emphasized that the therapist needs to take head on the painful transfer-
ence reactions of the patient which sometimes come as direct attacks. Our task is
to absorb them, not fend them off. These transference reactions give us insight
into how the patient is feeling, what he is suffering, and by that process itself
gives the patient some measure of relief – a sense of being understood. My recom-
mendation in that paper was to view the analytic role as being active internally,
intrapsychically. I do not mean here to be active in relating to the patient. The
theme of our 2017–2018 seminar was “The Use of the Other,” and in this chapter,
I take up that theme from the perspective of what we as therapists and analysts
do to let ourselves be used as an other, as an object for traumatized patients, as
an instrument in patients’ movements toward sturdier character structures, even if
not more total cures.
In the 2017–2018 Master Speaker Seminar Series, Charles Ashbach (2017) pre-
sented a paper titled, “A Reversible Perspective: Who the Subject? . . . Who the
Object?” He said,

Traumatized patients . . . avoid the pain and [sense of] danger associated
with . . . the compromised nature of his/her attachment to the primary objects
of infantile experience [which leads] to fears of abandonment . . . and intense
feelings of ambivalence that threaten the [patient’s] sense of self, security
in object-relationships and his/her ability to lead a satisfying and creative
life.” Ashbach continued, “The patient engages in blockages, confusion and
dangers in the process. . . . The term resistance [has been used] to describe
such moments in [such a patient’s] . . . treatment . . . but we note the dangers
involved with [using this term]. . . . The patient ‘resists’ not because he/she
is stubborn or oppositional, not because of . . . [a] . . . Freudian . . . death
instinct, but because of the. . . [terror of psychic] danger, of the threat to the
[patient’s] sanity . . .”

I agree wholeheartedly with Ashbach’s comments. The word “resistance” is a packed

symbol that needs to be unpacked whenever it arises in the analyst’s mind during
treatment, in supervisions, or in writing. The idea of “resistance” is a place to begin
understanding, not foreclose it. In times past, to say a patient was “resisting” often
took on a tone of denigration. A patient’s resistance has dynamic meaning that needs
to be ferreted out! Why is the patient resisting? What is dangerous in this moment? In
this process? Between analyst and patient at this moment in the transference?

W. R. D. Fairbairn’s theoretical contribution

Fairbairn (1944, 1963) teased out the dynamic mechanisms internal objects
influence in the formation of character structure. According to him, being in
70 Nancy L. Bakalar
relationship with a good enough object does not require repression. However, bad
object experiences link to parts of the ego, parts of the central self, and, for protec-
tion, must be repressed into the unconscious. This maneuver diminishes the sense
of self and saps the life-force from the person because, along with the bad object
experience that is repressed, the part of the self that is linked to bad objects is also
repressed. Patients L and M, described later, intermittently wail about a feeling of
not having a “self.” These patients often cannot live up to their potential in life or
work, their creativity stifled and their ties to others thin and fragile. My counter-
transference experience with these patients is usually one of my feeling not in a
close emotional relationship to them. They have built up a protective shell inside
their mind, and so I feel as if I cannot connect with them emotionally, nor does my
relating to them seem to touch them affectively.
Here are a few quick sketches of patients who have left me feeling blocked out:

• A patient whose mother was sick from his birth and died when he was a tod-
dler. Basically, he went through life never asking for help. He also played a
lot of sports to fill up the emptiness and the loss. I looked for him to attach to
me, but he never really did and left treatment prematurely.
• A woman whose mother was cruel and critical, who likely was not able to
think symbolically, and whose father was an absent businessman. The patient
suffered from hypersexuality and promiscuity and lived a manic lifestyle.
• A man in his early 60s who had recently divorced, lost his job and was some-
times frighteningly suicidal said, “I just want to have fun.” Here, the desire to
have fun was a desire to fill up the void and cover over the dread of an uncon-
scious sense of being alone. Early in this analysis the man’s dreams were also
of a psychotic nature in that the elements of the dreams were not linked.
• Patients with a Dead Mother Complex. Andre Green (1972) described this
psychic situation. It occurs after a child has been in a good (enough) rela-
tionship with his mother, and then something catastrophic happens to her.
The mother becomes severely depressed and withdraws affectively from the
child. Suddenly, the child is related to by an emotionally deadened mother.
The lights go out in his world.

Andre Green’s Dead Mother Complex

Andre Green’s theory (1972) points to a sudden change in the child’s caretaker’s
emotional state. I offer three case examples in which patients suffered with moth-
ers who themselves had Dead Mother Complexes. These mothers could not con-
nect emotionally with their infants and young children. All three mothers seemed
(from what I can glean from the patients’ treatments) not to have been able to
think symbolically – there was insufficient maternal alpha function. To paraphrase
Bion (1962), it takes two minds to think one’s thoughts. The patients described
herein did not have a mother/parent to help them develop their thinking apparatus
by mutual projection and introjection and therefore were unable to convert beta
 Analysis interminable 71
experiences to psychological understanding using alpha function. This occurs
naturally between infant and mother in good-enough mothering and is the mecha-
nism in therapy and analysis most used in treating patients who suffer in ways
described here.

John Steiner’s theory of psychic retreats

In his book Psychic Retreats John Steiner (1993) took up the study of patients
whose intrapsychic organizations spanned characterological types from the nor-
mal to the neurotic, borderline, and psychotic. Steiner’s experience was that these
patients seemed to hide or take refuge in or retreat into an intrapsychic place
where they felt protected from anxiety and pain. Quoting Steiner,

Trauma and deprivation in the patient’s history have a profound effect on the
creation of pathological organizations, even though it may not be possible to
know how much internal and external factors contributed.
(p. 8)

These mechanisms are present to a greater or lesser extent depending on the health
of the individual. In severe forms of pathological organizations, the patient’s mind is
in shambles. While healthier patients intermittently feel overwhelmed with anxiety
and an inability to think, they are only transiently unable to shake their minds free
of collapse. At the more ill end of the spectrum, those patients who have less mental
scaffolding to draw upon, individuals experience the internal attack of repressed
bad objects as coming from the outside. It is the splitting and repression of self and
object; under stress, the patient feels obliterated or annihilated. Quoting Steiner,

These [psychic] organizations are conceptualized as both a grouping of

defenses and as a highly structured, close-knit system of object-relationships.
(p. xi)

Steiner continues,

Sometimes the retreat is experienced as a cruel place . . . but more often the
retreat is idealized and represented as a pleasant and even ideal haven.
(p. 2)

This defensive system offers the patient protection from the fear of annihila-
tion – and therefore there is resistance to giving it up, even though patients suffer
immensely.

It is as if the patient has become accustomed and even addicted to the . . .

[psychic] retreat and gains . . . perverse gratification from it.
(p. 12)
72 Nancy L. Bakalar
This harkens back to Freud’s death instinct and to the ideas he put forward in
Analysis Terminable and Interminable (Freud, 1937). Freud would have viewed
this pathological defensive mechanism as “constitutional” rather than due to
external trauma; as nature, not nurture.

Case of L
I met L about 15 years ago when she sought me out to manage medications for
her anxiety and depression. L worked and was reliable in her job. After several
years of beginning treatment, she married and remains so. So, she functioned well
enough in the world. Most of her leisure was spent reading books or watching
TV or movies. She never talked about what she was reading or what she saw on
TV. I came to realize that this was a symptom of her psychic retreat to literally
mind-numbing activities. Intermittently she had horrible, abusive arguments with
her partner.
L’s developmental history was traumatic. Both her parents grew up with trauma
in their own families of origin. Her parents were of the hippie generation and
thought it was fine to “let it all hang out!,” which they did with their children.
When L was a toddler and her mother returned to college, L was left with her
father as caretaker. He took her into the shower and exposed her to pornographic
materials. Her mother neither intervened nor set limits. Then and now L says that
she liked this sexualized relationship with her father. She learned to masturbate
at age four or five. Only recently in her analysis were new details revealed: at
age seven she remembered being on the parental bed with her father, mother, and
brother. They were all looking at pornographic magazines. She became aroused
and was both excited and horrified by this in the presence of her parents. She
believed her parents knew she was aroused. As her treatment unfolded, it became
apparent that her mother had minimal alpha function, minimal ability to think
symbolically, and so there was no way for L to think about her overstimulated and
confused feelings and bodily sensations.

Treatment
In the early years of treatment, L suffered severely without being able to verbalize
her proto-feelings. I also could not put words to them, because she had no words
for them. I just saw the suffering and must admit that, sitting in the therapist’s seat,
I was none too eager to get close affectively. She often bent over from the waist,
holding her head, shaking it from side to side, and said with profound angst, “Bees
are buzzing in my head.” She could not bear for me to speak, move, take a sip of
tea, even breathe. She often held up her hand like a traffic cop to stop me from
speaking. All my movements reminded her that I was alive, a person. She wanted,
perhaps needed, me to be a statue, dead, non-living. This would be in keeping
with her murderous desire to kill me as representing the bad object and resonated
with all the bad objects she had deadened inside her.
 Analysis interminable 73
As Ferro (2003) described in his paper on his patient Marcella, the first four or
five years with L were spent building – as much as possible – some psychologi-
cal foundation to help her begin to think; a psychic structure that could tolerate
affects, my being not only alive but also a separate individual with my own needs
and desires. I offered myself as an object for her transference as a dependable
figure with a reliable frame. I bore her attacks. I named feelings for her. For years,
she sobbingly railed at me for doing so: “I hate having feelings!” This was consist-
ent with Steiner’s (1993) conceptualization of the psychic retreat – a walled-off
place where feelings can be numbed or evacuated into the unconscious and from
which the patient does want to be pried loose. L did not want to suffer her feelings.
L made appreciable progress during the first five years of twice-weekly therapy,
as was evidenced by less anxiety and more empathy with people at work. How-
ever, she still suffered severely and continued to escape into mindless activities.
I offered, and she accepted, psychoanalysis about seven years ago. About four
years ago, she made a very personal attack on me. I was stunned but stayed silent.
By the next day she apologized profusely. She was able to sense me as another per-
son who could be hurt. At that moment she was oscillating between the paranoid-
schizoid and depressive positions. She truly understood she had hurt me and made
amends to repair. She was terrified that I would drop her as a patient. After that,
she never made a direct, personal attack on me again.
The next dynamic issue that emerged was her despair and rage that I was not
her mother. By then, an experienced patient, she sensed a great difference between
how I listened and responded to her and how her mother, with whom she spoke
often, did so. She understood the reality that she was not born to me, but she shook
her fist at the universe in rage and despair. Another dynamic during this period
was that any comment or interpretation that I offered linked up in the transfer-
ence to her critical, demanding father – and so, for a long time, I was not allowed
to make interpretations. That transference reaction still is present intermittently,
although she catches herself and realizes her reaction is in response to the old
experiences with her father and not to me. Then she is able to pull back the projec-
tion and somewhat grudgingly invites the interpretation.
Finally, an erotized dynamic emerged. It started some years before in that L
told me she got aroused in the presence of her male boss and then with her female
friends and her minister. Then she said she was aroused almost all the time in the
presence of anyone. The arousal entered the consulting room. This was extremely
painful for both of us. She wanted to touch me sexually. She wondered what my
body looked like. She believed I was aroused in her presence – a projection. Later
she talked about wanting to be in my womb, as she termed it, and wanting “to
relate to me from [her] vagina.” (As an aside, the confusion about names of the
genital body parts and anatomy, I believe, is a symptom of the hysteric mind – a
mind which cannot think.)
Revealing these wishes left her with considerable distress. By this time, I was
seeing her by video-teleconferencing because I had moved to another state. This
seemed to make bearing the erotized transference easier for both of us. Initially in
74 Nancy L. Bakalar
the countertransference, I felt disgusted and was repelled – not able fully to offer
myself as an object for her use. Taking her in felt too sexual. Then, in my reverie,
I could picture her being on the changing table as a baby and her dad or mother
looking primarily at her genitals and not into her eyes and cooing at her. I said
to her, “I think you want others to look at your face, to look into your eyes and
to see you, not be seen in a sexual way.” She sighed, “Yes!” and then said, “And
I want to relate to you from my heart and my mind, too, not from my genitals.”
Internally I sighed with relief because it seemed some understanding had come
through these links.
We worked on these issues for a couple of years, but L seemed not to be able to
make appreciable use of them; there was no evidence of significant transforma-
tion, even though her functioning in the external world was improving. She got a
higher-paying job; she felt stronger inside; she was getting along with her family
members better, showing more empathy toward her children. She had allowed her
friends and family to come alive and no longer needed to turn them into statues.
L had come to my home state once before to see me in person, but on that first
occasion I saw her for one session two days in a row. I then suggested she come
out for a weekend so we could work intensely together for seven hours per day,
from 10 a.m. to 6 p.m., with an hour break for lunch. She was surprised, maybe
slightly shocked: “You would do this for me?! You would give up your Sunday
for me?!” “Yes,” I replied.
This treatment suggestion was modeled after the technique Bollas described
in his book Catch Them before They Fall (2013), a technique used for patients
who were on the brink of breakdown and psychic collapse. Bollas stated that he
would cancel patients to make himself available for up to three days. This inten-
sive treatment had been successful in averting a collapse and (as I understood it)
strengthened the patient’s psychic structure.
L agreed to the offer. We settled on meeting seven hours on a Sunday and
three hours on Monday morning. Once she was there, I began to feel vulnerable
and scared, feelings that I had not experienced when I had arranged this. Retro-
spectively, I now understand that these feelings were both a countertransference
reaction and a realistic one. In the countertransference, I was feeling what she
felt with me and what in her childhood she had felt in the presence of her father.
From a reality perspective, I was seeing a woman with an erotized transference on
a Sunday, all day, in an otherwise almost empty office building, and my analytic
sofa was actually an upholstered twin bed! What allowed me to proceed was that
I had worked with her for more than a decade; there was a good alliance; and she
accepted boundaries although they made her angry – so I felt comfortable enough
to proceed.

Thoughts and plan for my approach to the extended session

I held in mind that L had been excessively sexually and affectively stimulated
as a very young child, that the sexual stimulation had overwhelmed her, and, at
that young age and because neither parent seemed to have symbolic thinking, she
 Analysis interminable 75
had had no way to think about the confusing physical and psychical sensations.
Because I saw her trauma as primarily pre-verbal, I had offered her the extended
time, the space of my office, and the space of my mind to use as she needed.
I waited and hoped it would be helpful.

Summary of the extended day

L showed up on time Sunday morning well prepared. She had brought all she
thought she might need, including bottled water and lunch. She dressed in a forest
green sweater set, a long black skirt, and black boots, and she carried a maroon
purse. This outfit mimicked a sweater set that I wear often with black pants, and
my everyday carry-all bag is the same maroon. When a patient and I show up in
the same colors, especially several days in a row, I take it as a sign that we are in
good conscious and unconscious resonance in the therapeutic endeavor.
L chose to sit on the regular sofa in the main treatment room, facing me. I asked
her if she minded if I took notes. She replied, “No, because then I know you are
really listening to me!” This was a momentous day for me, venturing into a treat-
ment modality that I had been interested in for a long time without an opportunity
to try it out. Later in the day, I realized that, by taking notes hour by hour, I would
have documentation in case there were any accusations of a sexual nature that
might arise in L’s fantasy but might seem real to her.
L chose to use the regular sofa in various ways. Sometimes she sat up facing
me; sometimes she lay down as in analysis; and sometimes she lounged with her
legs on the sofa but facing me. It felt important to give her freedom of movement
without comment. I just noted the shifts to myself.

L’s dream
She started with a dream: “I was in a hotel room. There was noise in the hall. There
was food on the floor. I didn’t know how it got there. I thought it was a ghost, but
that didn’t make sense. It was the end of the world. I didn’t know why. I was hold-
ing my young child’s hand. . . . Then there was a medicine bottle with pieces of
pills in it. The little girl opened it. She swirled some pieces and pill dust with her
finger and put them in her mouth. I told her, ‘No!’ I swept my finger through her
mouth. I’m not sure I got all the pieces out. But I was with a young, blond doctor
(it was you!) who could help me. I then realized the child was not my daughter.
The face was long and gaunt. It was my face as a young girl, but gaunt, like the
painting ‘The Scream.’ (She sits up and looks away.) I’m here. I don’t feel I’m
here. All these damn layers of defense I need in order to accept your presence.”

N: My presence is different?
L: It’s awful. What I most want is what I’m most frightened of. It causes me
great pain. (She looks at me.) I have no doubt you’re in me . . . (she holds her
chest) the internal Nancy has great difficulty soothing the core of the core.
(A few minutes later, crying and leaning away:)
76 Nancy L. Bakalar
L: Your presence scares the crap out of me. (She actually suffers from what she
terms “fecal leakage.”) I can’t talk to you like a regular person. I noticed you
were slightly limping. I can’t ask you about it, and if I did, I’d be afraid of the
answer.
N: You can ask.
L: How’s your knee?
N: It is still sore.
L: I’m afraid to ask questions. I might be rejected.
N: I know.
L: My goal was to lie on your analytical couch. . . . I’d like to just rest on your
couch if that’s okay. I don’t see how I’m going to be able to do that without
traumatizing myself. . . . It’s a couch, just a couch. (She stands up and looks
at the analytic sofa in the other room.) I don’t trust you.
N: I know.
L: (Crying.) It’s not personal.
N: I know.
L: I don’t trust you after so many years. I don’t trust my mom. My dad is dead.
I don’t trust myself.
(A bit later:)
L: I’m having the arousal feeling and the wrist symptoms (A feeling of cutting
her wrists, which she has never done) . . . no matter what I am talking about.
N: I want to hear about it. (Here I am opening myself up to be the object for her
projections even though in the past I shrank from it.)
L: When I tell you about my bodily sensations, it interrupts relating to you – it’s
about the body instead of about the relationship. (Sitting up facing me) . . . It’s
about being in your space . . . that helps me . . . this is a patient’s dream . . . to
have you all day. . . . (The language is infantile and sexual.)

Highlights of the session

Now I will condense a considerable amount of material that was explicitly sexual,
material that I had to open myself up to, again, to serve as the object for her
fantasies and projections, so that the important dynamic work had a platform for
discussion and thinking.
Sitting up, L repeated her childhood sexual experiences of being exposed to
pornography with her parents and her desire to touch her parents’ genitals and the
arousal and guilt that desire caused. She spoke of how she would sneak into their
bedroom to look at the pornography and then steal back to her room behind the
bed to masturbate. She felt betrayed and angry that her mother did not protect her
from her father. She linked these old experiences to the analytic sofa, how terrified
she was to use it and how disappointed she was with herself that she could not.

N: You’re afraid.
(She notifies me that she is aroused and immediately asks, “When’s lunch?”
I tell her whenever she chooses. She says she wants to run away.)
Then:
 Analysis interminable 77
L: I want to have a relationship with you. . . . Oh! Just then, I got aroused.
N: You equated the relationship with me to a sexual relationship.
L: Yes! But the original thought was pure! It just got sexualized in my mind. . . .
Now the two are intertwined – the pure desire for a relationship with the sexual-
ized relationship. . . . (thinking for a moment) . . . That was the first time I’ve been
able to separate it. (She continues around the betrayal of her parents encouraging
her to have these sexual experiences because they were “natural.”)
L: And when I showed anxiety, I was chided and mocked!
(A few minutes later).
I cannot go to the analytic couch because it will symbolize that I want to have
sex with you. (She is now lying down on a regular sofa in the therapy room.)
I have a fantasy and desire that you [would] come over and perform oral
sex. . . . (I brace myself; this is difficult for me.) Apologetically: I’m aware
this is part of the work. . . . I feel this is futile. . . . I feel hopeless and help-
less. . . . It’s a part of me. . . . It’s my psychology, in my body, in my life. . . .
(She has been going on for a few minutes, and I decide it is important for me
to open up more space for thinking about this . . . although it feels risky.)
N: What would it be like for me to perform oral sex?
L: Frightening and fantastic! (Then:) Did you have to ask that?! Was that
important?
N: Yes.
L: Why?! You made a mistake. . . . Now my mind is even more . . . (pause) maybe
it wasn’t a mistake. (Crying) . . . I desire you. I want to take you in. . . . (She
sits up.) No! my dad lost his license because he asked a client to masturbate
in his office. . . .
N: (I interrupt) . . . I’m not asking you to masturbate . . . I’m asking what it
would mean to you.
L: That’s how you would love me and I would enjoy it. . . . Because it was sexu-
ally exciting. (Pause.) Now I am angry at you!
N: (I feel in danger now.) It feels very dangerous!
L: I feel taken advantage of. . . .
N: I’m not interested in you sexually. I’m here to help you with these things that
keep you anxious and unhappy.
L: I don’t believe you! How are you not sexually aroused?! I’m so angry with
you!
N: We are not the same person. I don’t feel what you feel. (She goes back to my
question of what it would mean to her.)
...
L: (She is sitting up.) It would be what I wanted all along . . . a re-enactment
with dad and mom. This feels extremely dangerous. It would be the only way
I could know they cared about me. . . . It would be the only way I could take
them in . . . the only way I could take you in . . . the only way! (She pauses.)
Very lonely, you know. . . . The only way I can let you in is in a sexual
way. . . . So I have to block you out. . . . Interesting, it’s oral sex . . . oral suck-
ling my genitals. . . . The only way of affection, nourishment, communica-
tion . . . like suckling at the breast. . . . Everything I hold most dear is locked
78 Nancy L. Bakalar
up, hidden – too dangerous to give since it is sexual – so it is just locked
away . . . [the sexual interaction] is how I could receive what a mother should
give her daughter (affection). . . . It’s not the healthy, productive way. . . .
What I needed was cooing, talking and sharing laughs. . . . Yeah! I was pretty
cheated. . . . I have a fantasy of having oral sex on you . . . that would be my
way to suckle you. (Here we see that infantile need/desire/form of attachment
gets/got sexualized.) Does that answer your question?
N: You’ve done a lot of work in the last 15 minutes.
L: I’m really angry at you . . . (pause) . . . I’m making snarky remarks in my head.
N: You’re mocking the process?
L: Yes! (She lies back down, covers her eyes, and rests.)

Request to take a nap

(After working through the sexual material:)

L: I feel so embarrassed – what I said. I feel like I have ruined our relationship.
N: This is the purpose of our work together.
L: I know . . . I feel so tired. I want to talk . . . I want to sleep . . . I want to run.
N: You can set the pace.
L: I want to sleep. Can I sleep on the sofa?

She lay on the regular sofa and then asked for a blanket. I had an afghan, which
I handed to her, ensuring that I did not cover her with it. That would have been too
intimate. I asked if she would like me to sit quietly in my usual chair while she
slept or if she would like me to work quietly at my desk. She preferred the latter,
for which I was grateful. She slept lightly for most of an hour, deeply for a brief
interval. I felt like a mother watching over her infant or toddler napping, keeping
an ear out for noises she made, what they might mean. Was she sleeping restfully?
From my position ten feet away she heard the gentle tapping of the keyboard,
which I thought might be soothing to her.
In the remainder of the session, pre-verbal/pre-Oedipal and verbal/Oedipal and
post-Oedipal dynamics were present simultaneously. During this extended ses-
sion, moment to moment, I was most aware of staying focused on keeping the
literal space and the space in my mind open for her infantile dynamics. In review-
ing my notes, I can see that overtly I was dealing with the predominant sexual
Oedipal material and with some interpersonal boundary confusions. However, the
pre-Oedipal issues were embedded in the behaviors and processes between us.

Keeping in mind, managing, and responding to

L’s pre-Oedipal dynamics
How did I attend to her pre-Oedipal dynamics? I gave her considerable freedom
in time and space. The only things we had agreed upon ahead of time were that
we would meet for seven hours and take an hour lunch break. She chose when we
 Analysis interminable 79
took breaks and for how long and when to take a break for lunch. I allowed her to
move about the three rooms (the waiting room, the regular treatment room, and
the analytic room) as she chose. She was free to sit up and face me, lie down in
analytic style, or lounge. She was free to walk around. At one point, she stood in
the doorway between the treatment room and the analytic room and said, “I just
can’t go in there.” I immediately understood that the analytic room stood for her
parents’ bedroom. I said, “That’s fine.”
The main treatment room is long and rectangular. My desk and bookcases are
at the far end. At one point she got up and wandered to that end of the room and
began staring at my diplomas. When she seemed to be reading them too closely,
I asked her not to. Why? Because of the multiple names I have on various diplo-
mas, which I thought would stimulate questions about me and would contaminate
her treatment. She accepted the limitation fairly easily.
The rooms of my office represented the mother’s body. Allowing her the free-
dom in time and space to walk around in it was as if she were exploring the
mother’s/the analyst’s body. We allow children in play therapy to move about the
room, to use the space to work on their dynamic issues. So, too, when we are in
the throes of working on pre-Oedipal issues with adults, they need full access and
use of space and time within the boundaries of the session. These movements need
to be understood but usually not interpreted. To deny movement would re-create
the trauma the young child experiences when prohibited from doing something
she needs to do to explore a psychological issue. For the analyst to think that the
patient is resisting by getting up would be an error in understanding and technique.

Managing and responding to L’s Oedipal dynamics

From her neurotic part, L talked about her anxiety about lying on the analytic
sofa, how it reminded her of her parents’ bed where she was overstimulated,
of their betrayal and her hatred of them for that, and of me in the transference
because I even have an analytic “bed” to offer her. She talked about her desire
to touch her parents’ genitals and her interest in mine. She suffered arousal
much of the session. She spoke of her wish to have sexual experiences with
me. Now, at this stage in my career and experience, I was able to open myself
up to the analytic endeavor, to offer myself as an object to better understand
what her sexual desires for me (and everyone else!) meant. I was both surprised
and pleased to see that her desire for oral sex linked so directly to the infantile
wish to be held, nourished, and loved. In several analytic cases I have found
links between a disturbance in the infant/toddler relationship with the parents,
poorly developed or absent alpha function, inappropriate sexualization of rela-
tionships, and sexual perversions.

Follow-up sessions
L had to return to the east coast Sunday night because of a storm. In Monday’s
session by video link, she was exhausted, embarrassed about all that she had said,
80 Nancy L. Bakalar
and angry at me for it. She was distraught. Tuesday’s session was the most inte-
grated, thoughtfully linking session she had ever had. It was as if she were func-
tioning as her own analyst:

L: I am ready to work. The work is how I feel sexual toward you and want a
sexual relationship with you . . . and how the fantasy interferes with my getting
help from you. . . . I now have a better sense of this fantasy. . . . I know the more
I talk about it the more you can help me. . . . This fantasy has become so big . . .
but it is just a fantasy . . . so, I try to turn off my feelings, but they come out
any way . . . I didn’t get the nourishment at the breast – I got it at the crotch . . .
my dad’s penis at eye level in the shower when I was four . . . at the mouth
level. . . . It feels like that was all that was offered . . . my wires got crossed.
N: Your infantile longings got sexualized as you became older . . . at age four,
five, six. . . .

L’s current work

As I write, two and one-half months have passed since L’s day-long session. L still
struggles, but, overall, I see her thinking as much more integrated and symbolic.
When I met her about 15 years ago, she functioned in the world but had psychotic
thinking. She has developed the capacity to name her feelings, although she still
resents having to bear them. She no longer walls others off in her unconscious or
kills them off by making them “statues.” She is insightful and self-analyzes well.
She has internalized a faint to moderate sense of me as an object that she can call
upon to soothe herself. She has had set-backs in being able to give a narrative
of her feeling states. She is struggling with mourning. I hope that once she can
mourn more reliably, her internal objects will be more available to her. As Hanna
Segal said in Dream, Phantasy and Art (1991, p. 40), “A symbol is like a precipi-
tate of the mourning for the object.”

Case of M
M is a 45-year-old plain-dressing woman, the oldest of eight children and daugh-
ter of a senior church leader. Her father was blustery, critical, demanding, and
himself fraught with anxiety. Her mother was a largely non-thinking woman who
could not keep up with the workload of the large family and taking care of the
family business while the father spent most of his time tending to church matters.
Religious teachings include not spoiling children, not allowing them to cry, pay-
ing little attention to them, and employing corporeal punishment. More serious
issues, such as sexual abuse, are “swept under the rug.” The family was poor.
Food was scant and of poor quality. There were insufficient clothes.
M sought treatment about 12 years ago. She was bedridden with anxiety and
depression and suffered panic attacks. She continued with me by telephone and
then by video-teleconference when I moved to another state. I treated her in ther-
apy for several years and then offered and she accepted analysis about six years
ago by video technology.
 Analysis interminable 81
In the analysis, we pieced together an understanding that with her father’s loud,
frequent, thunderous outbursts and because of her mother’s inability to physically
and emotionally contain her and the general inattention of being left in the crib to
cry much of the time, she was left in a state of fright much too often. She devel-
oped an obsessional style, one of “doing” to solve emotional problems, unable to
think symbolically. Through the analysis she had a difficult time feeling close to
me or, despite my many years of treating her, feeling that I cared about her. She
suffered from Steiner’s (1993) “gang” of repressed bad objects.
She did well in analysis. After five years or so, she was able to function as a
thoughtful mother and to do her work more easily, was less obsessional, and took
on important social projects in the community. But recently she suffered a return of
severe anxiety and fears of rejection, set off by two family issues: one involved her
father, who she felt would put an end to her community project, and the other related
to her son, whom she feared would get a rejection letter from a young woman he
wanted to date and with whom she overidentified around feelings of rejection.
Her recent anxiety was not as severe as that she experienced five years before
but was quite disturbing. Earlier in the analysis, I was identified with the critical,
demanding father. Now I was identified with the unhelpful mother who couldn’t
understand and was not capable of helping her. M feared she would be “too much
for [me]” and that I would never be enough for her.
She asked for double and extra sessions. So, for a while I saw her up to ten
hours weekly. As with L, this increased intensity of sessions was in line with tend-
ing to her infantile needs, a kind of “feeding on demand.” As with L, I allowed
M the freedom to sit up, lie down, and move around the room. Patients who are
working in the pre-Oedipal dynamics desire and need to see the analyst’s face.
They are looking for the mirroring and to be understood. Also, as with L, I kept
the time boundaries.
In one of these sessions, M reported that she had difficulty sleeping, instead
tossing and turning. Then she said, “In the middle of the night, I thought of you
and held you close to me and that gave me some relief.” So, here we see evidence
of internalizing the good object experience with me as analyst, as a source of
comfort, even though the description of it has a concrete quality.
Soon after this, M needed to get up. She placed her laptop on the coffee table,
pointing it down the room, and then I saw her pace agitatedly back and forth for
a few minutes and look out the window briefly. She may have been speaking or
not. I don’t remember. The most important part was to see her. When she stopped,
I said to her, “M, it looks like you were feeling like an out-of-sorts, unhappy tod-
dler needing to be picked up and soothed.” She agreed. After a few minutes she
wanted to lie down. She put the laptop on the floor and lay in front of it, on her
stomach, her head toward me. Her arms were down by her sides. Then, surpris-
ingly, she put her forehead on the carpet, appearing to balance her head in that
position. I was startled in that she didn’t even use her forearms to rest her head on.

N: (In the countertransference I have the fantasy of a downed soldier playing

“possum,” pretending to be dead so as not to be shot at or further injured.)
M, you look like a dead soldier on the battlefield.
82 Nancy L. Bakalar
M: (She gets up, looks at the camera, and, crying, says:) That is the lowest I can
go! That’s what I felt like growing up – lying flat, waiting to be picked up.
I felt totally annihilated.
N: Dead.
M: (She is sobbing now. She has never vocally cried before in the many years
that I have known her.)
N: You needed me to see all that to better understand what you experienced and
suffered.
M: Yes. (Then there is a calmness in her voice, and her facial expression seems almost
totally relaxed. Then she surprises me and says:) Good-bye! (as if addressing her
father. Then, smiling:) I’ve got a life to live! (and she waves her arm away as if
dismissing and banishing her father in a tone of “Enough with you!”)

She struggled over the next week, wrestling with her anxiety and obsessions, wor-
ried that she would never get well, that she would be burdened by her anxiety
for the rest of her life. Then, a week later, on a Thursday, she asked me for extra
time on Friday and over the weekend. I found an hour for her on Friday. She said,
“What about Saturday?” I told her that I couldn’t. She seemed slightly surprised,
anxious, but accepted it. Why did I deny her the extra time on Saturday? Because
I couldn’t be a bottomless pit for her, because I was tired, because I had many
things to get done over the weekend, and because I wanted to set a limit and see
what she would do with it. The timing of this seems to have been good. She did
a lot of thinking, linking, and solidifying her insights. She reassured herself that
she had all that she needed in the way of real and emotional supplies, that she
had been strong and productive these past five years, and that she didn’t need to
be a slave to her internalized, demanding father and absent, dead mother (Green,
1972). Wednesday, she was able to link her infantile, toddler, young child, and
adolescent family experiences with her symptoms in relation to her parents and to
me in the transference. That day, I was once again a good-enough analyst.
Although I am not completely sure, I believe she is in the last stages of her
analysis and that this last regression, though fairly short-lived, was a recapitula-
tion of her life struggles and an opportunity to finally anchor her insights, trans-
formations, and success. I believe what was powerful here is that M, like L, had to
show me her pain – not tell me about it. I had offered the freedom and space to do
so – in the room and in my mind. And through that process she could experience
me as someone who cared about her, as a good analyst, as a good object, as a good
parent. Her bad object experiences have been detoxified, not completely but sig-
nificantly. And because parts of Fairbairn’s Central Self are linked to bad object
experiences and repressed into the anti-libidinal ego, detoxifying and freeing the
bad object also releases the lost parts of the self, a self that she can now sense and
appreciate and for which she was grateful.

Case of P
P is a 77-year-old married man who came for treatment about four years ago,
suffering with marked anxiety, depression, low motivation for life, low energy,
 Analysis interminable 83
and fear of death. His anxieties related to violent fantasies of attacking his wife
or other women with knives or guns. He suffered poor self-esteem, and conse-
quently, in relation to me, even during the evaluation sessions, he wanted to dem-
onstrate that he was smarter than me.

Developmental history
P was the fourth of five children. He has a sister about six years older and a brother
who is two years younger. A sister and a brother, born in the years between his
older sister and himself, are deceased. His parents divorced when he was four or
five, establishing him as an Oedipal victor. His natural father was alcoholic and
emotionally abusive and shaming. P described his mother as full of life, viva-
cious, hard-working, and admiring of accomplished men. She worked to support
herself and the children after the divorce. He admired and loved his mother, really
believing she “knew everything.” In fact, she could not tolerate his moodiness and
mocked his tears, chiding him, “You look ugly when you cry!”
His mother worked when he was a child, and he was left alone in the care of his
older sister. He described being sad and forlorn as a boy. He didn’t leave the house
or play when his mother was away. He wanted to be there as soon as she returned.
When his mother did come home, tired and distressed, she secluded herself in her
bedroom resting, pushing him away.
His mother dated during his latency, and he and his sibs were left with an aunt
for weekends and sometimes weeks at a time, which he resented. His rage toward
his mother was exemplified by his holding a young female cat hostage for three
days without food or water, then repeatedly making the cat swim across a stream
and finally, with his neighborhood friend, stabbing her to death. There was also
sexual stimulation in the home. His mother took him into bed with her when he
was sick, walked through the house with just her underwear on, and was not pri-
vate about her monthly periods. Poignantly, he found a pair of her “falsies” in the
trash can and carried them in his pockets for a while. He was precociously sexual
with neighborhood girls from the age of ten.
Through our work together, it became apparent that his mother did not possess
significant alpha function. She taught her children how to live by mottos! A penny
saved is a penny earned! Waste not, want not! His mother remarried when he was
13, and so he was displaced permanently by his stepfather during his adolescent
Oedipal phase.
When he was 18, he married and moved to a neighboring state to go to col-
lege. He then had an emotional breakdown and briefly had to be hospitalized.
He missed his hometown and his mother and had developed violent fantasies of
stabbing his wife or other young women in the community. Shortly thereafter, he
moved back to his home state, finished college, and became a professional. He
stayed married but was emotionally abusive toward his wife. He was somewhat of
an underachiever in his professional life because he always felt inferior to “alpha”
males, the real go-getters.
He had extended psychotherapy treatment with someone who was not dynami-
cally skilled. He developed a crush on her, really became possessed by her. She
84 Nancy L. Bakalar
stimulated his fantasies, and there were mild indiscretions, such as mutual gift-
giving and kissing on the cheek. She also shared her personal history of recent
divorce and encouraged his fantasies, and so, once again, he was an Oedipal
victor!
As soon as treatment started with me, he had violent and sexual fantasies about
me. The violent fantasies subsided almost completely after we worked on their
early life origins. However, he developed a crush on me and was quite angry that
I held the treatment boundaries and would not budge on what he called my “pro-
gram.” I offered and he accepted analysis about one year in to treatment.
For this patient, this sexual fantasy life continued into and lasted throughout
his adulthood, to fill the void created primarily by the “dead mother” emotional
experience; by his mother’s real absences and brush-offs; and, originally, by his
father’s meanness and then later by his father’s real absence.

A session from a year ago

P: I think about you all the time. This morning I was in the shower and . . .
(I immediately get an icky feeling – it feels like something sexual.) I was
washing under my arms, and I thought, “I wonder if Nancy washes under her
arms?”
N: (My first thought is, ‘Of course, I do!’ Then I think, why armpits? Where is
this going? I feel uncomfortable. Then I think, armpits are near the breasts
and think of the absent breast, the absent mother, her absent attention . . . the
bad breast that needs to be washed.)
P: I think about you no matter what I am doing. . . . If I am eating breakfast,
I wonder, “Is Nancy eating her breakfast? Does she eat cold cereal?” If I am
reading, I think of you sitting and reading. I picture you with your husband,
but sometimes I picture I am your husband and you are with me . . . that you
are mine. . . .
N: (I am still feeling a little creeped out. I feel taken over inside with what he
is saying, just as he describes I have taken over his mind. However, that he
“sees” me and thinks about me in so many different places gives me a clue.)
I think you think about me in all these places as a way to keep me close to
you. It is as if you want the thought of me to fill up the empty space, the void
that creates so much longing and the void that has left you feeling alone,
anxious and lonely. . . .
P: Yes! That is exactly right, Nancy. (And with this both arms arch out to his
sides and he brings his arms together and clenches his fists.) I just want to
grab you and take you inside me and hold on to you. (This is an enactment of
his need and desire, as we saw L’s and M’s enactments in their sessions.)
N: Yes! I see that. It is to fill the empty, longing space. . . .
P: I think about you all the time . . . I think of your voice, how much I like it.
I think of how you look. . . .
N: You like my voice because it is soothing to you. . . .
 Analysis interminable 85
P: Yes, that’s right. and I like that you’re smart because I want to be seen as
smart, too. (This comment speaks to his desire to internalize the analyst/
mother and be like her.)

Offering myself as an object for repair ten months later

The patient had been talking about the anxiety and a void he had experienced his
whole life and had been reminiscing about his most recent therapist, a woman
with whom he had been infatuated.

P: Today when I was getting ready to come here, I took a shower and I was put-
ting on my underwear, “Body Armor,” and I was thinking it would really be
cool if Nancy could see me. . . .
N: What would be so cool about it? (Here I invite the details of the erotized
transference.)
P: Well, Body Armor is really cool . . . first of all they are spandex and they have
a pouch! I would like you to see how I fill out the pouch. . . . (He is embar-
rassed as he describes this.)
N: (In my mind I “run” from the image. He has made me feel like a voyeur.
I then visualize little kids 2½ to 3½ years old running through the house
naked, proud of their bodies, wanting their parents, especially the parent of
the opposite sex, to see and admire them.) You’re proud of your body and you
would like me to admire it. . . .
P: Yes . . . and to be sexually attracted to me. When I was sitting out in the wait-
ing room, I had the fantasy of taking off all my clothes and then I would come
in here and you would have all your clothes off too, and we would have sex
on this analytic sofa! I still think about that even though we have talked about
it so many times (pause). . . . Today I had to go down to the university clinic.
My wife wanted to go . . . but then she wanted to rush the doctor. . . . I told
her I didn’t want to rush the doctor. I wanted a full and complete evaluation.
She acted miffed and it just upset me. . . .
N: She wanted to go and that felt supportive, but when she got anxious about her
own appointment, it diminished the support and added to your anxiety . . .
P: Yes . . . I did want her support. You know, I always said that if I had some-
one’s support, I could do anything . . . like a boss, or someone. . . . I needed
my mom’s support and I never really felt I had it. I remember I was in the
bathtub one night with my brother. As my mom was drying me off, she said,
“Tomorrow you will start first grade.” I thought, “What?! I’m not ready for
that! I don’t want to go! I want to stay home with my mom!” I hadn’t gone to
kindergarten. She had never mentioned that I would go to school. It came as
a complete surprise.
N: You’ve wanted and needed support and felt like you didn’t get it from her and
didn’t get it from your wife this morning . . . and you need to be here with me
in your analysis. . . . You don’t want to be rushed or pushed out.
86 Nancy L. Bakalar
P: Yes . . . I fill . . . (He means to say “feel” but says “fill.”) this void inside
me. . . .
N: You fill the void with fantasies of being with women, now me. You’d like to
be naked with me and have sex, and you would like me to see you and admire
your body. . . . (I continue to invite the erotized transference.)
P: Yes . . . but I know that will never happen. (It is getting near the end of the
hour.) I will try to fill the void, Nancy.
N: You said you would try to fill the void, as if you had to do that all by your-
self . . . as if you didn’t have me to help you with this. (Here I am offering
myself as a good object to be taken in.)
P: (His hands come up to his face. He struggles to hold back tears.) I can’t
believe you said that! You are offering to help me with this . . . to fill up the
void . . . this is so moving to me . . . (after a pause) . . . but I have to be care-
ful . . . I have to remind myself that this is not an offer for sex . . . that is where
my mind goes . . . but it is an offer for help . . . so I don’t feel so scared and
lonely . . .
N: Yes . . . that’s right. . . .

Offering ourselves as objects for our patients’ use

By the patient’s projection and our introjection, we actively seek and take in
beta experience, think about it, process it, and then return it to the heterogene-
ous patient – those patients who suffer from pre-Oedipal trauma and Oedipal/
post-Oedipal conflicts. We do this by behavioral means and by interpretations.
This is a variant of the normal mother/infant interpersonal communication.
In doing so, the patient’s productions and suffering are contained. Ideally, the
child also introjects the process of metabolizing affects himself and thereby intro-
jects the dynamic of the container-contained (Bion, 1957, 1962), thereby develop-
ing his own internal thinking apparatus.
Mourning requires symbolic thinking, converting beta bits into alpha bits and
then alpha functioning. It is through mourning that internal objects are created.
Steiner said (1993, p. xii), “it is through the process of mourning that parts of the
self are regained [in analysis].” Hanna Segal, in Dream, Phantasy and Art (1991,
p. 40), writes, “A symbol is like a precipitate of the mourning for the object.” If
we pull from Kleinian and Bionian theory, we see that the baby does not have to
think about the breast that is present, warm, soft, providing milk and comfort. But
the absent breast, when the baby is hungry or when the breast is needed for com-
fort and reassurance, leaves the baby distressed, sometimes even falling apart,
as if he were losing his mind. Likely all three of the cases presented here had
that experience, especially M, whose infantile experiences emerged so clearly
behaviorally and in her associations. The baby is searching in his mind/experi-
ence for the breast, and it is not there! It must be mourned and, in the mourning,
the idea, the symbol appears of the “no-thing,” the “no-breast,” an absence. The
symbol is a representation that can then become a part of an internal object. If the
baby cannot gather up a memory and the idea of the “no-breast,” his mind and
 Analysis interminable 87
experience will be chaotic, and a chronic inability to symbolize will leave him
with psychotic foci.
The three cases presented in this chapter are what in Freud’s time likely would
have been considered interminable, not fully treatable cases. I believe he would
have categorized them as such because he would have considered these patients’
constitutional strengths, their id instincts, to be predominant and excessive. He
would have felt they suffered from weaknesses of the ego, masochism, and so on.
All the cases presented herein suffered in Steiner’s (1993) psychic retreat or the
presence of a gang of repressed internalized bad object (experiences), a derivative
of Fairbairn’s theory that bad object experiences are repressed and become the
anti-libidinal ego or internal saboteur that then sadistically tortures the patient. In
these cases, the suffering caused by the internal saboteurs was manifest by loneli-
ness, feelings of emptiness, severe anxiety, compulsivity, obsessions, and a sense
of there not being a self and at other times experiencing a collapsed, psychotic
mind.
All of the cases were also examples of Andre Green’s (1972) Dead Mother
Complex. They each had internal mothers whose alpha functioning, ability to
symbolize, was weak or nearly absent, so that these patients did not sufficiently
develop symbolic thinking. Instead L developed global embodied arousal as well
as disorganized, hysterical thinking like Freud’s Dora (1905); M developed obses-
sional thinking and compulsive behaviors; P filled his empty void with violence
and sexuality because of insufficient symbolic thinking.
These cases were described to bring theory to life but also to give insight into
the extended time needed to treat these patients; the care and thoughtfulness
needed to properly manage the frame and the transferences; and the need to under-
stand the countertransference and use it to understand the patient. Although it may
seem as if I broke the frame in offering extended sessions and allowing the patient
free rein of space, I believe I held a firm frame but held it gently. Perhaps what is
most important is an analyst’s capacity to hold the frame firmly intrapsychically,
not just to prevent serious breaches and enactments but also to offer the patient
the kind of well-grounded analytic mind needed to work through the painful early
dynamic issues brought to analysis.

References
Ashbach, C. (2017). A reversible perspective: Who the subject? . . . Who the object? Pre-
sented at the International Psychotherapy Institute Master Speaker Seminar, Chevy
Chase, MD, Fall.
Bakalar, N. (2017). The use of the self: When the patient is stuck, the therapist digs deeper.
Presented at the International Psychotherapy Institute Master Speaker Seminar, Chevy
Chase, MD, Spring.
Bion, W. R. (1957). Differentiation of the psychotic from the non-psychotic personalities.
The International Journal of Psychoanalysis, 38: 266–275.
Bion, W. R. (1962). The psycho-analytic study of thinking. The International Journal of
Psychoanalysis, 43: 306–310.
Bollas, C. (2013). Catch Them before They Fall. London: Routledge.
88 Nancy L. Bakalar
Fairbairn, W. R. D. (1944). Endopsychic structure considered in terms of object relation-
ships. In Psychoanalytic Studies of the Personality. London: Routledge and Kegan Paul,
1952, pp. 82–135.
Fairbairn, W. R. D. (1963). Synopsis of object-relations theory of the personality. The
International Journal of Psychoanalysis, 44: 224–225.
Ferro, A. (2003). Marcella: The transition from explosive sensoriality to the ability to
think. Psychoanalytic Quarterly, 72: 183–200.
Freud, S. (1905). Fragment of an analysis of a case of hysteria (1905 (1901)). Standard
Edition, 7: 1–122.
Freud, S. (1917). Introductory lectures on psycho-analysis, lecture XXVIII. Standard Edi-
tion, 16: 448–463.
Freud, S. (1933). New introductory lectures on psycho-analysis, lecture XXXIV. Standard
Edition, 22: 136–157.
Freud, S. (1937). Analysis terminable and interminable. Standard Edition, 23: 209–253.
Green, A. (1972). The dead mother. In On Private Madness. London: Karnac, pp. 142–173.
Quinodoz, D. (2001). The psychoanalyst of the future: Wise enough to dare to be mad at
times. The International Journal of Psychoanalysis, 82(2): 235–248.
Segal, H. (1991). Dream, Phantasy and Art. London: Routledge, p. 40.
Steiner, J. (1993). Psychic Retreats: Pathological Organizations in Psychotic, Neurotic
and Borderline Patients. London: Routledge.
6 Can an ingroup be an internal
object? Ron B. AviramCan an ingroup be an internal object?

A case for a new construct

Ron B. Aviram

The concept of “ingroup” is not typically used in psychoanalysis. It is more famil-

iar in social psychology, anthropology, and sociology. Similarly, “internal object”
is not a concept that is utilized in those disciplines. Yet, if these two terms can
be integrated across disciplines, the result of conceptually enriching each may
become apparent. The limitation has persisted because one term refers to inter-
group behavior, while the other term applies to unconscious processes in the con-
text of interpersonal behavior. This chapter examines how identity groups are
internalized and function unconsciously in the minds of individuals. It addresses
the psychological transformation of the individual operating in an interpersonal
context into an identity group member functioning in an intergroup context. The
capacity to understand more about this complicated experience requires a con-
struct that usefully explains how an identity group is internalized and thereby
functions intrapsychically to influence behavior. The construct of a social object
representation is discussed to clarify how an ingroup can be an internal object and
how it can influence both self-experience and intergroup behavior.
“Ingroup” refers to an identity group in society to which an individual has an
actual and psychological-emotional attachment. The ingroup contributes to our
conception of ourselves, our self-concept. Related to the ingroup, the concept of
“outgroups” refers to identity groups that we do not belong to and at times out-
groups can be in conflict with our ingroup. It is clear that ingroups have a signifi-
cant impact on human lives. In order to understand whether ingroups can become
internal objects, we need to clarify what internal objects represent.
In this chapter, “internal object” refers to the internalization of an external
object with which one has a significant relationship. Although there is no con-
sensus about what constitutes an internal object across varying psychoanalytic
models, most of the time when we speak about objects we are referring to other
people. “Internal object” refers to the internalized representation of an affective
connection between the self and an other (Kernberg, 1976). Importantly, it can
also pertain to the relationship of the self with an animate or inanimate object,
which is satisfying or unsatisfying (good or bad).
The pioneers of psychoanalysis had to formulate concepts that articulate what is
happening when experiences of relationships are internalized and become dynam-
ically influential in the course of a human life. Abraham (1911), Ferenczi (1909),
90 Ron B. Aviram
and Freud (1917) introduced three constructs associated with internalization.
Taken together, they describe psychic maturation of internalization processes.
Incorporation and introjection are more primitive forms of internalization. In
these two psychologically early forms of internalizing an external object, distinct
self-other differentiation is not complete. These processes are building blocks for
psychically associating with the external world. They provide a means for the
self to take in or “internalize” experiential dimensions of the relationship with the
object (initially the mothering person). As self-other differentiation develops, new
experiences of relating can be internalized. The process of identification facili-
tates a more mature form of relationship with an object. Freud (1921) suggested
that identification is “the earliest expression of an emotional tie with another per-
son” (p. 105), at which point distinct self-other differentiation is present. This
comment foreshadowed an object relations perspective in which the experience of
oneself is interdependent with the object. Internal objects are important in clinical
psychoanalysis because they provide a conceptual basis for understanding how
external experience can be internalized, allowing the mind thereby to influence
behavior, pathology in particular.
The concept of internal object relations was described by many theorists
throughout the twentieth century, each having his or her particular emphasis
(Director, 2018). (For a thorough overview of the evolution of ideas regarding
internal objects see Ogden [1983].) The focus of this chapter is on an uncon-
ventional use of the concept of internal object. The emphasis will be on how
large groups (specifically identity groups) influence the development of mind,
perception of self and other, and, most important, groups of others. Fairbairn’s
(1952) ideas about internal objects are well suited for this purpose. A core tenet of
Fairbairn’s perspective is that libido is object seeking. In other words, individu-
als are oriented toward other people from the beginning. He believed that human
motivation is oriented toward facilitating satisfying and cooperative relationships.
However, given the inevitable imperfection of relating, he believed that we inter-
nalize the unsatisfying experiences of relationships with our first significant oth-
ers (parental figures). This happens as a way to manage the anxiety aroused by
dependence upon these unsatisfying but significant external others. The fact that
these experiences are negative leads to their repression, and this establishes the
first internal objects. Fairbairn’s internal objects are completely dependent upon
the behavior of the external object (individuals).
Internal objects are pathological in Fairbairn’s unique metapsychology. This
is logical if the definition of internal objects is that they are established through
repression of “bad” experiences with external objects. Fairbairn did not see any
reason for a satisfying relationship (a good object) to be repressed. Therefore,
only bad objects, which cannot be tolerated consciously, are internalized and then
repressed, becoming internal objects. The internal object is a defensive effort to
deal with a frustrating and unsatisfying external object. Fairbairn suggested that
at a very early time in development the infant establishes internal objects to make
up for not having a satisfying external object (1952, p. 34). The self is dependent
upon the external object from the beginning. From a developmental perspective,
 Can an ingroup be an internal object? 91
pathology is an outcome of what Fairbairn called infantile dependence persisting
into adulthood. In this mode Fairbairn writes, “the object with which the indi-
vidual is identified becomes equivalent to an incorporated object, or to put it in
more arresting fashion, the object in which the individual is incorporated is incor-
porated in the individual” (1952, pp. 42–43). If this is true, it explains how a
significant external object can have a place in the mind.
The self is unavoidably, to varying degrees, intertwined with external objects.
When the inevitable unsatisfying aspects of a relationship upon which one is
dependent become intolerable, they are repressed. This results in everyone having
some degree of identification with an object, because parenting is never perfect.
In other words, each person internalizes some aspects of the negative relationship
with a significant other. People have internal objects because of the imperfection
of human relations. This is why Fairbairn wrote that our identifications become
our experience of ourselves (1952, p. 47). But, unlike Freud’s use of identification
as a tie to a differentiated object, for Fairbairn it is a basis for human interdepend-
ence. If this is an acceptable way to think about internal objects, could this suggest
how ingroups (if they become significant objects upon which we depend) can
have a place in the mind? And can it then explain how ingroups can thereby affect
the way we behave and experience ourselves?

The first social group

In an early paper, Fairbairn (1935) articulated how the family context is associ-
ated with progressive “sociological” group formations. Extrapolating from there,
we can say that this paper implies that an ingroup can have a place in the mind
alongside internal objects that are associated with individuals of historical sig-
nificance. Conceptually, the family is a holding environment for the individual
caregivers. These significant individuals are the ones who become the original
internal objects. Therefore, the family context influences these internal objects.
In his paper, Fairbairn examined the evolution of social groups beginning with
the family as the first social group. He described how the family is a fundamental
component of subsequent larger groups such as clans, tribes, and nations. Fair-
bairn’s description of the family as the first social group and how it is interrelated
with larger social groups is an early psychoanalytic articulation of the formation
of ingroups. Unacknowledged is the fact that the individuals who represent the
first internalized objects in the mind operate within the larger group structure of
the family. We tend to overlook the potential of the family and, possibly, the social
groups that stem from it as internal objects (Aviram, 2014).
In dialectical fashion, individuals influence the family atmosphere, while the
family atmosphere affects the individuals. Fairbairn believed that each person’s
loyalty to the family can be extended to identity groups, which become his or her
ingroups. We can understand this to be an extension of his premise that libido is
object seeking, now applied to important identity structures in society. So long as
the groups do not seek to replace the family ties by demanding complete allegiance,
he thought, individuals need and seek ingroup affiliations. Only pathological large
92 Ron B. Aviram
groups like the fascist and communist movements in Fairbairn’s time and, pos-
sibly, radical Islamic organizations such as ISIS in our time try to replace family
bonds by demanding loyalty to the large group instead. They insist on becoming
the individual’s new family. These pathological ingroups try to eliminate the need
for the family of origin. Fairbairn correctly predicted that those kinds of large
groups would ultimately fail, because the family seems to be a core component
of self that is rarely given up. In fact, it is likely that only the most internally
fragile are willing to reject their association with the original family group. This
perhaps offers a way to predict what will happen with the current destructive
large groups in our epoch. Those familiar with Fairbairn’s work will recognize
the parallel between this description of the importance of the individual’s tie to
the family and his discovery that children do not relinquish ties with parents even
if they are abusive. Here we have a parallel with another important concept in
social psychology, called ingroup favoritism. It is a common finding that people
favor their ingroup over outgroups (Hogg and Abrams, 1988). The internalized
family provides a psychodynamic basis for the occurrence of this phenomenon
in society. Most people do not seek out other families to replace their own. Fair-
bairn believed that the difficulty of rejecting poor caregivers was a reflection of
the internalization and repression of the negative elements of the relationship. In
adulthood, these internal “bad” objects continuously shape the course of life and
perception of interpersonal relationships. They limit psychological growth and the
potential for consciously engaged, mature interdependent relationships. In other
words, unconscious processes, such as transference, shape relating.
Can a large group to which an individual belongs also become internalized in a
way that can psychologically have an impact how that individual feels about him-
self or herself and influence perception and behavior? This would be similar to
but not identical with how internal objects associated with individuals shape inter-
personal relationships. If the family is the first social group, what happens to our
early experience of this group? How is it represented in the mind? The influence
of the family atmosphere is an important lasting emotional memory for most, if
not all, individuals. The family, like a significant individual caregiver, is an early
context upon which we are unconditionally dependent. The family can provide an
additional layer of satisfaction and safety to the one offered by the interpersonal
relationship with each caregiver. Both offer a context that meets physical and psy-
chological needs. As the child and young adult emerge into the world beyond the
atmosphere of the family, many of the identity groups that continue to meet the
sometimes physical but certainly the emotional needs that began in the family also
promote emotional well-being and can at times determine survivability.
At the same time, there are dissatisfactions with the family, in parallel to the
individual caregivers. Clearly some family environments are emotionally and
physically safer than others. Recall that Fairbairn believed that we internalize
and repress “bad” or unsatisfying objects. If the family, the first social group, is
“bad” and all families are to some extent, is it not possible that the family will
also become a potential object for internalization? In that case, the bad aspects
of the family are split off and repressed as bad objects. Fairbairn believed that
 Can an ingroup be an internal object? 93
our unconditional dependence upon the early environment is the ultimate cause
of internalization and repression (Fairbairn, 1952, p. 66). Unconditional depend-
ence is what makes “badness” intolerable in consciousness, in that survival is
dependent upon this individual/family. Repression of the split-off bad aspects of
the family allow one to continue to function in that context. As Fairbairn (1952)
put it, “the sense of outer security resulting from this process of internalization is,
however, liable to be seriously compromised by the resulting presence within [the
person] of internalized bad objects. Outer security is thus purchased at the price
of inner insecurity” (p. 65).

The social object representation

I have called this kind of internal object a social object representation (Aviram,
2005). The construct is needed in order to differentiate the social object representa-
tion from internal objects associated with interpersonal relationships of historical
significance. It represents a place in the mind for the earliest experience of oneself
as a family/group member. It lays the foundation in the mind for all subsequent
associations with identity groups. The social object becomes the unconscious rep-
resentation for our potential relationship with ingroups, society’s extensions of
early family experience, which, however, is not a substitute for the actual parents.
These identity groups function as the external context through which to engage
the dynamics associated with the human need to belong (Baumeister and Leary,
1995). This may be expressed by children when they feel insecure about their
place in the family or how welcome they feel in peer groups. An example of this
is the frequent report of having fantasized about being adopted. Another is a child
“running away from home” by hiding in the bushes to see if someone will come to
look for him. Later in development, teenagers wrestle with these feelings as they
traverse high school territory with its large number of cliques.
Fairbairn’s “endopsychic mind” was originally conceived to reflect interper-
sonal relations with individual caregivers. The first external object is the mother.
The world is brought to the infant by this important first object. A developmental
process unfolds with the first experiences dependent upon one other person. There
has been precedent for considering that the object world can be multidimensional
beyond a two-person relationship. For example, Scharff and Scharff (1987) intro-
duced the representation of the internal couple that we carry of our parent’s rela-
tionship. The internal representation of the parental couple influences subsequent
marital relationships with needs for love and defenses against rejection.
In early life, the meaning of family also emerges to become the first social
group. The family is greater than the sum of its parts. Experientially, the family
offers something in addition to experiences provided by the mothering figures
(and possibly siblings) in the infant’s life. If the parents offer acceptance, the
family can offer belonging. It is important to note that the family is not a paren-
tal substitution. This suggests that the family and subsequent large groups with
which we affiliate can have independent effects on minds of individuals that can-
not be anticipated as an outcome of interpersonal histories. If that is so, then we
94 Ron B. Aviram
need a construct to represent the social groups with which we are all interdepend-
ent. I have commented before (Aviram, 2014), just as there is no baby without a
mother (Winnicott, 1965), there is no adult without an identity group (nationality,
race, religion, ethnicity, age cohort, profession, and so on).
Belonging is the experience of love that the group provides, alongside the car-
egiver’s love, associated with acceptance and unconditional positive regard (Rog-
ers, 1951). The dynamics of belonging play out on a continuum, from feeling
like an outsider to being an insider. It is relatively common in psychoanalytic
psychotherapy to discover the patient’s underlying and long-standing experience
of feeling like an outsider. This makes sense: if the maturational intent is to relate,
then the struggle to belong takes shape in feeling like an outsider. Are feelings
of being an outsider an indication of the “return of the badness” of the repressed
social object? Initially, the dynamics of belonging occur within the family, but
obviously it is relevant for identifications with one’s clan, tribe, and nation – or
any other identity group to which we develop an attachment as we go through life.
To wish to belong is a common desire. It makes sense that if individuals struggle
to establish meaningful, cooperative, and satisfying interpersonal relationships, at
the group level they can struggle with similar feelings associated with belonging.
If the family is as important as individual parents are, then libido continues to seek
similar group affiliations. Regarding the social object, the seeking pertains to an
atmosphere of belonging that was uniquely experienced with the family and is a
continuation of our object-seeking nature.

A third internal object

In keeping with Fairbairn’s notion of a dynamic endopsychic mind, the social
object becomes a third “bad” object with which the libidinal and antilibidinal
ego/selves engage under certain conditions. As an internal object that can influ-
ence our relationships with societal identity structures, the social object operates
alongside Fairbairn’s exciting and rejecting objects, which reflect interpersonal
relations. Most of the time this third internal object is dormant. A majority of
people do not participate in society with a constant awareness of their group iden-
tities. The social object representation, however, has the capacity to become a
supraordinate internal object. What I mean by this is that any individual can be
overwhelmed by societal conditions that are associated with identity groups. The
most obvious examples are wars and societal stressors that manifest in prejudices,
but it also operates in more common situations. For example, the social object
may be activated when a police officer engages an African American in the United
States. When young adults find their way into gangs, or cults, or the Boy Scouts,
or armies, perhaps the social object is activated and influencing perceptions of
oneself and others as group members. For sure, when sports fans from rival teams
riot, it is unconsciously motivated; otherwise, why would such destructive behav-
ior occur over such a trivial matter? Although appearing trivial, the significance
of group belonging is the motivator. What about when men and women interact
in a context with power differentials? At those moments, there is a psychological
shift in which individuals perceive themselves and others as ingroup and outgroup
 Can an ingroup be an internal object? 95
members. For brief moments, they are not individuals; they are identity group
members. Social psychologists have reported on this for a long time. They have
found that when group identity is salient, individuals perceive themselves and
others as group members rather than individuals (Hogg and Abrams, 1988).

Group membership and the social object

The implications for intergroup behavior are significant. When an individual
psychologically transforms into a group member, the social object overrides the
rejecting and exciting internal bad objects associated with interpersonal relations.
When this occurs, there is a subtle experience of outsider or insider, inferior or
superior, depending on the historical relationship one has had with group mem-
bership. The social object representation is the unconscious template for group
belonging. At those moments, the social object influences behavior as a group
member, rather than as an individual. For brief moments, and for some people for
extended periods, relations with other people become intergroup relations. The
social world has shifted into perceptions of group belonging and the unconscious
need to establish safety. The threat can range from mild anxiety to annihilation
anxiety. Anxiety initiates behavior that can be destructive in an effort to establish
psychological safety. Individuals can be overwhelmed by social forces that turn
them into group members (or create the perception of exclusion from the group).
For example, during periods of economic hardship, otherwise tolerant people
can become rejecting of outgroup members (immigrants, minorities, people with
lower or higher socio-economic status). Stressful societal atmospheres can acti-
vate ingroup status as an avenue for emotional safety. To be part of a group offers
safety in numbers, whereas the lone individual is more vulnerable. All individuals
can be affected by these societal conditions. Therefore, all individuals are suscep-
tible to the “return of bad social objects.” Fairbairn explained, “an unconscious
situation involving internalized bad objects is liable to be activated by any situa-
tion in outer reality conforming to a pattern which renders it emotionally signifi-
cant in the light of the unconscious situation” (1952, p. 76). Furthermore, “when
such bad objects are released, the world around the patient becomes peopled with
devils which are too terrifying for him to face” (p. 69). Fairbairn dealt with the
problem of a return of bad objects from the standpoint of interpersonal relation-
ships. He suggested that when a person breaks down, it is a failure of repression
that releases the bad object in the form of a malevolent mother or father.
When we encounter behavior connected to identity group status, it is not
so much a malevolent mother or father emerging out of repression as much
as activation of primitive associations with belonging. The implication of a
failure of repression of the “bad social object” is that identity groups begin to
represent survival in such a way that belonging is a matter of life and death. To
be outside the ingroup is to be in a vulnerable situation, and the most extreme
behaviors are likely to be associated with the earliest fearful perceptions of
unconditional dependence upon the family. At that earliest period, as well as
in adulthood, vulnerability and survival are interdependent with belonging to
the family/ingroup.
96 Ron B. Aviram
The need to maintain an attachment to the family/ingroup becomes paramount
when anxieties activate the repressed unconscious social object. Self-protective
defenses begin to influence perception. This relies on the defense of splitting
that simplifies the world. The axis of belonging that engages the continuum from
being a lonely outsider to being a desperate insider will determine how splitting
will operate. This defensive stance is maintained so firmly because, as Fairbairn
put it, it is literally a matter of life and death (1952, p. 67). In a context of compet-
ing identity groups, individuals who manifest the dynamic of the insider are at
higher risk for destructive intergroup behavior than the outsider. For the insider,
the ingroup is used defensively to provide safety and self-esteem. Under more
threatening conditions, how he or she treats the outgroup is a function of many
variables and is especially dependent upon societal norms, deterrents, and ingroup
leaders’ messages about the outgroup. Societies have developed ways to contain
the risks of this destructive process most of the time. The degree to which a person
identifies with his or her ingroup is an outcome of several variables. If societal
conditions are threatening (e.g., war), most people will be strongly identified with
the ingroup/ nation. When conditions are less threatening in society, the influence
of the unconscious will operate to determine the degree of identification with
the ingroup. The person overidentified with his ingroup reflects libidinal needs
at a group level that manifest in a feeling of superiority. In contrast, the outsider
struggles with vulnerability of isolation but is often passive, looking on, feeling
excluded or inferior.
Consider an example I observed of this in society. A Caucasian man stepped
in front of a woman of color on a line for a rest room. The woman did not accept
his slight and informed the man that she was waiting on the line, requesting that
he return to his place behind her. He seemed to have made an assumption that she
was not a customer in the shop because he told her that the rest room was only
for customers. She explained that she would be buying something after she used
the bathroom. At that point he increased his hostility and told her to “go back to
where [she] came from.” I am sure he did not mean “outside the store”! In that
context, it was understandable that he was referring to some far-off native land.
She understood that he was attacking her with prejudice. She remained composed
and told him that he would be going after her, as she stepped in front of him and
calmly held her place on line.
We can understand such incidents by recognizing that this man was overidenti-
fied with his ingroups of white, male, and American, implying that the woman
was not an equal as an outgroup member. His behavior was dismissive of her as
a person. At that moment, her social object was activated as a foreigner, a woman
of color. Our hypothesis regarding this event is that the man was overidentified
with an ingroup, which activated an entitled superiority in relation to the woman
outgroup member. He perceived her not as an individual but rather as a member of
an outgroup. The woman herself appeared to have maintained an optimal balance
between being a group member and being an individual, all indicative of psycho-
logical health. The capacity to function effectively as both an individual and a
member of a group even when ingroup status is activated is healthy. If this were
 Can an ingroup be an internal object? 97
not the case, it is likely that this event would have escalated as the two individuals
became group members, each representing the outgroup for the other. When the
threat becomes too great, optimal balance dissolves for most people.

The psychodynamics of the social object

A person within an optimal range balances autonomy as an individual with func-
tional group belonging. This healthy balance permits the social object to func-
tion as a dormant third internal object, while the person participates in society
with other individuals interpersonally. Balance of autonomy as an individual with
functional ingroup attachments assists the overall functional wholeness of the self.
This helps the group dimension of human life to enhance and strengthen one’s
existence. Individuals who fall beyond the outsider-to-insider optimal range, at
the extremes of the Bell curve, manifest difficulties that show up in the way they
feel about group belonging. For these individuals, the social object is activated in
a way that overshadows internal objects of interpersonal relations (rejecting and
exciting “bad” objects in Fairbairn’s scheme).
Experientially, the outsider (beyond the optimal range) struggles with his or her
perception of rejection from the group. These individuals can recognize feelings
of resentment and jealousy. They may look at what others seem to have together
or how happy they seem to be, and yet they do not feel that they can be part of
the group. Outsiders feel fragile in society. They look on and perceive that other
people feel connected with each other in a way that eludes them. If they do par-
ticipate in a group it tends to offer a transient sense of belonging. Their group
identity is precarious, and they do not feel secure in their experience of belonging.
Such individuals are likely to come for psychotherapy when their sense of being
outsiders becomes unbearable in the form of detachments from others. They then
report an inability to form lasting relationships or a feeling that what they have is
not good enough or their ongoing insecurity in trusting whether someone does or
could love them. If you ask, they are likely to report that they have always felt like
outsiders. Their family histories will indicate something about this experience.
These individuals live out Fairbairn’s recognition that internal bad objects provide
external security at the cost of internal insecurity. They bring this into the world
of social groups. They perceive the ingroups from which they are excluded as all
good, while they themselves are bad.
The insiders (those outside the optimal range) tend to overidentify with the
ingroup. These individuals need the group to feel secure. They probably have a
history of seeking a variety of groups to shore up their self-esteem. The ingroup
can play that role so long as it does not disappoint. The overzealous soldiers that
Fairbairn (1943) wrote about who were sidelined and then had breakdowns repre-
sent this group. These are also the prejudiced individuals in a society. As a result of
the overidentification with the ingroup, these individuals tend to perceive all oth-
ers as either ingroup or outgroup members. They tend to function at a group level,
rather than the interpersonal level. This manifests in idealization of the ingroup
and disparagement and hate of the outgroup. The overidentification reveals the
98 Ron B. Aviram
underlying pathology of the social object. For these individuals, the self and the
ingroup have merged. These individuals try to reverse Fairbairn’s notion about
external security at the expense of internal insecurity. For the insider, a semblance
of internal security is achieved with the merger of the self and ingroup. In this case,
splitting operates to maintain the ingroup/self as all good and superior, thereby
making them individually superior. This comes at the cost of external insecurity
with outgroups that constantly feel threatening. These individuals are not likely to
come to psychotherapy for their intergroup attitudes. However, addressing inter-
personal crises with other ingroup members and enhancing personal self-worth
can shift the overidentification with ingroups by initiating more secure autonomy
as an individual.

Effects of psychotherapy on the social object

In an interpersonal relationship, which the psychotherapy context offers, the iden-
tity group is not often highlighted. In therapy, the two individuals form a bond
that is interpersonal. That does not mean that the identity group dimension of
the relationship is not noticed or talked about. Therapists can check with patients
regarding historical experiences that pertain to belonging as a way to give voice
to the part of mind associated with the social object.
The pathology of the social object is an aberration of our relational needs,
expressed in terms of the need to belong that groups provide. It is built on the
developmentally preceding interpersonal experiences one has had with caregiv-
ers. Even though individual pathology associated with the interpersonal world
can be present, a pathology of group belonging can also affect the course of life.
The social object implies that individuals seek affiliation with identity groups in
similar ways to early family group experiences.

The good social object

Fairbairn was criticized for not making room in his endopsychic model for a
good object to also be an internal object. His logic did not permit him to equate
the two experiences in the unconscious. Repression was strictly for bad, intoler-
able experiences. This also made sense when considering that Fairbairn believed
that infants are born whole with an unsplit, “pristine central ego.” The infant is
innately oriented to seek positive, cooperative, and satisfying relations with its
external objects from the beginning. It implies that the infant starts life with a
whole good object. It is only after the inevitable dissatisfactions become chroni-
cally experienced that repression of the split-off, intolerable rejecting or exciting
but unsatisfying aspects of the relationship with the external object happens.
Fairbairn (1958) understood that the personal relationship with an analyst
offers to correct distorted internalized relationships with bad objects. This antici-
pates the view that a relationship with a good object provides multiple new con-
figurations within the self system (Skolnick, 2014). This implies that subsequent
 Can an ingroup be an internal object? 99
positive relationships can heal pathology and bring one closer to the original
potential of the self that starts out whole and good before bad experiences occur.
A new positive relationship with an analyst offers a working-through process and
simultaneously provides a real relationship that does not have to be repressed.
Instead, it is experiential and functions in both conscious and preconscious fash-
ions. An outcome of the relationship with the good external object reinstates the
original object-seeking potential that can operate anew with less unconscious
negative influence. Patients engage external good objects in healthier ways, and
that implies more consciousness. The internalized but not repressed aspects of our
historical experiences with good objects, as well as new experiences, can also be
thought of as becoming suffused throughout the personality, as J. D. Sutherland, a
colleague of Fairbairn, commented (Personal Communication, D. Scharff).
All this applies to relations with identity groups. People are conscious of their
identity group affiliations. The group’s values contribute to self-esteem. Some
individuals struggle with belonging and cannot integrate the ingroup as a good
object. For others, the possibility of using the ingroup as a compensation for a
fragile self is useful but promotes other difficulties with outgroups. In these cases,
the ingroup functions as an external good object. For these individuals, identifica-
tion with the ingroup tends to become an overidentification. In Fairbairn’s terms,
primary identification has eliminated any differentiation between the self and the
large group, and this is an indication of pathology. The social object represents
the repression of difficulties with group affiliation that began with the first social
group, the family. If and when new and positive relationships are engaged, the
potential to rebalance the capacity to function as a person and a group member
simultaneously can be instated.

Conclusion
In an otherwise healthy individual, the ingroup functions alongside the family,
and the family operates as a support for the individual who engages interperson-
ally with others. The healthy individual is able to interact with a diverse set of
individuals with little attention to the large-group membership of the other. Iden-
tity groups are important resources for people in society, complementing their
interpersonal relationships. They exist as unavoidable categories of identity that
extend developmentally outward from the original family. Identity groups rep-
resent the group dimension of our innate object-seeking nature. They function
alongside our interpersonal relations, rather than taking over as an object upon
which the person is fully dependent. The social object that is a bad internal object
functionally engages with the external identity group in a way that shows how
the need to belong is intertwined with survival and growth. In the pathologies of
social objects, individuals struggle with either feeling like outsiders or merging
with ingroups as overcompensation for their need to belong. Most people func-
tion within an optimal range. However, societal conditions can activate the social
object with preference for outsider or insider dynamics for all people.
100 Ron B. Aviram
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7 Beyond subject and object,
or why object-usage is not
a good idea Juan Tubert-OklanderBeyond subject and object

Juan Tubert-Oklander

Classical psychoanalysis has had an anti-environmental bias. There were some

personal determinants of this on Freud’s part, but also various psycho-social fac-
tors and many of his philosophical and epistemological assumptions led him to
hope that the discipline he had created would become just another natural science.
This led to a theory-building strategy based on an individual paradigm, the pri-
macy of the past (which seemed to fit quite nicely with causal explanations), and
the focus on the intrapsychic. There have been many attempts to transcend this
bias, from both a relational and a social and political perspective, which led to the
development of group analysis. There have been various attempts to integrate the
individual and the collective perspectives, and I believe there is an urgent need for
a new paradigm of the human being, developed along these lines, based on and
transcending both psychoanalysis and group analysis.
Nonetheless, the very nature of Freud’s discovery of the procedure he devised
for the treatment of and inquiry into neurotic afflictions and the experiences that
emerge from it was of quite a different nature from the impersonal objective
facts that characterize the natural sciences. Although he never openly acknowl-
edged it, his work was more akin to the humanities than to the reductionist natural
science he had received from his teachers. Yet he was also aware that his sub-
ject matter was imposing on him something different from what he had intended.
In his case story of Elizabeth von R., in Studies on Hysteria (Freud, 1895d), he
writes the following caveat:

I have not always been a psychotherapist. Like other neuropathologists, I was

trained to employ local diagnoses and electro-prognosis, and it still strikes me
myself as strange that the case histories I write should read like short stories
and that, as one might say, they lack the serious stamp of science. I must
console myself with the reflection that the nature of the subject is evidently
responsible for this, rather than any preference of my own.
(p. 160, italics added)

Hence, he was afraid of losing “the serious stamp of science,” perhaps because
he was afraid that his discoveries and ideas might be rejected by the scientific
and academic establishments he so passionately yearned to be a part of. But this
102 Juan Tubert-Oklander
was also an expression of a deep split in his personality, between two roots of his
spiritual development: the physicalist science that prevailed in his medical stud-
ies and the German Romanticism he had absorbed from his cultural background,
particularly through Goethe (Tubert-Oklander, 2008, 2017a). In any case, this
deep split has remained ingrained in the further developments of psychoanalysis,
establishing a gap, perhaps a chasm, between the analytic practice and experience
on one hand and the formal theories that purport to account for them on the other.
It is usually said that the real beginning of psychoanalysis was on Septem-
ber 1897, when Freud (Letter of September 21, 1897, in Masson [1985], pp. 264–
267) abandoned his so-called seduction theory – which was really a theory of
the traumatic effects of child abuse – and turned his attention from environmen-
tal stimuli to the exclusive study of intrapsychic processes. He had come to the
conclusion that his patients’ descriptions of sexual abuse in childhood had never
happened: they were either delusions or lies. But, surprisingly enough, he did
not leave a single note documenting a case that led him to such conclusion. This
was most atypical for Freud, who was always meticulous in clinical research.
Such lack of documentary evidence, plus the passionate reactions of Freud and his
circle whenever someone – such as Ferenczi (1933) – tried to take a new look at
the traumatic theory of neuroses he had summarily discarded, suggests that there
were unconscious emotional motives behind his decision.
Freud’s original theory of an environmental causation of psychopathology was
quite subversive, and generated intense and violent rejection from both his col-
leagues and the learned public. The mere suggestion that parents and other adult
caregivers could and often did abuse and do harm to the children under their
care undermined the very basis of social authority. For, if parents and relatives
could not be fully trusted, this distrust would surely also apply to nurses, teachers,
doctors, priests, analysts, policemen, and government officers – that is, anybody
who had helpless people as charges. No wonder such ideas generated widespread
animosity and outrage among the young doctor’s colleagues (Tubert-Oklander,
2016)! And the very same thing happened when Ferenczi (1933) read, in the 1932
Weisbaden Congress, his paper “Confusion of Tongues between the Adults and
the Child,” which posed a revamped version of the traumatic theory and his tech-
nical suggestions for the treatment of severely traumatized patients. But this time
the indignant individuals who viciously demolished him with utter disqualifica-
tion and slander were his fellow psychoanalysts and former friends and students.
However, beyond these psycho-social unconscious emotional aspects, there
were also a number of assumptions, characteristic of Western thought in the mod-
ern era, that underlay the theoretical paradigm that Freud strove to construct with
his metapsychology, which emphasized the primacy and centrality of the individ-
ual. These were (i) materialistic metaphysics; (ii) the Cartesian subject; (iii) deter-
ministic positivism; (iv) neutral objectivism; and (v) rejection of teleology.
The materialistic metaphysics that underlies positivistic natural science and
most of our everyday conception of the world conceives the universe as a vast
space in which there are objects – called “matter” – and forces – called “energy.”
This is the Newtonian conception of the universe, to which Freud adhered. Indeed,
 Beyond subject and object 103
his 1895 Project (Freud, 1950a), which set the bases for his future metapsychol-
ogy, took as a starting point the attempt to apply the Newtonian schema to develop
a theory of the mind. Consequently, if only matter and energy are “real,” the only
possible basis for mental processes is the individual organism, and “mind” turns
out to be a mere epiphenomenon of brain function (Tubert-Oklander, 2016). This
conception has been surpassed by modern developments in physics and biology
and most certainly contradicts the essence of Freud’s major contributions.
The Cartesian subject, conceived as an autonomous mental entity, capable of
thought, perception, and volition and neatly separated from the world of “objects”
and from the body, came as an expression of the ethos of the bourgeoisie that
emerged after the Renaissance. Up to that point, the only way to have access
to riches, power, and prestige was through being born into the aristocracy, but
now major merchants and businessmen could attain them by their own efforts.
This fostered the belief that the individual was solely responsible for his destiny,
in sharp contrast with the primacy of social structure in the Middle Ages. Even
though Freud’s discoveries and ideas undermined the alleged autonomy of the
conscious subject, he still adhered to the centrality of the individual as the locus
and starting point of all mental processes. This is particularly clear in the follow-
ing quotation from “Instincts and Their Vicissitudes” (1915c):

Let us imagine ourselves in the situation of an almost entirely helpless living

organism, as yet unorientated in the world, which is receiving stimuli in its
nervous substance. This organism will very soon be in a position to make a
first distinction and a first orientation. On the one hand, it will be aware of
stimuli which can be avoided by muscular action (flight); these it ascribes to
an external world. On the other hand, it will also be aware of stimuli against
which such action is of no avail and whose character of constant pressure per-
sists in spite of it; these stimuli are the signs of an internal world, the evidence
of instinctual needs. The perceptual substance of the living organism will
thus have found in the efficacy of its muscular activity a basis for distinguish-
ing between an “outside” and an “inside.”
(p. 119, italics added)

The antithesis ego – non-ego (external), i.e. subject – object, is, as we have
already said . . ., thrust upon the individual organism at an early stage, by the
experience that it can silence external stimuli by means of muscular action
but is defenceless against instinctual stimuli. This antithesis remains, above
all, sovereign in our intellectual activity and creates for research the basic
situation which no efforts can alter.
(p. 134, italics added)

So, in the beginning was the individual, “an almost entirely helpless living organ-
ism,” trying to discover the world, and the subject-object differentiation is an
absolute fact, an antithesis that “remains, above all, sovereign in our intellectual
activity and creates for research the basic situation which no efforts can alter.” In
104 Juan Tubert-Oklander
other words, this is an assumption, a part of his Weltanschauung, which is previ-
ous to any psychoanalytic inquiry and inherently contradictory to the alternative
assumption of a primary and essential social nature of the human being (Hernán-
dez Hernández, 2010; Hernández-Tubert, 2009).
By deterministic positivism, I refer to a certain view of science that prevailed
in the nineteenth century (the period during which Freud was reared and had his
scientific education) and that posited that everything that happens is determined
by the strict laws of causality, so that an immensely powerful mind that had all the
information about the relevant facts and the immutable laws of science (Laplace’s
Demon) would be able to predict all future events. In such a view, which has been
refuted by the new developments of physics during the past century, the universe
is conceived as a gigantic piece of clockwork, in which every possible move is
determined by its structure and the initial conditions. This is clearly incompatible
with a treatment such as psychoanalysis, which affirms that making conscious
the unconscious determinants of a person’s behavior can free the person from the
chains of repetition and predictability that we call “psychopathology.” Nonethe-
less, Freud firmly adhered to a belief in universal determinism, as can be seen in
the following quotation from his Introductory Lectures (Freud, 1915–16):

What does [it mean when someone speaks of “chance events”]? Is he main-
taining that there are occurrences, however small, which drop out of the uni-
versal concatenation of events – occurrences which might just as well not
happen as happen? If anyone makes a breach of this kind in the determinism
of natural events at a single point, it means that he has thrown overboard the
whole Weltanschauung of science. Even the Weltanschauung of religion, we
may remind him, behaves much more consistently, since it gives an explicit
assurance that no sparrow falls from the roof without God’s special will.
(p. 28)

One can only wonder what Freud would have thought of Heisenberg’s principle
of uncertainty and other developments in quantum theory or of Gödel’s incom-
pleteness theorems, which undermined the belief in predictability in physics and
consistency in logic and mathematics!
Neutral objectivism implies that it is both possible and mandatory for a scien-
tific observer to exclude himself from his descriptions so as to avoid contaminat-
ing his descriptions with his own subjectivity. An “objective” description is one
that includes only data from the object under study and none from the observer
who makes the description. In other words, it is a description of some state of
affairs as if the observer were not there at all. But this is utterly at odds with
contemporary developments in physics, biology, psychology, and most certainly
psychoanalysis, which show that there is no way in which the observer’s influ-
ence may not be a part of the phenomenon being observed. This is the gist of field
theories, particularly of psychoanalytic field theories (Baranger and Baranger,
1961–62, 2008, 2009; Stern, 2013a, 2013b; Tubert-Oklander, 2007, 2017b), in
which the observer is always a part of the field of observation.
 Beyond subject and object 105
The rejection of teleology has been an essential part of the scientific credo for
a long time. Just as causal explanations account for a present event in terms of past
events, teleological explanations do it in terms of some future state of affairs that
is conceived as an aim or goal. This led to a discrediting of teleology, which was
associated with religion and mysticism, since it seemed to imply an underlying
intelligent intention or purpose, instead of the mechanics of an invariable chain
of causation. Such an approach works quite well when dealing with the world of
inanimate objects but inevitably fails when one is trying to account for the behav-
ior of living beings in general and human beings in particular (Bateson, 1972),
which always includes an intention.
Nevertheless, Freud’s clinical method, with its emphasis on meaning, nec-
essarily implies an underlying intention. This is the principle of intentionality,
which the young Freud received from his teacher of philosophy Franz Brentano.
It asserts that all psychic acts have an intention, that is, they tend to something –
existent or inexistent, psychical or material – and this implies a relationship. Such
teachings had an impact not only on Freud’s psychoanalysis but also on Husserl’s
phenomenology.
The fact that Freud never mentions Brentano in his published writings is quite
striking, particularly since Freud’s letters of the time to his friend Edward Silber-
stein (Boehlich, 1990) show the profound impact that his teacher’s thought and
personality had had on him. Freud sought a personal relationship with Brentano
and even considered entering the Faculty of Philosophy; on finding that it was
not possible to study two careers at the same time, he still intended to do a doc-
torate in philosophy after completing his medical studies (Domenjo, 2000). So
why this flagrant omission of Brentano’s name? It may have to do with Freud’s
rejection of his teacher’s theism. Be that as it may, this ablation of the memory of
a person who had had a momentous influence on him, plus his later disparaging
comments on philosophy, suggests that the youngster must have suffered a major
disillusionment.
The case is that not only did Freud receive from Brentano the concepts of rep-
resentation and affect, but “he also found in this author that which is intrinsi-
cally psychic in the relationship between subject and object, which Brentano calls
intention” (Domenjo, 2000, p. 113). As this implied a teleological view of mental
acts, Freud sought to reduce it to a causal (biological) explanation, and this he
found in his theory of instinctual drives (Freud, 1915c), which to my mind does
not really solve the problem.
All these assumptions upheld the individualistic paradigm, which reigned
unchallenged in his metapsychology. But there was an alternative view of the
human condition, one that had existed since classical Greek philosophy. While
Plato’s theory was based on the individual, Aristotle affirmed the essentially
social nature of the human being. And the Aristotelean view had a much greater
affinity to Freud’s clinical discoveries and to the analytic experience. It is also
worth noticing that he attended two courses on Aristotle taught by Brentano. Such
a view underlay the relational tradition of psychoanalysis, from Sándor Ferenczi,
through the authors of the British Independent Group (Fairbairn, Balint, Winnicott,
106 Juan Tubert-Oklander
Rycroft, Milner, Little, Guntrip, Sutherland, and many others) and Interpersonal
Psychoanalysis, up to contemporary Self Psychology, Intersubjective Theory, and
Relational Psychoanalysis (Guntrip, 1961; Greenberg and Mitchell, 1983; Kohon,
1986; Aron, 1996; Clarke and Scharff, 2014; Tubert-Oklander, 2014a, 2018).
Although these relational perspectives took into account the relationships with
other human beings, implicitly including relations with collective entities such
as groups, communities, institutions, and society at large, they still viewed these
relationships from the perspective of the individual. Of course, this was to be
expected, since the psychoanalytic experience emerged from and was explored
through the bi-personal device of clinical psychoanalysis. But there was still
another way, which also derived from the inquiry of the unconscious aspect of
human life inaugurated by Freud but did it by means of a different setting and
technical device. This was what became known as group analysis.
Group analysis is something quite different from psychoanalytic group psycho-
therapy. The latter consists in applying the well-established theories and techniques
of bi-personal psychoanalysis to the treatment of patients in groups. Group analy-
sis, on the contrary, is the analytic inquiry of the shared experience people have
in groups, whether therapeutic or non-therapeutic; small, medium, or large; natu-
ral groups or stranger groups. The group analyst does not just apply pre-existent
psychoanalytic knowledge, ideas, or techniques but approaches the group with an
analytic attitude and develops new interpretations and theories to account for the
group-analytic experience in the same way psychoanalysts ever since Freud have
done with the psychoanalytic experience derived from the bi-personal psychoana-
lytic situation. In doing so, group analysis has had to rely upon and lean on the
contributions of the social sciences and the humanities, just as Freud did with biol-
ogy and other natural sciences. But in both cases, the gist of their research is to be
found in the analytic experience itself.
Group analysis emerged, independently and simultaneously, in two far-away
places: in England. with S. H. Foulkes (1948, 1964, 1975), and in Argentina,
with Enrique Pichon-Rivière (1971, 1979; Tubert-Oklander and Hernández de
Tubert, 2004; Losso, de Setton and Scharff, 2017). Even though it was Foulkes
who coined the term “group analysis” and although the name usually refers to
the school he founded, while Pichon-Rivière called his own approach “operative
groups,” I strongly feel that the similarities between their respective thinking and
practices far outweigh their minor differences, so that they may be viewed as two
forms of a same praxis (I use this term to refer to a dialectical process of putting
theories into practice and theorizing the experiences derived from practice).
But even though group analysis strove to transcend the limitations imposed
by the individualistic paradigm, most group analysts remained fettered by their
allegiance to some theory of the personality, which they used to understand the
pathology and dynamics of the individual members of their groups. Hence, a
Freudian psychotherapist would carry out a Freudian group analysis, a Jungian
would do Jungian group analysis, and so on. And, indeed, we need to find a
way of viewing, understanding, and dealing with intra-personal, inter-personal,
and trans-personal phenomena and experiences, without being split between
 Beyond subject and object 107
diverse theories, based on different assumptions. And this requires the develop-
ment of a new paradigm of the human being (Hernández-Tubert, 2011; Tubert-
Oklander, 2017a).
Such a paradigm implies a conscious inquiry and revision of many of the under-
lying assumptions that are the bases of all our thinking, feeling, and acting – in
other words, our Weltanschauung (conception of the world) and Lebensanschau-
ung (conception of life). These conceptions constitute a psychological structure,
which is largely unconscious and stems from the unconscious aspects of social life
and is internalized from all our relations, starting with the very first introjections
and reinforced by all our later interpersonal and social experiences. This accounts
for the almost unquestionable certainty with which we uphold these assumptions,
which we do not usually perceive as being assumptions at all but only as “the way
things are” (Hernández Hernández, 2010; Hernández-Tubert, 2009).
Of course, trying to develop a new paradigm of the human being in order to
transcend the limitations of the old paradigm requires that the implicit assump-
tions of the latter be made explicit so that their implications can be sorted out and
duly criticized. This is an arduous work, since it implies not only an epistemo-
logical criticism of the underlying bases of our theories and practices but also an
analytic work of interpretation and working through of the powerful emotional
forces and social injunctions that oppose the disclosure and questioning of these
assumptions.
In our discipline, the task is even harder because the analytic identity is based
on a frequently non-analyzed transference with Freud and other founding fathers
or mothers of the analytic tradition into which the would-be analyst is being initi-
ated (Tubert-Oklander, 2014b). Hence, our frequent unsolvable theoretical dis-
cussions with other colleagues who espouse views different from our own are
not really about theory but instead are about our underlying world views and
emotional allegiances to ideal objects (Hernández Hernández, 2010; Hernández-
Tubert, 2000, 2015).
As I posed at the beginning of this chapter, Freud´s passionate desire to be a
great scientist was in conflict with the real nature of the intellectual, relational,
and social revolution he had initiated when he created psychoanalysis. He insisted
over and over again that psychoanalysis should become a natural science and
ignored the fact that his creation was bound to demolish the very bases of that
positivistic science that he firmly believed to be the only possible way to reliable
knowledge (Freud, 1933a). This obviously created a split in him, which is to be
found all through his written work and which has been unconsciously transmitted
to the subsequent generations of analysts, who also had to deal with their idealized
and often ambivalent transference relation with their forefather.
This is a most complex issue, which deserves a more extensive study. At the
moment, I wish to illustrate the form in which these unconscious conflicts were
dealt by a well-acknowledged psychoanalytic pioneer and innovator, Donald
Woods Winnicott, and how they limited the scope of his contributions. This is
a major example of the contradictions and conflicts that emerge when we try to
revise our deeply rooted beliefs.
108 Juan Tubert-Oklander
Winnicott’s contribution to the development of psychoanalysis was truly revo-
lutionary, but he did not conceive of his work that way. He frequently declared in
his writings that he had nothing to add to the generally accepted theory and then
expounded his ideas on what he apparently viewed as a minor detail, without
appearing to notice that they were truly incompatible with some major aspects of
Freudian theory. One clear instance of this is his reformulation of the psychoana-
lytic theory of motivation (Tubert-Oklander, 2017c).
In his classical paper “Metapsychological and Clinical Aspects of Regression
within the Psycho-analytical Set-up” (1955), he introduces a distinction between
“wishes” and “needs.” A wish seeks gratification, and, if this is not found, the
result is frustration. A need is neither gratified nor frustrated; it is either met or
not, and if it is not responded to, “the result is not anger, only a reproduction of
the environmental failure situation which stopped the processes of self growth”
(p. 22). Later, in “The Capacity to Be Alone” (Winnicott, 1958), he introduces the
concept of an ego-relatedness, quite different from an id-relationship, to refer to a
non-instinctual bond between mother and child or between patient and analyst. He
sees this bond as most important, as he considers it to be “the stuff out of which
friendship is made” and which “may turn out to be the matrix of transference”
(p. 418).
In 1960, he comes back to this subject, in “Ego Distortion in Terms of True
and False Self.” There he explicitly differentiates “ego-needs” from “id-needs.”
Id-needs are the instinctual wishes – sexual or aggressive – of drive theory. They
are organic tensions that tend to a pleasurable discharge, which we call “gratifica-
tion.” When this is lacking, there is an experience of unpleasure, which breeds
irritation and anger, called “frustration.” Ego-needs, on the other hand, require a
personal, loving, empathic, validating, and understanding response from another
human being. These needs are neither gratified nor frustrated, since they have
nothing to do with pleasure or displeasure. When they are met, the person’s expe-
rience is not pleasure but a feeling of harmony and well-being, a sense that eve-
rything is as it should be; when they are not, the inner response is not unpleasure
but a feeling of futility, hopelessness, and lack of meaning.
Winnicott was obviously introducing a radical change in the psychoanalytic
theory of motivation, one that replaced Freud’s purely functional biological con-
cepts with a theory of personal relations. We could now say that the theory of
drives belonged to Martin Buber’s (1923) I-It world, while Winnicott’s relational
proposal was clearly placed in the I-Thou domain. Hence, it is quite surprising
that his conclusion, at the end of the paper, is that these concepts should be “able
to have an important effect on psycho-analytic work [but] as far as I can see it
involves no important change in basic theory” (Winnicott, 1960, p. 152).
How is it possible that Winnicott failed to see the full import of his innovative
ideas? Greenberg and Mitchell (1983) believed that this was a strategic move,
intended to somehow disguise the implications of what he was saying and avoid
conflict with his professional community. I do not think this to be the case. Winni-
cott was an original thinker, and he was quite adamant about his need to think and
 Beyond subject and object 109
understand things in his own words and language, not in those of someone else
(Rodman, 1987). But he also had a positive idealized transference with Freud and
a yearning to belong to the tradition inaugurated by him. How was he to reconcile
these seemingly incompatible needs? I believe he did it by means of a splitting,
quite similar to the split in Freud between the practice he had created, focused on
inner experience and meaning, and his passionate wish to turn it into a natural
positivistic science.
This unconscious maneuver was helped by the fact that Winnicott rejected
systematic thinking and grand formal reconstructions of thought. His own think-
ing was more fluid and dialectical. So he did have a tendency to avoid reading
abstract theory. His feelings toward Freud were quite ambivalent: on one hand
he loved and admired him, but on the other he was rebellious toward this over-
powering father figure, and this led him to reject reading metapsychology. Con-
sequently, he was free to use the regular psychoanalytical vocabulary in new and
unexpected ways. But he also felt guilty about it. Thus, he wrote, in a letter to
Clifford M. Scott of December 26, 1956, quoted by Brett Kahr in D. W. Winnicott:
A Biographical Portrait, during his first term of office as president of the British
Psycho-Analytical Society,

I feel odd when in the president’s chair because I don’t know my Freud in the
way a president should do; yet I do find I have Freud in my bones.
(Winnicott, 1956, quoted in Kahr, 1996, p. 70)

“Having Freud in my bones” obviously refers to a deep identification, while

“knowing my Freud” as a requisite for being a president suggests that the Soci-
ety is an institution devoted to the preservation of the words and the idealized
image of its founding father. How could he, in view of such deep-rooted feelings,
acknowledge that he was actually discarding some of the basic axioms of the lat-
ter’s theories?
Indeed, when he and Masud Khan wrote a review of Fairbairn’s 1952 book
Psychoanalytic Studies of the Personality (Winnicott and Khan, 1953), they, in
spite of writing a very positive valuation, took exception to the fact that the author
rejected and proposed a theoretical alternative to some of Freud’s fundamental
assumptions. Their main argument, which clearly showed some irritation, was as
follows:

A reviewer is in a less fortunate position than an ordinary reader, since Fair-

bairn makes a definite claim, and it must be this claim that gets the appraisal
and the criticism. The claim is that Fairbairn’s theory supplants that of Freud.
If Fairbairn is right, then we teach Fairbairn and not Freud to our students.
If one could escape from this claim one could enjoy the writings of an analyst
who challenges everything, and who puts clinical evidence before accepted
theory, and who is no worshipper at a shrine. But the claim is there.
(p. 329, my italics)
110 Juan Tubert-Oklander
Of course, this criticism was not valid, since it relied on the fallacy called the
argument ad verecundum – resorting to authority: “this cannot be so because it
contradicts the sayings of a most prestigious author” (Tubert-Oklander, 2018).
But it is even more surprising when we consider that Fairbairn’s most objection-
able assertion was that the main motivation behind human experience, thought,
and behavior is the search for the object – that is, relationship – and not the search
for pleasure. This he posed in the following terms:

Libido is primarily object-seeking (rather than pleasure-seeking, as in the

classic theory), and that it is to disturbances in the object-relationships of the
developing ego that we must look for the ultimate origin of all psychopatho-
logical conditions.
(Fairbairn, 1944, p. 82)

This was precisely the very same idea Winnicott had been working on for some
time and that he developed in the papers of 1955, 1958, and 1960, quoted earlier.
It was to become the theoretical foundation of the British Independent Group’s
Object Relations Theory. But Winnicott never wrote it as a disagreement with
Freud. Indeed, the only issue on which he openly disagreed with his master was
Freud’s concept of the “death instinct,” as he wrote in the following quotation:

I have never been able to follow anyone else, not even Freud. But Freud was
easy to criticize, because he was always critical of himself. For instance,
I simply cannot find value in his idea of a Death Instinct.
(Winnicott, 1962, p. 171)

It is true that he was never able to follow or use anyone else’s language, as he was
too intent on thinking things through in his own words. But it was also true that
he had deep feelings of love, gratitude, admiration, and even awe toward Freud.
Hence, what both he and Khan criticized in Fairbairn was not his original ideas,
which were akin to theirs, but the fact that he openly acknowledged that they were
incompatible with some of the basic tenets of Freudian theory. It must be said, to
their credit, that both of them later recanted what they had written, recognizing
that they had not really understood Fairbairn’s ideas at that time (Clarke, 2014,
p. 303).
These are some of the emotional factors that oppose the possibility of a major
revision of the generally accepted theories. But there are other, subtler pressures
that are much more difficult to perceive, identify, and think through. These have
to do with the general assumptions about reality, knowledge, and the human con-
dition that constitute our Weltanschauung. And these usually persist under the
arguments of even the most revolutionary thinkers, as we have seen in the case of
Freud. I shall now examine, as a clear example of this, Winnicott’ s (1969) con-
ception of the use of the object.
Donald Winnicott read the paper called “The Use of an Object” (Winnicott,
1969) to the New York Psychoanalytic Society on November 12, 1968. He was
 Beyond subject and object 111
sternly criticized by the three official discussants (Edith Jacobson, Samuel Ritvo,
and Bernard Fine), who took all the allotted time, so that there was no space for
a discussion with the very large audience. They obviously did not understand or
accept his arguments and his idiosyncratic use of language, and, although the
transcripts of the session describe “a spirited intellectual exchange without signs
of personal animosity or rancor” (Goldman, 1993, p. 216), there is also some evi-
dence that the reaction to Winnicott’s paper was quite violent:

[S]ome participants in the meeting clearly recall an atmosphere of profound

intolerance toward Winnicott’s originality (Annie Bergman, personal com-
munication, June 16, 1992). In the aftermath of the formal presentation, one
participant noticed Winnicott to be visibly shaken and overheard him com-
menting that he now understood better why America was in Vietnam (Steven
Ellman, personal communication, May 15, 1992).
(p. 216)

Be that as it may, Winnicott, who had already come to the session feeling ill,
developed pulmonary edema while still in New York and had to be hospitalized in
a cardiac care unit for several weeks. So, there are some grounds for the interpre-
tation that the fact that he had not been able to convey an idea that was obviously
very important to him and had instead received a hostile response had at least
contributed to the aggravation of his medical condition (Goldman, 1993).
But what had Winnicott said in his presentation? In a nutshell, his argument was
as follows. For him, there was a basic distinction between what he called “object-
relating” and “object-usage.” As he had already written in many previous articles,
he believed that the starting point for the baby is a state of non-discrimination, in
which the infant is not aware of the existence of the mother. This determines an
“absolute dependence [since] the infant has no means of awareness of maternal
provision” (Winnicott, 1963, p. 87). At this stage, the object has become vitally
and emotionally significant for the child but is not yet perceived as existent in its
own right. This he calls “object-relating.” If the mother is good-enough, her min-
istrations come more or less at the time in which the baby’s need of her arises and
the infant evokes the memory of previous encounters with her. This creates for the
infant the illusion that he has created the object with his desire. This is what Freud
(1900a) conceived as a hallucination of the memory of the experience of satisfac-
tion, but Winnicott saw it not as a hallucination but as an illusion – a perception
of something that is really there, but with an added subjective meaning. Such an
object, perceived as if it were created by the child, he called a “subjective object,”
and this relation he called “object-relating.”
But this illusion, which determines a normal, desirable, and phase-adequate
feeling of omnipotence in the baby, is bound to collapse sooner or later, particu-
larly when the mother emerges from her regressive state of “primary maternal
preoccupation” (Winnicott, 1963) and starts recover her life, The baby reacts to
this with a bout of destructive hate that in his present state of omnipotence should
have annihilated the mother, but, to the infant’s surprise, she survives it and is still
112 Juan Tubert-Oklander
there. This is a breakdown of the previous omnipotence and the beginning of the
belief in an outside world, since it brings the first inkling that Mother really exists
as a separate object. It is the end of the subjective object and the birth of the real
object, which the child is now able to use, because it is real and full of unsus-
pected qualities to be discovered and enjoyed. Hence, object-relating is replaced
by object-usage.
Winnicott (1969) describes this in the following terms:

The subject can now use the object that has survived. It is important to note
that it is not only that the subject destroys the object because the object is
placed outside the area of omnipotent control. It is equally significant to state
this the other way round and to say that it is the destruction of the object that
places the object outside the area of the subject’s omnipotent control. In these
ways the object develops its own autonomy and life, and (if it survives) con-
tributes in to the subject, according to its own properties.
In other words, because of the survival of the object, the subject may now
have started to live a life in the world of objects, and so the subject stands to
gain immeasurably; but the price has to be paid in acceptance of the ongoing
destruction in unconscious fantasy relative to object-relating.
(p. 713)

The very same thing happens in the psychoanalytic treatment of severely trau-
matized patients: the patient destroys the analyst and the analyst survives, thus
becoming a real person to him.
This was a revolutionary statement, which was understandably misunderstood
and rejected by his three New York discussants. So, why do I say that this paper
shows, at one and the same time, his deep theoretical innovations and his subser-
vience to the old individualistic paradigm? Winnicott had been striving, during his
whole career, to develop a view of psychoanalysis in terms of personal relations,
which should have led him to a fully intersubjective theory and practice. But both
his allegiance to Freud and the fact that he was a medical doctor and had great
respect for natural science shackled him to the objectivistic conception upheld
by science, philosophy, and common sense. This is shown by the terms he chose.
First, we have the unfortunate use, which is generalized in psychoanalytic dis-
course, of the abstract terms “subject” and “object,” which conceals the fact that
we are talking about relations between real living persons, not mere acts of per-
ception or use of things. Such language is clearly positioned in the I-It construc-
tion of the world and not in the I-Thou one (Buber, 1923).
Then we have the fact that Winnicott, as well as most of the writers of the
Independent object-relations tradition, were striving to include the “real other” in
the understanding of the subject – whether a child or a patient – but did so almost
exclusively from the standpoint of the individual. In Winnicott’s theories, both
Mother and the analyst have a major impact on the human being who is under
their care, but only as functional objects. Winnicott’s “mother” is either “good-
enough” or “not-good-enough” in fulfilling her child-care functions, but nothing
 Beyond subject and object 113
is said of her as a person, her subjectivity, her fears, her wishes, her dreams, her
feelings, and the impact they have on her child. So, he stopped short of entering
the intersubjective domain. The same is true for the patient-analyst relation. In
this he strictly adhered to the medical and psychoanalytical tradition of keeping
an absolute asymmetry in therapeutic relations. He could have found some ele-
ments in Sándor Ferenczi to aid him in revising such overpowering assumptions,
but Winnicott also rejected reading Ferenczi. Indeed, he once said that he “was
reluctant to read the works of Ferenczi, lest he discover that he had actually stolen
ideas from him” (F. Robert Rodman, personal communication to Dodi Goldman
[1993], p. 5). Besides, Ferenczi’s 1932 Clinical Diary (Ferenczi, 1985), which
described his experiments in mutual analysis, was only published in French in
1985 and in English in 1988.
Third, there is the underlying assumption, which Freud seems to have derived
from Darwin’s evolutionary theory (Frank J. Sulloway, interviewed by Rudnytsky
[2000], pp. 137–209) and Haeckel’s biogenetic law (Peter J. Swales, interviewed
by Rudnytsky [2000], pp. 275–345), that human development follows a linear
course, from the more primitive and undifferentiated stages to the more mature
and normal ones. In such a view, “normal” means the usual mental state of a wak-
ing cultured adult male in our present society, and other forms of mental organi-
zation, such as those of children, women, mental patients, the lower classes, and
the “primitives” – that is, non-European – are to be considered underdeveloped or
even pathological. Freud argued, in Civilization and Its Discontents (1930a), that
an undifferentiated phase, which he called “oceanic feeling,” was a most primitive
state of mind, characteristic of the baby, which should be completely overcome
during normal development, remaining active in adulthood only in pathological
cases, and that it had nothing to offer to normal psychic functioning. And this is
the generally accepted version of orthodox psychoanalysis. But the idea that such
an organization persists as an alternative form of experience during the whole life-
time is what allows us to transcend the abyss that the subject-object differentia-
tion introduces between persons in the individualistic paradigm. Winnicott, who
was striving to develop a relational theory, was nonetheless tied to this traditional
view of existence and conceived personality development as a progression “from
dependence to independence” (1963) and from subjectivity to objectivity (1969),
and this prevented him from taking his nascent relational practice and theory to its
logical conclusions (Tubert-Oklander, 2014c).
Finally, there is the very concept of “object use.” The term “use,” in common
parlance, has connotations of exploitation and abuse. I know this is not what Win-
nicott meant; what he was trying to say is that a real other is much more satisfac-
tory than an invented object that emerges from the baby’s omnipotence. But why
did he choose this unfortunate term? I believe that he was influenced by Freud’s
assumption, which is a dogma of faith in our current social organization derived
from the Industrial Revolution, that the human being is essentially selfish and
strives only for the satisfaction of his needs and wishes, as Freud clearly said in
Civilization and Its Discontents (1930a) when he wrote that “we assume quite
generally that the motive force of all human activities is a striving toward the two
114 Juan Tubert-Oklander
confluent goals of utility and a yield of pleasure” (p. 95). Winnicott, who had wit-
nessed, as a pediatrician, thousands of mother-child interactions, knew better than
that, since he had seen how babies, from the very beginning, showed expressions
of concern and care for their adult caretakers. In the same vein, he acknowledged
and accepted, in his clinical practice, his patients’ expression of love, care, and
concern for their analyst. But nonetheless, he still insisted in his belief in the
baby’s “ruthlessness” (Guntrip, 1975).
I hope that this brief study of Winnicott’s contradictions may serve to illus-
trate the formidable and sometimes insurmountable difficulties we have to face
when we attempt to identify, question, and revise the set of implicit and frequently
unconscious assumptions that underlie our cherished theories and practices. But
there is, nonetheless, a most urgent need for us to do so, in order to contribute to
the development of the new paradigm of human life we so sorely need. Such a
paradigm cannot emerge only from psychoanalysis, since it is being constructed
from many sources in science, the humanities, art, religion, politics, and society,
but we should do our best effort to ensure that psychoanalysis have a place in this
transcendental change for humankind (Tubert-Oklander, 2019).

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8 The use of the object Jill Savege ScharffThe use of the object

Personal and clinical reflections

Jill Savege Scharff

“The use of the object” is the theme selected for this book, to which the editor,
my husband, David E. Scharff, has invited me to contribute, and so I must write
something that fits the theme. What exactly is he looking for? What is an object
anyway? In our work as therapists, the term “object” may refer to a literal object,
a thing that is used in various ways and that we then interpret as a metaphor for a
mental function. Perhaps that would be interesting to write about. “Object” may
refer to the external object, a term for an actual person such as a significant other.
I always think that expression is a bit weird and could be boring. More interest-
ing, “object” may refer to the internal object, a structure in the mind that is a trace
of interactions with and experience of a significant other in the formative years.
Then again, “object” is often used as shorthand for “internal object relationship”
and thus has a more complex meaning, referring to both an internal object and the
part of the ego that relates to it and all the affects that connect them (Scharff and
Scharff, 2005). So which of these should I write about?
Frankly facing the task of beginning to write this chapter was not easy. I couldn’t
decide. I couldn’t settle. I felt stuck. So, I tried to go to sleep. I was hoping that as
I slept, my unconscious would give me the answer or, better yet, write the chapter
for me. But my unconscious said, “No way. But I will give you a dream, so at least
you can sleep.”

The dream as an object

In my dream, I saw David indoors in a corridor in January, wearing a suit made of
patches of cotton fabric in a green, blue and purple Madras pattern and a bow-tie.
I thought it looked fine, but the fabric was unexpectedly lightweight for winter.
A woman told him his suit was ridiculous. He ignored her, but I knew he was
irritated. When she persisted in criticizing him, he said, “Enough. Meet me down-
stairs. We need to have a text meeting.” I was glad he confronted her, but I was
giggling to myself that the phrase is text message not text meeting, and he seemed
ridiculous using such an odd description for a meeting.
In this dream, the patchwork of David’s suit reminds me of a favorite pair of
patchwork tie-dyed pants I had in Scotland before I knew him and also of an
American version of a Scottish plaid, but the colors of the suit are the colors of the
 The use of the object 119
marketing materials for the International Psychotherapy Institute (IPI), which we
founded. The corridor setting reminds me of the Rockville conference hotel where
we hold in-residence training courses. The light weight of his suit makes me think
of April, when graduation occurs. The woman who was angry at David looks like
a patient of mine who has been angry at her husband and critical of his way of
doing things, while she does nothing but now is afraid of losing him. The word
“text” seems to refer to the missing text of this chapter that I owe him but that is
not yet written. He hasn’t confronted me about getting the chapter written in time
but he has been teasing me about how ridiculous it is that I will do everything else
first – clean my desk, arrange family dinners, clean up all the administrative tasks
that must be done – before I will write. And is there a message in the dream about
my chapter?
The dream as an anxiety release object did let me sleep, and I did wake up with
the dream as an object for contemplation and a start for my essay. It shows me
that David is being patient while controlling his irritation with me, that I rebel
against the task, and that I would rather ridicule David than co-operate. I would
rather ridicule him than feel so ridiculous and inept myself. I would rather it were
April, after the Master Speakers date, so that I could be watching students gradu-
ate rather than step up myself. I have to agree with my dream that indeed it is time
for a text meeting. I have to stop my use of the term “object” as a verb to mean
“I object” and start creating a chapter, thanks to the work done in the dream. The
dream has given the format to “suit” the theme of the book. The book will be a
patchwork of chapters, each of them an association to “the object.” My chapter
will be one of the patches. And within my chapter will be many smaller patches
comprising my many associations to the term “the object.”
Now I can look back on the dream itself as an object. It is an object for anxiety
discharge, for contemplation of the unconscious roots of resistance, for taking
back unconscious projective identifications and freeing the ego for work.

The literal object: use of the computer as an object

With the advent of technology, we have ready access to computers and hand-held
devices for computation, text messaging, audiovisual communication, memory
storage, and games. These are objects that can enhance our capabilities and expose
our deficiencies as they challenge us beyond our expertise. Children are grow-
ing up with technology as part of their environment, and they relate to technical
devices intuitively. To them the devices are familiar extensions of themselves and
the world around them. Using Pichon-Rivière’s link theory (Losso, Setton and
Scharff, 2017), we might say that these technology objects are part of the link into
which these people are born and upon which they will exert an impact as they use
them in more and various ways that we cannot yet imagine. These objects are also
exciting and frustrating in offering immense possibilities and then leaving you in
the lurch as the screen goes dark, the Internet connection is lost, or malware cor-
rupts the system. Email can become a persecuting object driving a relentless pace
of interaction and creating a record that can come back to haunt you.
120 Jill Savege Scharff
For some patients who live remote from a major center, technology-assisted treat-
ment and supervision have been a lifeline, a sustaining object. For analysts who
accept these patients, teleanalysis has been a secret, a guilt-ridden object that can
draw attack and shaming (Scharff, 2013, 2015, 2017, 2018). According to conserva-
tive, traditional analysts, “This is not analysis!” But teleanalysis has a specific set-
ting, a frame of treatment, a private space for reflection, a focus on the unconscious,
and in that setting the analytic process occurs through transference and counter-
transference and the ensuing interpretation leads to therapeutic action. But the bod-
ies are not in the same room, there is no bodily communication, and some people
say that therefore there cannot be an analytic process because it is not real. So, for a
clinician who does accept patients from afar, teleanalysis has become a controver-
sial object about which study and research may bring validation of its worth.
During distance analysis or therapy of individuals or couples, the technology
itself becomes an object of study too. Just as the traditional analyst works with
displacement of unconscious desire onto objects outside the transference, the
teleanalyst notes that the transference is displaced to the computer screen, the
bandwidth, and the choice of setting and gathers it from there to himself. Fail-
ure to arrange for adequate bandwidth may be a way of expressing resistance
to treatment. It is tempting for the technology novice, the “digital immigrant,”
to brush past technical problems so as to avoid noticing anxiety about the use
of the technology and ineptness with equipment. The teleanalyst is vulnerable
to viewing technology as a shaming object and wants to deny its power. But to
erase the impact of a failed connection is to miss the opportunity to respond to it
as an empathic failure, a sudden deletion of the connection between the preced-
ing thought, feeling, or interaction. When teletherapy is a trusted object, we can
proceed to interpret the abandonment anxiety of the failed connection – and that
may take us to a discussion of its connection to the maternal void and ultimately
to issues of life and death.

The use of the body as an object

The body as a quantified object

How many of my women friends and colleagues use smart watches or Fitbits to
track the biological functioning of their own bodies and of their babies! This gives
them a feeling of control over sleep and dreaming, exercise (10,000 steps a day!),
heart rhythm, and breathing rate and over the baby’s input and output, its sleep and
wake cycles. I have heard this described as the quantified self (Wolf, 2009), but
I think of it as the quantified object. The body becomes an object of the mind rather
than the spontaneous source of sensation that drives the formation of the self.

The use of the female body as an object

It’s all over the news that women have been putting up for years with sexual
aggression and attacks on their competence at work by being reduced to sex-
ual objects. We have been scared of getting physically hurt, accused of being
 The use of the object 121
provocative, and left with ruined reputations, too scared to speak up and accuse
the perpetrator on whom we are dependent for income and promotion. We are
afraid that blame will be turned on us. In non-violent situations, there is discom-
fort, if not fear. As a young psychiatrist I was viewed as fair game by a senior
psychiatrist I worked for. This is a man of integrity who would never have cheated
on his wife, but he saw no reason not to comment on my figure. He would loudly
propose taking me into the bushes. There was no inappropriate touching. I was not
afraid that there might be because I knew he did not mean it, but it was excruciat-
ingly embarrassing to me because I had no idea how to handle it, and so it kept
happening. What kind of object was he to me? A man who could break through
my defense of being a serious MD to make everyone around see me as a woman
to flirt with, a woman who was dependent on him for a job and a performance
review, a young woman who didn’t know how to play that game and felt patheti-
cally in need of a champion. When a woman is used as an object, she finds it very
difficult to be herself and to speak to the issue in a way that does not then treat the
man as an object. When we speak about the use of the object, we are really talking
about the failure to use the self effectively.
Pregnant women are exposed to lots of non-consensual touching. I am not talk-
ing about those times when a woman invites a friend or family member to feel the
baby move. I am talking about those times when strangers feel entitled to pat the
swollen belly. Some indulge in telling the woman horror stories from their deliv-
eries, and others talk about damaged babies. As a pregnant psychiatrist, I was in
class at an analytic institute where most of the teachers were MDs. When one of
the teachers saw that I was pregnant, he said that he would have to start carrying
his penknife around with him in case he had to do a quick C-section. Clearly the
pregnant belly, associated as it is with intercourse, is an object of fascination and
the growing fetus an object of envy as well as of hope and wonder. On that occa-
sion I felt a lot of unconscious aggression in my teacher’s medical bravado.
As a child and family therapist, I note the way that my body is used as an object.
In family therapy, as part of a game, a young boy taped my mouth shut with elec-
trical tape, blindfolded me with a piece of cloth, and spun me around in my office
chair so that I could not see what was happening or locate myself in relation to the
family, and therefore I could not speak to the dynamics. Of course, I could imagine
the family, I know my office well, and I could speak past the tape. I said that he
wanted me to know how it felt to be in that family. It must feel so unsafe to look and
see what is happening and speak about it that he could feel like he was being spun
around by all the forces in the family, all the more in the session with me because
our task was to explore the family situation and try to understand it together. His
use of me as an object gave me access to his self-experience of his family.

The unpossessible object

The unpossessible object for the needy child

In the autistic child, a child whose emotional and cognitive deficits lead to an
inner feeling of spacelessness and mindlessness, the autistic self is dismantled
122 Jill Savege Scharff
into its sensual components that attach themselves to the most stimulating object
of the moment (Meltzer, 2008). This gives a vacuous feeling of omnipotent con-
trol over and separation from its objects but leaves the child’s mind with a feeling
of falling into bits. This feeling of the dismantling of the self leads to extreme
dependence on the mental functions of an external object, and not just on the care,
holding and handling provided. Because of the unfortunate combination of the
inadequacy of the child’s equipment and the mother’s limitations, a fundamental
failure of dependence occurs. The child comes into therapy or analysis and, again,
the container-as-object, now in the form of the therapist, is experienced as totally
untrustworthy and must be held in place or entered as a way of taking control of
it by a kind of fusion rather than inter-relating. This fusion with the object is seen
in behavior such as burrowing into the therapist, using the therapist’s hands to
accomplish manipulations, and demanding to use the therapist’s body as if it were
furniture. In such cases the therapist may usefully allow a “degree of permissive-
ness with regard to physical contact, in touching, looking, smelling and tasting.”
The children are intrusive, highly sensual, and possessive, as if they were desper-
ately trying to possess an unpossessible object by adhering to and capturing its
surface qualities but sadly finding it permanently devoid of substance.

The unpossessible object for the unrequited lover

Another variety of unpossessible object is seen in the situation of an adult woman
who longs for a lost lover. What or who does he represent to her? What has she
projected into her attachment to him? One such woman is Lilia, whose longing is
extreme and keeps her frozen in place as a single woman.
Lilia makes a small salary, is an excellent money manager, and is able to pay me
a reasonable reduced fee for once-a-week therapy. She is not able to pay for more
in terms of time or money. She is a good patient, walking at least 30 minutes to my
office, always on time. She is quite depressed and slow to get around to her own
problems and begins most sessions with a passionate statement about her latest
blog on democratic political ideals, especially gun control, global responsibility,
diversity, and social service. She works in the non-profit world and wears simple
clothes and no makeup, her short blond hair swept behind her ears. I often feel
I would like to fix her to bring out her beauty, and I recognize in that a mother’s
wish to have her daughter look attractive.
Lilia’s presenting symptom is that she cannot get over the pain of losing a man
with whom she had a wonderful intimate relationship for less than a year, now six
years ago. His name was Pablo, and he came from Panama, so his English was
excellent. They met in Kazakhstan, where each of them was doing service abroad.
She thought at first that this would be just a fling lasting a couple of months before
their posting ended, but it became a wonderful, warm relationship, and Pablo
visited the United States and stayed with her and her family. Then he got a job in
a remote part of South America, and he expected her to emigrate to be with him.
But she didn’t speak Spanish and didn’t have a work permit, and, although she
wanted to be with him right away, she decided to wait, took a job in New York,
 The use of the object 123
and informed him that she couldn’t join him yet. She expected to continue the
relationship on a commuting basis, but he took her decision as a rejection. He
didn’t come to the United States, and he didn’t fight for her to come to the country
where he was then living or ease her way there. Lilia looks back on her decision
as a response to some problems in the relationship that she hadn’t acknowledged,
his way of making assumptions about her relationship to him without discussion
of her fears and needs, and also her fear of the unknown. But that insight didn’t
reconcile her to her situation.
Lilia constantly tortures herself with thoughts of how her life might have been
different had she gone to be with Pablo. Since communication was so difficult, she
went to South America to see him in person and hoped to work it out. That was
five years ago. She said, “He was glad to see me, we went out and had fun but he
was treating me like an old friend, and there were always these two other women
with us. He said I had changed. I was too afraid to ask him how I had changed,
and I just acted badly, crying, and jealous and screaming about feeling excluded.
No way to get someone back. He said he was ‘done with it.’ And I am still crying
about it years later. So, a couple months ago I went again to see him to settle it
once and for all. There was so little likelihood it could work, but I had to try it.
And again, he was pleased to see me, we had fun, and again, he was with someone
else. I am glad I didn’t act badly, but I am still so torn up about it.”
Both times she has been faced with the reality of Pablo’s current attachment
to another woman and of his interest in her purely as a friend. She seemed to me
to be in an Oedipal loser situation and to be behaving out of control, which is an
aspect of her father that she can’t stand and fears. Yet the lost love is still firmly
installed as a desired and frustrating love object in her heart and mind. When
I described the hold she let him have on her, Lilia thought I said hole. This helped
me see the defensive reason for her installing him as an internal object to fill a
hole and to keep her from risking involvement with any other man, but I didn’t
yet know the reason.
In the session before the one I will present, Lilia explained, “I had always cho-
sen where to live and work on the basis of a sense of calling. This was the first
time I thought with my head, not my heart, and I have been regretting it ever
since. I was ready to go on a tourist visa, but I was afraid. I need an internal pro-
cess to figure out the right decision, and he didn’t give me that. I was thinking
with my heart not my head, and something was telling me don’t go. He was slow
to respond on G-chat. Instead of confronting him and saying I feel you are not
fully engaged, not helping me with this transition, I just shut down, and moved to
DC for a safe job.” I noted the reversal of heart and head but waited to see what
I could make of it.
In the next session, she began by telling me she had noticed two things about
herself: “I really want you to like me so that I will get what I need from therapy
and get better, and I am trying not to cry, which could make you think that I am
just like those dramatic people you always hear talking about their parents in
therapy on television.” I had noticed she was leaning forward talking and gesticu-
lating and smiling as if to engage me actively because she was unable to assume
124 Jill Savege Scharff
I would listen and keep my commitment. She often tells me successful things she
has done at work activity to make me admire her and delay work on her insecuri-
ties. I also noted that she does cry by the end of sessions, which feels like a relief
to me, not a dramatic maneuver at all. I want her to cry or not cry, just be herself
as we try to get at her underlying problems.
Lilia said, “My Dad is the most introverted person you will ever meet, and
I love it that he doesn’t give a crap about what people expect of him in the Hamp-
tons where they live. But at home I hate it that he is like a terrorist suddenly
getting so angry and being impossible. And my mother can’t protect us from it.
On the other hand, he is really there. He spent all his money on education for us
and adventure vacations. And our college tuition was fully funded. Even though
he had a stroke, we had no worries about staying in school. I drove down from
school to see him every week for eight weeks when he was recovering. I am so
glad I did that.”
I asked about the illness, and she began to cry.
“Yeah he had a stroke. I was in shock. I called my sister and asked her what
we would do if he didn’t survive. She just said calmly she would take Mom to
live with her, and Mom could take care of the grandchildren. Maybe it would be
better for Mom, but that is the way my sister is. She deals. But then he had a good
response to rehab, and he can still work full-time.
“After the stroke he dropped from 350 pounds to 250. But that is still too heavy
for his height. I told him I couldn’t fight him on it anymore. If he wants be fat and
drop dead of another stroke or a heart attack, he will just have to do it.” Lilia is
crying again. “My Mom never said anything about his weight. She doesn’t fight
about anything at all. Well, my Mom just isn’t there. Call her up for a conversation
and she talks about the news and the weather. I never learn anything about her, or
who she is apart from him.”
I said, “Your sister responded to the threat of losing your father in terms of your
mother’s needs. But what about the effect on you of losing your Dad? Then you
would be left with only your mother.”
Lilia started to cry again.
I said, “How does all this connect to you?”
She asked, “What do you mean?”
I said, “Well, your mother is subsumed in your father. He is big and she is tiny.
You feel she is nothing for you to relate to.”
“Yes, she is all about him. I just don’t know who she is. I wish she had a pas-
sion, but she doesn’t. She just gets consumed in him. Oh, she took a class in
botany, which could be a great thing, but it was just to pass the time. I can relate
to that, though. Sometimes I just want the time to pass so I can go to sleep and the
pain will stop. I hurt all the time. The first time I felt it was in seventh grade when
the girls suddenly excluded me from the clique.”
I asked if she has an image of the pain.
She said, “I feel that there is pipe stuck through my heart, and my heart is beat-
ing around it.”
 The use of the object 125
I remembered her references in the previous session to thinking with her heart
or her head. I said again, “Let’s see how this connects to you. You are like your
father in being education oriented, ambitious, and passionate about education,
human rights, and women’s issues. But you are like your mother in being sub-
sumed in Pablo. You both make the man into a wonderful, powerful object for you
to desire and feel hurt by. Pablo is so big in your life, and he just sits there in your
heart, and you are not able to think of making room for any other man to make a
relationship with. We can’t know why your mother lives through your father, but
we can see that you use Pablo like a pipe to fill the hole that’s left in your heart
from before you ever met him.”
It seems that Lilia’s identification with her mother’s way of using her husband
as an object in which to lose herself drove the fantasy of immersing herself in life
with Pablo in his culture, but because of actual lack of connection to her mother’s
self she reacted against that identification and decided not to go. Now it seems that
Lilia’s fighting for Pablo is a way of creating a man to make up for what is miss-
ing in her relationship with her mother and an experience of losing out to another
woman, as the child must lose out to her mother who is already her father’s wife.
Is Lilia’s fight for Pablo also a way of exploring whether her father’s angry out-
bursts are not simply a response to stress, as claimed, but rather a reaction to her
mother’s emotional absence and a search for a present but unpossessible object?

The patient as the therapist’s object

The valued and envied object

At this point in my career, most of my adult patients are mental health profession-
als. I feel an ethical responsibility to restrict my use of their material for teaching
purposes. So, although in the office context these patients are gifted in their capac-
ity for deep unconscious communication and analysis, in the teaching setting they
are off limits. These are people who respond well to analysis, who engage with
me, fight with me, and make reparation to me and in whose sessions I generally
feel that I am a good analyst. Of course, you will have to take my word for it. You
might not agree at all. But I still have the fantasy that if I presented their sessions,
they would make me look good. So what kind of an object is such a patient?
A narcissistically gratifying object, a precious hidden gem, but one that leaves me
depleted of the opportunity for external validation – or course correction – from
helpful colleagues, which leaves me and them vulnerable to countertransference
mistakes, to overvaluation, and to living through them. Some patients make you
feel like a talented analyst when others do not. I am reminded of Winnicott’s
compliment to Guntrip as the patient who made him look good whereas the chap
before him did not (Guntrip, 1975, p. 153). So, these patients are reassuring
objects to me. And yet if they are candidates in training, the institutional context
bears down on the analysis, and these treasured objects are exposed to attack that
may have more to do with the institution’s envy of the analyst for having such a
126 Jill Savege Scharff
candidate to work with than anything to do with the candidate himself. Here the
candidate is an object for displaced attack.

The elusive object

In my case, the patient who does not make me look good is the one I could more
easily present, the one who showed up in my dream. But I find I don’t want to.
She is an at-home mother who does substitute elementary school teaching. So,
she has a late-afternoon appointment time, which is when I am most tired. She is
intelligent, pretty, and devoted to her family. She is a good patient, punctual, reli-
able, flexible, and compliant. She talks freely about her life, and her feelings of
rejection by her husband, who does not join her interest in social life and tennis,
and her child, who is secretive about her activities and her feelings. She is open
about her depression and negativity, her jealousy of people with confidence, and
her total lack of confidence in her ability despite positive feedback at work. She
brings in notes on her dreams, which are so long and complicated that she cannot
remember them, and if I don’t write them down, I can’t reconstruct them in my
mind either. She is not boring, but she is somewhat opaque to me. She is afraid
that no matter how hard she tries or how faithfully she attends, she will never get
to the root of her lack of confidence.
As I work with this patient, I feel I am not getting beyond the surface. She
does not engage with me as the others do. I make interpretations and she often
accepts them and elaborates on them, but they don’t seem to make a difference.
She still feels that she is not the woman she wants to be. She has many friends,
never more in evidence than now when her daughter is ill, but she feels unwor-
thy of their care and basically does not feel loved. It feels as if my therapeutic
love is not enough either. Her resistance is shown not against the frame or in
direct challenges to me but against herself and me as the person with therapeu-
tic ambitions. Perhaps she doesn’t want me to feel better about myself than she
does. This patient is a test of analysis and of me as her analyst. In this case the
patient is an elusive object.

The ideal object, the denigrated therapist

My first male analytic patient was an ideal object to me. I was enchanted by his
discourse, fascinated by his accent, and impressed by his access to Washington
political life. I overlooked that fact that he made no money, that he paid me from
his inheritance less than I paid my supervisor, and that his denigration of his wife
and neglect of his children would soon fall upon me. My supervisor was equally
enchanted with the patient and with me. He listened intently, never interrupted,
and at the end of the session murmured something approving. After the patient
had been in analysis for two years, I got pregnant. The supervisor instructed me
to make no announcement, to wait until it appeared in the man’s associations. But
the man ignored my pregnancy, preferring to think that I was getting fat. This man
 The use of the object 127
was an only child and had never had to deal with a rival for his mother’s devotion.
When his children were born, he hated his wife being so preoccupied with them.
When my imminent delivery could be avoided no longer, he apparently accepted
that I would be away on maternity leave and return in two months. But, a week
after delivery, he called up my husband to ask him what I had had, a boy or a girl.
David told him that mother and baby are both well and any other questions he
might take up with me on my return. The man was furious. He returned after the
two months, deeply offended at my husband’s reply. He said, “I called to express
my concern for you, but your husband was rude, like an officious clerk at a ticket
counter saying next counter please.” I was sympathetic to his feeling of rejection
and appreciative of his concern. But when I too did not answer his question, he
quit, and he did not answer my letters asking for closure. He did not pay the bal-
ance of my bill, left unpaid for two months before my maternity leave began, and
I had to write it off. I had abandoned him for a husband and a baby, and we had
denied him access to knowledge about our baby. Mutual idealization defaulted to
denigration and traumatic loss. This overvalued first patient became a disappoint-
ing object because I had disappointed him in failing to accept his concern and,
I might add, in failing to see what a baby he was in real-life and what a baby I was
in doing my first analysis.

The reparative object

More recently I had a similarly narcissistic male patient. His intellect was quite
amazing, but thanks to my earlier experience I was not bewitched. I could be
appreciative, but also call him on the narcissism of his intellectual defense and
help him heal himself. Unlike my first case, he became a reparative object for me.

The memorable object

Another woman patient was directly challenging to me. She was furious at me
much of the time because she felt that I was refusing to agree to her demands that
I love her. She had lost her mother in a traumatic way and really felt the need of
maternal care. On the couch, what she needed to do was to scream at me in rage
at all she had lost so that she could stop being so vicious with people in her life.
Sometimes I hated her as much as she hated me. She and I had lengthy engage-
ment in dark hours, affect storms, and hurts until her neurosis, and its installation
in the transference/countertransference dynamic, was represented in a dream as a
point on the shore that became smaller and smaller as she was rowing out away
from it. At the end of her successful analysis she told me that she realized that
what she had had from me was not love as such but love such as it is. And it had
been what she needed. This was years ago during my training, but her conclusion
about love has remained with me, and so has she. She is a highly valued object in
my internal world as an analyst, rather like a first love, let go of, grown beyond,
but never forgotten.
128 Jill Savege Scharff
Summary
In this chapter I explored the meaning of the term “the object.” I addressed the
literal object, such as the computer used as an object for interpretive work in tel-
eanalysis. I look at the use of the body as an object – especially the female body,
very topical and always strikingly relevant for the child therapist. I have illus-
trated the use of the object in intimate and therapeutic relationships to express,
hide, deny, attack, or cohere parts of the self and to absorb desire or hatred. The
concluding section featured the patient as the therapist’s object.

References
Guntrip, H. (1975). My experience of analysis with Fairbairn and Winnicott. International
Journal of Psycho-Analysis, 16: 145–156.
Losso, R., Setton, L. and Scharff, D. (2017). The Linked Self in Psychoanalysis: The Pio-
neering Work of Enrique Pichon-Rivière. London: Karnac.
Meltzer, D. (Ed.) (2008). Explorations in Autism. London: Karnac.
Scharff, J. (Ed.) (2013). Psychoanalysis Online: Mental Health, Teletherapy and Training.
London: Karnac.
Scharff, J. (Ed.) (2015). Psychoanalysis Online 2: Impact of Technology on Development,
Training and Therapy. London: Karnac.
Scharff, J. (Ed.) (2017). Psychoanalysis Online 3: The Teleanalytic Setting. London:
Karnac.
Scharff, J. (Ed.) (2018). Psychoanalysis Online 4: Teleanalytic Practice, Clinical Research
and Teaching. London: Karnac.
Scharff, J. S. and Scharff, D. E. (2005). The Primer of Object Relations, 2nd Edition.
­Lanham, MD: Jason Aronson.
Wolf, G. (2009). Know thyself: Tracking every facet of life; from sleep to mood to pain.
Wired Magazine, 24(7): 365.
Epilogue David E. ScharffEpilogue

David E. Scharff

The idea of how we use others has spawned diverse theories, from the intersub-
jective way that we co-create experience with others to the theorists of the link in
South America who see the encounter with others as always constituting a chal-
lenge to the continuity of our psychic selves.
In this volume, written largely from the vantage of psychoanalytic object rela-
tions, the contributors have looked at how we encounter, use, and relate to others
from a number of perspectives. Listening to and, later, reading the thinking of
each contributor has expanded my own way of seeing the psychoanalytic object.
The objects we encounter as the history of each patient comes to life through
daily analytic work show us details about our patients as their objects acquire ever
more vivid qualities, brought into focus as we probe the depths of our patients’
unconscious. As we do so, we also come to constitute an increasingly complex
object for each patient.
In this process, we are gradually transformed from seeming to them to be a new
edition of old objects to becoming an object of a new kind. In this way we hope
to disrupt how they have seen and related to their old objects. We hope to foster
growth by being developmental objects, we offer to be transference objects, and
ultimately, we aspire to become transformational objects.
In this way, we lend ourselves to be used in the way Winnicott proposed more
than 50 years ago. In his terms, we offer to move from being objects to whom our
patients relate, to being there for object use, as patients explore the world of others
and move beyond the constraints that bound them when they first sought our help.
I hope that this book, too, will have become an object for use – a guide offering
an opportunity to think anew about common clinical dilemmas and, at oppor-
tune times, an object that creatively disrupts ways of thinking in order to lead us
toward opportunities for growth in our capacity to help our patients.
Index

Note: Italicized page numbers indicate a figure on the corresponding page.

alcohol use/abuse 34 – 35, 36 Civilization and Its Discontents (Freud)

alpha function 68 113 – 114
Analysis Terminable and Interminable Clinical Diary (Ferenczi) 113
(Freud) 67, 68 co-creative experiences 129
anchor points in narrative 48 communicative disturbances 45
animal abuse 83 communism 92
anti-environmental bias in computer as object 119 – 120
psychoanalysis 101 conditional value 28
anti-libidinal ego 82, 87 conscious interactions 6
antithesis ego 103 constitutional phonological disorder 64 – 65
anxiety release object 119 contextual transference 44, 48
argument ad verecundum 110 countertransference 5, 7, 31, 43
Aristotle 105
Ashbach, Charles 69 Darwin’s evolutionary theory 113
Attachment and Loss (Bowlby) 1 “Dead Mother Complex” (Green) 68,
autistic children 121 – 125 70 – 71, 87
autistic objects 50 denigrated therapist 126 – 127
depressive form of relating 58, 73
bad object experiences 87, 92 – 93, 94 – 95 destruction of object 4
bad objects 13 deterministic positivism 104
belonging dynamics 94 developmental history of trauma 72
Bionian beta bits 68 developmental objects 43 – 44, 46, 48 – 49,
blame in relationships 14 52 – 55, 58 – 65
body as object 120 – 121 digital immigrant 120
Bollas, C. 74 Dream, Phantasy and Art (Segal) 86
boredom in relationships 14 dream as the object 118 – 119
Bowlby, John 1 dream work by therapists: in challenging
breastfeeding problems 42 cases 31 – 34; course of treatment 36;
British Independent Group 105, 110 interpretation of 38 – 39; overview of
34 – 35; session examples 36 – 38, 39 – 40
capacity for concern 4 dynamic interactions 7
“Capacity to Be Alone, The” (Winnicott)
108 ego 68, 108
Cartesian subject 103 – 104 “Ego Distortion in Terms of True and False
Catch Them before They Fall (Bollas) 74 Self ” (Winnicott) 108
Central Self 82 elusive object 126
child abuse trauma 102 emotions without meanings 33
childhood sexual experiences 72, 76 endopsychic mind 93, 94
 Index 131
envied object 125 – 127 intentionality principle 105
environmental causation of interference, defined 19
psychopathology 102 interminable cases: case study of L
environment mother 44 72 – 80; case study of M 80 – 82; case
erotized transference 73 – 74 study of P 82 – 86; developmental
evolutionary theory 113 history case example 83 – 84; dream
external object 18, 90 – 91 examples 75 – 76; Fairbairn’s theoretical
contribution to 69 – 70; Freud’s ideas
Fairbairn, W.R.D. 69 – 70, 82, 90 – 93 about 67 – 68; Green’s Dead Mother
fascism 92 Complexes 68, 70 – 71; introduction to
female body as object 120 – 121 67; Master Speaker Seminar Series 69;
Ferenczi, Sándor 113 pre-Oedipal/Oedipal dynamics 78 – 80,
focused transference 44 81; session examples 74 – 75, 84 – 85;
Foulkes, S. H. 106 Steiner’s theory of psychic retreats
Freud, Sigmund 67 – 68, 101 – 114 71 – 72; therapist as object 85 – 87;
treatment examples 72 – 74
garbage spaces 20 internal analytic setting 58
good-enough analysts 82 internal mother 54 – 55
good-enough mother 44, 112 – 113 internal objects 4 – 7, 18, 69 – 70, 87, 89;
good objects 13, 81 – 82, 90, 98 – 99 see also ingroup as internal object
good social object 98 – 99 International Psychotherapy Institute 69
Green, Andre 68, 70 – 71, 87 International Psychotherapy Institute
grief experience, unconscious 38 (IPI) 119
group analysis 106 intersubjective contracts: Damien case
group identity 95 study 22 – 28; external/internal objects
18; intrapsychic vs. 18 – 21; the object
haunting of the phantom 20 in patient’s lives 18 – 21; summary of
here-and-now presence of the other 19, 48 29; therapeutic strategies for diseases of
heterogeneous patients 67 21 – 22
husband-object 11 – 15 intrapsychic vs. intersubjective 18 – 21
Introductory Lectures (Freud) 104
I-It 108 Introductory Lectures on Psychoanalysis
I-thou 108, 112 (Freud) 67
I-thou-and-them 32 introjection in internalization 90
id 68, 108
ideal object 15, 107, 126 – 127 Jacobs, Theodore 1 – 2
identification process 19, 90
identity groups 93 – 94 Kaczynski, Ted 17
illusion vs. hallucination 111 Kaës, Rene 20
implicit relational patterns 20, 22 Klein, Melanie 4
incorporation in internalization 90
indwelling 20 Lebensanschauung (conception of life)
infantile dependence persisting into 107
adulthood 91 libido 110
ingroup as internal object: bad libido as object-seeking 90
object experiences 92 – 93, 94 – 95; lines of flight 20
ingroup, defined 89; introduction link theory 119
to 89 – 91; psychodynamics of social literal object 119 – 120
object 97 – 98; psychotherapy impact living in the object 4 – 15
on social object 98 – 99; social object
and group membership 95 – 97; marijuana use 34 – 35, 36
social object representation 93 – 94; Master Speaker Seminar Series
sociological group formations 91 – 93; (2016–2017) 69
summary of 99 materialistic metaphysics 102 – 103
132 Index
meanings without emotions 33 principle of intentionality 105
memorable object 127 Project (Freud) 103
“Metapsychological and Clinical Aspects psychic conflict over trauma 68
of Regression within the Psycho- Psychic Retreats (Stiener) 71 – 72
analytical Set-up” (Winnicott) 108 Psychoanalytic Studies of the Personality
molestation 13 – 14 (Winnicott, Khan) 109
mourning losses 40, 86
radical Islamic organizations 92
Naltrexone treatment 35 Re-finding the Object and Reclaiming the
neutral objectivism 104 Self (Scharff ) 32
New Introductory Lectures on rejection of teleology 105
Psychoanalysis (Freud) 67 religious devotion 23, 25 – 26
Newtonian conception of the universe reparative object 127
102 – 103
non-consensual touching 121 seduction theory 102
non-ego 103 Segal, Hanna 86
not-good-enough mother 112 – 113 self-and-object organization 10 – 11
not-thinking 25 self-blame 26
self-devaluation 24, 25
the object in patient’s lives: bad object self-negation 23 – 24
experiences 87, 92 – 93, 94 – 95; body self-organizations 7
as 120 – 121; developmental objects self-other differentiation 90
43 – 44, 46, 48 – 49, 52 – 55, 58 – 65; self-punishment 68
dream as 118 – 119; external/internal sense of self 4 – 5
objects 18; good objects 13, 81 – 82, 90, separation anxiety 42 – 43, 46, 50 – 51
98 – 99; internal objects 4 – 7, 18, 69 – 70, sexual abuse 80
87, 89; intersubjective vs. intrapsychic sexual experiences in childhood 72, 76, 83
18 – 21; introduction to 17; literal object shame 25 – 26, 35, 40
119 – 120; living in 4 – 15; multiple social/interpersonal environments 17
psyches and 31; patient as object social object: as bad object 94 – 95;
125 – 127; social object representation group membership and 95 – 97;
93 – 94; summary of 128; therapist as ingroup as 91 – 93; as internal object
object 85 – 87; unpossessible object 93 – 94; psychodynamics of 97 – 98;
121 – 125; see also internal objects psychotherapy impact on 98 – 99;
object mother 44 representation of 93 – 94
object relating 4, 111 – 112 sociological group formations 91 – 93
Object Relations Theory 110 son-as-object 8 – 10
object-usage considerations 101 – 114 spiral process 43
Oedipal issues 6, 13, 67, 78 – 80, 81, 123 Stiener, John 71 – 72
others 1 – 3, 19, 32 Studies on Hysteria (Freud) 101
subjective object 111 – 112
paranoid-schizoid form of relating 9, 10, subject-object differentiation 103
58, 73 suicidal thoughts 23
patient as object 125 – 127
patient trauma 31 teleanalysis 120, 128
Pichon-Rivière, Enrique 106 teleology, rejection of 105
Playing and Reality (Winnicott) 1, 4 therapeutic interference 27
pockets of intoxication 20 therapist as object 85 – 87
points of urgency 46 transference 5, 7, 31, 73 – 74
post-traumatic stress syndrome 64 transference objects in child analysis:
pre-Oedipal dynamics 78 – 80, 81 analysis vignettes 46 – 48; case overview
pre-verbal trauma 68 44 – 46; developmental objects and
primary maternal preoccupation 111 43 – 44, 46, 48 – 49, 52 – 55, 58 – 65; early/
 Index 133
middle phase of psychoanalytic therapy unconscious interactions 6 – 8
50, 50 – 64, 53, 55 – 56, 61; early phase of unconscious relational others 32
psychoanalytic therapy 49; introduction unpossessible object 121 – 125
to 42 – 44; summary of 64 – 65 unrequited lover 122 – 125
transitional phenomena 4 Use of the Object, The (Jacobs) 1 – 2
trauma: child abuse and 102;
developmental history of 72; by patient valued object 127
31, 43; post-traumatic stress syndrome
64; pre-verbal trauma 68; psychic Weltanschauung (conception of the world)
conflict over 68; treatment of severe 104, 107, 110
trauma 112 wife-as-object 4 – 7
Winnicott, Donald Woods 107 – 114
Unabomber see Kaczynski, Ted
unconscious grief experience 38 zones of silence 20