How To Play With Patients Who Would Rather Remain Remote

Abstract

Playful technique with negativistic, schizoid patients is described and further explained. They are seen as closing their mind, imagination, needs, and feelings to protect themselves against the terrifying dangers of human relatedness (vulnerability, need, hurt, loss, fusion, destruction). The analyst, while respecting the schizoid patient's need for protection, affirmation, and validation, seeks creative ways of engaging the patient more closely. Playful technique with schizoid patients combines the analyst's sensitive, playful attitude with an invitation to playful action as an experiment with new feelings, longings, hopes, and expectations. Playful engagement is one technique for attempting to engage patients not now open to verbal interpretation. To succeed with such patients, the analyst needs to connect with the core of their protectiveness and thereby come to enjoy their defensive powers, tolerate their need of the analyst, and not feel insulted. The analyst's light, playful approach to these patients' life-and-death terrors of hating and loving aims to show them that they have grossly exaggerated the powers of their hatred and their love.

Race, African Americans, and Psychoanalysis: Collective Silence in the Therapeutic Situation

“…To work with Mr. T. effectively I had to confront my own negative identifications regarding whites, including my need to de-escalate the sexual hostilities and tension that Mr. T. used defensively. This allowed us to face what once seemed impossible to bear and to “play” with this highly charged regressive material with increasing depth and insight (Coen 2005).…”

Countertransference Identification and Fantasy in Psychoanalytic Process

“…Despite my overall difficulty with Ms. C, enough intermittent and moderate contact was made over several years that the analysis continued to progress slowly. A "playful" attitude (Coen 2005) in addressing her aggression and my own was crucial, as was a firm but matter-of-fact insistence on the existence of transference fantasy, which she so emphatically denied. I developed a rather routinized habit of asking, "Where am I in all this?"…”

Between Action and Inaction: The Space for Analytic Intimacy

“…Early in my work with Ms. R., I had to respect her need to protect herself by staying emotionally distant rather than challenge her defenses. She was reluctant to grasp that her dream of a turtle in a shell was about herself, though she had often referred to herself as being in a shell (Coen 2005). Steingart (1983, 1995) strongly advised that patients evincing pathological play need to be taken as they present themselves, with no initial challenge to why they are doing so.…”