Identity Maintenance in the Affectively Distant Patient

Abstract

Patients who are affectively distant, in that they appear to have little conscious emotional investment in the analyst, have been described increasingly in the psychoanalytic literature of the last twenty years. Typically, they have been understood either from a developmental point of view as defensively struggling against wishes for symbiotic union or, on the Kleinian model, as having unconscious fantasies of bodily fusion with the mother that, upon separation from her, result in annihilation anxiety that generates autistic defenses. Of special importance is the work of Heinz Lichtenstein, who stresses early identity maintenance and the role of mirroring experiences with the mother in the development of an "identity theme." This concept is used here as a symbiotic precursor of ego identity that ties the self to a particular mother. It is this primitive form of identity that can occasion regressive self-definition in the transference of the affectively distant patient. Two cases are presented that illustrate dynamics and transference dispositions occurring in the psychoanalysis of these patients. The discussion focuses on the role of the patient's catastrophic fear of acceptance, as well as on the consequent need for self-protective measures. It is argued that careful and consistent analysis of these conflicted areas of these patients' transference leads toward greater integration of their identity and personality.

Identity Disturbance In Distant Patients

“…Problems with identity have been noted in patients who are distant and withdrawn from contact with the therapist (see Winnicott 1960a;Lichtenstein 1977;Boschan 1989;Steiner 1993;Hoffman 2003;Kirshner 2004;Green 2005). They seem to lack a constant sense of self and therefore of an embodied existence.…”

Brittle Diabetes: A Contemporary Review of the Myth and Its Realization

“…in recognizing self-boundaries, sexual identity, and facing the oedipal conflict. On all these occasions their reaction is to run away from treatment in a state of deep regression, feeling suicidal, and liable to seriously harm their self through the mistreatment of their diabetes (Hoffman, 2003). Patients with long standing brittle diabetes with numerous episodes of diabetic ketoacidosis and frequent hypoglycemic episodes may present significant pathological changes in the gastric wall that affect all major components including muscle, neurons and interstitial cells of Cajal.…”

How To Play With Patients Who Would Rather Remain Remote

“…Freud 1952;Fraiberg 1955;Blos 1958;Sterba 1957;Olinick 1964Olinick , 1970Khan 1972;Asch 1976;Klein 1946;Rosenfeld 1952;Akhtar 1995;Schulz 1983;Lewin and Schulz 1992). Two distant patients' terror of closeness was recently described as being regressively subsumed as only an extension of the mother/analyst, threatened by loss of separate identity (Hoffman 2003). Both mothers were difficult to engage emotionally; one was cruel, intrusive, abusive.…”