finally, they are facing self disorders

While all these transformations have enabled so many of us to breathe more easily as psychoanalysts and work with creativity and engagement, we have also come to ask about the patients who are not so able to engage in a dialogic interaction and who barely recognize another self or subjectivity in themselves or in any others including the analyst (Director, 2009; Grossmark, 2012a, 2013). Such patients have gained much attention in the object relations and contemporary Freudian literature and perhaps less in the relational literature. These are patients for whom there is little or no self or object constancy, for whom there are few alternatives to merger and the loss of self in human interaction, for whom sadomasochistic object relations predominate their every interaction and for whom space, time and reality are simply not experienced in a cohesive ongoing manner. Such patients have chronic experiences of emptiness and fears of relational impingement (Bach et al, 2014).

I am also referring here to patients who may have areas of the self that are more developed and may present with, and be able to engage in, what can appear to be intersubjective vitality. The relational embrace of the multiple and decentered self allows us to consider that many patients who present in this way also harbor self-states that contain earlier undeveloped and unspeakable parts of themselves. Such states, as Bromberg (1996, 2006) has so forcefully described, are sequestered and encrusted due to unbearable shame and envy. I would add that patients also harbor empty, unformulated and undeveloped parts of themselves that can find no expression in language. I would suggest that such areas of the self or self-states are much less likely to be reached by dialogic engagement. Such self-states are often chased underground, as it were, by a psychoanalytic treatment that puts a premium on relatedness, thought and dialogic exploration.

In this chapter I will outline some thoughts as to how a relational psychoanalyst might work with these patients in the areas of un-relatedness, psychic deadness and the non-symbolizable. I will outline an unobtrusive yet deeply connected register of psychoanalytic engagement that foregrounds the patient’s unique idiom and signature, and respects the need for a transformational space within which the patient and analyst can find meaning together, via mutual regression, in non-alive and non-representable psychic spaces. (Chap 8. The unobtrusive relational analyst and psychoanalytic companioning, Robert Grossmark)

De-Idealizing Relational Theory: A Critique From Within (Relational Perspectives Book Series) (pp. 168-169). Taylor and Francis. Kindle edition.

see also

The Unobtrusive Relational Analyst: Explorations in Psychoanalytic Companioning (Relational Perspectives Book Series), by Robert Grossmark, Routledge, 2018 (kindle 2018-6-21)

Robert Grossmark Ph.D. (2012) The Unobtrusive Relational Analyst, Psychoanalytic Dialogues, 22:6, 629-646, 

Robert Grossmark (2016) Psychoanalytic Companioning, Psychoanalytic Dialogues, 26:6, 698-712, 

Joseph Newirth (2016) When Relatedness is Damaged or Undeveloped: A New Consideration of the Link between Relational Psychoanalysis and Object Relations Theory, Psychoanalytic Dialogues, 26:6, 713-721, 

Bach, S., Grossmark, C. and Kandall, E. (2014). The Empty Self and the Perils of Attachment. Psychoanal. Rev., 101(3):321-340