Sunday, November 18, 2018

Mrs B

The patient, Mrs B, had nearly died of burns when she was eleven months old. What we did not know until near the end of this analysis was that her mother had been instructed by a doctor, after the burning, that she must only barrier nurse her baby: she must never hold her. 

A major focus in the analysis was around a later occasion concerning not being held when, at seventeen months, Mrs B had to be operated on by a surgeon under a local anaesthetic. During this, her mother was holding her hand. Then she fainted. Mrs B had imagined that it had been her fierce need of her, when she was so intensely anxious, that had been too much for her mother, even that she might have ‘killed’ her when she disappeared from sight. 

In her analysis, when Mrs B began to re-experience that moment with the surgeon, and then her mother no longer holding her, she had virtually demanded that I should allow her to hold my hand if it ever got so bad again. At first I agreed. But almost immediately Mrs B reverted to her conviction that she would have to protect me. She felt that I would collapse if it became too much for me. She sensed, quite correctly, that my offer to hold her hand would be easier for me, too, bypassing the worst that was still to be faced by allowing focus to be concentrated on the mother who had not been able to hold her. 

When I consulted with Dr Paula Heimann on this, she agreed with me that I would have to find a way to withdraw the offer of my hand. In the very next session, Mrs B had an image of me as stationary, again controlled by her. She saw me becoming a collapsed analyst. It was then that I knew I must withdraw the offer of my hand, a clinical decision that several commentators have failed to understand.



Casement, Patrick. Learning Along the Way: Further Reflections on Psychoanalysis and Psychotherapy (p. 99). Taylor and Francis. 2019, Kindle edition

see also

1. Casement, P.J. (2000). The Issue of Touch. Psychoanal. Inq., 20(1):160-184
2. Pizer, S.A. (2004). Learning from Our Mistakes; Beyond Dogma in Psychoanalysis and
    Psychotherapy. Patrick Casement. New York: Guilford, 2002. 144 pp. $26.00.. Amer. Imago,
    61(4):543-556
3. Casement, P. (2004). Response to Stuart Pizer. Amer. Imago, 61(4):557-564

now, this controversy illustrates the enigma of mutual re-enactment, which should have no read-made answer, and is never easy to walk through, you just have to be there, throughout, to survive your patient's helplessness, longings, disappointments, and attacks