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
