Panel II: Adult Case:
Balancing Enriching the Sense of Self and the Intersubjective Realm

This panel focused on an adult case in order to explore how analysis can enhance both the analysand's individuality and intersubjective realm. After a warm introduction by Susanna Federici-Nebbiosi, Ph.D., Elizabeth Carr, MSN presented her case. The discussants Ronald A. Bodansky, Ph.D., Andrea Harms, Ph.D., and Sheldon Meyers, M.D. followed with their responses to the case.

The Case: Dr. Carr presented the case of Aron, a 57 year old married man without children. The patient described states of unrelenting fear in which his very existence is threatened. He held a deep sense of inferiority. Alternatively and alternately, he lived in a state of being that he called "that guy" in which he felt strong and capable.

Aron began analysis with Dr. Carr 12 years ago, following a three year classical analysis. He had a long history of mental health treatment, subsequent to a childhood of abuse and neglect. He told Dr. Carr that his father used to beat him severely and unpredictably. He stated that his father "hunted him down like a dog." He tried to protect his mother and hoped for protection from her. Dr. Carr maintains that he had a disorganized attachment---fear without solution. Fortunately, he had a life saving relationship with his grandparents. He began having panic attacks when he was in graduate school, derailing his life and initiating what has ultimately been a very long road of seeking to be well.

Dr. Carr described three phases of treatment and their extraordinary efforts to find a safe way of being together. The first phase focused on "learning to feel." They struggled with his dissociated affects related to abuse. He felt that if he were to be aware of his childhood trauma, he would die. The intersubjective space was filled with discouragement and shame. His childhood experience was of being alone. During the second phase, described as a "difficult time," Aron lost his job. It took several years before he found full time employment. His wishes for revenge threatened the analysis. Currently, he has a job and is taking medication to manage his anxiety. He felt under siege by his new boss, who Aron experienced as hypercritical. He is beginning to address his conflict with being "that guy" and his mother's requirement that he be miserable. His dreams revealed the depth of this struggle and his recognition that the analysis is allowing him to survive.

In his response, Dr. Bodansky identified the major themes of the analysis of this terrified, traumatized, intelligent man. First, he wants a warm intimate relationship with a woman. Second, he wants to literally relive his childhood, described in the case presentation as a curative fantasy. This raised the question about his mentalization qualities. The disorganized attachment is clearly demonstrated in the treatement. Dr. Bodansky refers to Giovani Niobossi's discussion of four different models of disorganized attachment: victim, persecutor, savior, stupefied confusion. He believes that all are present in the case material.

Dr. Harms began her discussion by identifying the vertical split demonstrated by Aron's report of two self states. She referred to Aron's therapists and medication as his "life companions" in place of actual relationships. She believes that the analyst/patient relationship provides him with a more organized notion of the prior mother/child relationship and promotes his continuity. Dr. Harms identified what she considered to be a turning point, when Dr. Carr and Aron had to accept their mutual feelings of vengeance. Implicitly, the survival of the analysis represents the forward edge and the re-working of Aron's near death experiences.

Dr. Meyers focused his discussion on Aron's need to regulate distance from his analyst. His defenses, born out of a childhood with an unresponsive mother and a frighteningly abusive father, kept him from connecting. Once he felt safely understood, the analysis could proceed. Aron's intense need for vengeance caused a rupture in the treatment. Until Dr. Carr could understand it, Aron experienced fragmentation anxiety. Dr. Meyers asserted that Kohut practiced a two person psychology-that emersion in the intersubjective field leads to individuality for the patient.

All presenters were very appreciative of the excellent analytic work presented by Dr. Carr. They recognized that the intersubjective space was filled with painful affect and self states that had to be lived with and through. They also recognized the importance of working with the self of the analysand-that it is essential to be open to another's experience. This case presentation demonstrated how challenging it was to be engaged intersubjectively and to comprehend and accept all aspects of the analysand's experience.

Amy Eldridge, Ph.D. is Dean of the Institute for Clinical Social Work in Chicago, where she also has a private practice. Dr. Eldridge is on the Council of IAPSP, is an Associate Editor of the International Journal of Psychoanalytic Self Psychology and is on the editorial board of the Clinical Social Work Journal.