Panel III From Southern Europe:
Empathy, Vulnerability, and Shame: Understanding the Therapeutic Process Today

Affective attunement, vulnerability, empathy: The analytic experience with Veronica.

Veronica, a thirty-year-old woman, began her analysis ten years ago. She came across to me as a very frightened person who had little control over her feelings. She revealed to me that she had been traumatized in her past which lead her to the present disoriented and frightened state she found herself in. Two years earlier she had an anxiety attack during a business meeting. She was overwhelmed by the fact that she thought she heard her colleagues talking like robots and could not believe what she had experienced.

After these painful and alarming experiences, the patient had begun psychoanalytic treatment with Dr. C. One day, Veronica was in the area near her analyst's office, in a state of deep anxiety. All of a sudden, it occurred to her that she must surely be homosexual, an unprecedented fantasy which, at the time, could not be associated with doubts regarding her identity and sexual orientation. So she went to Dr. C.'s office, who invited her to come back at the scheduled time. In a state of utter confusion and anxiety, Veronica decided to sit and wait until it was time for her session in a dark corner inside a building near Dr. C.'s office. The patient remembers the two hours she spent huddled up in that dark corner as a terrible dissociative experience. When she came out of the dissociative state, she managed not to miss her session with Dr. C., who welcomed her more warmly than usual this time. However, for most of the session, as she lay on the couch, she could not think of anything to say. Towards the end of her hour, she apologized to Dr. C. for disturbing him ahead of time, an unforgivable mistake she would surely try to make up for. In the months that followed, the patient never mentioned that experience again.

The empathic rupture experienced with Dr. C. at the time caused another serious fragmentation episode that resulted in the end of the analysis. On a cold winter morning, the patient found herself wandering aimlessly around her neighborhood without remembering anything about herself, and she was taken home by a passerby who had realized that she was lost and upset. Veronica had to resort once again to psychopharmacological treatment, which lasted several months and was still under way when we first met.

I was deeply affected by Veronica's analytic experience with Dr. C.. I realized that I found myself in a very delicate spot. It was not the first time that I had in treatment someone who had interrupted therapy with a colleague. I was aware of how tempting it could be to represent myself as "the good analyst", while keeping Dr. C as the "bad" one. I would join with the patient in her critique of Dr. C in order to feel really "good about myself", and to be recognized as the "more capable analyst".

At the same time, I sensed that the patient really needed to feel that I was on her side, and her frail sense of self came forth from the very first sessions, for she was always on edge, fearing possible retraumatizations. The patient was so worried that I might have difficulty in becoming attuned that I began to feel almost as if I were holding a vase made of very fine crystal that could shatter into pieces at any moment.

The toxic residues of the invalidating and disconfirmation experiences, which were in all likelihood the outcome of the retraumatization that had taken place in the analytic treatment with Dr. C., were organized, with me as well, around the theme of her feeling guilty of not being able to be "normal", that is of experiencing the continuity of her self. On the contrary, she experienced herself as being disrupted and disorganized and flooded by shame. In the early months of the analysis, my often unsuccessful attempt to see things from her point of view led me to feel that I was dealing with something that was "too much", too unbearable, too heavy, too hard.

The psychoanalytic rearticulation of some episodes of her childhood, allowed Veronica to understand how easily she can feel humiliated and how difficult it is, in certain conditions, for her to understand other peoples' intentions. In particular, we co-created the hypothesis that it is this difficulty in understanding that generates perceptive and interpretive distortions. In fact, at times the patient can feel within her self the relational configuration in which something she herself believes in is what triggers a humiliating experience. This repetitive experience tends to produce a profound mistrust in the behaviors of others, even when they might be well-intentioned.

Around the beginning of the fifth year of analysis, Veronica meets Roberto, a young man whom she soon marries. Veronica experiences with him a relationship characterized by deep misunderstanding, mutual acts of violence and volatile conflict.

During a session just before the Summer break, the patient, pointing out to the uselessness of her existence and insisting in a worrisome way on the possibility that she may harm herself, asks me to call up her husband and tell him to come and take her home. I remember that phone call very well because I was truly stunned as I listened to the voice of a person who not only played down in a most annoying way what was happening in my office, but went on to heap insults upon his wife for disturbing him at work. This proved to him that she was completely crazy and unworthy of being at his side. In fact, he was very late in picking her up, thus forcing me to cancel the three sessions that usually follow Veronica's.

This episode actually left a positive mark on this phase of the analytic work, for it stands as an intense moment of affective sharing between the patient and myself. The enactment would be recalled in the following years as the experience that marked the transition towards a deeper and more structural change in Veronica's mental functioning and life experience.

As we explored the enactment during the following session, the patient and I come to understand that the episode clarified the experience she had lived years before with Dr. C.. We also discussed the risk that Veronica may split "goodness" and "badness" with her husband and myself in the present, just as she risked doing with Dr. C. and myself in the past.

In spite of all this, a few months later Veronica is pregnant ( she did three abortion in the past ). The pregnancy soon proves to be a life-giving experience for Veronica and little by little clears a truly genuine affective path that enables her to welcome and take care of little Martina, who is born strong and healthy.

Veronica decides to divorce from her husband. She decides to live with her little daughter in a small flat offered to them by her father. The experience of living with her daughter in the flat given to them by her father soon becomes one of the central narratives of the analytic work with me.

Veronica's analysis ended in December of last year, as scheduled and agreed. A few weeks before its conclusion, the patient met Mario, a man who is separated and with whom she has begun a relationship that from the outset has given her new confidence and reassured her as to her ability to be with a man. We talked about this often during the final sessions. We talked about it. But the words between us no longer had the same impact as in the past. We often remained in silence, even for several minutes.

A silence, however, without loneliness.

Paolo Stramba-Badiale, PhD.: Psychoanalyst. Faculty and Training Analyst ISIPSé (Institute of Specialization in Psychoanalytic Self Psychology and Relational Psychoanalysis). Member IAPSP and IARPP. Member of the Council of IAPSP. Milan, Rome, Italy.