Wednesday, January 10, 2018

Klein's Contributions: Projective Identification

In the TBIPS course, Intro to Psychoanalytic Concepts I, we have come -- after months of discussing an analytic attitude and ways to be in the clinical situation -- to the historical contributions of major psychoanalytic theorists. For a few weeks we discussed Freud and Ego Psychology and today began looking at Object Relations, especially Klein’s projective identification and the paranoid-schizoid and depressive positions. One informative paper is Spillius’ 1992 Clinical Experience of Projective Identification.

Spillius describes Klein’s idea that in projective identification the patient extrudes parts or characteristics of the self and, in phantasy, places them in the other, and -- beyond simple projection -- operates as if these extruded parts are under the control of the self. Bion elaborates Klein by noting the communicative part: that through projective identification the analyst has the opportunity to feel what the patient feels or to feel what the patient wants the analyst to feel. Joseph adds that through projective identification the analyst is ‘nudged’ to behave the way the patient expects. One candidate contributed Ogden’s elaboration that the analyst owns the projection. [The class aptly noted that, while relational is on its horizon, the Spillius paper has not quite made it to intersubjectivity, for it does not much describe the analyst’s contribution to triggering the patient’s use of projective identification.]

The candidates posed to one another fascinating questions regarding the analyst’s struggles to determine what or how much comes from the patient and what or how much from the analyst:  Doesn’t the projection have to resonate somewhere within the analyst? What if the projection is ego dystonic? Many analysts are trained to see the projection as an entirely intrapsychic phenomenon rather than struggling to accept it as intersubjective in some way. Can ‘wearing the attributions’ ascribed by the patient sometimes be defensive on the analyst’s part, as when the analyst wants to avoid confrontation or wants to show superiority by being able to accept the attribution? One pointed resonance is when the projection, which narrows the analyst’s experience by requiring the analyst to behave in a certain way as to meet the patient’s expectations, triggers childhood experience of parental expectations which restricted the child’s burgeoning self. It was also noted how ‘blind spots’ likewise can narrow the experience of the analyst by, for example, attenuating the ability to self reflect.

One very fascinating part of the discussion was a clinical example provided by a candidate: A patient continually praised the therapy and its gains yet the analyst kept thinking the patient was about to leave treatment. This idea greatly narrowed the analyst for she could think of nothing else when with the patient. Because the candidate-analyst was going through a difficult period of being very tired and feeling insecure, as well, about her abilities, and because she worried her difficulties would also chase off other patients, she considered that her idea this patient was about to leave her was all her fault! That is, that the idea came solely from herself. With supervision, and with her own capacity to struggle with the question ‘what comes from whom?’, the analyst overcame her immobilization and her fears of embarrassment should the patient say ‘That is your problem, not mine!’ (or fears the patient would feel misattunement) and shared with her patient that she had the thought he would leave despite all his accolades about therapy.  She put herself in the position to own something very shameful should it not also belong to the patient. As it turned out, as one might expect, it enlarged the opportunity to see how both had co-created what was happening between them [Bromberg notes that the analyst’s feelings about the patient are not the sole property of the analyst]. The analyst did not say to the patient ‘This is yours!’ nor could she allow that ‘This is solely mine’ and from the struggle, instead, negotiated with the patient, ‘what comes from whom.’

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