Unpleasant Bodily Odour in a Psychoanalytic Treatment: Bridge or Drawbridge to a Troubled Past?

In this paper, I explore the topic of primitive bodily communications and countertransference enactments, with a particular focus on the part played by bodily odour. To explore this topic, I discuss a two-year treatment with a patient who presented with a mix of borderline and narcissistic diagnostic features. I describe meaningful aspects of the difficulties faced in countertransference work when receiving and making sense of the patient's use of primitive defences and I highlight their expression through a very uncomfortable symptom: an extremely unpleasant bodily smell. My thesis is that the smell communicated preverbal and unsymbolized experiences of early physical and emotional neglect, as well as evacuating the toxicity of those experiences. In this way the smell acted both as a bridge, which could help me reconstruct my patient's early traumatic past, and as a drawbridge, to keep me at distance and maintain his past dissociated. The invasive and aversive nature of the smell can also be seen as representing the approach-avoidance dilemma typical of a disorganized attachment state of mind, acting both as a bridge and as a drawbridge to attachment and relating.     

The Wish to Never End: Grappling with the Termination of an Infant observation And its Relevance to Clinical Work

This paper uses a psychoanalytic infant observation to highlight the significance of grappling with endings. It describes the termination of a two-year relationship with a child and his mother, who were observed weekly by the author. The content of the ending process is extrapolated to apply to infant observations in general, with implications for termination of psychoanalytic psychotherapy treatments with patients of any age as well as personal relationships. Transference and countertransference reactions and enactments evoked during the prelude to termination are considered. Vignettes from the infant observations illuminate important crossroads during the termination process. The paper also illustrates the resilient capacity that a child (and by extension the child part of an adult) can have to experience, process and bear the ending of a relationship, as well as to continue to hold that relationship internally. This glimpse into one child's, one mother's and one observer's experience of separating from each other demonstrates the ways primitive aspects of the psyche may be activated during a termination. Finally, Donald Meltzer's concept of three-dimensional interior space and Bion's idea of open-ended reality are applied, indicating how relationships that have ended may be contained within one's psyche, enduring beyond their ending.     

Holding and Visceral Attention: Bodily Concentration of an Analyst under COVID-19 Lockdown

This essay emerged from my clinical experience of working psychoanalytically by remote means due to the pandemic of COVID-19. During analytic listening, in the absence of bodily togetherness and in the presence of heightened anxiety about survival, I turned my attention inwardly towards the interior of my own body and made a spontaneous gesture of doodling. These two moves, mental and bodily, both unintentional and unconventional to my analytic training, restored my psychic aliveness and facilitated the process of analytic holding. I will reflect on this particular experience using Milner's concepts: framed gap and the analyst's concentration of the body, which I further conceptualize as ‘visceral attention’. I consider it as a corporal counterpart of ‘free-floating attention’. It is my contention that the concept of visceral attention has a wider implication for analytic technique in the ordinary psychoanalytic setting when uncertainty prevails in psychoanalytic treatment and with patients whose predicament is marked by body–mind split. The essay explores an analogy between visceral attention and doodling to hold the analytic process at a non-verbal level. The blank paper and blank inside of the body stand for the ‘framed gap’, the negative space for a new symbol to emerge.     

Sentenced to Life: Reflections on the Inability to Bear Vitality,Following the Movie Turtles Can Fly

The paper focuses on psychic states in which living and bearing one's vitality have become hindered or totally obstructed, either as a result of a primary trauma or of a late-onset trauma. The author relates especially to patients who have been severely traumatized and have withdrawn into encapsulated states with schizoid/autistic-like features that create complex challenges in therapy. The paper weaves together clinical cases with theoretical understandings and with a discussion of the Kurdish movie Turtles Can Fly, in which many orphan Kurdish refugee children try to survive emotionally the traumatic life they have been going through. The author discusses the complex states of mind of the patients presented and of the orphans in the movie, who are sentenced to life, having lost all their hope and ability to tolerate their own vitality or that of others, due to extreme traumas. Consequently an encounter between themselves and another person, including a therapist/analyst, frequently becomes a flooding experience that is beyond their abilities to assimilate, being experienced as an annihilating threat to one's emotional existence and being in danger of creating states of a therapeutic and undigestible excess for which the term toxemia of therapy is suggested.     

Early Emotional Development and Primitive Mental States: A Brief Perspective

This paper focuses on early emotional development, both during pregnancy and in early infancy, as relevant to understanding primitive mental states encountered in clinical work. The first prism chosen in this search to understand the origins of our mind is based on clinical experience and its psychoanalytic theorization. Two main psychoanalytic theoretical approaches are relevant to understanding the psyche of the infant: the first emphasizes primary narcissism and conceptualizes the baby as immersed in a mental state of merger with the primal object; the second approach relates to the baby's psyche as a separate entity that is able to experience a raw sense of separateness from the object, right from the beginning of life. Clinical implications that stem from each theoretical approach are discussed. The second prism chosen is based on psychoanalytic interpretation of fetus and infant observations and on developmental studies. These observations and studies deepen our understanding of the coming into being of thinking processes, emotions and relational patterns during the whole lifespan, in general, and in the therapeutic situation, in particular. The author also discusses the limitations inherent in building retroactive conclusions, about the origins of emotional development that are drawn from within the clinical situation.