The psychoanalytic paradox: the self as a transitional object.

I have focused upon a group of patients whose biological needs for nurture and comfort were adequately met but whose mothers never related to them beyond simple caretaking. They never smiled at their children inasmuch as they derived no pleasure from playing with them or in their emerging sense of aliveness. From both the analyses of mothers and these patients, it appears that the mothers used their children as transitional objects. In turn, the children's emotional development became fixated in the in-between transition space. This fixation led to specific types of character structure and ego defects. Early development levels did not form a smooth continuum with higher later acquired adaptive ego states. There seem to be extensive lacunae in the middle layers of the psychic apparatus which manifested themselves as defective modulating elements. These patients showed extremes of behavior, marked polarities of sane, sensitive rationality to psychoticlike irrational episodes. There were no transitional gray areas between black and white. They exhibited a peculiar kind of fragmentation or splitting in which connecting bridges between higher and lower levels were missing. There are many such patients who seek treatment. However, they present special problems in therapy which can be explained in terms of the psychoanalytic paradox. The psychoanalytic paradox refers to a treatment impasse caused by an imbrication of psychopathology and various attributes of the psychoanalytic method. The mother's attitude toward her infant child has some similarity to the low-keyed objective analytic attitude, what has been sometimes referred to as analytic neutrality. These patients require different modes of relating which indicate that the therapist is, unlike the mother, very much concerned with their patient's developing autonomy and their entering and exploring the external world. These variations of analysis are not modifications or deviations of analysis. They are elements of the analytic process necessary for the treatment of specific types of psychopathology. Just as each patient is unique and the transference manifests itself in a particular fashion which then causes the analyst to make certain interpretations, the variations of technique discussed in this article address themselves to the construction of a holding environment appropriate for this group of patients.