Treating the sequelae of chronic childhood emotional abandonment.

Chronic emotional abandonment is traumatic for children, and often leads them to identify with the aggressor (IWA)-in order to hold onto their needed attachment to their parents, they feel, think, and do what their parents require, blame themselves for being abused and for their family's unhappiness, and feel ashamed. IWA often persists as a general tendency. Treatment requires therapists' dependability, attunement, empathy, interest, humility, and perhaps playfulness. Patients' history of abandonment should be explored in detail, though patients may be protective of their parents. Therapists should explore their own behavior if necessary, and acknowledge lapses; normalize and explore patients' shame; and avoid trying to "rescue" patients. Patients must be helped to re-find authority and agency over their own lives, and mourn their early loss of feeling "the right to a life." The treatment of "Claire," a 40-something child of two depressed parents, illustrates some of these points.

The Narcissistic dynamics of submission: the attraction of the powerless to authoritarian leaders.

Ferenczi's conception of identification with the aggressor, which describes children's typical response to traumatic assaults by family members, provides a remarkably good framework to understand mass social and economic trauma. In the moment of trauma, children instinctively submit and comply with what abusers want-not just in behavior but in their perceptions, thoughts, and emotions-in order to survive the assault; afterwards they often continue to comply, out of fear that the family will turn its back on them. Notably, a persistent tendency to identify with the aggressor is also typical in children who have been emotionally abandoned by narcissistically self-preoccupied parents, even when there has not been gross trauma. Similarly, large groups of people who are economically or culturally dispossessed by changes in their society typically respond by submitting and complying with the expectations of a powerful figure or group, hoping they can continue to belong-just like children who are emotionally abandoned by their families. Not surprisingly, emotional abandonment, both in individual lives and on a mass scale, is typically felt as humiliating; and it undermines the sense that life is meaningful and valuable.But the intolerable loss of belonging and of the feeling of being a valuable person often trigger exciting, aggressive, compensatory fantasies of specialness and entitlement. On the large scale, these fantasies are generally authoritarian in nature, with three main dynamics-sadomasochism, paranoid-schizoid organization, and the manic defense-plus a fourth element: the feeling of emotional truth that follows narcissistic injury, that infuses the other dynamics with a sense of emotional power and righteousness. Ironically, the angry attempt to reassert one's entitlements ends up facilitating compliance with one's oppressors and undermining the thoughtful, effective pursuit of realistic goals.

Thoughts on the limits of a mutual technique.

Ferenczi's appreciation of the inherently mutual nature of the analytic encounter led him, and many who followed, to explore the value of mutual openness between patient and analyst. Specifically, Ferenczi saw the analyst's openness as an antidote to his earlier defensive denial of his failings and ambivalence toward the patient, which had undermined his patient's trust. My own view is that, while the analyst's openness with the patient can indeed help reestablish trust and restore a productive analytic process in the short term, it also poses long-term dangers. In certain treatments it may encourage "malignant regression", where the patient primarily seeks gratification from the analyst, resulting in an unmanageable "unending spiral of demands or needs" (Balint, 1968, p. 146). I suggest that an analyst's "confessions", in response to the patient's demand for accountability, can sometimes reinforce the patient's fantasy that healing comes from what the analyst gives or from turning the tables on his own sense of helplessness and shame by punishing or dominating the analyst. In such situations, the patient's fantasy may dovetail with the analyst's implicit theory that healing includes absorbing the patient's pain and even accepting his hostility, thus confirming the patient's fantasies, intensifying his malignant regression and dooming the treatment to failure. When malignant regression threatens, the analyst must set firmer boundaries, including limits on her openness, in order to help the patient shift his focus away from expectations of the analyst and toward greater self-reflection. This requires the analyst to resist the roles of rescuer, failure, or victim-roles rooted in the analyst's own unconscious fantasies.

FERENCZI'S EVOLVING CONCEPTION OF NARCISSISIC PATHOLOGY AND ITS BASIS IN TRAUMA.

Ferenczi's landmark contributions to understanding and treating psychological trauma are inseparable from his evolving conception of narcissism, though he grasped their interrelationship only gradually. Ultimately, he saw narcissistic disorders as the result of how children cope with abuse or neglect, and their aftermath-they identify and comply with the needs of the aggressor, and later of people more generally, and dissociate their own needs, feelings, and perceptions; and they compensate for their submission and sacrifice of self by regressing to soothing omnipotent fantasies-which, ironically, may facilitate continued submission. Ferenczi's experiments in technique were designed to help patients overcome their defensive retreat to omnipotent fantasies and regain their lost selves. His earliest experiment, active technique, in which he frustrated patients, was a direct attack on their clinging to omnipotent fantasy. But as he came to see such narcissistic personality distortions as a way of coping with the residue of early trauma, his focus shifted to the underlying trauma. His loving and indulgent relaxation technique was intended as an antidote to early emotional neglect. His final experiment, mutual analysis, characterized by the analyst's openness and honesty in examining his own inevitable insincerities, was an attempt to heal the damage from parents' hypocrisy about their mistreatment, which Ferenczi came to see as most destructive to the child.

The analytic state of consciousness as a form of play and a foundational transference.

The analytic state of consciousness is a particular regressive altered state in the patient characterized by an increased sensitivity and reactivity to impressions arising from both the inner world and the analyst, a heightened sense of dependence and vulnerability, a permeability of boundaries in regard to the analyst, and a shift toward functioning on the basis of omnipotent fantasy in the analytic relationship. These changes are accompanied by a feeling of realness of one's psychic reality, but without any true loss of reality testing. Based on an analysis of the structure of play, this state can itself be understood as a kind of play; it serves as a foundational transference underlying more specific transference manifestations; and it is central to the analytic process. Over time, in response to physical aspects of the analytic setting, its safety, the analyst's emotional accompaniment, and a generally restrained analytic stance (an issue I discuss in some detail), it emerges in a more developed form that promotes symbolization and ownership of aspects of self, greater emotional presence, and a deeper sense of meaning in one's experience. Additionally, the concept of the analytic state of consciousness provides a new look at the role of abstinence and frustration in analytic process.