Women's unconscious use of their bodies. Unconscious use of the body by a woman (Pines Dinora)

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Title: A woman's unconscious use of her body

About the book “The Unconscious Use of Her Body by a Woman” by Dinora Pines

The famous British psychoanalyst Dinora Pines dedicated her book “The Unconscious Use of Her Body by a Woman” to the study of the problems that women face throughout their lives. Some of them are natural, some are caused by tragedies. The author examines different stages of the life cycle: puberty, the first sexual experience, and further up to menopause and old age.

This work is of great value. A significant part of the work covers pregnancy, both desired and undesirable, its favorable and unfavorable outcomes. This is the result of twenty years of practice in the field of psychotherapy.

Since Dinora Pines is a follower of the psychoanalytic tradition, the book “The Unconscious Use of Her Body by a Woman” examines all issues from the point of view of psychoanalysis. Also, a special imprint was left by the fact that the author came to psychology from medicine. Therefore, Pines understands very well in practice how strong the connection between mind and body is. After all, the body can often “tell” something that the person himself is not aware of. From this perspective, important issues such as transference and countertransference are considered, as well as how early skin diseases influence these processes. Without an understanding of these topics, qualitative analysis and the entire process of psychoanalytic counseling are impossible.

Then the author touches on the problem of promiscuity among adolescents. She uses clinical cases from her practice to explain. Below you can read about how Dinora Pines views pregnancy and motherhood. She studies the interaction of fantasies and reality, the characteristics of pregnancy in teenage girls, and the phenomenon of early motherhood in general. The issue of premature birth and abortion is covered in depth. There is a section dedicated to the emotions that accompany infertility.

"The Unconscious Use of Her Body by a Woman" is a comprehensive work. In it, the life of a woman is also studied during menopause and old age. In addition, the author’s conclusions obtained as a result of working with women who managed to survive in the death camps are of particular interest.

Of course, a psychoanalyst writes primarily for his colleagues - doctors, psychologists, sexologists and teachers. However, due to the fact that the narrative style is quite simple and accessible, anyone can understand the author’s ideas and find something useful for themselves in the book. We recommend reading “The Unconscious Use of Your Body by a Woman” to everyone who is interested in the topic of female sexuality, motherhood and childhood. This is an opportunity to better understand clients and yourself.

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Dinora Pines - (Dinora Pines) (30
December 1918, Lutsk, Poland
(now Ukraine) - February 26
2002, London) - British
psychoanalyst, doctor
medicine, member of the British
Psychoanalytic Society.

Relevance

The book is devoted to problems that
arise naturally or tragically
different stages of the life cycle of each
women: from puberty and onset
sexual life before menopause
pauses.

Basic Concepts

Transference – unconscious projection
the patient previously experienced emotions on
a person to whom they do not belong.
Countertransference is defined in a narrow sense
as a specific reaction to transfer
patient. In extended - everything
the analyst's emotional reactions to
patient - conscious and unconscious, in
in particular, those that prevent
analytical understanding and technique.

Frustration is a special emotional
a condition that occurs when a person
when faced with any obstacles,
can achieve your goals and satisfaction
any desire or need
becomes impossible. Frustration may
arise as a result of a collision with
external obstacles, as well as
intrapersonal conflict.
Identity is a person’s awareness of one’s own
belonging to one or another social and personal position within social
roles and ego states

Chapter 1: Skin Communication: Early Skin Diseases and Their Impact on Transference and Countertransference

Pines addresses portability issues and
countertransference, in her opinion, they highlight
a basic distortion of the primary mother-child relationship.
Children whose infantile eczema drove them away
mothers, feel terrible shame and
subsequently treat the analysis as a situation,
where this shame may have to be experienced again

Chapter 2. Psychoanalytic dialogue: transference and countertransference

As clinical experience increases, many
analysts began to consider the transfer rather the most important
a means of understanding psychic reality
patient than the initial resistance, like
Freud believed.
British Society Training Analyst Paula
Heimann (1950) in his seminal work
drew attention to the positive aspects
use of countertransference: “I assert that
the analyst's emotional response to his patient in
analytical situation is
the most important instrument of his work."

Chapter 3. Promiscuity in Adolescents: Case Presentation

Sexual life was the main thing for Maria
a way to give vent to your aggressive feelings and
desires. She let her get excited and
weaken control over her body (although she does not
never reached a complete orgasm) and with her speech,
arguing and quarreling after another adventure.
Only after this was her self-esteem restored,
and she felt peace and tranquility, since she did not give
castrate yourself, but, more likely, castrated
partner. Feeling of love and mature object
relationships did not exist for her.

Chapter 4. Pregnancy and motherhood: the interaction of fantasy and reality

One of the most expressive features that
need to pay attention during analysis
pregnant women, this is a return of previously repressed
fantasies into the preconscious and consciousness and the fate of these
fantasies after the birth of a real child.
Pregnancy is the most serious test
mother-daughter relationship: pregnant woman
must play the role of mother for her child,
remaining a child to his mother.

Chapter 5. Teenage pregnancy and early motherhood

However, although the newly acquired maturity and
sexy body responsiveness young
women introduces her to the adult world
sexuality, it may also push her towards
to start using your body for
protection from unresolved emotional
conflicts of a much earlier stage of life,
sex can be a way to achieve
peace of mind and understanding.

Chapter 6. The influence of mental development in early childhood on the course of pregnancy and premature birth

Ambivalence of a pregnant woman towards her
unborn child may reflect it
earlier tense
ambivalence towards his mother,
which resulted in difficulties
Self/object differentiation and
further difficulties in separating individualization.

Chapter 7. Pregnancy, premature birth and abortion

Women suffering from miscarriage or
deliberately resorting to abortion,
perhaps they unconsciously find it difficult
identify with the image of the generous
a mother capable of motherhood because
the mother who fed them is two-faced for them
figure: powerful, generous, nourishing
and life-giving object and its complete
the opposite is an evil witch, a murderer,
bringing vengeance upon her daughter.

Chapter 8. Emotional aspects of infertility and their treatment

Lack of reproductive control
ability of one's own body - monstrous
personal crisis, a killer blow to
narcissism, through pride in one's image
adult body, in relation to the Self and
on sexual relations.
Sadness never disappears and hope never disappears
leaves the patient until menopause, she
maybe if you help her cry, she can recover
their self-esteem at the expense of other aspects of life and
find satisfaction in them.

Chapter 9. Menopause

A woman faces emotional problems
separation and loss: separation from children,
leaving home, the impending loss of the aging
parents (who, in addition, often need
departure) and inevitable own end or, before,
death of a spouse.
Some women who have not given birth to children or all
were going to start them until it became
too late, sometimes they deeply mourn the departed
opportunities to become pregnant, as was the case with their
mothers. For other women whose highest
the pleasure was pregnancy, the birth of a child
and motherhood, coming to terms with the loss of all this can
become one of life's most difficult tasks.

Chapter 10. Old age

As in other stages of life, in old age
much depends on previous history
man, from the path he walked to happiness
and achievements or, on the contrary, to misfortunes and
grievances In addition, we are all affected by
how much we are able to yearn for
past and leave it to find
new sources of satisfaction.

Chapter 11. Working with Women Survivors of Extermination Camps: Affective Experiences in Transference and Countertransference

The aspirations of young concentration camp survivors
women get pregnant and give a new one
life in a world where sadism and
mental death was all-consuming.
Agreeing to share with the patient
suffering, in the hope of alleviating his despair,
the analyst makes it easier for him to mourn
The disaster and its victims.

Chapter 12. The impact of disaster on the next generation

Many children of survivors who love their
parents, passionately desire to save and heal them
from pain and melancholy, compensating them for the loss of loved ones
objects.
Parents who suffered so much - and in
concentration camps, and in difficult times after
release (for example, in difficult conditions
camps for displaced persons) - not only
pass on depression and guilt to their children
survivors, but also expect confirmation from them that
all this suffering was not in vain.

Conclusion

The body of an adult woman provides her with
peculiar means of avoiding awareness
mental conflicts and work on them
Pregnancy can also be used for
resolving unconscious conflicts
The end of the childbearing period is often
accompanied by a painful death
woman's dreams about future children

Dinora Pines
(Dinora Pines)
A woman's unconscious use of her body
Content:
"_Intro" t "_parent"Intro
"_Chapter_1_Skin_communication: early skin diseases" t "_parent"Chapter 1. Skin_communication: early skin diseases and their impact on transference and countertransference
"_Chapter_2_Psychoanalytic_dialogue: " t "_parent"Chapter 2. Psychoanalytic dialogue: transference and countertransference
"_Chapter_3._Promiscuity in adolescents" t "_parent"Chapter 3. Promiscuity in adolescents: presentation of a clinical case
"_Chapter_4_Pregnancy_and motherhood:" t "_parent"Chapter 4. Pregnancy and motherhood: the interaction of fantasies and reality
"_Chapter_5_Teenage_pregnancy and" t "_parent"Chapter 5. Teenage pregnancy and early motherhood
"_Chapter_6_Influence_of_mental characteristics" t "_parent"Chapter 6. The influence of mental development characteristics in early childhood on the course of pregnancy and premature birth
"_Chapter_7_Pregnancy,_premature" t "_parent"Chapter 7. Pregnancy, premature birth and abortion
"_Chapter_8_Emotional_aspects of infertility" t "_parent"Chapter 8. Emotional aspects of infertility and their treatment
"_Chapter_9_Menopause" t "_parent"Chapter 9. Menopause
"_Chapter_10_Old Age" t "_parent"Chapter 10. Old Age
"_Chapter_11_Working_with women survivors" t "_parent"Chapter 11. Working with women survivors of extermination camps: affective experiences during transference and countertransference
"_Chapter_12_The blow of the catastrophe on the next" t "_parent"Chapter 12. The blow of the catastrophe on the next generation

Introduction
My profession as a psychoanalyst brought me into close contact with men and women, forcing me to share their innermost experiences, conscious and unconscious. It's easy to talk about love, fun and the joys of life. But secret and unspoken remain the childhood fear of being unloved and abandoned, the fear of loneliness, of being unwanted to anyone, and the lifelong struggle against one’s mortality. No one wants to talk about these things, no one wants to feel shame and guilt. Anxiety about them unites patients and analysts, men and women - after all, we are all human. But among the most important life events there are those that happen only to women, and one of them is pregnancy. At a certain period in my life, I was especially interested in these aspects of a woman’s life cycle, both in terms of my own experience and observing the reactions of my patients.
I graduated from a girls' school and received a degree in modern languages ​​from a mixed-education university. Just as I was thinking about further education, a war broke out that threatened the very existence of England, and at that time it seemed very inappropriate to engage in research in the field of medieval languages ​​​​and literature. I decided to study medicine, perhaps because I unconsciously wanted to somehow help people who found themselves defenseless against the cruelty of the world around them, and to somehow straighten out their crippled destinies.
My parents were doctors and always wanted me to become a doctor. It is possible that my art degree was a kind of teenage rebellion against them, but this rebellion opened doors for me into a world of literature and language that you will never tire of admiring in amazement. Great literature, which absorbed all the complexity of human relationships and feelings, subsequently became for me a reliable basis for a painstaking study of those relationships and feelings with which they come to the analyst’s office. Sensitivity to language, to the choice of words and their meaning is as important for the analyst as for the writer.
At the beginning of the war, in 1940, very few medical schools accepted women. Therefore, I enrolled in one of the educational institutions available to me - the London School of Medicine for Women, whose clinical base was located at the Royal Free Hospita. All the students and most of the teachers were women - the men went into the army. Air raids became more frequent. One of the V-2s ended up in the traumatology department as soon as we finished our duty and went our separate ways. After that, we were evacuated and assigned to live with other people’s families. The owners were not very happy about the uninvited guests. We were far from our own families, and a faulty communication line completely cut us off from home. Very early in our lives, a real awareness of the power of the forces of life and death, our vulnerability and the fragility of the world around us came into our lives. Although, of course, this experience cannot be compared with that of the rest of Europe, which was subjected to enemy invasion, with its prisons and camps, with the murder of people on racial or political grounds.
Having received our specialty in 1945, most of us were eager to go to war, but by that time the Armed Forces no longer needed doctors, and we were sent to different hospitals to treat the civilian population. At that time, rumors were already widespread about what was happening in the concentration camps. I was recruited and prepared to lead a liberation aid group sent to Auschwitz, but for unknown reasons the group was disbanded without any explanation. This was a heavy blow for me, because by that time I already had reason to suspect that some of my relatives, whom I knew in childhood, died there. My knowledge of the extermination camps came in handy later, when I began working with victims of the Holocaust (Holocaust).
When I began working as a hospital dermatologist, I gradually learned to listen carefully to what my patients were saying as I examined their bodies and, more importantly, to what they were not saying. The longer I worked, the more interested I became in the relationship between body and mind. In the article “Skin Communication” (see Chapter 1), I described how vividly and clearly the bodies of my patients expressed the unbearable pain of these women, pain that they could neither talk about nor even think about. Since words were not available to them, they were forced to express their feelings physically, communicating them to the doctor, who could and was obliged to understand them, because she had the opportunity to think about the situation of each patient like a mother trying to bring relief. Thus, the phenomena of transference and countertransference between doctor and patient entered my medical experience and forced me to seek new knowledge. Fortunately for me, Hilda Abraham, a psychoanalyst, the daughter of Karl Abraham, one of Sigmund Freud’s first students, worked at our hospital. She supported me when I began to discuss my clinical cases with her and when I tried to take an analytical approach. With her help, for the first time I truly understood the existence and power of the unconscious. Our medical training at that time did not include knowledge from this area at all. Fortunately, this is no longer the case.
When I started general therapeutic practice, I saw the life of men and women from other sides. Girls during adolescence go through inevitable changes in their bodies and experience the emotional impact of powerful sexual needs. They can, as psychoanalytic experience has shown, either accept these changes or reject the advent of adult femininity by developing amenorrhea or anorexia, thereby avoiding the development of secondary sexual characteristics, such as breasts. Young women get married, become pregnant, give birth to children and nurse them, and in all this there is always not only the joy of motherhood, but also numerous emotional problems. And these are the problems that should be seen and alleviated by an attentive doctor who observes a woman at home and knows her husband, mother, children and other relatives. Husbands, with their problem of paternity and their new position as head of the family, are an independent part of the problem. Thus, the family crisis that inevitably follows the birth of a new child would in all cases need to be monitored by a doctor, since it is difficult for the mother, on whose shoulders this crisis usually falls, to grasp the whole picture alone.
When I was undergoing psychoanalytic training (1959-1964) and was just beginning to practice on my own, these were the problems that appeared most often in the stories of patients. But only when I myself underwent analysis and began to understand myself better, I could see them more clearly, understand the patient’s pain and enter into a psychoanalytic dialogue with him. This dialogue required listening carefully to what the patient was not saying, and noting how his body was forced to act out feelings that were unknown to consciousness and could not be expressed consciously. I have seen that many patients prefer to somatize rather than talk. It happened that during periods of stress they developed a rash, and often a stomach ache interrupted their story just at the moment when painful feelings were about to reach their consciousness. In some patients with a history of asthma, the aggression they expressed during the transference was accompanied by hoarse, labored breathing, although they were able to avoid an actual asthma attack because they expressed their unconscious and translated it into conscious experience during the session.
It seemed to me that these bodily expressions of unbearably painful feelings were more common in women. Reflecting on this observation, I realized that the body of an adult woman provides her with a unique means of avoiding awareness of mental conflicts and working on them. For example, while observing my patients, I gradually discovered behavior patterns associated with the use and even abuse of pregnancy. On a conscious level, a woman may become pregnant in order to have a child, but her unconscious ambivalence about her pregnancy may manifest itself in the form of prematurity or miscarriage. Pregnancy can also be used to resolve unconscious conflicts regarding sexual identity or other mental problems, such as unconscious anger against the mother.
Even if a woman does not use her body to escape conflict, the changes that occur to the body throughout life are deeply shocking to her, and different women cope with them differently - depending on their ability to solve life problems in general and depending on on how their lives turned out. The end of the childbearing period is often accompanied by the painful death of a woman's dream of future children, children whom she will never be able to conceive and give birth to. The pain of infertility, when everyone around you seems to be giving birth, is enormous and unbearable. A woman's aging body and loss of reproductive function can be a brutal blow to her self-esteem, as if the part of her that men like has died off. At the same time, menopause can also prompt the search for a new path in life, new solutions when mourning for the past part of the life cycle ends.
And finally, while working with victims of the disaster, I had the good fortune to witness the amazing ability of some of them to begin to live anew, to begin a new life in themselves and to help others in this after everything they suffered. And yet the secrets of their past lived in them and their families, and, as analysis showed, affected the lives of the next generation. Others were less fortunate - despite the analyst's desire to teach them not to somatize their unbearably painful emotions, they remained victims of them. But I am convinced that the experience of transforming the unconscious into the conscious in the process of psychoanalysis has enriched and renewed the lives of all patients. Once revealed, the secret allows the patient to think about it instead of acting it out.
This collection of articles written by me over the past twenty years tells the story of my psychoanalytic journey and some of the problems that I hope I have come to understand more fully over time. As I reread it, I saw a growing understanding of the importance of listening sympathetically and compassionately to the patient, regardless of the analyst's theoretical views. Such relationships are sometimes very difficult to establish in psychoanalytic dialogue, as indeed in any relationship between two people, especially when one of them unconsciously develops a feeling of anger and hatred towards the other, no matter how strongly he defends himself against this feeling on a conscious level. An analyst is also a person, not an ideal. Benevolence does not mean suspending the doctor's criticality, but that during the psychoanalytic dialogue the patient should find himself in an atmosphere of sympathy, empathy, which will give the opportunity to open up to the angry, offended child living inside him or her, and to the adult to reconsider his past actions and decisions, not feeling humiliated. I think the past cannot be erased, but a more mature understanding of oneself and others can help transform aggression into compassion, and the patient will be able to start anew and enjoy life again.
There is still a lot to understand, not only for myself, but for everyone who works in this field. I enjoy learning and will continue to learn from them. I am grateful to my patients, with whom, in the process of analysis, we together gained life and professional experience and learned to understand more than we initially understood.
Chapter 1 Skin Communication: Early Skin Diseases and Their Impact on Transference and Countertransference
Presented at the XXXI International Psychoanalytic Congress, New York, August 1979. Published in the Internationa Journal of Psycho - Anaysis (1980).

Introduction
In this article I am going to describe and discuss the mental problems of patients who suffered from infantile eczema during the first year of life. An account of my direct observations made while working as a dermatologist in a women's hospital will be followed by a history of psychoanalysis of a patient with a history of similar illness. I will focus on the issues of transference and countertransference because, in my opinion, they highlight a basic distortion of the primary mother-child relationship. This distortion is resurrected at each transitional phase of the life cycle and gradually affects it.

Skin as a means of communication
I emphasize the fundamental importance of the skin as a means of communication between mother and infant during the period when the mother provides an understanding environment (the walking environment), which lays the foundations for the child's primary identification. In a film about the process of childbirth (Leboyer, 1974), we see the immediate calming effect of skin-to-skin contact between mother and newborn immediately after the baby abruptly passes from the warm mother's body into the cold and unencompassing world.
Contact through the skin re-establishes the mother's innermost sense of her child. At the same time, they seem to become one again, as during pregnancy, when the mother’s skin covered both of them. The skin becomes a means of physical contact, through it the child receives a feeling of peace from hugs, it transmits smell, tactile sensations, taste and warmth - everything that can be a source of pleasure and closeness between mother and child. The skin establishes the boundary between the Self and the non-Self and contains the Self of the mother and the Self of the child. This is one of the main and oldest channels of their preverbal communication, through which nonverbal affect is transmitted somatically and becomes accessible to observation.
When caring for a child, a mother's skin can convey the entire spectrum of feelings - from tenderness, warmth and love to disgust and hatred.
A child can react with his skin to kind maternal feelings with a feeling that he feels good, and to unkind ones - with various skin diseases. The infant's nonverbal affects may find expression through his skin. The skin may itch, the skin may “cry” (wet), the skin may become irritated. Her behavior will be determined by her mother's ability to accept and comfort her brat. The child may internalize such a situation, as Bick (1968) described in her article. She showed how the containing object - the mother - is actually perceived by the child as skin, and that the mother's ability to contain the child's anxiety is introjected by the child. This gives rise to his concept of external and internal space. Failure to introject the function of containing oneself into oneself and failure to assimilate, rejection of the fact that oneself and the object are each contained in one’s own skin, separate from each other, leads to the phenomenon of false independence, to “adhesive (“sticky”) identification” (Angesia - sticking together of surfaces two dissimilar bodies) and to the inability to recognize the separate existence of oneself and the object.

Direct observations in a hospital setting
In my youth, working as a dermatologist in a busy hospital, I saw that some patients with severe skin diseases, for whom the isolated use of traditional therapeutic agents had failed, were often helped by my then insufficiently qualified attempts at psychoanalysis, combined with compassion and appropriate local procedures. I noticed that during the course of therapy, some of their symptoms disappeared altogether, while others improved. But when I went on vacation and our relationship was interrupted, it got worse again. Despite the fact that from time to time I was simply shocked by the sadism with which these women attacked their own bodies, tearing their skin, despite the disgust at the unhealed ulcers, I felt pity and compassion for their obvious suffering and wanted to alleviate it.
When I was pregnant, some hospital patients reacted to this in a very peculiar way: they switched to me from their attending physician. Their response to my condition was as silent as the pain behind their skin disease was silent. When I returned from maternity leave, they questioned me and were clearly relieved to hear that I was fine. They seemed to be vividly reliving the events of their lives, following the events of mine, and felt that now, with new life experience, I would be able to understand them better. A little later they began to tell me about the unbearably painful loss of the object and the endless mourning for it, which was expressed by their irritated or weeping (“crying”) skin.

***
Mrs. A., an elderly widow, was covered in a bleeding, weeping rash. In early childhood, as I learned from the anamnesis, she had infantile eczema. Her appearance made a painful impression on me; I was tormented by her silence, despite the fact that a mask of pain was frozen on her face. Still, I continued to talk to her and took care of her skin myself. When I returned from my maternity leave, the rash gradually began to go away. Mrs. A. later told me that her rash usually appeared as soon as she inserted the key into the keyhole of her house door on Friday evening, and all painful rashes disappeared when she returned to work on Monday. When I asked her if anything had happened in the hallway, she replied that one day, having returned home like that on Friday, she found her son hanged there. I, then still a young mother myself, was horrified by her words and sat in silence. Having shifted the burden of her grief onto me, Mrs. A. began to sob, for the first time since the terrible death of her son. She mourned him, and soon after, her rash disappeared. My psychoanalytic training then helped me understand the essence of her illness: she had to terrify those around her with her body, just as her son terrified her with his.

Psychoanalytic interpretation of direct observations
Freud (1905, 1912), describing the phenomenon of transference, emphasized that the analytical situation only more clearly highlights the transference that is present in any relationship between doctor and patient. The resulting healing alliance (or therapeutic alliance) should be used so that the patient can fulfill his mental task - to promote his own recovery. Winnicott (1965) emphasized the important role of the maturationa environment provided by the mother during the primary stages of ego development. This special role of the mother is reflected in the special role of the analyst and the analytic environment in establishing the therapeutic alliance. Many authors, including M. Balint (1950, 1952), Khan (1974), James (1978), developed this topic and expanded our understanding of this aspect.
In their work, Heimann (1950, 1956), Hoffer (1956), and King (1978) warned female analysts about the importance of being mindful of their response to the patient and being aware of its possible consequences. King (1978), in particular, emphasized the need for the analyst to be extremely attentive to her own feelings of countertransference with a patient whose preverbal trauma was not simply a consequence of her condition, but also the result of the mother's affective reaction to the child's painful reactions.
The hospital environment can be seen as a reproduction of the long-lost primary understanding environment in which feelings of transference and countertransference can be experienced by both patient and clinician. The patient is looking for a treatment that would allow her to turn back into a baby and in which another woman would touch her and soothe her pain. Preverbal communication and physical contact can sometimes bring relief and hope for healing, even when verbal communication is blocked. From my point of view, such patients avoid hopeless despair with the help of a psychosomatic response to mental pain. They successfully regress and rediscover the most ancient, primary preverbal form of maternal consolation. In this way they reproduce their infantile experience, seeking protection in the state of a child whose mother knows how to take care of his body, but not his feelings.

Psychoanalytic situation
The psychoanalytic situation as described by Limentani (1977) is interpreted as a reproduction of pre-existing relationships in the mother-child system, with the fundamental difference that physical contact is impossible in it. This limitation is especially frustrating for those patients who, whether they know it or not, suffered from eczema in infancy. These patients apparently then found close contact with the mother's body and through her - relief to their body, but were unable to separate from her in due time. Hallucinations and fantasies on this topic or the use of any transitional object are unsatisfactory and insufficient for them, since the source of affection and peace for the baby is exclusively the mother and maternal warmth. It must be said that mothers of such children are faced with a very difficult and sometimes impossible task of constantly comforting their capricious, restless baby. Their function - to serve as a "safety blanket" for the child (Hahn, 1963) - is probably only partially fulfilled, since the child's demands exceed the level of patient care that a good enough mother can provide. Such children suffer not so much from physical discomfort due to the affected skin, but from a feeling of overwhelming uncontrollable primary aggression. At the same time, they are deprived of an adequate maternal “mirror” response - admiration and love for their own painful body. The mother's narcissistic disappointment with the child's body will naturally be reflected in her response to his demands and will have a fundamental influence on the child's own narcissistic attitudes and self-image.
E. Balint (1973), discussing the technical difficulties in analyzing patients by a female analyst, identifies the following as the center of the problem: a girl in infancy introjects the satisfied and satisfying body of a woman and identifies with it. But this happens only if the girl brought bodily satisfaction to her mother and received it from her. The patients I describe lack primary stable and sufficient internalization of the feeling of satisfaction with life (“I feel good”), since their early bodily experience of communication with their mother (in the initial situation of the mother-child pair) was, as a rule, only partially satisfying, and more often - unsatisfactory. The girl who felt at this stage that she was not satisfying her mother physically and did not receive adequate satisfaction from her will never be able to make up for this basal loss. For in order to satisfy her mother physically, she must sacrifice her normal desire for a positive oedipal outcome, as well as her development as a mature female personality.
The patient enters the analytic situation with the hope that she will be understood, with the hope of meeting a real analyst. However, the patients I describe are haunted from the very beginning by the fear of reliving the primary narcissistic suffering - the shame of being a brat exposed to everyone. They are, in my experience, unusually empathetic and observant, and constantly suffer from profound anxiety that can lead to borderline symptoms. They detect the slightest change in the analyst's mood, change in her voice and appearance, and are easily overcome by fear of their own aggression. They pacify and try to appease the analyst, adapt to her, sometimes to the detriment of their own mental health. Secretly, they want to repeat their unreasonably long primary experience of experiencing the unity of mother and baby, with all its mental content and physical soothing caress. On the other hand, emotional sincerity in communication with the analyst arouses great anxiety in them. The patient experiences a strong desire to merge with the object and an equally strong fear of regression and loss of Self.
When analyzing such patients, one should always expect that they will have a distorted self-image associated with disturbances in narcissistic structures and an acute sensitivity to object relations, which poses a problem both for the patient herself and for the analyst.
The nature of the transference in such cases is usually determined by the patient's ability to contain feelings, define personal identity and defend against the fear of complete “annihilation”. Kohut describes patients who compensate for the lack of internalized structures by using the analyst as a direct extension of the early interpersonal object reality. The patient's transference that I have described in this article also resembles the “addictive transference” that McDougal (1974) describes. With addictive transference, the analyst becomes a kind of center of the patient’s life, since he recreates an object such as the patient’s Self, which belongs to the level of mother-child object relations, and therefore overshadows all other objects. Parting with the analyst in such cases is accompanied not only by quite ordinary and normal sadness, but often leads to pronounced psychosomatic manifestations or even temporary psychoses.
In the second type of transference, patients have a more confident sense of Self and, apparently, achieved greater independence from the mother in the separation-individuation phase, so that, having entered the Oedipal phase, they were able to some extent to find a solution. Thus, their life history and character are relatively normal. However, the same strong attachment anxiety and ambivalence towards the mother may resurface in the transference to the female analyst, and the patient may try to avoid this by acting out or by somatizing the overwhelming primary affects.
The patient's ego split (incorporation of Winnicott's "False Self") often results from a desire to avoid the feelings of shame and narcissistic suffering resulting from total exposure. She clings to the analyst and wants to get rid of her intrusion into her private, intimate world: she gives her the keys, but misinterprets which key is for which door. Such patients are often as sensitive to the analyst's unconscious countertransference as they were at one time to the mother's ambivalence and her ability or inability to nurse them. It follows that countertransference creates difficulties for the analyst, and the patient's transference, which was such a positive factor in the hospital setting, now becomes an analytic problem. The patient's regressive longing to be embraced and comforted by her mother/analyst is directly counterbalanced by the intense fear that emotional intimacy arouses. The fear of being absorbed and losing her Self constantly torments her.

Clinical material
First phase of analysis
Mrs. B was undergoing her first analysis following severe depression with suicidal and psychotic episodes. Hypochondriacal fears haunted her all her life, but by the end of the analysis she had turned into a pleasant, attractive woman with an established family life. From time to time she called the analyst, and this supported her until the analyst emigrated. After this, she began to experience such a deep depression, with the complete impossibility of verbalizing it even to herself, that she, in the full sense of the word, arranged a car accident for herself, in which she received multiple injuries to the skin. In the hospital where she was taken, the regression reached such a degree that she ate only if the psychiatrist fed her, and refused to get out of bed. She was covered in a rash, thus expressing the despair and anger that she could express. When Mrs. V. came to see me, despite her obvious depression and confusion, she was carefully dressed. She began her first session by asking me what I thought about the analytic technique at Hampstead Clinic, as if to say, “What disguise should I put on to please you and hide my real self?”
This theme was heard throughout the entire period of analysis: Mrs. V. did not stop sensitive attempts to show not only the appearance that, in her opinion, I should like, but also to please me with her feelings, presenting those that, again, in her opinion I think I want from her. My role as analyst (and I often failed in this role) was to try to help her get in touch with her true feelings. Their separation occurred so early that she could not reach them. Mrs. V.'s intense suicidal tendencies were evident in her frequent, frantic phone calls: she demanded my immediate attention, like a child who can only be soothed by the caressing sound of a voice, containing his fear of disintegration. She abandoned her family. However, no matter how confused and frightened Mrs. V. was about her condition, every day between sessions she took a bath, after which she carefully lubricated her skin with oil and went to bed to sleep. It was a ritual she had been performing since her nanny started it.
The first phase of her second analysis was a challenge for both of us. We both had to test not only my ability to understand her, but also my ability to recognize and contain the aggressive feelings I was experiencing in countertransference in response to her “itching and scratching transference.” And my countertransference was just as strong. I felt lost, confused, almost crazy at times. Mrs. V. was compliant and punctual, but her dreams and associations made no sense, and I could not reproduce them clearly. However, despite her incessant calls and my frustration and confusion, I was very interested and wanted to help. When Mrs. V. told me that her favorite trick was to mislead tourists about the buildings they were looking at, I knew she needed to test my ability to tolerate feeling confused. In turn, she opened up to me about the sense of confusion that had lived within her since infancy. None of her sincere, true feelings were accepted or understood by her mother, although the nanny conscientiously looked after her body. So caring for the girl was contradictory: bad and good at the same time, and this confused the growing child. In addition, Mrs. V. was in daily contact with her mother, who still had a negative impact on her daughter’s mental state. Mrs. V. felt that she was being cared for only when she was physically or mentally ill. This second complication also lasted throughout her life and threatened the healing alliance. To recover meant for her to lose maternal care for herself as a sick child. We realized that Mrs. B's previous mental health had been based on the previous analyst's reasonable restrictions and her agreement with what she thought he wanted from her. The state that followed his departure seemed to be depression, grief, but in fact it was a complete loss of the Self, since this object disappeared and it became impossible to continue its imitation. At the same time, Mrs. V. regressed to the only real state for her - a particularly sick child.
Joseph in his article (1975) emphasizes that the pseudo-cooperative part of the patient does not allow the part of him that really needs it to come into contact with the analyst, and if we fall into this trap, we will not be able to expect change from the patient because we will not establish contact with that the part of him that requires the life experience of “I am understood,” as opposed to “I understand.” Mrs. V. was extremely observant and could notice any small change in my countertransference or in my attention to her. At the same time, I was shocked by the complete denial of the fact that I could be sad, I could be tired. She did not recognize any weakness in me, for in the mother-child pair she was always the baby. As Mrs. B's depression subsided, my calmness and interpretative style, which distinguished me from the previous analyst, became a source of anxiety for her. We were able to begin to work through her imitation of me and her acquiescence, not until I realized how much direction I was still unwittingly giving her.

Second phase of analysis
Mrs. V. said that she was the youngest child in the family, and shortly after her birth, her father went into the army. Her childhood was unhappy, she felt out of place both at home and at school, she was withdrawn, apathetic and lonely. But inside the suffering child lived the talent of an observer, a critic, an imitator, which her father sometimes supported in her. These few positive experiences were a source of great pleasure for her, but the talent had to be hidden from her critical mother, just as now, in a transference situation, it was not to be exposed to me. Both at home and before the analyst, she always appeared desperate and helpless.
For many years, Mrs. B's high moods were labeled as manic phases and her bad days were labeled as depressive phases, even though she considered these to be normal mood swings. She complained to doctors about paralyzing fatigue, and they attributed such fatigue to depression, although she herself considered it to be physically caused. I suspected thyroid dysfunction, the endocrinologist confirmed this and prescribed appropriate treatment. Mrs. V. received physical relief and the atmosphere of the analysis changed. Two women, an analyst and an endocrinologist (the mother and nurse of the transference), sympathetically confirmed the truth of Mrs. V.'s judgment about her bodily health. After this, Mrs. V. decided that she could now allow herself to show the true state of her feelings, and manic triumph ensued.
This was the moment when Mrs. V’s fiercely guarded Self appeared for the first time during the analysis. Her conciliation and compliance with the analyst and her family disappeared. Now she expressed wild rage at the slightest sign that I did not understand her or was inattentive. She screamed and pounded the couch in a fit of anger, as if it were me. Her hands were swollen and irritating her. Sometimes she put gloves on them. These outbursts frightened both of us, but later, as we learned to tolerate them, Mrs. V. found relief in expressing her long-repressed feelings. Her attitude towards her husband was ambivalent. She felt both gratitude towards him for caring for her during her illness, and anger and now physically attacked him with malice for old narcissistic wounds that she had never even admitted to herself before. She developed anorexia nervosa, and only later did we realize that this was her personal Declaration of Independence. She no longer imitated me. Now I seemed to her like a plump mother who always eats herself and stuffs others. At times, when she began to panic, she called the psychiatrist, whom we have already discussed, and was terribly angry when he sent her to me. It was as if she were encountering a parental pair for the first time that her omnipotence could not separate. It must be said here that when Mrs. V.'s father went to war, she had a fantasy about the separation of her parents because of her birth. My own countertransference has changed dramatically. Contrary to usual, I became increasingly angry with the patient and disliked her for making me look and feel helpless and incompetent. And again I was in uncertainty. It was unclear to me: was she introjecting my hatred or was she projecting her own onto me? But when one day I realized that I hated Mrs. V. because she wanted me to, and that when faced with her own hatred of me she did not regress to the state of a sick child, then the analytical atmosphere changed for the better. It became clear to us that in the process of analysis the patient had matured, having discovered that hatred could be experienced without completely destroying any of us.
Then Mrs. V. saw and told me several dreams in which she was dressed as a man. Although the acting out and dreams indicated (at first glance) that the dyadic situation in analysis had developed into an Oedipus triangle, it was just as false as in her life. Her passionate desire for her absent father was resolved in these dreams by appropriating his appearance. These dreams and fantasies expressed her feeling that the only way to please me (the analyst mother) with her body was to dress as a man and excite me, as my father excited my mother when he returned from the war. All of Mrs. V.'s relationships with people were a repetition of the mother-child relationship. In her early childhood, her father was absent physically, and when he returned from the war, psychologically. Both the male analyst and her husband represented a mother figure in her psychic life, but she did not betray the primary feelings of hatred and anger against them, generated by her helpless dependence on these persons, just as she initially hid such feelings from her mother. The explosion was avoided by regression and loss of ego boundaries or by compromise. Her second analysis, this time by a woman who could physically be her mother, seemed to provide her with new opportunities for mental maturation.

Third phase of analysis
After we worked through this material, Ms. V's anger and irritation began to sublimate into imitation of me, sometimes turning into cruel and sadistic mimicry. She was surprised that I could withstand these violent attacks of hatred and envy, and that her marriage could withstand them. For the first time in her life, Mrs. V allowed another person to experience the outburst of her rage. Now she allowed herself to flaunt both the shameful appearance of her body and the despair of not being able to please her mother or herself with her appearance. She told me that as a teenager she had acne on her face and had coarse hair, and when she was little she wore special glasses to correct squints and special plates to correct her bite. Mrs. V. remembered that she decided then to accept her ugly, smelly Self, hide it and never show it to anyone. After this, she hid her shameful body physically and psychologically even from her first analyst. “Well, how can you tell a man about this? - she asked. “It seems to me that you seem to have removed, layer by layer, makeup and skin from me, and now I am no longer embarrassed or ashamed.”
Following this session, Mrs. V dreamed that her body was completely covered with a rash. The next day her body was red and itchy. It became clear to her that when she suffered from eczema in infancy, it was her mother, not her nanny, who lubricated her body with emollients and soothing agents. This was the archaic relationship that Mrs. V had always strived to achieve, although she had no memory of it. The girl grew up with a mother who completely denied her disappointment in the child, as well as her daughter’s suffering. But the daughter saw her mother’s disapproval and her hidden disappointment that constantly going to doctors did little to improve the child’s appearance. Her mother constantly told her that she was lucky. She can be treated, she has enough food and a roof over her head. Her parents sent her to one of the best boarding schools because they love her. How dare she be unhappy after this!
But Mrs. V. knew that she was deeply unhappy and eventually gave up trying to express her true feelings even to herself. The ugly, stinking, dirty child, as she always remained in her imagination, was hidden behind a mask of elegance in an adult woman; similarly, her mother hid her narcissistic rage and hatred. Only during the second course of analysis was Mrs. V. able to reconstruct from her dreams that her earliest experience of soothing bodily caress was not with her nanny, but with her mother. Because her mother failed to provide her with sufficient emotional care, Ms. B's ability to tolerate physical pain was reduced because she did not internalize her comforting parents. Mentally, she chose to remain a dependent child who needed to be nursed, and thereby sacrificed much of her individualization.

Conclusion
I proceeded from observations of women suffering from skin diseases and an analysis of a woman who suffered from eczema in infancy. A patient with eczema had a long history of physically soothing maternal affection, with the result that the symbiotic phase of her relationship with her mother was excessively prolonged. My first goal was to show that the preverbal trauma of infantile eczema is reflected not only in the fundamental disruption of the mother-child relationship, but also in repeated attempts to regain contact with the archaic object with which the primary experience of bodily calm was experienced. This passionate desire seems to run through the entire life cycle and is woven into every new relationship. The patient's hope of integrating with this object and its calming role is revived each time, but then she abandons it. The primary fear of loss of the Self is a strong threat to the normal course of the individualization process.
Secondly, I tried to show that a mother’s humanly understandable disappointment with her child’s appearance gives rise to a basal narcissistic vulnerability in the child, which changes little in the future, even despite the real successes of adult life. The early image of the Self is fixed and remains unchanged in the True Self. It happens that painful deviations in the early relationship with the mother are not compensated, and the woman experiences this misfortune again and again at each transitional stage of the life cycle, despite the enriching reality of a long relationship with a man, despite even the deep emotional maturity brought by motherhood and which made it possible to raise normal children.
Patients with a history of both adaptation to maternal inability to understand and tolerate their emotional hunger and a long period of bodily soothing in early childhood find alternative means of communication. As a result, they will learn how to translate mental suffering into the language of a visible physical illness and thereby awaken attention and care. This is how one “learns” how to bypass the mental side of unbearable suffering in the future. It follows that whenever a female doctor treats a female patient in a hospital setting, she thereby restores the primary soothing contact between mother and baby.
The analytical environment, where there is no physical contact, becomes especially frustrating for such patients. Their narcissistic problems with the concept of self and their extreme sensitivity to object relations make both transference and countertransference feelings difficult for them to bear. The patient's transference shows us both a passionate regressive desire to be held and reassured, and a countering strong fear of emotional intimacy, since in such intimacy the primary anxiety of being completely absorbed and losing the Self is revived. Children whose infantile eczema alienated their mothers , experience terrible shame and subsequently treat the analysis as a situation where this shame may have to be experienced again. Therefore, they perceive the analyst not only as a skin that contains them, protecting them from disintegration, but also as an uninvited stranger who invades their inner world full of pain. The split in the ego protects the patient's true feelings from psychic exposure, even to herself, and they are replaced by surrogates of agreement and imitation. However, the feelings transferred to the analyst remain strong, and the patient may resort to acting out to escape from them.
Countertransference feelings can be just as strong. These patients test the analyst's endurance not only to the primary aggressive feelings that the patient projects onto her, but also to her own irritation, which rises against the patient. They can be demanding and intrusive, with little ability to restrain themselves or care about the object that brings them comfort. In a dyadic situation, they almost always want to remain a baby. The female analyst's physical ability to be a mother seems well suited to the transference of primary sensations that go back to the patient's partial maternal deprivation. Such patients require great patience from the analyst, but at the same time awaken a desire to alleviate and soothe their pain. They are tiresome, and their keen observation and heightened sensitivity to the analyst require an equally sensitive monitoring of their countertransference feelings. Such patients are always a challenge, since they arouse anxiety and confusion in the analyst until the primary nature of certain disorders can be revealed by the subtlest shade of interaction in the analytic situation. But once the therapeutic alliance has been tested, these patients can finally complete their psychic task of responding to Winnicott's "primal agony." The verbalization of long-repressed affects, such as strong irritation and anger, may become easier for them, and then regression and somatization will be discarded. Despite all of the above, the psychic pain of these patients is very real, as is their hope that the analyst will penetrate into the inner life and understand them, and they can begin again the process of their individuation, with a true separation from the mother.
Chapter 2 Psychoanalytic dialogue: transference and countertransference
Article from the series "Psychoanalysis in Britain", 1984-1989, presented annually to the British Psychoanalytic Society.
Analysts belonging to the British Psychoanalytic Society now place particular emphasis, both in their clinical practice and in their teaching, on the importance of observing, understanding and interpreting the phenomena of transference and countertransference; in other words, they call for careful monitoring of the emotional and affective relationships of the two people involved in the process of psychoanalysis: the analyst and the analysand. These relationships can be characterized as intense and constantly evolving, and each participant brings into them his past life experiences, conscious and unconscious feelings, hopes and desires, as well as his life situation outside of analysis in the present. Of course, the same can be said about any couple involved in a close, systematic relationship. However, the special framework of the analytical space, the conditions that the analyst sets to facilitate the therapeutic elaboration of the patient’s problems - all this makes the analytical relationship very specific. The analyst invites the patient to enter into a deep interpersonal relationship with her and at the same time, as it were, imposes the frustration of the lack of normal bodily contact, bodily communication and bodily satisfaction. She invites the patient to expose herself, while she goes into the shadows, in order to fully reveal the patient’s feelings towards the most important figures of her past and present, which she projects onto the analyst. When transferred, these people actually come to life and are perceived almost as real persons. Freud (1912) noted that the analytical process does not create the transference, but exposes it. Thus, in our daily work, both analyst and patient deal, very intensely, with the most powerful human passions. The difficult compromise that every person must make in order to reconcile his own and others’ interests has to be found here again and again. Every child encounters powerful opposition to his healthy desire to grow into an independent person, to achieve the sexual freedom that physical and mental maturity brings, and to come to the positive side of ambivalence, and this opposition pushes him into cozy regression, into an inability to separate from original objects and hatred of him for his position as a prisoner, real or imagined. Today we understand that childhood and adolescent conflicts and the affective response to them easily awaken in both - in the analyst and in the patient - because we now see in analysis two participants and a two-way process, although Freud did not consider analysis from such a point of view. Both the analyst and the patient are not free from ordinary human weaknesses and follow a common path of spiritual development.
Thus, my current topic is dictated by the clinical practice of psychoanalysis. But considering psychoanalysis as a relationship between two people, we will find it difficult to choose precise definitions, since each analyst and each analysand will experience transference and countertransference in their own way.
Let us therefore turn to the origins. In Autobiographical Sketches (1935), Freud wrote:
“Transference is a universal phenomenon of human consciousness and virtually dominates all relationships of a person with his environment.”
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