The Lost Ones

Ingrid Coltart, Coline Covington, Roger Hobdell

and Arthur Sherman

Abode where lost bodies roam each searching for its lost one. Vast enough for search to be in vain.
Narrow enough for flight to be in vain . . . From time immemorial rumour has it or better still the
notion is abroad that there exists a way out. Those who no longer believe so are not immune from
believing so again.
Samuel Beckett (The Lost Ones)

SUMMARY. This is a clinical paper in that it deals with a series of patients seen for psychotherapy by a
group of trainees who were supervised together. Several common characteristics emerged and four of
the most typical patients are described in detail. They were all difficult to work with, had seen or were
seeing many other therapists and could not use insight interpretations. They had all suffered rejection,
real or imagined, from previous therapists but persisted in their search for the ideal therapeutic partner
who would omnipotently remove their symptoms. The degree of their perplexity and frustration led us
to look upon them as lost. Following the description of each of the patients, the paper comments on four
main areas: story making and its absence; the importance to the patient of not knowing; holding;
technique. We believe that every analyst has encountered such a lost one in their practice.

Introduction

The people described in this paper all appeared to be lost or forgotten. Sometimes, like
a misplaced library book, they seem to have lost themselves. They had often been rejected
by the formal clinics such as the Tavistock, the Institute of Psychoanalysis, the C.G. Jung
Clinic of the Society of Analytical Psychology and also by some of the alternative
therapists. On top of which, most could not afford anything like the normal fee.
The main qualification to be included in this study was that they should have had
multiple rejections or multiple therapies, leaving them disillusioned with the past but
optimistic that there was still a therapy that would satisfy. It became apparent that searching
for the right therapist was also a search for self. Jung listed three qualities needed for
individuation: insight, endurance and action. All our patients lacked one of these qualities
and sometimes, it was felt, all of them. In particular, the inability to use insight and depth
interpretations was paramount. This posed a special problem for our group of therapists.
The group began some years ago during the training of Ingrid Coltart, Coline Covington
and Arthur Sherman with the Society of Analytical Psychology. They felt they lacked
experience of a broad spectrum of patients and asked Roger Hobdell to supervise them in a
group concerned with people they would see once or twice a week. They wished to create
the nucleus of a therapy practice and for the time being income was not a priority. What
occurred was the experience of most trainees and newly qualified analysts: they were
referred the most technically difficult and unpromising candidates for psychotherapy. The
penetrating insights and interpretations learned on the course were to no avail and were
often treated with scorn and indifference. We puzzled a lot about questions of diagnosis
and, after trying out various phrases like

The authors are all Members or Associate Members of the Society of Analytical Psychology. Address
for correspondence: 24 Oxford Road, London NW6.

British Journal of Psychotherapy, Vol 4(4), 1988

© The author
Ingrid Coltart, Coline Covington, Roger Hobdell and Arthur Sherman 381

narcissistic damage and hysteria, more or less decided to confine ourselves to the job in
hand and look at what was going on.
This is therefore a clinical, descriptive paper where theory takes second place. We are
not seeking to be original but to describe our experiences. We hope it illuminates some
areas in every analyst's practice that are often seen as failure. Hospital outpatient therapists
and psychiatrists may also recognise this group in their own practices. If there is a
difference, we feel it is in our attempt to work within the analytic frame and in the fact that
we were the entire treating agent. We were neither part nor representative of a hospital or
independent agency. The main advantage was that we were less likely to be the carriers of
institutional depersonalisation processes. The corresponding disadvantage was that we had
no immediate back-up for emergencies and no ready help with the anger and rage that
arose. Let us outline the common characteristics of the patients with whom we were
dealing.
First, in spite of having seen many therapists, these patients often did not have much
idea about what would be most productive to bring to treatment, so that a process of
educating them to be patients had to come first. This of course could not be a didactic
process but one which was achieved through the rough and tumble of the sessions. It took
time, causing a large amount of frustration and resentment which on occasions led to the
treatment ending.
The frustration was compounded by their second characteristic: they were marked by
extreme psychic and physical pain. Indeed some had no history except of pain so that their
personal myth was having pain but no story, no thread running through their lives.
Thirdly, the patients understood their heroic search for a therapist not as a search for
themselves, as we thought, but as a search for someone to remove the pain in a magical,
omnipotent fashion, thus bypassing the normal channels of consciousness and preventing
the integration of ego and self that they sought. Labouring under such expectations, the
analyst was a sad disillusionment.
Fourthly, all the patients had marked feelings of hopelessness, which were easily
passed on to the analyst, and an unusual ability to de-skill the analyst. It meant that the then
trainees had to face both the patients' lack of faith in the treatment and their humbling
ability. To have just reached the first step of the professional ladder only to have it taken
away was painful. It seemed to re-enact in each case that patient's inability to get going
with life.
A note on the writing of the paper: the three who were then trainees qualified as
analysts, and because of this and the fact that we were working within the theoretical
framework of analysis we have called ourselves analysts. All four of us worked together on
the paper so it seemed invidious to label any one part as belonging to one person. However,
to preserve the structure of the individual confrontation with the patient, we have used the
pronoun `I' for the case reports. We have selected four typical patients out of at least a
dozen discussed in the supervision group. After each case report we have put forward our
ideas on the following subjects (in this order): story-making, not-knowing, holding,
technique.

William

William is 35 years old, tall and well built. He is single and lives on a temporary basis
in a house with several others who are also transient. He has been unable to keep a
382 British Journal of Psychotherapy

regular job or attend any educational courses on a regular basis, and lives on sickness
benefit supplemented by part-time work.

He is neatly dressed but often looks as if he has just woken up, with a dazed and
innocent expression on his face. William had been referred to me after being turned down
for a clinic analysis at the SAP. He had tried a variety of therapists over the last few years
and had also been involved with a number of religious communities from time to time. He
described these previous attempts as useless; no one had been able to tell him what was
wrong with him and, more importantly, no one had been able to take away the pain he felt.
In his first session William complained of feeling lost, having no direction and being in
continuous physical pain. This felt like a knife sticking in his stomach - he was like `a
wounded animal with a sword stuck in his guts'. No physiological cause had been found in
connection with his pain although he had consulted numerous doctors and clinics. He
explained that he wanted someone to take out the knife, but he was also afraid that if the
knife were to come out all his insides would come pouring out with it. In addition to the
pain in his gut William also complained that he felt as if he were choking and strangling on
something caught in his throat, which he described as a secret he could not spit out or
swallow. As with the knife, he wanted someone else to force the secret from him, without
his awareness. He knew that if there was a conscious struggle he could only resist.
William often arrived late for his sessions or not at all, occasionally missing weeks at a
time until I wrote to him that it was impossible to continue therapy without him, which
invariably brought him back. He continually talked of ending his therapy, saying he did not
see the point of it, he was not getting any better and what he needed was to find the right
therapist or healer who could take his pain from him. I too began to wonder what the point
was and whether therapy, or indeed I, was `right' for William. Throughout the two and half
years I saw him, he experimented with other forms of therapy while seeing me. Many of
these therapies were physically based - bioenergy, yoga, holistic medicine, acupuncture,
fasting and so on. It seemed that in these efforts William was trying to find a way to
embody his pain and in that way to digest and transform it. While I tried to analyse these
attempts as William's search for the perfect parent, who would know how to hold him
without the separation of speech, I often thought he was in fact trying to compensate for
what I could not give him in the form of actual physical holding.
William also tested me out by seeing other therapists, telling me in an off-hand manner
at the end of a session that he had just started therapy with someone else and seeking my
advice about whether he should continue seeing this person. William's infidelities became a
test of my faithfulness. At the same time it became clear that he had gone through so many
therapists in part because of his promiscuity. I felt the real battle was to resist my own wish
to reject William out of anger and exasperation, which would in turn only confirm his belief
that no one cared enough about him to stay with him. Holding on to him seemed to be the
main objective of the therapy while trying to resist being turned into a totally bad object
myself.
At the start of each session William walked through the door beaming radiantly. He
then sat down and told me how dreadful he felt. Often he sat and said nothing, staring at me
for the first 15-20 minutes, making me feel as if he wished to penetrate me and prevent me
from seeing into him. I once suggested that William wanted to fix me to the
Ingrid Coltart, Coline Covington, Roger Hobdell and Arthur Sherman 383

spot and he agreed, commenting that he did not want any movement around him, that
movement would mean losing everything. It seemed that my presence could serve as a point
of orientation for him at these times.
Through his silences and abstract way of speaking about himself William tried to tempt
me, sometimes successfully, into asking him one question after another, into being his
interrogator who could draw his secret out of him, without pain or knowledge. As long as
he did not know the content of his secret William could remain innocent. The secret
exposed, the pain extracted, William feared he would be left without a point of orientation.
His dreams were alternatively of being lost on a journey, not knowing where he had come
from or where he was going, and of being stuck in-between - as in one dream of climbing a
mountain and finding himself clinging to the side of a rock - the air being too fine to breathe
further up and yet not being able to descend for fear of falling. He survives by eating bits of
grass on the rock face. Both motionless and always moving, thoughtless and always
thinking, he made it his aim and survival to say in the same place.
William's pain could not be mitigated and I began to see it as the barrier protecting his
secret or his real self. His image of himself makes this clear, as he described himself
surrounded by a circle of spears which served both to shield him from outside attack and to
prevent him from moving, imprisoned within his own defensive structure. William's
identification with his pain - this outer self - seemed to be an identification with his shadow,
which perhaps explains why he came across as a hopeless case. His fear of disorientation
and annihilation, should his secret be exposed, similarly seemed to point to his fear that he
would be flooded by shadow projections. And so the real self must be protected, hidden,
and preserved through the continuity of pain. For my part I felt as long as I could hold some
of the shadow, as the useless therapist, I could be of some use.
As with the sense of motionlessness, there was also a sense of timelessness - there was
no apparent time sequence but rather time frames collapsed into one another. This was
manifested not only in the material within sessions but by the fact that William often mixed
up the times of his sessions, arriving at the wrong time. William's disorientation in time was
also experienced by him in his physical sensation of dislocation and fear of falling. His
physical boundaries were not clearly delineated as he said, 'I don't know if I am my feelings,
or if my feelings are me'. His confusion and feelings of being lost were conveyed by his
difficulty in remembering, and in relation to this, in having a story. Although it was possible
to piece together an abbreviated history William had few memories of the events in his life.
More importantly, however, he seemed to have no emotional story.
William said with despair that he did not know what to say to me because he had 'no
story to tell'. Without a story to tell he felt unable to use therapy. And in one respect he was
right insofar as without a sense of continuity reconstructions have little meaning and cannot
be integrated. As a result the only story that could be constructed was what occurred within
the sessions (and, specifically, within the transference and countertransference). For
William it seemed that the purpose of therapy was not to make sense of himself and his
history - what Freud described as the making of an 'intelligible, consistent and unbroken'
life story (Freud 1905, p. 18) - but to create a history in the present.
384 British Journal of Psychotherapy

Story-Making

William's inability to tell a story meant that we had to find our positions as if out of
nowhere. For the story locates us in time and place, it is told from a particular point of
view, it defines and limits us, it links us in relationship, and through its sequence connects
our experience. This capacity to make connections gives us a sense of causality and
meaning, or what Kohut would refer to as the `continuity of self' (Kohut 1977, p. 253)
The essential component in being a patient is the telling of one's story - to be able to
show oneself to the other and be reflected back. Analysis can be seen as a process which is
dependent upon and centres around the narrative from which a story, or a series of stories,
can be made.
Analysis begins with the case history which in itself is the telling of a story. Ricoeur
points to the active role of remembering as not only to recall past events but to be able to
form connections between them. `In short', he writes, `it is to be able to constitute one's own
existence in the form of a story where a memory as such is only a fragment of the story. It is
the narrative structure of such life stories that makes a case a case history' (Ricoeur 1977, p.
253).
A story begins as interpretation and is then subject to interpretation (Kermode 1981, p.
81). If analysis is contingent upon the capacity or potential for interpretation, this must be
intrinsically linked to the potential for story-making. But the patients we describe seem to
have no story - remembering is not possible, reconstruction is not possible, and therefore
interpretation cannot be taken in.
To be able to narrate a story involves the relating of past experience and signifies an
acknowledgement of separation in time. For some patients, such as William, this separation
can be denied by the failure to narrate - there is no story to tell, no beginnings and no ends.
The story then becomes the repetition lived in analysis - a kind of anti-narrative that takes
place in the immediate moment within the session or that moment between sessions, each
constituting its own time frame. In these cases the story cannot be told because there is no
memory - or to be more precise, as in William's case, some things can be remembered and
not others, but no memory that is recalled seems to fit. It is then that the gaps are perceived
as providing the missing links. What is most striking in the absence of a narrative is the
sense that there is a secret hidden away - as William was the first to point out. The secret
defies disclosure within the story, it remains undefined and cannot be relinquished because
it is the secret which paradoxically contains the identity of the illusion of a self unchanged
in time and therefore continuous. It is perhaps this failure to narrate that creates not only
disorientation and confusion but also a sense of hopelessness - for both patient and
therapist.
Over the two and a half years some changes occurred. For a brief period William gave
up seeing other therapists and no longer missed his sessions with me. What this signified
was doubtful - not insight nor action - perhaps endurance. He has stopped seeing me but
keeps in contact occasionally and writes saying he would like to resume therapy with me
when he can afford it. In the meantime he is going the rounds of therapists and has been re-
referred to a clinic for the pain in his stomach.

Sarah

Sarah was 23 when she came into therapy saying that she was liMen unbearably
Ingrid Coltart, Coline Covington, Roger Hobdell and Arthur Sherman 385

miserable and cried for hours on end. She sat in a crouched position looking rather like a
wounded animal protecting the seat of pain. Occasionally she glanced at me with a pleading
look. Her face was pale and angelic with large doe-like eyes; her voice was unexpectedly
deep. She evoked immediate sympathy in me and a wish to protect her from a cruel world.
During the case-taking she spoke of having been under psychiatric care on a number of
occasions since early childhood, but she could not remember the reasons for this beyond her
feelings of depression. More recently she had asked for help from her college counsellor but
had not found this helpful since neither of them had spoken at all. This time she sought
therapy at the instigation of her brother, who though concerned could no longer satisfy her
demands for constant attention.
Her parents had separated when she was six and both had since remarried. Sarah
claimed not to have any memory or feelings about these events. She described her father as
`charming but irresponsible'. As if to enlarge on these characteristics she recounted how he
had always been proud of her and had frequently invited her to partner him at company
receptions until his second wife had become jealous and brought this to a close. Since then
Sarah and her father have kept their meetings secret. They have continued their earlier habit
of taking short holidays abroad but in order not to be discovered they travelled alone. Her
mother whom she described as `sensitive, highly strung, sweet and popular' had on
occasions been hospitalised for depression, `but not madness' Sarah was keen to stress.
Talking of her condition she said that her feelings were manageable on some days when
she could work on her course in dressmaking and design, but there were other days when
she was overwhelmed by misery and hopelessness which drove her to feel quite suicidal.
During these times she could not bear to be alone.
Although she did not directly convey a reluctance to talk about her family and friends,
everything she said was brief and only in reply to questions. The account of her life and her
unhappiness was given in a completely detached and unemotional way. It sounded as
though she was describing somebody of little interest to her, and felt as though she was not
fully present to make a connection with me.
Sarah's difficulty with initiating an interaction continued and grew. Apparently the only
area of her life that was undeniably real to her was her emotional pain, yet at the same time
she could not fully allow herself to experience this pain. In an attempt to escape her feelings
she felt both lost and empty.
It became apparent that Sarah thought she had told me all there was to tell in the first
session and it seemed that she imagined it was a case of just being present so that I could
perform the act of making her better. Occasionally she spontaneously told some anecdote
involving her stepmother or her father's girlfriend, then fell back into silence. These long
silences seemed an expression of her despair and hopelessness. She could not see the point
of talking or doing anything. `Nothing changes' she said, `I will always be unhappy; things
don't work out for me, fate is not kind to me'. Any attempts on my part to suggest that
reasons for her unhappiness could be discovered met with a blank look. She did not want to
hear these ideas. Neither did she want to take up my suggestions of her feelings about our
sessions or myself. However, she continued to attend, even if irregularly, for the first two
months.
One day quite unexpectedly she spoke of a short happy relationship with a boyfriend
who had since left her. This marked the beginning of her recent period of unhappiness and
confirmed her belief that she had been wrong in allowing anyone to get close to her
386 British Journal of Psychotherapy

- a mistake she vowed never to repeat. Her remaining concern was to discover a way of
wiping out all memories of the relationship. My suggestion that she may be experiencing
feelings of having been abandoned like at the time her father had left her met with surprise
and denial. Clearly I had disappointed her in not offering a way of forgetting and our
sessions once more resumed their silent emptiness. Her attendance became less regular.
As if to compensate for her silence in the sessions her family began to act for her. Sarah'
s brother wrote a long letter giving a description of her moods, her childhood illnesses, her
tempestuous attacks on her mother from an early age, and her secretivenes which he said
was the reason for his letter. He said that Sarah had expressed some enjoyment of her
therapy sessions, but he nevertheless felt sure that she would not be very forthcoming and
he wanted to make up for this.
Later when Sarah was threatening suicide her mother telephoned me to ask for advice
and comfort saying that Sarah's flatmate had got in touch, who in turn felt unable to cope.
Rather surprisingly she said how grateful she felt for the work that was being done since
Sarah was beginning to talk to her after many years of silence. Reflecting on Sarah's earlier
difficulties and rebellious moods she wondered whether her distraught response to her
father's leaving had produced a lasting effect. Was it the case that Sarah could not or would
not remember these early feelings?
Possibly in response to rediscovering some good in her own mother, Sarah grew bold in
her expression of the inadequacy of her therapy. She said it clearly did not suit her, that she
had told all there was to tell in the first few sessions, that she felt quite sure nobody had
more to say than she did, and that she did not want to go on being encouraged to remember
the very things she wanted to forget. Finally she came saying that she had discovered the
solution to her problem - she was going to be hypnotised to forget.
Her disillusionment and anger with me were apparent but once more denied. Our
meetings had lasted, if intermittently, for six months. At the end of this time it was difficult
to know if any real change had taken place. In as much as her search to be held and to lose
her pain was continuing she had not completely succumbed to hopelessness.
Holding Sarah was difficult since the threshold of her endurance ws so low that she
threatened suicide whenever the seat of the problem was approached. She had not been
converted to the view required for therapy - namely that she needed to remember the very
thing from which she was in flight. Instead she was maintaining her expectation of a magic
something that could take away her emotional pain and at the same time allow her to remain
unconscious and unknowing.

Knowing and Not-knowing

During her time in therapy it was apparent how important it was for Sarah not to know
what was actually taking place, both in her life and in the interaction between her and
myself. Sarah lived in a state of phantasy and illusion and seemed to be unwilling or unable
to emerge from this condition which at times was quite disabling. The question of whether
she was unwilling or unable to emerge is a difficult one to settle since her state could be
described as both knowing and not-knowing at the same time. It was as though she had
access to reality but chose to ignore it.
Steiner in writing about the Oedipal myth calls this mechanism 'turning a blind eye',
Ingrid Coltart, Coline Covington, Roger Hobdell and Arthur Sherman 387

which he says is more accessible to consciousness than projective identification or denial

but nevertheless creates a cover-up of a perverse kind. It leads to misrepresentation and
distortion of psychic reality and effectively functions to maintain the status quo. The reason
for this type of cover-up Steiner suggests is early denial of oedipal impulses, a denial that
leaves the oedipal conflicts unresolved and in turn prevents an internal parental couple from
being established on whom the child can depend. Instead only a phantasy situation of
illusion is possible, which is both insecure and difficult to maintain (Steiner 1985, p. 170).
It was clear in Sarah's case that her attempts to maintain the cover-up brought her no
satisfaction in life. Her relationships were with people who would either collude with her
phantasies of incestuous connectedness or those who would reject her, leading to feelings of
anguish and increased attempts at forgetting. By the time she came into therapy her fear of
abandonment had already caused her to resist forming new relationships altogether.
Jung says that when a resistance to external love objects is created the libido returns
again to an incestuous object, since the inertia of the libido would like to hold fast to objects
of the past. It is this inertia he says which is a `dangerous passion that lies hidden beneath
the hazardous mask of incest. It confronts us in the guise of the Terrible Mother and is the
mother of innumerable evils, not the least of which are neurotic disturbances' (Jung 1912,
pp. 253-254).
It seemed to me that Sarah was trapped in a situaton where the urge to differentiate was
constantly being overwhelmed by the inertia of the libido, leading to helplessness and
despair. Put another way it was not surprising that given her oedipal conflicts and resistance
to insight, coupled with a lack of ego strength and endurance, she was repeatedly falling
back into what Gee calls an `incestuous obscurity' (Gee 1985, p. 240).

Mrs P

Mrs P aged 63 was referred to me from an outpatients' clinic by one of our members
who had taken a full history. She remembers this as the first real history that had been taken
though she had been treated for her hypochondriacal fears for the last thirty years. Her
symptoms began when she passed out watching the film Twelve O'Clock High. Since then
she has suffered anxiety and panic attacks which have been treated by GP's and
psychiatrists with pills and ECT. She has had hospital admissions and a diagnosis of
schizophrenia has been made but she has never previously had any formal
psychotherapeutic treatment.
Her mother had TB and went into hospital when the patient was five years old.
Although her mother then died, her father kept up the pretence that she was still alive in
hospital until the patient was eleven years old when she found her mother's death certificate.
She and an adored older brother were brought up by her father who had a series of
girlfriends. But it was she who began to look after him, doing the cooking and ironing for
the family. She described her childhood as grim. Her brother left home when she was
fifteen, and after being alone with her father for a year she met her husband-to-be. She has
had no other relationships.
By the time she came to therapy her husband had been dragged into the role of guardian,
treating her like a small child. She took no apparent responsibility for herself but controlled
her husband with her distress and symptoms. Her husband became anxious himself at
having to leave her alone. She felt she had some strange cerebral
388 British Journal of Psychotherapy

disease, multiple sclerosis or 'inflammation' of the brain. She was afraid that every small
symptom was a sign of cancer and she was at her GP's surgery three times a week. She
believes the doctors are lying when they say there is nothing wrong with her, which touches
on the importance of the lie throughout her life. The doctors do not understand her and
think she is mad.
When I see her she is always highly made up, with a face held rigid with cream and
powders which seems out of keeping with her age but is visible evidence of her false self. I
began to see there was great pain behind the facade. In narrative terms the false self, such as
one meets in younger analysands, had become institutionalised into a false legend which in
turn tyrannised her. I found the falseness difficult and unpleasant. She tried to control me
by leading me off on anecdotal excursions, telling stories rather than having a story of her
own.
She could find no language for her emotions other than using facts about her body. Her
exchanges with the outside world were conducted in this symptom code. She seemed
strangely divorced from her actual wants and wishes. I saw her as unable to hold them
within a containing ego. They then assumed a compulsive, tyrannical character and were
acted out unconsciously. At this point I began to feel I was unable to hold her.
She could see no sense in the idea that her present mental state might be influenced by
her early experience, especially her mother's disappearance and death and the period living
alone with her father. She broke any linking attempt I might make in the session and could
not make any links herself between the inner and outer world.
After four months she dreamed that she was in a cemetery, watching herself in a coffin
being buried in her mother's grave. She was very frightened in the dream. The nature of her
unconscious identification with her dead mother began to emerge in this session. It opened
an important area of contact between inner and outer reality and between psyche and soma.
There was less resistance to working in the area of her loss and she began to stop using
symptoms to get attention from her husband. Previously, I had felt her resistance to be of an
almost physical barrier that I had to burrow underneath or climb around.
Unfortunately, the holiday period set in at this point. Mrs P started to get 'arthritic' pains
just before I went away. Then she and her husband went away during which time she
contracted shingles. She has not been seen for the last two months and the only contact has
been by phone with her husband.

Holding

One of the main characteristics encountered in working with these patients was the
difficulty experienced in establishing a containing relationship. Little could be achieved
until this had occurred. The problem was that once it had occurred the discomfort level rose
in both parties, leading to a situation that had to be endured or broken. Attacks by the
patient on the holding were frequent and it was sometimes difficult to avoid it becoming a
holding on to the patient, rather as one might struggle with a wriggling baby.
The commonest way to break it was to somatise the pain and see the psychic problem as
one of the body. One person referred had seen ten therapists in the previous year and after
two months of therapy went to have surgery on her nose. Another, while in therapy,
convinced a surgeon to operate on the real nerves in her leg. Others sought to
Ingrid Coltart, Coline Covington, Roger Hobdell and Arthur Sherman 389

relieve the unendurable by seeking multiple therapies simultaneously. There was little we
could do in the circumstances except carry the pain as best we could until there was a
chance to let the patient repossess it. We realised with some patients that we might never be
able to hand back the pain, and in such cases we had to bear with a sense of inevitable
failure whereas in more regular analysis there is more often a place for hope.
In the case of Mrs P, I was striving for a transformation of a pain inflicted on a split-off
body into the suffering of a reasonably whole person. Her dream is a case in point. I
understood from this that I had been able to create enough of a holding situation for her to
confront her dead insides, and that I had shown I was not afraid of them.
With all these patients we had to create a space within which they could experience
themselves. In this our aims were similar to those in classical analysis. Unfortunately, we
were not able to reproduce the same conditions, particularly of frequency or regularity of
attendance. Also, any action by the analyst felt like a threat and it is possible this was
understood as the analyst's attempt to get free by imposing the unendurable on the patient.
If we wished to go on treating our patients, we were not in a position to give ultimatums
about boundaries. We had to achieve holding without setting boundaries in an authoritarian
way and in most cases it was brought about by using the inner space of the analyst (
Casement 1985, pp. 181-182). Here the pain could hopefully be faced, however briefly, and
with subtle use of a receptive inner space the patients' attempts to get themselves rejected
could be minimised.

Diana

Diana came to me after becoming dissatisfied with marital therapy as a way of

reclaiming a boyfriend. It is now two years after that initial interview and recently I found
myself saying to her that for her own good she should not telephone her boyfriend again,
that he was not the right man for her and that she knew that. Such unanalytic behaviour
illustrates the despairing attempts, admittedly unusual, to which I was driven by her.
Perhaps it is less reprehensible if it is understood that she is now 50 years old and for
the past 20 years has been seeing a succession of therapists and analysts, all of good repute.
She drifted dissatisfied from therapist to therapist, ending up in a combination of individual
and group therapy about twelve years ago. At last she seemed to have established a good
transference relationship but within two years the analyst suddenly died. The blow was
made worse by the fact that her parents had both died two or three years before. She had
also given up her career and was living on a small inheritance from her parents. She was
thoroughly lost.
At this point the analytic group was inherited by a colleague and with her consent I
contacted him. The following is an abstract of his report.

Diana was glamorous, raven-haired, always well-dressed, and flirted with men. She lived the life of
an attractive woman kept by a man and went to great lengths to maintain it. But there was no man,
only the financial structure that her father had set up which allowed her to live in the family house,
which by the age of forty she had never left. She appeared completely aimless as though the thread
of her life had snapped. She was still mourning the loss of her parents but unsuccessfully. There
was no progress. She spent her days shopping and looking after the house, occasionally working for
a few days for friends. She also began to see physicians and surgeons for a series of
hypochondriacal complaints.
She was extremely controlling in the individual interviews, allowing only her persona to appear and
Often talking me down when I was making an observation. She spoke at length about her
390 British Journal of Psychotherapy

boyfriends to the exclusion of her own thoughts and feelings. She had been engaged for twelve
years but her fiance had broken it off by which time she had still not had sexual intercourse. She
complained that men did not take her seriously enough. She went out to dine with them and now
occasionally to bed but, unlike the envied men of her girlfriends, they never took her away for the
weekend or even stayed the night. She spoke about the men in the vocabulary of a teenage
magazine. They were not so much idealised as romanticised.
I began to dread the superficiality of the sessions and her controllingness. Sometimes I felt tense,
sometimes bored. She was impregnable to interpretations which she thought were silly and could
see no sense in reconstructions. In fact the transference was difficult to disentangle since it was
shared between me, the previous analyst and several physicians.
After two years in individual and group therapy with me, she took herself off to Buenos Aires to
stay with relatives for a six month holiday. I have often thought of her since, imagining that she
might have married and settled down there. I felt somewhat hurt that she had never written to me
nor to the group, which would have been the usual practice for this group.

After receiving this report I could see some similarities and some differences. From the
comparison with her present state, can we get a picture of what may be happening to the
other people in this study in ten years time? She had in fact returned from South America
after the six months and was working sporadically again, selling family furniture to tide her
over the lean periods. She had also sold the family house and bought a newly constructed
flat where she has now been for six years.
I could be initially heartened by the fact that this time she was depressed and suicidal.
The teenage persona was shattered. On two occasions, after discussion, I phoned her family
doctor out of fears for her safety. Fortunately, the doctor was supportive of her therapy. For
Diana the other side of men was now visible. They were no longer romanticised but were the
objects of her anger when they refused to love her. She poured her animus contempt upon
them when they did not behave as she knew real men behaved. The sessions were filled
with speculations about the motives behind her current boyfriend's behaviour to the
exclusion of the exploration of herself. Obviously this was still the same, but now she often
grizzled about the unfairness of life, would cry copiously and shout at me `Well SAY
something'. All this was gratifyingly real when compared to the description of her former
self.
She never mourned not having children, perhaps because she was still mourning the loss
of her own childhood. She still dismissed interpretations, usually by changing the subject in
a rather regal way as though the remark had never been made or, if it had, was beneath her
consideration. Often people with this defensiveness respond well in analytic groups, being
able to learn the benefit of self-examination from peers, thereby sidestepping transference
problems with the parent/analyst. After several years in groups Diana had never achieved it.
She never believed in symbols, never had dreams to report and was at times so concrete in
her thinking that she appeared to be of low intelligence, which she clearly was not. One
could say that she was never able to achieve a coniunctio, either with a man or with an
analyst, but especially as an internal symbolic act.
At the time of writing Diana has been attending again for three years. The content of the
sessions is still the same, embracing the perfidy of men, sorting out the lives of her friends
and wondering at the luck of others compared to herself. Paradoxically, in spite of
repetitions and a restricted range of exploration, the sessions have ceased to be boring. She
is not now so glamorous though the men she meets still initially judge her to be ten years
younger then she is. Her face registers something of what she has been through. She is still
rather aimless and some weekends are spent in bed asleep. She has begun to adjust her
grandiose self to the real world and has started a more regular job
Ingrid Coltart, Coline Covington, Roger Hobdell and Arthur Sherman 391

which further exacerbates the anger and frustration of this process. She feels more real for
the confrontation with the rage of the baby-giant and is not now so lost to herself.
Clearly some movement has occurred over the past twenty years in which the
vicissitudes of life as much as analysis have played their part. Although she is now more or
less self-supporting, the core problem that results in her difficulty in relating has not yet
been dealt with. She has recently been able to internalise and retain some of the ideas we
have discussed together, though the internalisation has been a rather indiscriminate affair.

Technique

It is generally felt that seeing someone on a once-a-week basis is more exhausting than
intensive analysis, and certainly within this group we felt we had to be more active. It was
not enough to attend to what was being said: the patients had to feel that we had a lively
interest in them. When the interest waned or when a break occurred, the rejection or
feelings of loss impelled them to go elsewhere. Overt threats to leave or split the
transference by going to another therapist or physician were frequent. On one occasion for
example, after interpreting a dream, the analyst was presented with the deliberations of the
two other therapists the patient was attending. With some patients there was no certainty
that they would return for the next session. We had to deal with the moment. We had to
achieve an interest without having any plans as to what therapy might be. We had to contain
a large amount of boredom in the face of machine-like repetition of symptoms, but
endurance on the part of the analyst offered the possibility that the symptoms and the
person suffering them might be endurable. These factors and the general feelings of
hopelessness accounted for most of our exhaustion.
It helped us in the supervision group to focus on the place of insight interpretation. (We
are using interpretation here in the rather limited sense of a verbal communication that
exposes a previously hidden configuration.) Our conclusion was that for the typical patients
in this group, interpretations were not experienced as therapeutic. It was too often the sigh
of despair of the analyst when he or she felt he had to do something. The analysand felt it to
be an indigestible package that had to be spat out, as with Diana's need to de-rail the
direction of flow.
For the more damaged, interpretation re-enacted those early impingements in infancy (
Winnicott 1972, pp. 46-47) that were too painful, thus forcing the infant to think too soon,
as in William's case. In those with stronger egos the interpretation produced extreme envy,
thus facing us with a paradox, for although the magical omnipotent therapist was overtly
longed for and desired, he or she was attacked and denigrated on sight. The problem of not-
knowing has already been mentioned. It is probable we were making interpretive remarks to
get ourselves out of a state of unconsciousness. In any case they were often experienced by
the patient as terminating a kind of oneness with the analyst, a state which seemed to be
highly valued by the patient and was perhaps therapeutic. Fordham (1978, pp. 136-137)
writes at greater length about the levels of regression with which we are dealing. Here the
analyst can only facilitate the deintegrative process, especially by not interpreting and by
treating any delusional transference material as true.
As there was such a resistance on the patient's part to working with the transference, it
must be clear by now that the technique we found evolving depended to a large extent
392 British Journal of Psychotherapy

on understanding and working with the countertransference, without feeding back the
insights we gained. And if we could not make the interpretation to the patient it became
essential to make it to ourselves. In this way the inner space mentioned in connection with
holding was the location for an internal dialogue in us. We had to trust that the contents of
the alchemical vessel would interact when only one party knew what might be going on or,
indeed, when neither party knew. We had to be analysts without appearing to be. It is too
early to say how successful this has been. We do know that the group supervision was a
rewarding experience in which we all learnt and that, with the support of the group, '
impossible' patients could be approached analytically and a beginning made to a healing
that would never be complete. To our knowledge group supervision has never been used in
the formal training of adult analysts in this country. It may be that it has a place side by side
with individual supervision or as a research arena.

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