Atención y cuidado a las personas dependientes

My patient, John, a middle-aged professional, sought analysis for help with relationships. Whereas he found attending sessions difficult, I sensed a deep unconscious commitment to his process of self-discovery. He had a remarkable gift for responding to and engaging with dream symbols using free association and active imagination in a creative union. He spontaneously used events in his life and from the setting and container of analysis to amplify what was becoming conscious. The regression in the container or ‘vas’ was in the service of progress, though sometimes we were both concerned he might get stuck there; as if in a uroboric unborn condition.

Early in the analysis there were two sessions containing spontaneous active imagination. On travelling to the first session, he was afraid something might go wrong. He felt I was on a faraway mountain and that he was making a sacred pilgrimage to me. He took care not to break his neck on the way. I suggested he feared I might kill him, the fear being projected onto his journey. He said it was fine for me to kill him, and proceeded to imagine I was driving a stake through his heart. He had a wonderful feeling of me concentrating all my attention on him, knowing every cell in his body. By knowing him so completely and paying such deep attention I was loving him. When I’d killed him he would be with me always, inside me, part of me. He wouldn’t have to do anything, not have to work, just be there, completely accepted. The session nearly over, he wondered what to do with the body; he imagined a boy who crawled onto my lap, then a baby I was nursing. He became the father coming to collect his little boy. Talking about the fantasy later, he was drawn to the death experience, the wish to be permanently and passively inside me, as in a womb. I was interested in the birth of the baby, a rebirth into the world. This was premature, as there was much work to be done before the baby, as self, could be born. This fantasy showed John’s regressive wishes and their link to death. It expressed his death wish, but he was also a vampire, with unconscious sadistic wishes to feed off me, sucking my blood.

The next session he dreamed Gordon Brown, the British Chancellor, gave him a pike. It was small, black and flat, like a fossil. He was full of feelings about the pike: he is king of the water and grows very large; malevolent, calculating, interested in you for what he can get out of you – a politician. The eye of the pike looks at you in a calculating way; powerful, self-serving, hard. John identified with

the pike, trying to second guess me. At the same time he wanted to get inside me, to be safe, relieved of the burden of living. The pike became a frequent figure in his imagination, representing a part of him which kept him above people, contemptuous. Sometimes he saw it as his persona, other times it resembled his father, who could be a bully but who also rescued him from bullies. The pike was the part of him wanting to leave the analysis, saying nothing had changed: exploring feelings was useless, hindering him. In the real world he could not afford to feel soft and vulnerable. Though the pike’s way of being was outdated, like a fossil, it persisted throughout the analysis.

A few weeks later, in the session before a holiday break, he brought a dream: he met a woman in a shop near my house. They discussed the difficulty of making a home. He thought the dream asked: could he make a home here? No, because it’s my room with my things in it. The only reason the room wasn’t attacking him was my presence. The things in the room felt alive. Over the break, the room and I would be glad he was gone. I reminded him of his vulnerable and dependent feelings, recollecting the baby: the room’s hostility could be his wish to attack me for going away. He said he wasn’t aware of feeling hostile, but he should pay me proper respect. A ritual would make him safe; there’s a procedure to be followed, as in a court. You don’t just say ‘Hi, Queen’, you follow the procedure. He imagines arranging the room, tidying it up, making me as comfortable as possible. Then he sits on the floor and listens to my words of wisdom. He makes me so very comfortable I won’t move until he gets back, I’ll still be sitting in the chair. It’ll be safe for him to leave then. As he was speaking, I felt disembodied, like the impotent white queen in Alice in Wonderland.

He continued imagining he was arranging the room. We reflected on how he had the power – I was queen, but he was in control. I said there was no relating. He agreed: he sits at my feet while I speak my words of wisdom but he doesn’t have to listen, they go over his head. I said in this way he doesn’t have to feel vulnerable or needy. Yes, the servant’s role gives him power. He suddenly wondered what would happen if I asked him to do something he disagreed with, such as moving a picture. He thought he would refuse. I said, ‘Now we know who’s really in charge!’ Again I had a strong embodied counter transference: I experienced myself as if on a high throne, watching him bustling around the room.

John’s queen–servant fantasy, just before a holiday, illustrates his experience of the negative mother archetype, the room, in her engulfing, enveloping and intrusive aspect. To counteract this, he allows me as queen to appear in control, but makes sure he, as servant, holds the power. He controls me so I won’t move from the chair until he returns: he need not feel I have left him. Although he sits at my feet, he pays no attention to what he scornfully calls my words of wisdom. I cannot reach him, there is no danger of intimacy or mutuality, nor anger or regret I’m going away: ritual replaces relating. A further twist is his hint that as masochistic partner he will never be left, because I, as sadistic partner, need to continue using my power over him, a power he has made illusory. Here we see the continuous and confusing to-ing and fro-ing of power and control; now I have it,

now he does. John used masochistic power to control, elevating the other as outwardly powerful, sometimes godlike, as in the imagined pilgrimage to me, then subverting this projected power. But John felt acutely what he lacked; his scornful pike’s voice was useless, since he felt empty and lonely. Despite the pike, he was allowing himself to experience these feelings. The imaginatio connected him both to his omnipotent masochism and his true aloneness, showing me the depth of feeling in his experience of separation.

The mother complex (maternal uroboros) appeared as the wish to be left alone, regressed to a baby state. Before sessions he sometimes dozed in his car outside my house, as if inside me. He fantasised about possible futures in work or relationships without taking action to achieve these. He remembered occasions when his mother tried to help him move away from her emotionally; he avoided them with tricksterish manoeuvres. A recurring defence was deathly nostalgia. He spoke nostalgically in the session about past sessions, eliminating the present as he did so. This made me impotent, like the fantasy queen.

Reflecting on the pike, I feared it would make mincemeat of the baby, bite its soft bottom. The pike told John he’s the one to look after him; he’s been doing it faithfully all these years without recognition. But the pike wanted my attention – like the elder brother of the prodigal son, who was with father all these years, not being a wastrel. John felt relieved and grateful when I acknowledged the pike, which he experienced as an icy grip on his heart turning him away from me. Slowly, positive aspects of the pike emerged. John was in a new relationship; although he was afraid the pike would hurt his girlfriend, the pike could also be strong for her. ‘He’s got some heart feeling. His coldness somehow creates a reflecting space where she can be.’

The first hint of the self was the baby, the second a feeling he described: ‘I feel all square, I can’t explain it – my heart feels square, calm’. It sounded like a mandala, four-sided. He retreated from this numinous feeling: I’d become too important. He imagined going off on his own to eat something stolen from me, cutting off the relationship. Movement towards the self was too dangerous. John oscillated between eliminating me by distancing talk, and feeling a voracious need for attention. The unmet need grew huge like a cavern, sucking me in and blowing me about. He imagined taking me inside him, to fill the huge space: he’d eaten me, it was a good solution. Now he didn’t even have to come to sessions anymore. Then, he was remorseful, feeling like Bluebeard, as if he’d attacked me sexually, keeping me in a cellar to murder me.

The amplificatio began with his cavernous need, and anger that I wasn’t filling it, and ended with him murdering me: a reversal of the earlier fantasy in which I killed him. He felt disgust at his triumph, and lonely. But the self always brought him back into relationship, through his feelings of emptiness and loneliness. He was courageous enough to listen to his unconscious and not run away.

In struggling with me and his new partner he noticed his fascination for, and disgust with, women. He felt small in relation to women’s genitals: they were large, arrogant and demanding. He couldn’t give them anything, nor could he go

away, so he ended up standing with head down, turned aside. There was neither possibility of relating nor of escape.

Next day, in reminding him he was late, I became the indifferent powerful genitals, as if I’d taken away his ‘bits’. Castration felt easier: ‘we don’t have to worry about all that erotic tension here’. As a eunuch, the women would include him, he’d know their secrets, be in their circle: accepted, attended to and even- tually indispensable. Then he started feeling empty and depressed. I suggested he was beginning to want his genitals back. ‘Yes, they may be small and useless, but they’re mine and without them I’m not whole, I’m not me’. He noticed a difference relating to me without them; there was no competition, no sexual spark. He was glad to have them back and to know he was a man, not a boy. This was a reworking of the queen–servant fantasy. At the point of being in control, as indispensable eunuch, the awareness of the lack of relating hit him as in the first fantasy: he felt empty and depressed. Now he wished to relinquish sadomasochistic defensive power and relate to me as himself, acknowledging his deficiencies within the feeling of being whole.

A few weeks later he dreamed he was in a castle. Everyone had duties: he had to clean the toilets, and fight to defend the place. Horsemen were attacking with arrows; he had an arrow and defended successfully. This surprised him; in real life he would have been afraid. Then he went inside, up the stairs. On the stair was a man who looked soft, with green fluid seeping from him, clear bright green like new grass, viscous. The man had a disease of copper, causing the fluid to seep out. John was contemplating moving in with his girlfriend. He dreamed of a Spanish girl, whom he ignored until his girlfriend pointed her out. The Spanish girl offered to teach him about love. Afterwards, he felt cold and lonely, though not empty. I suggested this was the pike, but he said not entirely, there was no energy, no meanness or hostility now. This was the first emergence of an anima figure in his dreams, and it needed another woman to highlight her. He was resistant to this anima and I had to keep reminding him.

The first alive coniunctio appeared in a dream of a fighting couple: John was in a garage which had repaired his car. A couple, male and female, were boxing energetically in their lunch break, treating each other as equals rather than engaging in a manipulative exchange. He was black, she was blonde. They were mechanics wearing overalls; she in a skirt of blue overall material. She was feisty, a good fighter. In amplificatio, John preferred to stay with his passive identity (the dream ego whose car was repaired) rather than be the heroic fighter, as in the castle dream. After this, he dreamed that a disreputable man wanted to pierce his face; John declined and the man didn’t press him. The man had black hair like his father; his white shirt was dirty and bloodstained. Amplifying, the man changed into a numinous figure, a shaman, who gave him an initiation: John knelt before him, the man changed his face. To John this meant changing himself, inwardly and outwardly. With a changed face he would relate better to women, love and care for them rather than showing off to be admired. After this session he felt energetic, able to do things he’d been putting off for weeks.

He then dreamed of an eagle and robin in his garden. Instead of attacking the robin, the eagle just observed it. He associated the robin to himself, the eagle to the pike; the eagle as a more developed form of the pike. It is not defensive or hostile, though it is harsh, unafraid and destructive. As a creature of the air, it has a larger view than the water-bound pike. John would like to be fearless like the eagle, but feared the eagle would tear into and kill the robin – the softer, smaller, tamer part of himself. The transformation of the pike into the eagle followed the transformation of his face, suggesting deep as well as surface change.

In amplificatio he talked to the Spanish girl: he is shy at first, but she says she knows him well, she’s always been there. When feeling love and tenderness he no longer wanted to dominate. He appreciated the analysis because with me he could feel his feelings, but he thought he should end since he had what he came for: a new relationship. He was moving between the opposites; the next session he felt down, the opposites had come apart, contact led to destructive withdrawal.

A crucial dream came next. He’s in a large cathedral. It has a famous pavement, unassuming in looks: round, marbly, pale cream, grey and maroon. It’s not in the centre, not underneath the dome, the sun does not shine on it. He suddenly realises the pavement’s function: it interprets or gives meaning to what the huge cathedral space does. The space transforms people but they don’t know it, or they don’t know the meaning, until they look at the pavement. The cathedral has no meaning without the pavement, the catalyst. He goes outside where a friend is being brash and insensitive.

I was immediately struck by the awe-filled and numinous quality of the cathedral and pavement, which John didn’t seem to notice, being more concerned with the friend outside. He acknowledged the magical and mystical aspect to the dream but felt uncomfortable. The atmosphere in the cathedral reminded him of how it sometimes was in the consulting room. Consciously, he could be brash and insensitive about analysis, but a part of him was fully engaged in the transfor- mative process and in finding meaning. This part needed my help to be heard; he was impatient with me for ‘dragging’ him back into the cathedral while outside with his friend. The following sessions were full of resistance. The pike returned, greedy, withholding, wanting to impress.

He felt he froze up during the next break, though managed to unfreeze in the following session. Nevertheless the sadomasochistic defence was operating: he felt he had been humiliated here, yet had persevered, despite embarrassment. He wanted calm and peace, and linked this to his deathly nostalgia, where nothing can happen, where he withdraws from relating: all is under control. His nostalgia kills me and the lively part of him which the pike sees as crazy. The opposites again: life versus death, relationship versus dominance–submission, analysis versus nostalgia, progression versus regression. He realised by talking that he changed the experience of the session from one where we related to each other in a living silence, to one where he was alone in a fantasy about a powerful therapist queen, worker of spells. He could take her away, look at her occasionally, dispensing with the real alive me.

He dreamed of a homosexual man whom, as in the shaman dream, he initially rejected. The man appeared in a dustbin, naked and covered with sores.

Amplificatio led to this tramp-like figure transforming into a numinous one. The

naked man became an important internal figure whom John consulted when he didn’t know what he was feeling; a recapitulation of the Spanish girl whose task was teaching him about love. The naked man seemed to represent his sensation function: he knows things and communicates them through his body, being vulnerable but not weak. John on the other hand felt guilty about his body, his sensuality and desires.

A key dream occurred during the break: a famous actress lives in a grand house in Mayfair; photographs of her adorn the walls. She’s beautiful, like Marilyn Monroe. She doesn’t go outside, just admires her photos all day long. Each photo was given by an admirer. Her husband comes to visit, he’s been outside, it’s a sunny day. He’s devoted to her, brings her a leaflet about astrology, hoping it will help her go out. She tells the servant, a small sharp woman, to throw it away. The servant puts the leaflet in the fire but then mistress wants it back. She talks to mistress, distracting her, as if she knows mistress’s wishes better than mistress does.

This dream indicated a regression to queen–servant relating during the break, when the relationship with me weakened. The fantasy has been internalised: the internal servant controls the internal actress queen who is beautiful but powerless. This sadomasochistic internal couple blocks change. The husband is a new third