ABSTRACT
In the “widening scope of psychoanalysis” (Stone, 1954), it often seems that the patients most in need of intensive treatment are the very ones least able to make use of it. In any treatment, the relationship between doctor and patient has trust as its foundation. And for those treatments which utilize transference as the primary vehicle for change, this is particularly so. As Eissler (1950) stated, transference mobilizes the archaic trust in the world and reawakens feelings of being protected by the mother. However, for those individuals whose attachment to the mother has been disrupted or for those who have been maltreated, traumatized, or abandoned, the ability to trust an intimate other may have been compromised by these early experiences and as such, the ability to make use of the analyst and of the transference in a positive way may be impaired. Frequently in such cases, the revelation of intimate thoughts and feelings is vigorously guarded against except through transference enactments. These may be dramatic and may potentially threaten the treatment. In order to provide a satisfactory therapeutic experience for such patients, enactments must be tolerated and understood, defensive maneuvers designed to keep the analyst away from “private” thoughts and feelings must be acknowledged and examined, and treatment may have to extend until such time as at least a minimal sense of basic trust can be established.
