Seeing Through the Fog: Learning to Work with Dissociation

by Rafael D. Ornstein, MD



Often the experience of learning from the patient is seamless, embedded in the unfolding clinical process. Patient and analyst bring their respective needs and capacities to this relationship and find new ways to collaborate toward the emotional growth of the patient, with the expectable amount of challenge and surprise along the way. Hopefully, analysts learn with every clinical encounter—but frequently it is when they are most challenged that they are aware of learning something particular from their patients about the therapeutic process. Patients with significant narcissistic vulnerabilities and corresponding narcissistic defenses can be quite challenging in treatment, especially in regards to the way that affects and whole sectors of the personality can be split-off and inaccessible in the treatment for a considerable time. It is the nature of this splitting-off, its subtle yet pervasive role in the treatment relationship, and the manner in which it led to both impasse and then insight, that became the focus of my learning from my patient. This article describes a treatment in which the dissociative process itself was dissociated, and how that came into awareness for both patient and analyst.


Psychoanalytic Inquiry, 35:257–270, 2015

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Previous Posts:

Nancy, J. Chodorow, PhD (2015). From the Glory of Hera to the Wrath of Achilles: Narratives of Second-Wave Masculinity and Beyond. Studies in Gender and Sexuality, 16: 261–270.

Rona Knight, PhD (2014). Free to Be You and Me: Normal Gender-Role Fluidity—Commentary on Diane Ehrensaft’s “Listening and Learning from Gender-Nonconforming Children” Related Papers. Psychoanalytic Study of the Child, 68:57-70.

Rita K. Teusch, PhD (2015). Sadomasochistic Relations Between Ego and Superego in Anorexic Patients. Psychoanalytic Psychology, 32/1: 191-212, October 2015.

Anthony D. Bram, PhD and Jed Yalof, PsyD (2015). Quantifying Complexity: Personality Assessment and Its Relationship With Psychoanalysis. Psychoanalytic Inquiry. 35, 74-97.

Mary Anderson, PhD (2015) The Conscious Heart: On the Act of Creation and the Compassionate Teachings of Art. Harvard Divinity Bulletin. Vol 43, No 1-2, pp. 21-31.

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