Tracking Changes in the Disruption/Repair Sequences: Important Aspects of Clinical Work

by Rachel Brier, EdD and Anna Ornstein, MD

Abstract

In keeping with the movement toward refining clinical theories and working with experience-near phenomena in the analytic situation, in this paper we are asking how we recognize change and how we know what particular interactional sequences between analyst and analysand have transmutative power. Following disruption-repair sequences in the therapeutic relationship sheds light on the process of change. Disruption-repair sequences not only re-establish the connection between therapist and patient, they also promote new levels of understanding for both parties in the dyad. Because such sequences are frequent in the course of treatment, they are particularly useful in creating and recognizing modifications in the patient’s defenses and related symptoms. In this paper, we track verbatim interchanges between analyst and analysand during two specific episodes of disruption-repair as a vehicle for understanding and illustrating the process of therapeutic change. This close tracking allows us to notice shifts in self-states within the analysand between trailing edge archaic selfobject mergers and forward edge strivings and transference as well as shifts in the therapeutic relationship.

Link to Online Publication [fulltext can be requested from the library].

Psychoanalysis, Self and Context, Dec 2020.

About Authors

Rachel Brier, EdD, is a psychotherapist and couple therapist in private practice in Great Barrington, Massachusetts. She was Clinical Director of the DeSisto at Stockbridge School, 1987-1990 and Clinical Director of the Gestalt Institute of the Berkshires, 1991-2002.

Anna Ornstein, MD, is a Supervising Analyst at the Boston Psychoanalytic Society and Institute, Professor Emerita of Child Psychiatry at the University of Cincinnati, a Training and Supervising Analyst at the Cincinnati Psychoanalytic Institute, a Lecturer in Psychiatry at Harvard University.  In 2018, Dr. Ornstein received the BPSI Kravitz Award in recognition of her dedication to teaching about the Holocaust and the dangers of intolerance: follow this link to watch her 2019 interview in the Kravitz Award series. On Nov 9, 2020, she received the Terezin Legacy Award for her lifelong dedication to Holocaust remembrance and education.


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