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

by Rachel Brier, EdD and Anna Ornstein, MD


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.

Previous Posts:

Rodrigo Barahona, PsyaD (2020). Living the Non-Dream: An Examination of the Links Between Dreaming, Enactment, and Transformations in hallucinosis. The Psychoanalytic Quarterly, 89:4, 689-714.

Sarah Ackerman, PhD (2020). A Diagnosis for Psychoanalysis in the 21st Century: Freud as Medicine. The Psychoanalytic Quarterly, 89:4, 667-688.

Lora Tessman, PhD (2020). Review of Ghost in the Human Psyche: The Story of a ‘Muslim Armenian’ , by Vamik D. Volkan. Contemporary Psychoanalysis, 56(2-3):457-464.

Steven H. Cooper, PhD (2019). A Theory of the Setting: The Transformation of Unrepresented Experience and Play. The International Journal of Psychoanalysis, 100:6, 1439-1454.

Anton Hart, PhD (2020). Principles For Teaching Issues Of Diversity In A Psychoanalytic Context. Contemporary Psychoanalysis, 56:2-3, 404-417.

Lawrence J. Brown, PhD (2020). Trauma and Representation. The International Journal of Psychoanalysis, 100:6, 1154-1170.

Penelope Moore, LICSW (2020). Incest from a Young Age … Lasting a Lifetime. Psychodynamic Psychiatry, 48(1), 41-54.

Judith L. Kantrowitz, PhD (2020). A Psychoanalytic Memoir: The Analyst Enabled and Disabled by What is Personal. Journal of the American Psychoanalytic Association, 68(1), 83–100.

Cuneyt Iscan, MD (2020). Learning Along the Way: Further Reflections on Psychoanalysis and Psychotherapy by Patrick Casement, Routledge, Abingdon and New York, 2019, 156pp. American Journal of Psychoanalysis, 80:2, 235-239.

Anna Ornstein, MD (2020). The Relativity of Morality in the Contemporary World. Psychoanalytic Inquiry, 40:4, 223-233.

Sarah Ackerman, PhD (2020). Impossible Ethics. Journal of the American Psychoanalytic Association. 2020;68(4):561-582.

Cordelia Schmidt-Hellerau, PhD (2020). How Demagogy Works: Reflections on Aggression in Politically Fraught Times. Psychoanalytic Inquiry, 40:4, 234-242

Judy Yanof, MD (2020). A Separation: Breaking Up Is Hard to Do. The Psychoanalytic Study of the Child, 73:1, 172-181.

Elsa Ronningstam et al. (2020). Psychotherapeutic Treatment of Depressive Symptoms in Patients with Narcissistic Disturbances: A Review. Journal of Contemporary Psychotherapy50, 21–28.

John C. Foehl (2020). Lived Depth: A Phenomenology of Psychoanalytic Process and Identity. Psychoanalytic Inquiry, 40(2), 131-146.

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