Some implications of the analyst feeling disturbed while working with disturbed patients

The analyst's experience of patients' disturbances is explored as an aspect of analytic technique. A number of premises are examined. First, it is expected that the analyst is committed to tolerating and understanding disturbances evoked in him by his patients' personalities and their disturbances. Second, that he regards the disturbances evoked in him as a form of manifest content to be understood in the usual method of association. Third, countertransference attitudes may propel the analyst toward rapid formulaic conceptions of his patients' disturbances or to considerations of diagnostic designations carrying serious, if not pejorative implications, such as borderline, narcissistic, perverse, or sociopathic. Such attitudes may also underlie the urge to consider psychotropic medications in response to the patients' disturbances. A selected review of the literature as well as illustrative work with disturbing patients are presented in support of the paper's premises.