Containment, enactment and communication

Two patients are described in whom ordinary means of communication were disrupted by the deployment of primitive defensive mechanisms that prevented the author from integrating affect, context and counter transference to provide meaningful communication of a straight-forward kind. In the first, thinking was fragmented and projections into the analyst were difficult to tolerate; in the second, a dissociation appeared between affect and language. The author describes how with both patients he was led to behave as if he could put right the deficit he encountered in their means of communication and how at times he could recognise what was happening and interpret the state that the patient was evading, but at others was led into enactments that interfered with containment and understanding. Nevertheless, these allowed an examination of the type of object relations that the patients demanded and believed they needed. The author considers that the state of mind this produced in him was partly an evacuation of states that the patients could not cope with, but also represented a means of enlisting him to carry out functions that they could not or would not tolerate. Both patients used the sessions to create a manageable situation that functioned as a psychic retreat that he was instrumental in sustaining and that helped them avoid contact with reality, impeding their development. However, recognising the role he enacted also advanced the understanding of the nature of the retreat and of the underlying pathological organisation of the personality.