Lessons from MacGyver: working psychoanalytically under less than optimal conditions

The author describes a model for working psychoanalytically under less than optimal conditions. Using the television character MacGyver as a metaphor, the author explores challenging situations in which factors related to the patient, setting, and therapist preclude the possibility of conducting a standard analysis. Psychoanalytically informed clinicians need to have a simple, practical model for understanding the psychical world and the importance of the unconscious. In this "search-and-rescue operation," the therapist helps the patient make fresh contact with split-off parts of his or her personality. The main tool used is psychoanalytic understanding, enhanced by analytic listening and the interpretation of the transference. Two clinical cases demonstrate how, even when so many prohibitive factors predominate, deeper contact with the patient's unconscious life and development of the personality can be facilitated.