The Broken Self: Injured States in The Transference-Countertransference Matrix

Themes of injury and injuredness reverberate throughout the treatment of patients categorized as having disorders of the self. Aspects of the various identifications that these patients may make with clinicians who are visibly physically handicapped from the outset of treatment are explored. Vignettes from psychoanalytically informed psychotherapies conducted at frequencies of up to three times weekly reveal how these identifications are used to externalize a sense of internal psychic impairment and to shed defective introjects in an attempt to preserve a faltering self. Themes of injury and defectiveness resonate throughout the transference-countertransference matrix, leading either to a working through of the injured state or, in unfortunate cases, to the disabling of the treatment itself. Particular attention is paid to patients who reveal during treatment that they were raised by a physically ill or handicapped parent and are therefore particularly vulnerable to castrative or disintegrative anxiety. Implications for the use of the able-bodied clinician by such patients are also considered, as well as the use of the clinician's injuredness by less primitively organized patients. The limitations of these treatments are also addressed.