A butterfly painting its own colours: Enactment, visualisation and differentiation

The clinician's emotional and somatic responses to patients are an essential source of information, but how can we disentangle what belongs to whom? A certain blurring of boundaries is inevitable in psychoanalytic work, with oscillations between more and less differentiated states of mind↔body, patient↔clinician and patient-clinician dyad↔wider institutional setting. In one sense, psychoanalytic work can be conceived as a cycle of repeated regressive enactments, followed by elaboration and differentiation après-coup. Referring to two clinical vignettes with pubertal/young adolescent patients, I reflect on the role of the clinician's visual imagination in this process. Accessing an internal, dimensional space can re-establish a boundary, while simultaneously processing a communication, thus forming a bridge between somatic reaction and thought. The particular relevance of this in relation to working with young adolescent patients is considered.