Selfobjects in psychosis--the twinship compensation

Psychoanalysts and psychotherapists who work with psychotic patients often encounter unusual clinical phenomena. In this article, a certain kind of phenomena is described, wherein the patient refers to a body part of the therapist as being owned by the patient. This "body part borrowing" or "merger" can be explained by the classical and object relations schools in terms of part and transitional object concepts. These diagnostic formulations will then guide therapeutic intervention. Newer concepts, from the psychoanalytic school of self psychology, particularly that of the twinship selfobject experience, provide for a more effective intervention in these complex clinical situations. Certain psychotic responses, in these cases, delusional misperceptions, can be viewed as the patient's attempt to stave off empathic rupture and fragmentation. "Body-part borrowing" in the treatment setting thus serves as a twinship selfobject compensation; it attenuates the unbearable affects generated by empathic failure. In this article, we offered clinical vignettes to illustrate these processes in two patients with psychosis and one with neurosis. We then offered various suggestions for clinical intervention based on a selfobject understanding of these phenomena.