It is clinical work with the most difficult patients - those with severe narcissistic, sadomasochistic, and borderline disorders - that poses the greatest challenge to the therapist's guiding assumptions about clinical process; indeed, such work often leads therapists to question beliefs and expectations that formerly seemed self-evident. In
Getting From Here to There: Analytic Love, Analytic Process
, Sheldon Bach elaborates the holistic vision that guides him in work with just such patients. He dwells especially on the "attentive presence" through which the analyst effects a "meeting" with patients that invites the latter's trust in the analyst and in the therapeutic process. And he writes of love - of patient for analyst and of analyst for patient - that grows out of this mutual trust and sustains therapeutic process. For Bach, analytic therapy aims at understanding the person as a mind-body unity that manifests particular states of consciousness.
This holistic vision of treatment sustains a flexible clinical orientation that enables the analyst to "meet" states of consciousness in order to bring them into a system of which the analyst forms a part. Bach thoughtfully explores the clinical issues that enter into this taxing process, among them the establishment and maintenence of basic trust; the patient's or the therapist's presence in the other's mind; and the shifts in agency between patient and therapist. And he describes at length the frequently exhausting, even demoralizing, transference-countertransference struggles that enter into this type of analytic work.
Throughout, Bach is guided by the conviction that work with extremely challenging patients promotes the psychological growth and increased self-knowledge of patient and analyst alike. And he is admirably clear that the "mutual living through" of such treatments nurtures a kind of love between patient and analyst.
Getting From Here to There
not only records the clinical lessons learned by an unusually gifted analyst; it also chronicles the movement of psychoanalysis itself from the dissection of love into component parts to a synthetic grasp of its vital role in psychoanalytically informed treatment.