Harry Sullivan noted that we are all more simply human than otherwise, be we mentally ill or not. Heinrich Racker, a Post-Kleinian Argentine analyst, pointed out the myth of the well analyst and sick patient. Harold Searles through a kind of brutal and honest self-disclosure saw the role his own psychopathology had on patients (e.g., through their introjection of his unconscious anxieties and defenses). In recent discussions with colleagues Pamela Saunders and Jessica Arenella, I have given more thought to the role of projective identification/counteridentification in our work as psychotherapists and psychoanalysts. My Post-Kleinian background has sensitized me to the importance of what Melanie Klein referred to as "internal objects" existing deep within the psyche (for a good review of M. Klein's theories see Melanie Klein: Her Work in Context by Meira Likieman published in 2001 by Continuum of London & New York).

Henri Rey, recently deceased Post-Kleinian psychiatrist, proposed a view of therapeutic action in analysis, in which the patient brings to the analyst her/his 'damaged' primary objects for symbolic repair -- as opposed to concrete attempts at reparation (perhaps for one's sense of having damaged or destroyed one's primary object/s). Counterprojection, as beautifully described by Leon Grinberg, entails a transformation of the analyst/therapist into how she/he is being perceived in the negative transference. In effect, it is a forcing back into the patient of the negative, hostile and/or narcissistic object (e.g., an object that demands total loyalty, subservience, compliance, non-separation, etc.) which is being projected into and onto the analyst. Our job is to experience this fully (Grinberg terms this consubstantiation) without retaliation via hostile counter-attack or emotional, or even physical withdrawal.

And as pointed out by Gaetano Benedetti, the therapist makes a positive, flip side rotation of the negative projective identification -- a positivization of the patient's existence based on the therapist's identification with the catastrophes experienced by the patient -- with the attempt to 'metabolize' these emotional traumas. Sometimes, the persecutor within the patient resists therapeutic positivization at all costs (I have seen this time and time again. The dynamic ranges from a desire not to fool the therapist or others into thinking that she/he is good when she/he is really a 'bad seed' to an almost complete identification with the aggressor -- an inner attack on dependence because the fear of dependency is so great. Dependency/attachment can signify abandonment and loss of self, ego autonomy, etc.). The therapist's hostile feelings towards the patient can be a form of emotional closeness as long as it is not enacted in forms of retaliation.

Now having briefly described these psychodynamics, I believe these hold for therapists/analysts as well. Perhaps we choose our field to 'cure' our own 'damaged' and 'dying' objects in our patients -- to also cure ourselves through the work with patients (this would be a form of negative narcissism if the other is not seen in her/his own light and existence). When patients do not get better, not only can this be an narcissistic injury to the therapist, but according to my formulation of earlier Post-Kleinian theory, this could entail that the therapist is 'stuck with' her/his own damaged objects and thereby intensifying depressive and paranoid-schizoid anxieties and guilt. Perhaps it is time for a sequel to Ann-Louise Silver's excellent volume on illness in the analyst-to focus on the role of emotional illness/difficulties in the analyst as well. Years ago, my own psychoanalyst wrote a series of papers on his personal experiences of anxiety in his work as a therapist. At the time, I think it was courageous of him to share this with colleagues. I think it was because he has great emotional strength and integrity that he was able to do this.

Brian Koehler