The seam between life and death and therapeutic presence

Abstract

This paper will explore the difficulties of treating people in an environment that is intraumatic-where trauma never ends. These circumstances evoke the massive use of primitive defence mechanisms that makes it difficult to work through the horror. I will examine the ongoing relationship between life and death and the clinical meaning of walking the line between them while maintaining it. In the heart of this approach is the paradoxical statement that in order to live you have to maintain the feeling of death. The therapeutic position is not necessarily interpretive but more of holding the infinitive unbearable and enigmatic meaning of death. Questions of setting are raised, especially around meeting a patient outside the therapeutic setting, for instance at the grave. © 2008 Association for the Advancement of Psychoanalysis.