Pathologic accomodation, mentalization and negative therapeutic reaction

Abstract

Pathological accommodation is conceived as an adequate reaction to pathogenic intersubjective experiences during the critical period of primary dependency, serving to maintain a crucial relationship by means of accommodating to the pathogenic object. Failure of primary maternal preoccupation and thereby an insufficiently developed "mental navel string" results in deficient mentalizing, which becomes apparent as a deficient ability for introspection and as a severe lack of empathy. Destructive introjects resulting from earliest experiences of interactions give rise to transferences and countertransferences that are often difficult to handle. Due to early pathogenic interactions and the intensification of earliest unfulfilled needs, later experiences of a good-enough-mothering and of desired "adequate" reactions are experienced as non-fitting, inadequate and jeopardizing the patient's identity in a fundamental way. The importance of earliest synchronization and affect attunements for the maturation of the ability to mentalizing is stressed by more recent findings of early developmental psychology and of cognitive psychological research in the theory of mind. Three vignettes, pertaining to an autistic structure and different levels of borderline development, illustrate different grades of impairment and different regulations of the self by the other. By means of describing a mini-enactment of a pathological accommodation and its resolution, it is shown how the analyst must accept becoming the object that arouses destructive psychotic fear in order to make a further development to a more stable sense of identity possible. © 2006 Springer Medizin Verlag.