[Early disturbances of development and their impact on the goals of analysis: symbolization and the establishment of the therapeutic alliance].

Abstract

The author examines some early disturbances in the capacity of some patients to become aware of their psychic and affective states. These exert a profound effect on the establishment of the treatment alliance and the ability to communicate with the analyst. She compares the difficulties sometimes encountered by child analysts, working with small children who do not communicate mainly verbally, with those encountered with adults whose awareness of their mental processes and affects reveal grave disturbances. Examples are given of patients who make extreme use of metaphor and/or symbolic enactments in the analytic situation for purposes of communication with the analyst.