Mental models and language registers in the psychoanalysis of psychosis: An overview of a thirteen‐year analysis

Abstract

The author suggests that the use of mental models and language registers may help an analysis to proceed, especially in psychosis, when the patient has not yet developed a mental space that will allow him/her the functions of knowledge and containment of emotions. Models, according to Bion, are a primitive approach to abstraction and a manifestation of the analyst's reverie that enables him/her to transform sense data into alpha‐elements. Ferrari, in a further development of Bion's theories, hypothesises a relationship between the transference and the internal level of body‐mind communication, and proposes the use of language registers to sustain the psychoanalytic process. The author presents several clinical examples from a thirteen‐year, four‐session‐a‐week analysis of a psychotic analysand who was initially confused, paranoid and altogether unable to bring self‐reflective thought to bear on her overwhelming emotions and had, by the end of the analysis, completely recovered from her psychotic symptoms. The clinical material shows how the technical tools of mental models and language registers helped in the construction of a mental space and spatio‐temporal parameters, permitting the patient to tolerate overwhelming concrete emotions and finally to recognise and work through the emotions of an intense transference.

The body in the analytic session: Focusing on the body–mind link

“…This is the case in psychotic conditions, for example, where an explosive body dominates the resources of mental containment. I have shown elsewhere (Lombardi, 2003a(Lombardi, ,b, 2005a(Lombardi, , 2007 the importance of a working through based on the body-mind relationship in the psychoanalysis of psychosis. Another important application is in the field of eating disorders (Charles, 2006;Ciocca, 1998;Sands, 2003;Zerbe, 1993), in which the dissociated body becomes a sort of 'Mr Hyde' with whom the patient cannot manage to establish contact (Bromberg, 2001;Ginzburg, 2006).…”

“…The reference to the concrete levels of the unconscious can also, I think, help us to put into perspective the phenomena of bodily countertransference that the analyst experiences with patients who have problems with body-mind integration (Lombardi, 2003a(Lombardi, , 2007, phenomena which particularly involve the analyst's deep unconscious and his ''capacity to absorb and contain in his own body'' the patient's massive projections (Williams, 2007, pp. 403-4).…”

The logic of turmoil: Some epistemological and clinical considerations on emotional experience and the infinite

“…In the clinical material at the end of this article, there is a clear focus on internal dynamics and a corresponding marginalization of transference interpretation. This choice should not, of course, be taken to indicate a disregard for the transference, which is still the mainstay of the analytic exchange: instead, transference interpretation is put off to phases in which the analysand has mental room for an opening to relational dynamics (Lombardi, 2003). Indeed when internal turmoil and structural conflict seem to be resolved, work on the transference makes it possible to put back into perspective the symmmetrization that characterized the analytic relationship, by working through the massive projective identification that can colour certain phases of analysis (Bon de Matte, 1988).…”

Knowledge and experience of time in primitive mental states

“…It will be clear now that I refer to a view of interpretations in primitive mental states that does not directly hinge on the transference. From a technical point of view my approach utilizes the mental models proposed by Bion (1962a) as suitable tools to promote abstraction, that is the most urgent requirement in those clinical situations characterized by lack of thinking (Lombardi, 2003).…”

“…My selection of the material is deliberately focused on certain aspects that could illustrate my topic. In the case of Giorgia, the reader interested in a wider perspective and on the multiple levels of my analytic work with her could nd them published elsewhere (Lombardi, 2003).…”