When pathological dissociation is operating, whether it is central to the personality or an isolated area of serious trouble in an otherwise wellfunctioning individual, part of the work in any analysis, at given points in treatment, is to facilitate a transition from dissociation to conflict, so that genuine repression can indeed become possible and its contents made accessible to self-reflective exploration, interpretive restructuring, and the experience of owning an authentic past. The issues of a person's shifting experience of time, and how the analyst regards the phenomenon of timelessness, are especially important here. Bollas (1989) and Ogen (1989) have, in fact, each developed the idea of historical consciousness as a mental capacity that must be achieved. Ogden writes that “it is by no means to be assumed that the patient has a history (that is, a sense of historicity) at the beginning of analysis. In other words, we cannot take for granted the idea that the patient has achieved a sense of continuity of self over time, such that his past feels as if it is connected to his experience of himself in the present” (p. 191). Until then, what we call “resistance” to interpretation is often simply evidence that some dissociated voice is experiencing the analyst's words as disconfirming its existence.
Let me describe such a clinical moment that may serve to illustrate what I mean. It is drawn from my work with a man for whom the ordinarily routine issue of missed sessions and “makeups” was more complex than I had anticipated, and led to an unexpectedly powerful revelation of his fragile link between selfhood and the continuity of past, present, and future. Because of the profoundly dissociated structure of his personality, he was unable to process the physical absence of an object and retain its mental representation with a sense of continuity. It was as if both the object (whether a person or a place) and the self that had experienced it had “died,” and nothing was left but a void. His solution, as with many such individuals, depended upon his being able to concretize the events that comprised each day's activity and hold them in rote memory, hoping that the cognitive linkage would lead to some experience of self-continuity that would “get by” socially. The one exception to his “laissez-faire” attitude towards life was his determination to “make up” missed sessions. Because I required him to pay for sessions he cancelled that were not rescheduled, I believed that his fierce insistence that every session be made up, no matter when, had to do with issues of power and money, and I particularly felt this as true because most of our discussions about it felt like thinly veiled power struggles. I can still recall the moment in which it became clear that something much deeper was at stake. We were in the midst of discussing this issue, once again, from our usual adversarial frame of reference, when I noticed that, inexplicably, I was feeling increasingly warm and tender toward him, and even had the fantasy of wanting to put my arm around his shoulder. This peculiar change in my own feeling state then led my attention to something in his tone of voice that I hadn't heard until that moment, and I asked him about it. I said that there was something about how his voice sounded at that moment that made me feel like a part of him was sad or frightened but couldn't say it, and I wondered whether he might be aware of anything like that going on. He then began to talk in a voice I hadn't quite heard before—a voice that conveyed, hesitantly butopenly, the sadness and desperation I had heard only as a shadowy presence. He began to confess, shamefully, what he had never before revealed, that his real need was not for me to reschedule sessions that he cancelled, but for me to reschedule all sessions, including sessions that I myself wished to cancel, including legal holidays. Exploring this with him was no easy matter, because as soon as I became directly engaged with the self-state that held the feeling of desperation and longing, he fled from the moment, became dramatically more dissociated, and lost all conscious awareness that his wish had any personal relevance other than revealing his propensity to be “impractical.” I then told him what I had been feeling toward him that had led me to hear that part of him that, until then, I had been ignoring. His eyes opened wider, and little by little, he began to speak more freely, but now as a frightened and confused child. “If I miss a session . . .” he said haltingly, “if I'm not at the session, I won't know what happened during it. . . . And if you don't make it up, I'll never know. I'll never have it again.”
Time, as you and I know it, did not exist for my patient in this state of consciousness, and had it not been for my awareness that my own state of consciousness had shifted in response to his, this unsymbolized self, lost in time, might not have been found. Reis (1995) has even gone as far as to argue that “it is the disruption of the experience of time that goes to the heart of the dissociative disturbances of subjectivity” (p. 219).
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