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Working With Regressed Mental States

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Length: 30 minutes

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Daniel Paul, PhD

Regression often accompanies change in psychoanalysis. A patient’s readiness to allow himself to regress is highly dependent on the analyst’s emotional responsiveness to his regressed state. If the analyst conveys that he is not threatened by the regression and remains emotionally engaged with the patient, then he provides an atmosphere in which the patient will feel safe to allow himself to further regress. However, if the analyst conveys through his interventions that he is threatened by the patient’s regression and does things to placate, reassure and cover over what the patient has dared to expose, then the patient may conclude that the analyst cannot bear his pain, repress it and adopt a compliant posture of giving the analyst a more superficial picture of his mental state. His opportunity to benefit from treatment will be circumscribed.

Freud asserts that there are three kinds of regression: topographical, temporal and formal. I would like to share my countertransference responses when working with these three types of regression.  Understanding the type of regression and my own disruptive countertransference responses to these regressed mental states in the patient allowed me to recover and be more emotionally engaged. Two areas are explored. 1. Regression to suicidal behavior and 2. Regression to fantasy.

There is a temporal regression in depression where an erotic tie to the loved one is replaced by an identification with the person so that the relationship need not be given up. Identification is an earlier method of relating to the other. Hate for the other is turned upon the self producing depression and suicidal behavior.

The analyst needs to determine whether the suicidal behavior is manipulative or unambivalent to guide his response. Frequently suicidal behavior provokes the analyst into action. Often the patient, at times like this, is trying to acknowledge rage at a parent, spouse or molester. It is the patient’s anxiety about this rage that produces his agitation and this needs to be interpreted. It is important that the analyst tolerate the anxiety stimulated by the patient’s agitation and not be mobilized to action.

When a person regresses his fantasy life is stimulated. Understanding the type of regression enhances understanding of fantasy. Understanding whether a regression is topographic or formal diminishes the analyst’s terror when working with the hallucinations of a wish fulfilling psychosis.

A temporal regression can also stimulate fantasy. However, what may be displaced onto the analyst is  not a replication of some childhood experience. A regression is not always a return to an earlier phase of development where satisfaction was not withheld. Longings for and ideal parent can generate fantasies unlike anything found in the real world. The analyst may need to link the fantasy to unique aspects of the patient’s history to be responsive and to deepen understanding of longings. Being able to tolerate urgent, concrete demands helps the analyst remain engaged.


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