The Misuse of Persons

In this major contribution to contemporary psychoanalysis, Stanley Coen illuminates a heretofore undescribed character structure especially resistant to analytic process. Pathologically dependent patients, for Coen, are identified not by surface character traits, but by their response to the intrapsychic demands of analysis. Such patients remain in treatment, sometimes contentedly, sometimes amid rebukes and complaints, but they do not profit from it. Their inability to use insight, especially in the transference, is matched by a proclivity for sadomasochistic enmeshment. In analysis, this tendency translates into a continuing dependent attachment to the analyst. In exploring the genetic roots of pathological dependency, Coen ranges beyond extant trauma theories in describing a pattern of parent-child interaction in which repetitive behavioral enactments substitute for the acceptance and resolution of conflicts, both intrapsychic and interpersonal. In analysis, pathologically dependent patients use the analyst as they have come to use significant others throughout their lives: as part of a defensive structure characterized by repetitive enactments and a refusal to face what is wrong with them. This ",misuse of others", is infused with destructiveness, hostility, and rage, and the analyst necessarily becomes the object of these powerful emotions. With such patients, then, the road to therapeutic progress invariably passes through the analysis of mutual transferential and countertransferential hate, the patient's tempting invitations to collusion and avoidance notwithstanding.

Auteur

Stanley J. Coen, M.D., is Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research, and Clinical Professor of Psychiatry, Columbia University College of Physicians and Surgeons. Dr. Coen is a member of the Editorial Board of the Journal of the American Psychoanalytic Association.

Contenu

I. Background for the Study of Pathological Dependency 1. Introduction 2. What Is Pathological Dependency? 3. What Is Destructiveness and Why Is It So Frightening in Dependency? II. The Inability to Manage Oneself 4. Responsibility for Conflict and the Incapacity to Bear It 5. Dependency and the Superego 6. Repetition Versus Change 7. The Sense of Defect III. The Need to Avoid Destructiveness 8. Sexualization 9. Superego Aspects of Entitlement 10. Psychosomatic Avoidance of Conflict IV. The Pathological Need for the Other 11. Some Problems for the Analyst in Analyzing Pathological Dependency 12. The Excitement of Sadomasochism 13. Perversion 14. Pathological Jealousy V. Conclusion 15. Toward a Passionate Analysis: Technique in the Analysis of Pathological Dependency