title: Self-mutilation, substance abuse, and the psychoanalytic approach: four cases.
abstract: While self-injury and substance abuse are difficult symptoms for both analyst and patient to cope with, and relapses are frequent, the emphasis does not have to be on managing crisis. The initial ego support and therapeutic boundary setting in these difficult cases must be matched by psychoanalytic exploration. In working with these patients, I find that, through mutual projective identification processes, the analyst and the patient are frequently resurrecting certain aspects of the patient's archaic phantasy life as defined by various self and object representations. Therefore, the continuous analysis of the transference and the countertransference is certainly essential. However, the additional willingness on the part of the analyst and the patient to explore the frequent and mutual interpersonal/intrapsychic acting out is paramount.
authors.affiliation: San Francisco Institute for Psychoanalytic Psychotherapy and Psychoanalysis, CA, USA.
authors.forename: R T
authors.initials: RT
authors.lastname: Waska
mesh_terms: D000328:Adult; D000437:Alcoholism / Q000523:psychology / Q000534:rehabilitation; D001883:Borderline Personality Disorder / Q000523:psychology / Q000534:rehabilitation*; D003131:Combined Modality Therapy; D003379:Countertransference; D003419:Crisis Intervention; D004532:Ego; D005260:Female; D006801:Humans; D008875:Middle Aged; D010553:Personality Development; D011573:Psychoanalytic Interpretation; D011575:Psychoanalytic Therapy; D011618:Psychotic Disorders / Q000523:psychology / Q000534:rehabilitation; D012652:Self Mutilation / Q000523:psychology / Q000534:rehabilitation*; D019966:Substance-Related Disorders / Q000523:psychology / Q000534:rehabilitation*; D014167:Transference, Psychology; D014473:Unconscious, Psychology