Journal of Analytical Psychology, 2015, 60, 4, 477–496

Revisioning Fordham’s ‘Defences of the self’

in light of modern relational theory and
contemporary neuroscience

Donald E. Kalsched, Albuquerque, NM

Abstract: This paper explores the evolution of Michael Fordham’s ideas concerning
‘defences of the self’, including his application of this concept to a group of ‘difficult’
adult patients in his famous 1974 paper by the same name. After tracing the relevance
of Fordham’s ideas to my own discovery of a ‘self-care system’ in the psychological
material of early trauma patients (Kalsched 1996), I describe how Fordham’s seminal
notions might be revisioned in light of contemporary relational theory as well as early
attachment theory and affective neuroscience. These revisionings involve an awareness
that the severe woundings of early unremembered trauma are not transformable
through interpretation but will inevitably be repeated in the transference, leading to
mutual ‘enactments’ between the analytic partners and, hopefully, to a new outcome.
A clinical example of one such mutual enactment between the author and his patient is
provided. The paper concludes with reflections on the clinical implications of this
difficult case and what it means to become a ‘real person’ to our patients. Finally,
Jung’s alchemical views on transference are shown to be useful analogies in our
understanding of the necessary mutuality in the healing process with these patients.

Key words: autism, defences of the self, dissociation, enactments, self-care system,
shame, soul.

Introductory Remarks
In this paper I would like to acknowledge the formative role that
Michael Fordham’s thinking has had in the shaping of my own ideas about the
‘inner world of trauma’ and its ‘archetypal defences of the personal spirit’
(Kalsched 1996). Fordham’s paper ‘Defences of the self’ (1974) together with
Leopold Stein’s earlier (1967) notion of the self’s ‘immunological’ dysfunction
became foundational pieces in the way I conceived of an inner ‘system’ of
dissociated parts of the traumatized psyche – a ‘self-care system’ as I called it.
In my first book I tried to show how the defensive system I had identified
becomes a defence against intolerable feeling and thereby an impediment to
feelings in general. I also was able to show how the system has an archetypal
basis, i.e., its parts are not just inner ‘objects’ in the usual sense but daimonic

0021-8774/2015/604/477 © 2015, The Society of Analytical Psychology

Published by Wiley Publishing, 9600 Garsington Road, Oxford OX4 2DQ, UK and 350 Main Street, Malden, MA 02148, USA.
DOI: 10.1111/1468-5922.12165
478 Donald E. Kalsched

inner objects, mythological objects, bound together in a syzygy of ‘victim’ and

‘perpetrator’. In other words I discovered that the defences go down deep and
activate primordial structures and affects from the collective layer of the
unconscious described by Jung. The idea that these defences might be
‘coordinated’ by the self fit in very well with these discoveries and made sense
out of the uncanny wisdom of the defensive system. So did the fact that ‘deep’
‘primordial’ ‘daimonic’ and ‘mythological’ might also translate into ‘early’
‘un-remembered’ ‘implicit’ and ‘infantile.’ That was equally compelling, and
it was supported by the fact that Michael Fordham was not only a Jungian
but a Jungian who pioneered analytic work with children.
In what follows I will briefly review Fordham’s ideas about defences of the
self as they emerged in his earlier work with autistic children and describe
how he applied these discoveries to a group of ‘difficult’ adult patients in his
paper ‘Defences of the self’ (1974). These patients seemingly found it
impossible to tolerate the ordinary deprivations of the analytic situation, and
as a result put Michael Fordham under great pressure in the transference.
After describing Fordham’s dilemma with these patients, including his advice
for their treatment, I will describe a similar crisis with my own patient ‘Mike’
where I was drawn in to an ‘enactment’ of what we would nowadays call
mutual dissociation. I will contrast Fordham’s understanding of such
impasses with a ‘relational’ understanding of enactments such as that
articulated by Allan Schore, Philip Bromberg and the late Paul Russell.
Finally, I will try to show how these new approaches require a certain
revisioning of our classic interpretive analytic attitude and approach in light
of ‘post-classical’ considerations.

The origin of Fordham’s ideas

Fordham began his professional life with a special interest in the application of
Jung’s concept of the self and its ‘ground plan for individuation’ to childhood.
When he began his investigations into infantile autism in the 1960’s, he was
challenged to figure out why the normally synthetic function of the self did not
lead to symbolic capacities in these children. Their inner-world/outer-world
integration was defective. Coincident with these early discoveries with children
he had evolved a theory of the self’s deintegrative activity starting from an
‘original self’ in infancy that contained all the psycho-physiological potentials of
the whole personality, existing even before birth as a unique individual, separate
from the mother. This primary self carries ‘archetypal expectations’ and
‘predispositions’. It ‘deintegrates’, moving into the environment seeking a ‘fit’ for
its archetypal expectations, and then ‘reintegrates’, establishing something
different than the original deintegrate and forming the basis for true internal
objects which are woven together from realities that are both ‘in here’ and ‘out
there’ and paradoxically both.
Revisioning Fordham’s ‘Defences of the self’ 479

But if the fit between the baby’s archetypal expectations and the mother’s
provision is bad – the mother may even have a death wish for the baby – then
(and here’s the compelling part) in order to protect the infant’s individuality,
defences of the self intervene and form an absolute barrier before there can be
any possibility of an internal world being formed. When I first read this it
struck me as an astounding statement. It suggested the unconscious ‘intention’
of the defence was to protect a core of individuality from violation and it
would do so even at the cost of a radical severing of life’s possibilities. I
thought that I had seen evidence for precisely this protection in the dreams of
certain patients.
These defences of the self, Fordham suggests, take hold with a particular
vengeance and continue long after the noxious stimulus is removed. To
explain this seemingly perverse aspect of the defences, Fordham employed
some ideas of Leopold Stein, who had proposed in an earlier paper (1967)
that the extreme negativity and self-destructiveness in people who are
primitively defended might be understood as an attack by the primal self on
parts of the ego that it mistook for foreign invaders. This would be equivalent
to auto-immune disease of the psyche. Stein did not suggest why the primal
self might mistake healthy psychological material for not-self objects, except
to say that perhaps the self’s ‘immune system’ depends on the ‘fit’ between
the baby’s archetypal expectations and the environment. In a traumatic
infancy this fit is annihilated, rendering the infant’s self immunologically
incompetent. The ultimate example of such immunological incompetence of
the defence in an adult patient would be suicide. Here is how Fordham
applied Stein’s hypothesis to autism:

[With this theory in mind] it becomes much easier to understand how a barrier is
constructed. If … a baby is submitted to noxious stimuli of a pathogenic nature … a
persistent over-reaction of the defence-system may start to take place; this may
become compounded with parts of the self by projective identification, so that a
kind of auto-immune reaction sets in; this in particular would account for the
persistence of the defence after the noxious stimulus had been withdrawn. Not-self
objects then come to be felt as a danger to or even a total threat to life, and must be
attacked … little or no inner world can develop; the self-integrate becomes rigid and
persists….
Because of the persistence of the self-integrate, all later developments based on
maturational pressures result not in deintegration but disintegration and the
predominance of defence systems leads to the accumulation of violence and hostility,
which is split off from any libidinal and loving communication with the object that
may take place.
(Fordham 1976, pp. 90–91)

My own theory and its debt to Fordham and Stein

The combined ideas of Fordham and Stein were important to me for many
reasons.
480 Donald E. Kalsched

First, they suggested that the primitive defences we find in the psyches of
patients who have suffered early trauma were organized by a self-regulating
‘intelligence’ in the psyche, one that obviously had a bigger vision than the
ego because the ego didn’t yet exist. According to Fordham, these defences
were interested in the individual’s survival in the face of unbearable input
from the environment, but they were interested in something else. They were,
in effect, protecting something absolutely essential in the personality that
must never be violated – the seed of a person’s individuality, the very
potential for wholeness in the personality: what I called in my first book the
‘imperishable personal spirit’ and, in my second book, the human soul.
This led to my own ideas about how the ‘auto-immune’ features of the
defence get established. If we imagine that the infant’s earliest extensions of
itself into the environment – its spontaneous gestures – are met with neglect,
abuse, or violence, then the result is impossible pain, speechless horror, what
Shengold (1989) called ‘soul-murder’. This must be avoided at all costs, and
so dissociation, guided by the intelligence of the self, effectively begins to
chop up experience in order to protect the vital core of the personality from
annihilation. Defences of the self can then be seen to attack all elements of
experience and perception that are linked with the child’s ‘reaching out’
into a world of objects that traumatized it. When life improves and
genuine opportunities present themselves for self-activation and aliveness,
the defence (still operating on the basis of its old assumptions) sees these as
dangerous invitations to the old disasters and so attacks them accordingly.
The result is auto-immune disease of the psyche. This to me was an
extension of Fordham’s ideas and a reasonable account of the mechanism
of immunological incompetence.
A second aspect of the Fordham/Stein hypothesis that proved essential to my
own thinking was the simple fact that they introduced the idea of defence into
Jungian psychology. This was a huge help to those of us who were trying to
reconcile the ‘primitive defences’ outlined by Winnicott, Guntrip, Fairbairn
and others with the more ‘mytho-poetic’ and compensatory understanding of
Jung, who speaks very little about defences. Granted, Jung is the one among
the early analysts who emphasized the ‘dissociability of the psyche’ and the
idea of defence is certainly implicit in complex theory, but Jung did not give
an adequate account of the kinds of self-attacking, self-destructive energies
and agencies that I kept encountering in the unconscious material of my
patients – especially those who had a history of severe early traumatic
experiences with their caregivers.
Here is where my own work takes Fordham’s theoretical conception in the
direction of how the defensive system actually operates symbolically in the
inner world. I started to witness – or thought I did – the different components
of the defensive system operating in dreams, fairy tales and other symbolic
narratives. If my impressions were correct it meant that the human psyche
was majorly concerned about defence and that ultimately what was being
Revisioning Fordham’s ‘Defences of the self’ 481

defended was a core of innocence and aliveness that seemed to carry some spark
of potential individuality and therefore must never be violated again. Ironically,
this soul-carrying part of the person was being defended by being imprisoned or
actively attacked, as in auto-immune disease. The attacking part was full of
aggression whereas the victim of such attacks seemed to be full of libidinal
need, leading to a kind of sado-masochistic dyad and proving the astute
observation of Ronald Fairbairn that the traumatized child ‘uses a maximum
of his aggression to subdue a maximum of his libidinal need’ (1981, p. 115).
Both love and aggression were thus ‘bound’ into a system that kept either
love or aggression from being expressed in the object-world of relationships.
Moreover, dreams that out-pictured this oppressive system often made their
appearance at moments in the transference when the patient was starting to
hope again, or risk a new attachment relationship, so the idea that potential
new life and attachment would agitate the defensive system seemed to support
the analogy of immune system dysfunction.
A third important source in Fordham’s writings of my own ideas was his
statement (above) that ‘the predominance of defence systems leads to the
accumulation of violence and hostility, which is split off from any
libidinal and loving communication with the object that may take place’
(1976, pp. 90–91). Together with Winnicott, Klein, and Paul Russell, the
Boston analyst who is little known in Jungian circles, I had become
convinced that early trauma liberates powerful volumes of volcanic hate
in the infant psyche, which affect has no adequate representation in
Jung’s ‘teleological’, compensatory, and individuation-striving model of the
human psyche.
One reason we must learn to work with primitive levels of hate in our
patients has to do with their developing capacity to feel in general. Paul
Russell, a specialist in trauma and the ‘repetition compulsion’, articulates the
intimate relationship between hate and primitive defences:

Hate occurs in response to an injury to the self. It is a species of pain, except that,
because it is the wish to injure, kill, and destroy, it can, like autoimmune disease,
become an illness itself [i.e., a defence]. The education and transformation of affects,
leading to competence, amounts to the transformation of wishes. Every stage of life
has its own version of the struggle between the wish to kill and the yearning for
attachment…. The wish to kill would not be traumatizing to the person who has no
attachment to that which he wishes to kill. But, in fact, this never happens. How is
it possible to hate the loved and loving object, and live?… The more profound wish
is the wish to love, but it must be discovered, and hate is on loan against the time
when the healing can occur.
(Russell 1999, pp. 43–45)

Russell suggests that at the moment of every trauma, two primordial affects are
liberated, hate and an injured need to attach, i.e. the child’s love and longing for
the object. These primitive affects cannot be expressed or metabolized, and
become bound into a defence against feeling altogether. Hence ‘psychopathology
482 Donald E. Kalsched

represents the scar tissue of the injury to the capacity to feel’ (ibid., p. 34).
Defences of the self would represent that scar tissue forming in the very
earliest stages of infancy.

An example of the ‘system’ in operation: my work with ‘Mike’

Mike had a severe early trauma history. Nonetheless, he was both a prolific
dreamer and at the same time not afraid to work in the transference. Hence
he taught me a great deal about primitive defences, i.e. defences of the self.
Mike had come into therapy for two reasons: first, because he was losing
control of himself in repeated ‘road rage’ incidents. Some driver would cut
him off and Mike’s volcanic rage would be triggered. Nothing could calm
him except the discharge of his rage in a fistfight or a literal smashing the
other person’s car. Well over 200 pounds and solid muscle, Mike put several
drivers in the hospital and was in repeated trouble with the authorities.
The second reason he came for help was that he and his wife had just had
their second child – a baby boy who had early health issues with jaundice and
other difficulties – and Mike was worried sick. It was more than worry. He
was feeling suddenly overcome with strange and powerful feelings of
vulnerability and fear – fear of losing this boy – fear of his own feelings
which were erupting in spells of sobbing as he ‘kept watch’ over his boys’
cribs at night while they slept. He was ashamed and confused by all these tears.
Mike had grown up as the middle child in a repressive German-Catholic family,
his father a tyrannical ex-Army man and his mother more emotional and closer to
him, now deceased. Over the course of the first year of our work together, certain
glimpses into his early history emerged. When he was two, after his brother was
born, he seemed to have become desperate. He was inconsolable when his
parents left – had repeated temper tantrums. His father would shame him for
crying – call him a baby. He started getting into trouble. He was willful and lazy
and his parents tried to break his will. They’d put him on a dog-chain in the
yard. His mother shaved his head once to teach him a lesson. They had to pay
babysitters extra to sit him. When Mike was completely dysregulated and
inconsolable, his parents would pack his bags and literally drive him to the local
orphanage, threatening to abandon him. On those occasions he remembered
screaming until he couldn’t breathe and then he’d black out, or go numb. ‘I
became an expert at going numb’, he said. Later, when his father beat him for
his poor performance in school, going numb became a life-saving defence.
As our therapy process began, Mike began to actually enjoy the analytic
process. In fact it became the center of his week. He felt safe enough to start
tentatively exploring some of his early injuries – each time covering them over
with bravado or black humour but nonetheless bravely, step by step, entering
the inner Hell in which he had locked away the memories of so much of his
childhood. He was like an Afghani warrior, stubborn and proud, full of life
Revisioning Fordham’s ‘Defences of the self’ 483

and humour and warmth as long as you didn’t cross him. Needless to say I
ended up ‘crossing’ him repeatedly.
There were several unusual features of my work with Mike. First, the entire
analysis was conducted once per week. And yet Mike’s progress was rapid.
One factor contributing to this development was the fact that he asked
permission to tape our sessions – then listened to them every day on his way
back and forth to work, reflecting on things we’d discussed and ‘taking in’
moments of his own painful affects and my response in the quiet and privacy
of his car. There were no incidents of road rage during these meditative reviews.
Secondly, it happened that during the time of our work together, Mike and I were
each building a home for our families on land we had purchased in the woods north
of New York City – he in New York State and me in Connecticut, 40 miles away.
We discovered this because we kept running into each other at a nearby lumber
supply center on weekends. Both of us had worked in construction as younger
men and both of us were somehow inspired by the same idea of carving out a
beautiful home from the materials on the land – and doing it mostly by
ourselves. To accomplish this we each had a garage full of tools as well as a small
diesel tractor with hydraulic implements for hauling, plowing, and splitting wood.
These common weekend adventures became the subject of many stories back
and forth together with a lot of good humor and competitive kidding as we
compared notes on our respective projects. In the course of this Mike always let
me know that he was the better carpenter, proudly showing me pictures of his
accomplishments. And one fact that he especially liked to remind me of – and
this helped to ‘equalize’ the power dynamics that always threatened to
undermine our rapport – was that his tractor was bigger than mine! This always
made me laugh and was part of our kidding and ‘masculine’ repartee.
Slowly, Mike let himself drop into the emerging pain, fear, and sadness of his
childhood memories. As he did so, dreams began to surface in which there was
a lost or injured child, often persecuted by a tyrannical figure.
Mike showed up at his session one day very excited. ‘I think I’ve had a big
dream,’ he said. ‘This dream both draws and repels me. It’s about this boy’s life’:

We’re in a huge hotel. I am a bodyguard for this child who seemed sacred or special in
some way – almost like the Christ Child. He’s in an adjoining room. Somehow the
child doesn’t know who he is. I can feel the presence of an evil person – someone
who has come for the boy and is very close by. I become vigilant . . . alert! Then
there’s an explosion set off by the ‘evil one’. I run into the child’s room. He’s five to
seven years old. The explosion occurred next door to him. The child is in shock. I
recognize him and know who he is; the images of his life flash by me (the only one I
recall is the image of this little blonde boy in school innocently curling his cowlick).
I sit down next to this boy knowing the explosion was only meant to tease. If they
really wanted to kill this child they would have. I also know that in the wreckage
next door they’ll find the destroyed mutilated body of a girl who knew this child
and the explosion had killed her. They had tortured her trying to get to this boy, but
the signs of this (they knew) would be obliterated by the explosion. She had
martyred herself to save this boy.
484 Donald E. Kalsched

I now start to shake this boy. ‘Who are you?’ I shout. ‘Do you know who you are?’
His eyes remain fixed, then roll up in the back of his head. My anger is mounting. I
knock him to the ground. I see a little smile on his face. Perhaps I have made
contact with him. But he won’t look at me. I feel so frustrated. I leave the room
crying out of helplessness.
Then in a final part, I’m trying to tell this dream to a man on the third floor upstairs.
A woman present has instructed me to tell him the whole story. I’m relieved at the
prospect of this but am blocked . . . like I’ve had electro-shock or amnesia . . . I
can’t remember his life story. I think perhaps I should go back for his history but I’ll
never escape the ‘evil one’ if I do. I feel compelled to wake myself up.

Mike had several important associations. To the man upstairs he associated me,
his analyst. My practice was on the third floor. The boy twirling his cowlick
reminded Mike of a picture of himself at three he had seen recently. To the
autistic child in the dream, he associated his own hardened inner child – the
part of him in a trance that had stopped attaching to anyone. But this child,
the dream now made clear, was somehow ‘divine’ or numinous, marking it as
a symbol of Mike’s potential wholeness – a symbol of renewal and new life.
The explosion set off by the ‘evil one’ Mike thought was like the anger that
often exploded in him to cover up and defend against the pain and torture of
his early life. If the explosion was big enough the scars of torture (to the
feminine in himself) would be obliterated.
In this dream we can see a dramatic example of what I mean by the self-care
system in action. Bound together in the inner world is an innocent, omnipotent
child on the one hand, burdened with ‘inferiority feelings’, shame, and a sense
of ‘original sin’, locked up there by a tyrannical terrorist who seems to be
threatened by this child and wants to destroy it. Here we have love and hate,
libido and aggression, bound into an in-grown impacted system, exactly as
described by Fairbairn and Russell above. Killing in dreams often means
‘putting out of consciousness’, so the role of the inner terrorist is to keep the
traumatic memories out of awareness – living in its autistic state within. Mike
was aware of his own intolerance toward himself. He loathed and hated his
own ‘weakness’ and he would attack it in himself and in others with great
contempt.
And yet hatred was not all that Mike felt towards his own inner feminine, his
own inner child. There was also a benevolent protective side to his ‘progressed
self’. This part was strangely drawn to this ‘innocent’ child, and he felt
compassion for that picture of himself at three years of age. In his more
reflective moments, Mike knew there was something missing in his life – his
capacity for intimacy – and he could feel this in his compassion for that little
boy whose whole life flashed before him in his dream. This reminded Mike of
how he felt about his two little boys. He loved them so much that it
frightened him. He would routinely go into their room while they were
sleeping and cry over their little bodies – tears he didn’t understand.
In my analytic work with Mike, which lasted over seven years, we were able
to witness a gradual transformation in the archetypal defences so that
Revisioning Fordham’s ‘Defences of the self’ 485

eventually the two sides of the ‘system’ (the ‘child’ and the tyrant, love and hate)
could co-exist together in his conscious, witnessing ego. This transformation
was gradual but there were certain dramatic ‘moments’ along the way which
accelerated this integration and one was a classic ‘enactment’ of mutual
dissociation in the transference. It illustrates a new way of thinking about the
kind of crises and impasses that Fordham describes in his paper ‘Defences of
the self.’

Psychological strain that primitively defended patients put on the analyst

Before I recount my enactment with Mike, I’d like to briefly describe Michael
Fordham’s struggle with such patients and how he understood the peculiar
pressure they put upon the analyst in the transference.
In comparing Fordham’s description of impossible patients with my own very
un-analytic enactment with my own ‘impossible patient,’ I want to draw our
attention to how defences of the self might be worked with in post-classical
analysis. In 1974, Fordham didn’t know how to work with these intractable
patients nor how to transmute their negative energies towards healing.
Neither did I. In those days, interpretation was the only tool we had.
Fordham describes the analytic goal as one of simple endurance, without
getting seduced by the pleas of the patient to provide ‘tokens’ or gestures of a
false mutuality. Simply maintaining the analytic attitude, he says, without
technical changes, is to be recommended. The analyst should not try to ‘be
himself’ according to the patient’s insistence, because the patient’s perception
that the analyst is hiding his real self behind his technique is part of the
patient’s delusion (1974, p. 196). Today we would see this quite differently.
At the time I blundered through my crisis with Mike I had no choice but to
‘be myself’ and the event felt at the time like an embarrassing loss of my
analytic standpoint. Now through the insights gathered from the relational
school, of which Philip Bromberg is a guiding light, together with the
revelations of affective neuroscience and attachment theory, we are beginning
to understand that what has been injured relationally must be repaired
relationally. These patients present us with transactional forms of dissociation
that can only be repaired if the analyst is prepared to show up as a real
person in the interaction.
Post-classical theory emphasizes that the analyst cannot simply talk about
emotions or just interpret drives and defences. Instead one must be ‘in’ the
emotion with the patient if emotional healing is to occur. This often means
living through transferential enactments of early failed attachment bonds
which leave the therapist feeling ‘bad’, and may shake the foundations of how
we understand the work we do. With these patients we often don’t have
much choice. We get pulled in. Instead of sitting outside the process and
providing insight or interpreting defences, we will find ourselves participating
486 Donald E. Kalsched

in repeated ruptures and, hopefully, repairs of our connection with the patient
as dissociated pieces of the patient’s experience get knit together. Bromberg
(1998) calls this ‘standing in the spaces’ between dissociated self-states, but it
can be a stormy and disillusioning affair. Communication is not linear and
rational (mediated by the left hemisphere of the brain) but non-verbal and
experiential (mediated by the right hemisphere). Allan Schore calls this ‘right
brain to right brain’ communication (2012, p. 39). These new ways of
working are helping us get around otherwise intractable defences and shape a
new model of psychotherapeutic intervention.
Providing such reparative emotional experiences for the patient is not
something that Michael Fordham or his generation would have approved.
And indeed his patients were so violently attacking of the non-gratifying
aspects of their analyst, including his technique, method and objectivity, that
Fordham was left to wonder whether they were analyzable at all. Whether
they were possibly psychotic. Descriptively, he says, these are people who may
fill the sessions ‘with denigration ending up in loud groans, screams or tears
whenever the analyst speaks (1974, p. 193) – patients who without
permission ‘will from time to time touch, get hold of, hit or bite the analyst
and may break or steal objects in the room’ (p. 197). These patients, says
Fordham, attack what is good in the analyst, denigrate him, nullify any of his
interpretations, flooding the space which such negative affect that the whole
therapeutic alliance is threatened.
Here we see what Fordham and Stein mean by the ‘immunological’
incompetence of the self’s primitive defences. The analyst is trying through
his interpretations to be helpful and to make meaning of the patient’s
communications. But the patient’s defences mistake these efforts as toxic and
alienating, experiencing the analyst’s words as stereotyped, false, objectifying,
and humiliating. In Fordham’s description the patient’s hatred becomes
malicious:

The patient remorselessly plays on any weak points he may discover in his analyst, his
aim being to destroy the mature nurturing, feeling and creative capacities of the
analyst. All this may be translated to mean basically that the patient aims to destroy
the analyst’s internal parents, basically the mother and her babies inside her.
(ibid., p. 195)

In this ‘Kleinian lament’, one can feel the paranoid/persecutory atmosphere that
threatens the analytic partnership. One senses how badly Michael Fordham
feels about the torture he is apparently causing his patients by just trying to
do analysis as he understands it. For a while he is tempted to write off his
patients’ negative therapeutic reaction as a constitutional excess of envy
deriving from the death instinct. But this won’t do. Instead – and here is
Fordham’s brilliance, and where he shows his true Jungian colours – he finds a
prospective, teleological meaning in these defences. The clue to this ‘meaning’,
he says, lies in what he calls his patients’ ‘delusional’ belief that the analyst is
Revisioning Fordham’s ‘Defences of the self’ 487

concealing himself and depriving the patient of his true, real self (ibid., p. 193).
This delusion is accomplished, says Fordham, by dividing the analyst ‘into a
bad, technical machine and a good hidden part, which it is the aim of the
patient to unmask and get for himself’ (p. 194). While delusional, such a belief
is ‘reparative and is to be understood, with Jung, as containing archetypal
forms aiming to re-establish relatedness [albeit] in a malignant form’ (p. 198).
As for the etiology of the condition, Fordham recognized that the feared toxic
self-states projected onto the analyst probably originated in some kind of early
catastrophe or disaster in the mother/infant attachment-bond – a disturbance in
breast feeding, an early illness, traumatic hospitalization, birth of a sibling etc.,
and recognizes that an accumulation of traumata may build up piling on earlier
woundings disaster after disaster. This leads to a total rejection of that part of
the analyst experienced as ‘not-self’, i.e. his technique, his interpretations, and
his analyzing activity. Unfortunately, the analyst is identified with these
roles – he wants to be helpful more than he wants to be real.

Enactment with Mike

The violent negative therapeutic reactions that Fordham describes in his classic
paper were not a regular part of Mike’s transference to me. Instead, Mike’s
aggression and violent reactions tended to be split off from the positive
transference and acted out in his incidents of road rage outside the hour.
However as he would continually report such incidents to me – and as these
dangerous and compulsive explosions continued to erupt despite our work on
them together – I began to feel my own version of paranoid anxiety.
As with many men who have suffered traumatic humiliation in early life,
almost any frustration in our modern world could trigger Mike’s humiliation,
shame, and helplessness. Immediately his tyrannical rage would come up as a
defence to cover up these unbearable vulnerabililties. This could happen if his
kids didn’t do what he told them to; if his wife wasn’t responsive to him; if
someone cut into the line in front of him in the grocery store. And it happened
repeatedly on the road. Someone would speed by him and cut in, creating that
old familiar ‘dissed’ feeling inside. Up would come his rage! Down would go
his foot on the accelerator – up would come his middle finger and out would
come the ‘F’ words until he and the other driver were often pulled off on the
side of the road and Mike was bellowing like a wild bull. If the other driver
got mad in return a fistfight inevitably ensued. Archetypal energies would pour
through Mike and he was temporarily out of his mind – like Cuchulain in one
of his ‘warp spasms’. Because Mike was 6 feet 2 inches tall and 220 lbs., he
often hurt his adversary badly. Then he would feel terrible remorse about what
he had done and sometimes drive his now bloodied antagonist to the hospital.
His self-recriminations after these events were intense, made worse by the
lectures he got from his wife and the obvious disapproval he felt from me.
488 Donald E. Kalsched

Knowing that his eruptive anger was a defence against the shame and
humiliation he had experienced in childhood (on his dog-chain and in the
beatings from his father), and with the dream images of his evil bomber and
traumatized child in my mind, I repeatedly tried to help these two dissociated
self-states get together. We did active imagination with these inner figures. We
reviewed each road-rage incident slowly in subsequent sessions, trying to slow
him down, paying attention to his breathing, connecting the dots with early
experiences. For a while these body-sensitive techniques seemed to work. But if
a stressful period ensued in Mike’s life, he would often revert to the old patterns
and the road-rage incidents would occur once again. I began to think he wasn’t
trying . . . that despite the appearances of regret, he really didn’t mean it.
Then came the session of our ‘enactment’. Mike came in and confessed
superciliously (and with a guilty grin on his face) to yet another incident of
road rage in which he had really hurt another man half his size. He was
completely activated again and I could find no regret – no guilt or remorse in
him, only the pumped up hyperarousal of this addictive violence. Sensing my
discomfort, he changed the subject to some ‘urgent’ issue about his wife. I sat
seething, trying to listen with that old familiar feeling of helpless rage. The
thought that he was a psychopath crossed my mind – that he was simply too
damaged for psychotherapy, etc. Recovering my senses, I suggested that he
was avoiding the most important thing we had to talk about and asked him
what he was feeling. ‘About what?’ he said with irritation. At that point
something snapped in me and I lost my mind – at least my analytic mind.
Somewhere from a far-off place inside, I heard myself say to him (with
apologies to those of you who may be offended by the language):

Look, you are threatening everything you’ve created in your life – your profession,
your family, your relationship with your wife, the boys, your relationship with me,
and that new friendship with that little boy inside you – all for the temporary high
of your little shit-fit rages. You think you’re getting even or administering some kind
of sick justice but the fact is you’re simply indulging yourself like a two-year-old.
You’re just emotionally incontinent! That’s your problem. You can’t hold it! When
are you fucking gonna learn to hold it? [Silence]

‘Fuck you!’ he said, turning his head away fuming. ‘I’m outa here!’ And he
lurched out of his chair, slammed the door behind him and locked himself in
the bathroom on the other side of the waiting room. (Fortunately there were
no patients waiting.) I sat in stunned silence for a moment, then followed him
and stood outside the locked bathroom door and said:

Mike, I am really really sorry. You didn’t deserve that outburst from me. It wasn’t any
better than yours on the highway! Let’s not let this wreck our connection. Let me in so
we can process this together. We’ve got too much going for us. There’s a lot at stake.

I heard the door unlatched from inside. I went in. He was seated on the toilet
lid, head in his hands. I sat on the bathtub and put my hand on his shoulder.
Revisioning Fordham’s ‘Defences of the self’ 489

Several minutes went by with both of us finally coming back into our bodies.
Then I noticed Mike’s eyes begin to tear up. I waited for him to say
something but nothing came. ‘What’re you feeling?’ I asked. He looked up at
me and saw the tears rimming my eyes also. ‘I don’t know’, he said, ‘Sad…
about my father I guess’. Then Mike really began to sob:

Nobody ever cared! I had to take care of it all by myself . . . I was always crying
out for help in my acting out, but nobody got it . . . Six felonies before I was 18
and my father never spoke to me about it! All they could do was make me bad.
You’re not making me bad.

‘You’re not making me bad’. Suddenly I felt a huge upwelling of relief and
gratitude inside my chest – relief because I really had ‘made him bad’ in my
mind, and I felt terrible about it. I had really hated him for a moment and it
hadn’t destroyed him. And it hadn’t destroyed us. Both love and hate, the
good and the bad, were held together in this moment for each of us but love
was stronger, and hence the relationship was both preserved and deepened.
Mike took my hand and we just sat looking at each other in this wet
beautiful moment. It was like the Balm of Gilead – healing and
reconciliation poured down on us both. Trauma repeated, acted out, but
repaired, right there in the session … the little boy and the murderous
protector (in both of us) present and getting to know each other.
In retrospect, I think Mike and I lived though what Russell called ‘the
crunch’ (1999, p. 24), by which he means repetitions of injuries in
important earlier relationships (in this case Mike and his father) that could
not contain strong affect. These injuries were now ‘delivered into the
treatment situation as a crisis and a threat to the treatment relationship
itself’. Russell points out that when relationships cannot contain and process
the inevitable mixture of positive and negative feelings that are a part of life,
then trauma is the result. ‘It is traumatizing because the individual must
attempt to do the containing himself’, says Russell. ‘The essence of trauma is
that without [relational] containment, feelings cost the individual the
relationship’ (ibid., p. 25).
One of the ways to think about Mike’s situation is that the trauma of
unshared emotion with his father was too painful to remember. So,
unconsciously, he sought out a relationship in which it could be repeated.
Repetition, says Russell, has to do with what we cannot feel, so it’s a kind of
affective incompetence. The repetition compulsion is an ‘organized system of
affective incompetence’ (ibid., p. 7) – a dysfunctional feeling system.
In the typical repetition, the patient gets attached to the analyst in what looks
like a working alliance but then things start to get complicated. The patient
begins to focus on some aspect of us that re-captures the past. With Mike and
me this was the father whose disapproval now found an echo in my own
disapproval, and whose abandonment of his son’s need and acting-out had
490 Donald E. Kalsched

left him full of hate and shame. With Fordham’s patients, it was (apparently)
early attachment bonds that were ruptured because of parental indifference,
distraction, neglect or emotional mis-attunement – all qualities that these
patients re-found in Fordham’s distance, objectivity and technique.
As advice to those of us caught in these impasses and repetitions with patients
(myself with Mike, Fordham with his bewildering, demanding patients), Russell
offers an important reminder. The things the patient complains about, he says:

are real parts of ourselves that do, to some degree, prove their point. However odious,
this aspect needs to be located in us, and for us to try to disown or disavow it, to
ascribe it to ‘transference’ is to sever the patient’s emotional connection with us. The
only thing that works is negotiation, namely a negotiation around whether things
have to happen the same way this time.
(ibid., p. 9, italics added)

The thing that was odious for me in this example was my own hatred of and
contempt for Mike – for his indulgent sadistic aggression – feelings I had
towards him but could not admit to myself. The thing that was odious to
Mike was the old familiar feeling of shame at failing one more time to please
the man he loved and whose pride in him he so desperately needed.
Fortunately, I did not dissociate my hatred for long. Once enacted, I could own
it, and this made my apology possible. That was the beginning of a negotiation
towards a different outcome. Allan Schore makes the therapist’s affective
integration, internally, of love and hate an essential ingredient of such moments:

When a therapist’s wounds are hit, can she regulate her own bodily based emotions
and shame dynamics well enough to be able to stay connected to her patient? Can
the therapist tolerate what is happening in her own body when it mirrors her
patient’s terror, rage and physiological hyperarousal…. Herein lies the art of
psychotheapy. For a therapist to stay with a dissociating patient who is projecting
his trauma onto her takes many years of experience. More importantly the therapist
needs to have worked deeply with her own trauma and has to keep working with it.
A successful therapeutic relationship precipitates emotional growth not only in the
patient but also in the therapist.
(in Sieff 2015, p. 132, italics added)

Philip Bromberg (2006) has a similar analysis of what these patients need from
their analysts. Bromberg describes a spectrum of treatment crises with these
difficult patients. On the more ‘difficult’ end of this continuum the analyst
finds himself in an impossible bind, he says. The more he tries to help with
his usual analytic understanding the worse the patient gets. ‘At such
moments’, says Bromberg:

we try our ‘best’ interpretations. We mutter things about repetition of early trauma.
We hint at parental neglect, maybe even parental abuse too early to remember … all
to no avail – the patient’s silent [painful] scream for recognition and relief goes on
and gets louder.
(2006, p. 88)
Revisioning Fordham’s ‘Defences of the self’ 491

Bromberg suggests that the most difficult part of this dynamic for the analyst is
that he/she gets plunged into his or her own shame dynamic. The analyst tries to
ward off his own impending sense of failure and helplessness – his horrifying
awareness of the ‘iatrogenic threat of potential retraumatization’ (p. 93). ‘You
feel the patient getting worse and worse right in front of your eyes. You
cannot do anything about it, but you cannot not try to do something about it’
(p. 91). This makes the patient’s shame worse as she realizes the analyst is
unable to just ‘be’ with her:

It is only when the analyst ‘awakens’ from his own dissociation that he is sufficiently
freed from the enactment to address and process with his patient their respective
contributions to it and the core affective issue it masks – the shadow of the abyss
and its threat to selfhood and sanity.
(ibid., p. 92)

Bromberg feels that the analyst’s failure and shame about it is the only way for
him to know, from the inside out, what the patient’s distress is all about. Such
painful affects displace the analyst from his comfortable professional stance
and force him beyond his comfort zone. This is why, says Bromberg:

historically, all attempts by analysts to cure patients through the technical stance of
trying to be a good object have failed, including Ferenczi’s mutual analysis. A patient
needs a human being as a partner, a human being who can accept (eventually) his
own limitations and failings, and, most important, a human being who can tolerate
not having seen his failings when they are pointed out. Only from an interchange
between human beings can something new develop as a relational event.
(ibid., p. 95)

A post-enactment dream
Shortly after our ‘enactment’ session, Mike had a dream. The dream presents an
image of healing and reconciliation between a ‘father’ and his ‘son’. It
profoundly moved us both and became an important, storied image for our
later reflection:

I’m a part of a police force and we’re chasing this young man who’s about the age of
my oldest son, ten or so. He looks like an Afghani child, neglected and lost. He carries
an old newspaper in his hand. This boy has eluded us for years, yet now that we’ve
captured him, I’m confused. He looks at me imploringly and says ‘Is it time?’,
tentatively handing me the newspaper. The front page article is about this lost boy,
and how much his father wants him back . . . he’s been lost or abandoned or
abducted! In that moment I recognize him as my son! (As if he’d been the child of
an old girlfriend I’d gotten pregnant). I’m overcome with grief and longing. All I can
say is ‘I love you’. I reach out for him in an embrace and wake up deeply moved.

This beautiful dream heralded a major shift in our work together and a major
integration in Mike’s psyche between a younger father-alienated part of him
492 Donald E. Kalsched

that was clearly ‘his’ yet had become ‘bad’ – a fugitive, shame-ridden – hence
lost to his ongoing life owing to the defensive system that had ‘abducted’ him.
Mike was in tears as he told it, tears of recognition that this lost boy was
himself and that there was a part of him that had been deeply wounded (in
his relationship with his father) and was starving and impoverished in his
own war-torn inner Afghani landscape. It was seemingly this father-wound
that Mike and I enacted.
Mike’s acting out had provoked me into making him ‘bad’ (my hatred) – just
like his father had done – no doubt after similar provocation. Here is the early
injury ‘delivered into the treatment situation as a crisis’ referenced by Russell
above (1999, p. 24). Yet hatred wasn’t all I felt toward Mike, and my
apology had introduced the deeper affection that united us and that his real
father could never reach to. Hence the love and hate that had become frozen
in a defensive spiral with his actual father could get un-frozen in our
transference enactment, and his feelings could flow once again. When Mike
looked at me in the bathroom with tears in his eyes, felt my affection for him,
and was able to say ‘you’re not making me bad’, he saw through the projection,
and the abandoned ‘boy’ in himself could return. The father-wound was
re-lived in the moment (repeated) but with a new outcome.
It would be important to acknowledge that this was also a healing moment
for me. Out-of-control anger and hatred is not a comfortable part of my
analytic identity, and the eruption that occurred in my enactment with Mike
left me feeling shame-ridden and ‘bad’ about myself. His ability to see
through this to my deeper affection and ‘good’ intentions (‘you’re not making
me bad’) felt like forgiveness – hence my own upwelling of tears and
gratitude. Dissociated parts of myself could come together in this moment
also and I felt inwardly reconciled.
In Mike’s dream, the ‘News’-paper brings the information that the boy’s
father wants him back – that it is indeed ‘time’ for him to return. And then
there occurs the epiphany that Mike is this boy’s father, i.e., the story is
happening now, and Mike is no longer outside the narrative but an intimate
part of it. The distance between the dream ego and the dissociated child-self
collapses. They fall into each other’s arms.
In this example we’re given a glimpse of the way the psyche seems to celebrate
(symbolically) the recovery of its own lost wholeness and the healing of its
dissociated parts – a father’s embrace of his lost son. In this case, and in
many others that I presented in my recent book Trauma and the Soul
(Kalsched 2013) the recovery of this lost wholeness seems to be out-pictured
in dreams by the return of an unacceptable ‘child’ from some state of
unconscious alienation. Moreover, this child is often numinous, soul-like in its
pristine innocence and truthful aliveness.
We can’t help asking ourselves, ‘Who is this child, who seems to be the central
concern of the defensive system?’ Here we can recall Winnicott’s (1963, p. 187)
description of what he calls the True Self’s core – a ‘sacred incommunicado
Revisioning Fordham’s ‘Defences of the self’ 493

center’ of the personality which must never be violated and which is the source
of our feeling alive and real.
Jung refers to this center in his essay ‘The Psychology of the Transference’
(1946, paras. 416 & 417) as the Primordial Man or Anthropos – an image of
the potential wholeness of the personality and also paradoxically its evolving,
individuating center. If I am not mistaken this true self seems to be the major
preoccupation of what Michael Fordham calls ‘defences of the self’. The
dissociative ‘system’ goes to great lengths to preserve this sacred core against
the potentially annihilating impact of a feared ‘reality’. And analysis can feel
like just such an assault.
Jung says that because each person in the analytic partnership is an
assemblage of different (dissociated) parts, the relationship is inherently
confusing for both the patient and the analyst:

The situation is difficult and distressing for both parties; often the doctor is in much
the same position as the alchemist who no longer knew whether he was melting the
mysterious amalgam in the crucible or whether he was the salamander glowing in
the fire. Psychological induction inevitably causes the two parties to get involved
in the transformation of the third and to be themselves transformed in the
process….
‘Ars requirit totum hominem,’ we read in an old treatise [The art requires the
whole man]. This is in the highest degree true of psychotherapeutic work. A
genuine participation, going right beyond professional routine is absolutely
imperative, unless of course the doctor prefers to jeopardize the whole proceeding
by evading his own problems which are becoming more and more insistent. The
doctor must go to the limits of his subjective possibilities, otherwise the patient
will be unable to follow suit.
(Jung 1946, paras. 399 & 400, italics added)

TRANSLATIONS OF ABSTRACT

Cet article examine l’évolution des idées de Fordham au sujet des « défenses du soi », y
compris l’application de ce concept à un groupe de patients adultes « difficiles » dans le
fameux article de 1974 portant ce même titre. Après avoir remarqué la pertinence des
idées de Fordham pour ma découverte d’un « système d’auto guérison » dans les
matériaux psychiques de patients précocement traumatisés (Kalsched 1996), je montre
comment les idées majeures de Fordham peuvent être réinterprétées à la lumière des
théories relationnelles contemporaines, des théories de l’attachement et des
neurosciences affectives. Ces réinterprétations impliquent de prendre conscience que les
blessures graves dues à des traumas précoces oubliés ne sont pas élaborables par
l’interprétation, mais se répéteront inévitablement dans le transfert, conduisant à des «
mises en acte » réciproques entre les partenaires analytiques, avec l’espoir d’une
nouvelle issue. Un exemple clinique d’une de ces mises en acte entre l’auteur et un de
ses patients sera donné. L’article se conclue par des réflexions sur les implications
cliniques de ce cas difficile et sur ce que cela signifie pour nos patients de devenir une «
personne vraie ». Enfin, les images alchimiques du transfert de Jung s’avèrent être des
494 Donald E. Kalsched

analogies utiles dans notre compréhension d’une nécessaire mutualité dans le processus
de guérison de ces patients.
Mots-clés: Âme, autisme, défenses du soi, dissociation, honte, mises en acte, système
d’auto guérison.

Der Beitrag untersucht die Entwicklung von Michael Forhams Ideen bezüglich der
‘Abwehr im Dienste des Selbst’, einschließlich seiner Anwendung dieses Konzeptes auf
eine Gruppe von ‘schwierigen’ erwachsenen Patienten, dargestellt in seinem berühmten
Aufsatz von 1974 mit dem gleichen Titel [‘Defences of the self’ / RW]. Nach der
Darstellung der Bedeutsamkeit der Fordhamschen Gedanken für meine eigene
Entdeckung eines ‘self-care system’ (Systems der Selbstfürsorge) im psychologischen
Material frühtraumatisierter Patienten (Kalsched 1996) beschreibe ich, wie Fordhams
fruchtbare Ideen im Lichte der modernen relationalen Theorie, wie auch der
Bindungstheorie, als auch der affektorientierten Neurowissenschaft überarbeitet
werden könnte. Diese Überarbeitungen beinhalten die Kenntnis, daß die schweren
Verletzungen der frühen nicht erinnerbaren Traumata nicht durch Deutung
transformiert werden können, sondern unausweichlich in der Übertragung wiederholt
werden, was zu gegenseitigem ‘Agieren’ zwischen den analytischen Partnern und,
hoffentlich, zu einem neuen Ergebnis führt. Ein klinisches Beispiel für ein solches
gegenseitiges Agieren zwischen dem Autor und seinem Patienten wird vorgestellt. Der
Beitrag gelangt zu Überlegungen über die klinischen Implikationen dieses schwierigen
Falles und dem, was es für unsere Patienten bedeutet, eine ‘reale Person’ zu werden.
Abschließend wird deutlich gemacht, daß sich Jungs alchemistische Ansichten
hinsichtlich der Übertragung als nützliche Analogien beim Verstehen der notwendigen
Gegenseitigkeit im Heilungsprozeß dieser Patienten erweisen.
Schlüsselwörter: Abwehr im Dienste des Selbst, Agieren, Autismus, Dissoziation, Scham,
Seele, Selbstfürsorge.

In questo lavoro si esplora l’evoluzione delle idee di Michael Fordham che riguardano
“le difese del sé”, includendo la sua applicazione di questo concetto a un gruppo di
pazienti adulti “difficili” nel suo famoso scritto dallo stesso titolo del 1974. Dopo aver
mostrato l’importanza delle idee di Fordham per la mia stessa scoperta “ di un sistema
curativo del sé” nel materiale psicologico di pazienti con traumi precoci (Kalsched
1996), descrivo come le nozioni originali di Fordham possano essere riviste sia alla
luce della contemporanea teoria relazionale che alla teoria dell’attaccamento precoce e
delle neuroscienze sull’affettività. Tali revisioni implicano una attenzione al fatto che
gravi ferite di un trauma precoce rimosso non sono trasformabili attraverso
l’interpretazione, ma saranno inevitabilmente ripetute nel transfert, portando a una
reciproca “rappresentazione” tra i partners analitici e, sperando, a un nuovo risultato.
Viene riportato un esempio clinico di una tale reciproca “rappresentazione”. Lo scritto
si conclude con delle riflessioni sulle implicazioni cliniche di questo difficile caso e su
cosa significa per i nostri pazienti diventare “una vera persona”. Infine vengono
mostrati alcuni punti di vista dell’alchimia sul tranfert che possono servire come
analogie per la nostra comprensione della necessaria reciprocità nel processo di
guarigione con questi pazienti.
Revisioning Fordham’s ‘Defences of the self’ 495

Parole chiave: anima, autismo, difese del sé, dissociazione, rappresentazioni, sistema
curativo del sé, vergogna.

Эта статья исследует эволюцию идей Майкла Фордэма относительно «защит самости»,
включая его применение этой концепции к группе «сложных» взрослых пациентов в
знаменитой статье 1974 года под тем же названием. После того, как я проследил
значимость идей Фордэма для моих собственных открытий в «системе
самосохранения» в психологическом материале клиентов с ранней травмой (Калшед
1996), я описываю, как плодотворные понятия Фордэма могут быть пересмотрены в
свете современной теории отношений, а также в свете теории о ранней привязанности
и в свете аффективной нейронауки. Эти переработки включают в себя осознание
того, что тяжелые раны ранней и не запомнившейся травмы не могут быть
трансформированы путем интерпретации, но неизбежно будут повторяться в
переносе, ведя ко взаимным «разыгрываниям» между аналитическими партнерами и,
будем надеяться, к новым результатам. Клинический пример одного из таких
взаимных разыгрываний между автором статьи и его пациентом представлен для
ознакомления. Статья завершается размышлениями о клиническом применении такого
сложного случая и о том, что значит стать «реальным человеком» для наших
пациентов. Наконец, показывается, что алхимические взгляды Юнга на перенос могут
быть полезными аналогиями в нашем понимании необходимости взаимности в
целительном процессе по отношению к таким пациентам.
Ключевые слова: аутизм, диссоциация, душа, защиты самости, разыгрывания, система
самосохранения, стыд.

El ensayo presenta la evolución de las ideas de Fordham en lo concerniente a las ‘defensas

del self’ incluyendo su aplicación de este concepto a un grupo de ‘difíciles’ pacientes
adultos en su famoso escrito de 1974 que lleva el mismo nombre. Luego de trazar lo
relevante de las ideas de Fordham para mi propio descubrimiento de un ‘sistema de
cuidado-del-si mismo’ en el material psicológico de pacientes que padecieron trauma
temprano (Kalshed 1996), describo como las nociones de Fordham podrían ser
revisadas a la luz de las teorías relacionales contemporáneas, de las teorías del apego y
de la neurociencia afectiva. Estas revisiones incluyen la comprensión de que las heridas
severas correspondientes al trauma temprano no recordado no son transformadas a
través de la interpretación sino que se repetirán inevitablemente en la transferencia,
conduciendo a ‘representaciones’ mutuas entre la pareja analítica y, con esperanza,
hacia una nueva posibilidad. Se ofrece un ejemplo clínico de una representación
semejante entre el autor y su paciente. El trabajo concluye con algunas reflexiones
respecto de las implicaciones clínicas de este difícil caso y sobre qué significa devenir
una ‘persona real’ para nuestros pacientes. Finalmente, se muestra como la perspectiva
alquímica de Jung en relación a la transferencia es una útil analogía en nuestra
comprensión de la mutualidad necesaria para el proceso sanador con estos pacientes.
Palabras clave: alma, defensas del sí mismo, disociación, representaciones, sistema de
cuidado del-sí-mismo, vergüenza.
496 Donald E. Kalsched

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