Max Cavallaro (2012) Understanding Compliance in Analysis




The observed behavior of a patient’s compliant stance in analysis was used as a tether, to follow and descend into the unconscious to try and further understand the core fantasies and conflicts of the patient.  By analyzing the varying degrees of compliance, defiance and cooperation within individual sessions and over time, inferences were made as to the patient’s level of object-relatedness.  The pathological uses of compliance found here showed that the patient seemingly operating on a ‘depressive’ level was in fact predominately operating on a ‘paranoid-schizoid’ level.

Modern Analytic theory was employed in the understanding of the patient.  This included the use of the ‘contact function’ as not only a therapeutic technique, but also as a prominent research tool unveiling major findings of the study.   Emphasis on countertransference in Modern Analytic research supervision played a prominent role, revealing an enactment that occurred within the research supervision, which paralleled enactments occurring within the analytic sessions.  Through the resolution of the enactment within the research supervision, a significant shift occurred in both the research process and in the patient’s observable presentation.  This led to a deeper understanding of the patient’s and analytic candidate’s resistances to acknowledging more primitive emotional states.  

By maintaining a compliant stance in the analysis, the patient demonstrated that she was disconnected from her real or genuine self, and rather felt herself as an object controlled by the whims of the other.  This stance appeared to operate to protect the patient from psychic annihilation on the psychotic end of the paranoid-schizoid structure and from the feelings of loss, grief, and the fantasy of an objectless world on the depressive end of the continuum.