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Summary of the psychoanalytic process with the focus on the changes in the manifest dream contents

Of course I can only summarize fragments of the psychoanalytical process (four sessions a week, for five years). As already mentioned, we discussed the material in the weekly clinical conferences of the LAC study, following the expert validation in the Three-Level Model (3-LM). My focus for systematically studying transformation processes in this psychoanalysis had been the changes in the manifest and latent dreams.

Nightmares and early enactments of the trauma in the transference

As discussed in other papers, central embodied memories of early trauma may be observable in the dreams of the initial phase in analysis (see Bohleber & Leuzinger-Bohleber, 2016). Often these embodied memories are enacted very early in the transference and evoke intensive affect in the counter-transference of the analyst. Often the meaning of the enactment cannot yet be understood during this early stage of treatment but only after years of psychoanalytic work. Here is just one example:

During the assessment interviews I had offered long-term psychotherapy in a vis-à-vis setting with one session a week, because, according to my clinical impression, Mr. W seemed too fragile for psychoanalysis. To my surprise Mr. W answered, "One session a week is not enough for me: you would never make it to reach me emotionally if you see me so seldom." I was very surprised but because I thought that analysands unconsciously are "always right." I agreed to take him into psychoanalysis. I managed to offer him four sessions a week.

At the beginning of our second week of psychoanalysis, Mr. W surprised me by not lying down at the beginning of the session. Sitting in the edge of the couch he turned his (frozen) face to me and said, "I have to ask you a question. If I should feel really bad and helpless during this treatment, can I contact your colleague, the medical doctor at your institute?" I was not only overwhelmed by this "action" but even more by my sudden, uncontrollable, intensive affects in my counter-transference. I was furious, felt devaluated and denigrated. Although I tried to control these intensive affects and did not say a single word, Mr. W. seemed to recognize them. He jumped up and said, "Sorry, I did something wrong—you probably don't want to work with me anymore. I will go then."

At that moment I did not have any idea about the unconscious sources of this enactment. Much later in psychoanalysis we understood that it had been an enactment of "embodied memories" of the traumatic experiences of Mr. W with his unreliable, affect-incontinent, alcoholic mother, which had been enacted immediately upon becoming involved in the psychoanalytical relationship. I will return to this central therapeutic experience.

To come back to the initial phase in psychoanalysis, for a long time it was difficult for Mr. W to freely associate. It was often hard to reach him emotionally. Many analytic sessions dealt with depressive selfaccusations, massive inferiority feelings, and the unconscious belief that he was "a strange loner, who no one likes, much less isn't loved." One strategy to cope with his extreme anxieties about giving up control was working with dreams: the patient often remembered dreams, often nightmares, and filled whole sessions with them. The dream-subject in these narrations was often flooded by waves, stuck in narrow channels (see above-mentioned nightmare), tortured or persecuted. Here just one example:

P: I was condemned to death and wanted to hang myself in the death cell. . . .

I woke up in panic.

Dreams like this one (and many others during this time) illustrate the enormous feelings of helplessness and archaic forms of guilt. These feelings were in the centre of Mr. W's depression: a feeling of being the passive victim of strokes of fate that he could do little to counter, as he was confronted during the 12 years of growing up with a severely ill mother. Besides, as the result of his pathological early object relationship in his first years of life (severely depressed mother, missing father) he probably had been hardly able to integrate his early sadistic and destructive impulses and phantasies or to regulate his unbearable affects.

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