Nr 18.  2008 sid. 31–44

Session with Sarah
and discussion

Antònia Grimalt


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Antònia Grimalt, M.D., psychoanalyst is working with children, adolescent and adults in Barcelona. She is training analyst and director of the Training Institute of the Spanish Psychoanalytic Society and member of Forum for child psychoanalysis, in the European Psychoanalytic Federation.

Before discussing the sessions with Sarah, let me provide some hypotheses, which help me to convey my perspective in trying to understand the material. I want to stress that I wouldn’t say to Sarah, the words I here put in Sarah’s mouth (about her needs). I use them (because I have only words), as a way of putting images to what I imagine is Sarah’s experience of a very primitive link, which is reproduced, in the therapeutic relationship. Only the therapist can know what to say, how to use it, and in what moment.

I suspect that the therapy with Sarah must have been difficult because of her intolerance of frustration and difficulties in maintaining her basic feeling of continuity (her feeling of going on living) due to a primitive lack of internal affect representation. There is, probably, a gap between a primordial unrepresentable affectivity and another level of representable affects; the registers of affects and representations do not coincide. Sarah’s different and disconcerting levels of functioning make me think that her outbursts, her retreat in the world of sensations, (spinning around), looking for a dizzy sensation, furnishes a feeling of being alive in a world of empty loneliness.

These sessions made me think (from a developmental perspective) about the importance of the object’s loving gaze; the concrete way, through which the mother conveys the loving mental matrix, in the process of dreaming her child’s experience. I mean the mother’s capacity for reverie and alpha function. When there are difficulties in this sense, the infant cannot develop a reflective attitude through the introjection of primitive (alpha) function, to link images to emotions, affects to representations, which would confer meaning to the emotional experience of the infant’s self. A meaning that Sarah now desperately looks for, (fortunately!). Having said this, I don’t exclude the child’s receptivity to the loving care, or her tolerance of frustration. My hypothesis is that, for one or both reasons, a link of not meeting had developed between Sarah and her mother.

I imagine that, from the beginning, the therapist must have been following Sarah very closely, trying to describe sensations and name emotions not imposing her presence and trying to fit with her expectations. I can see the therapist engaged in a careful observation in the session (looking at her and looking for her) trying to give meaning to Sarah’s emotional experience. My hypothesis is that this process gave way to a reliable therapeutic link. Sarah developed the hope of being understood and contained. Now she has the notion of a containing object (although very fragile inside) to whom to address her desperation and anger in the hope of being understood and contained. Good!
Sarah’s relationship with her therapist makes me think of this particular form of communication, made through interpsychic dynamics, in which the patient is unconsciously identified with the aggressor (often a deprived and depriving caregiver) while the therapist personifies the patient’s completely dissociated infant self, and not the more usual and frequent traditional parental imagos. The therapist must live “in the patient’s place” a part of psychic life, that is either simply unknown, or which has been expelled because of the pain linked to it.

Sarah, a seven year old girl, lives together with her single mother. The father left the family when Sarah was small. He now lives with another woman. When therapy started Sarah and her father met very seldom. Mother wanted help for Sarah since she had great difficulties in pre-school. She had great outbursts and had difficulties in playing with peers and the staff at the pre-school was quite worried about her behaviour. Most of the time she was sitting in a swing, spinning around.

The following two therapy sessions take place after almost one and a half years of treatment. Sarah has been in therapy twice a week. Her parents meet with a therapist every second week in separate sessions. Now Sarah has a much better contact with her father and she sees him regularly.

Session 67
When I come to the waiting room to meet Sarah I don’t see her. I look around and then I go back to my room. The second time I come to the waiting room I see her sitting high up in the espalier. “I saw you the last time, too”, she exclaims and climbs down. She has been sitting up there all the time without making herself known. I say that now we can meet and I ask where her mother is. Mother always accompanies her to her sessions. She says that mum left her on the street and drove away in order to go shopping. Later on I get to know from our secretary that Sarah came alone to the office today. Apparently she and her mother have come by car and mother has left her outside the clinic.

Sarah has brought two soft animals with her; she says that one of them is her pal animal. She takes them out of her bag and shows me, one big and one small soft dog. For a long while she now tries to get the small dog to stand on his feet. Again and again she tries to raise the little dog. She is patient and she doesn’t get angry, which she otherwise often gets. I say that I can see that the little animal tries to stand upright with his staggering legs. Sarah doesn’t answer but after a while she asks if there is ice on the edge where she tries to get the dog to stand. I say: “Mm, you can feel that way if your legs don’t feel steady.” She moves the dog to the sofa and manages to get it to stand for a long while. She looks upon me and looks really delighted. “You are happy when you can stand with staggering legs”, I say. She smiles.

Sarah seems pleased and walks with the dogs to the cupboard and brings a game called Memory. It is a game where you are supposed to find pairs of cards, two of the same kind. She wants us to play. The big dog may watch while the small one with the staggering legs is supposed to take part in the game. At the beginning everything goes fine, Sarah seems pleased and we take turns in the game. Sometimes Sarah looks at the other side of one or two cards on the table. When she finds a pair she makes a point of telling: “I didn’t peep, I didn’t cheat, you know”.

After a while she pulls out a drawer in the drawing table and she finds two brand new rubbers. She picks them up, turns them around and says that they are so very fine. She reads the long row of digits on them and notes that they have different numbers although they are quite alike in all other aspects. She drops a rubber on the floor and says: “look, it disappeared”. The rubber is right under her chair. I show her the rubber. She leans over and says: “I see nothing”.





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