Working Through the "Caesura": A Clinical Illustration.

More and more often analysts work with patients who must develop the capacity to participate in analysis. One such patient, H., conveyed the impression of being "bogged down." He did not work or study, and at home with his family was prone to violent outbursts; his social relationships were centered around drug use. Concepts from Bion and Winnicott helped H.'s analyst take the risks necessary to create a therapeutic relationship with him. The patient has come to realize the worth of analytic thinking, and its potential to transform his life. Deviance with respect to technique, and collusion between the narcissistic areas of therapist and patient, pose the risk of dangerous slips in the direction of analytic "omnipotence." Reclaiming the term collusion (from the Latin con-ludere, "to play together"), however, can allow analysts to remain faithful to Freud's ideas while maintaining a necessary flexibility vis-à-vis the patient. This ludic space can be expanded through Bion's ideas, which deconstruct a perspective through which we are able to observe "facts," with particular reference to what occurs in the psychoanalytic situation.