| Abstract: | In the context of work with an adult survivor of childhood sexual abuse, the interplay of multiple forms of engagement contributing to therapeutic action is explored. The compulsion to repeat old patterns is seen to be gradually overcome by new corrective experience in which the whole of the patient's sense of the analyst as a person is greater than the sum of its parts. Interpretation of enactments--often involving patterns of dominance and submission--is complemented by a range of "helpful" actions that must be detoxified. That process entails the progressive differentiation of coercion and influence, on the one hand, and of compliance and responsiveness, on the other In the end, autonomy and creative responsiveness emerge as integral to each other rather than as mutually exclusive. This development requires that the patient gradually relinquish an "essentialist" view of self and other in favor of a "constructivist" view, in which the ambiguity of experience offers opportunities for new forms of relational engagement and understanding. |
