Levels of analytic work and levels of pathology: The work of calibration

This paper identifies three points on a continuum of levels of analytic work and levels of meaning. The thinking arose out of many years of work with autistic and borderline children, who were not able, for reasons of profound ego impairment, to respond to the more traditional explanatory interpretation as a method of ascribing meaning. Their capacity for introjection was limited. The author suggests that a prior level – lending meaning via description or amplification – is more effective in helping them to think. The paper argues that this second method, where appropriate to the patient’s developmental and psychopathological level, need not be seen as inferior to or less complete than the former type. A third, more intensified level of work – an urgent insistence on meaning – is illustrated with a patient where the deficit was not only in the ego, but in the self and the internal object. The suggestion is that the issue at this third level – with emptied out patients – concerns, not thinking about feeling, nor even identifying feeling, but gaining access to feeling itself. The paper involves an attempt both to elaborate certain of the author’s earlier ideas on technique and to consolidate these into a wider schema of priorities.