A state of in-betweenness: the challenges of working with disavowal

Abstract

A presentation of emotional detachment is sometimes encountered in working with challenging patients. The term “disavowal” describes a particular kind of splitting of consciousness in which the person repudiates awareness of disturbing realities or their meanings. Disavowal involves a distortion of emotional significance, rather than a distortion of perception, as would be the case of a dissociative split in con-sciousness. Detachment protects the individual from emotional contact, which is experienced as potentially overwhelming. Safety is achieved, but at the cost of denuding mental life of meaning. With the help of detailed clinical material, the chal-lenges of working with a person who has established a psychic retreat based upon disavowal are outlined in this article. I describe the clinical challenges of working with someone who places themselves out of reach of emotional engagement. A state of in-betweenness protects the person from knowing about their aggressive impulses, their need for care, and the passing of time. This forestalls their experi-ence of dangerous, shameful feelings of dependence. The clinician needs to recog-nise the necessity for the defensive retreat, whilst being patiently ready to enter engagement when the patient becomes available.