A State of Inbetweenness: 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 in the case of a dissociative split in consciousness. 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 challenges of working with a person who has established a psychic retreat based upon disavowal are outlined. I describe the clinical challenges of working with someone who places themselves out of reach of emotional engagement. A state of inbetweenness protects the person from knowing about their aggressive impulses, their need for care and the passing of time. This forestalls experiencing the dangerous, shameful feelings of dependence. The clinician needs to recognize the necessity for the defensive retreat, whilst being patiently ready to enter engagement when the patient becomes available.