Luisa Seen Through the Lens of Tomkins's Decontamination Script: Commentary on Dr. Alvarez's Case Presentation

Abstract

Luisa is seen as deeply disconnected from her own thoughts, feelings, and initiatives, as reflected in both the therapist's and patient's experience of disconnection from each other. Examples are given of Luisa's idealization of her family, her polarized thinking, and her repetitive patterns of interacting as evidence for the presence of a repetition compulsion. The author's understanding of the dynamics of this compulsion is presented by referring to Tomkins' decontamination script, in which the repetition of painful affects is not conceptualized as the goal, but rather as the unanticipated consequence of a failed strategy. The central features of a decontamination script are described, namely that it manages the affect of disgust, in which the core experience is that good scenes that have turned bad, and that it entails a maximizing–minimizing strategy in which an attempt to decontaminate an exaggerated sense of badness is made by seeking nothing less than perfection, and is thereby doomed to fail. The parental characteristics and family dynamics that generate this script are described and related to Luisa's family and to her own psychodynamics. It is further argued that she has not developed beyond the dyad and is struggling to develop an autonomous self. Finally, the three therapy sessions presented by Dr. Alvarez are explored to illustrate how this formulation would organize the data conceptually, and how it would guide one's interventions.