Thinking About What We Know and What We Do Not (Yet) Know: Thoughts Stimulated by Anna Ornstein's, “Do Words Still Matter? Further Comments on the Interpretive Process”

Abstract

While affirming the overall congruence of her clinical approach and Ornstein', the author delineates the distinction between defenses initially described by Kohut and Ornstein and a defense later identified by Brandchaft. Although the former protects a vulnerable self developed in malattuned environments, the latter, structures of pathological accommodation, bears the imprint of the malattuned environment; the defensive behavior carries the mark of the narcissistic injury in some amalgamation with the child's response to it. The author links the tenacity of these defenses to attachment ties, for efforts to eliminate them may threaten patients with annihilation anxiety. Ornstein and Brandchaft agree that both forms of defense may co-exist. The author briefly underlines a similarity between a case described by her and one described by Ornstein, and draws attention to the need to continue the investigation of defensive structures to improve clinical efficacy with such challenging patients. Al afirmar la cong...