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Referências Feldman, B. (2004). A skin for the imaginal. Journal Of Analytical Psychology, 49(3), 285-311. <!--Outras informações:

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A skin for the imaginal Brian Feldman, PHD, author, is a member and on the training faculties of the San Francisco Jung Institute and the Inter-Regional Society of Jungian Analysts where he teaches child and adult analysis and infant observation seminars. He is also a faculty member of the Northwest Center for Psychoanalysis in Portland and Seattle, and the Jung Center of Mexico City. He trained in clinical psychology at Johns Hopkins and the University of California at Berkeley, and served as chief psychologist in Stanford's Child Psychiatry Department. His recent publications and research interests are in the areas of infant observation, attachment theory, and Latin American anthropology.; PO Box 61104, Palo Alto, California 94306-6104, USA Email:

befeld@postoffice.pacbell.net This paper focuses on the development of internal space, the evolution of psychological boundaries and the capacity for symbolization as they first arise during infancy. The concept of the psychic skin as an early form of psychological boundary is presented. The development of the psychic skin, or psychological container, is necessary for imaginal processes to function for the purpose of psychological growth and development. Infant observation material utilizing the Tavistock model and analytical material from an adolescent analysis is presented to help elucidate the theoretical concepts.

is presented to help elucidate the theoretical concepts. Within the field of analytical psychology the capacity
is presented to help elucidate the theoretical concepts. Within the field of analytical psychology the capacity

Within the field of analytical psychology the capacity for symbolization is a fundamental component of the analytic process (Jung 1956). The evolution of internal space and of psychological boundaries are both developmental tasks that facilitate the capacity for symbolization and significant components of psychological life that emerge in infancy and have a significant impact

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upon later development. These elements form the foundations for our experience of self and identity, as well as impacting on our capacity for attachment and individuation. My theoretical and clinical speculations concerning the development of these elements of the psyche stem from my interest in infant observation research that I have conducted in California during the past twelve years, and in my analytic work with children, adolescents and adults. I have been interested in understanding how the capacity for symbolization evolves from infancy onward as well as in understanding difficulties in symbolization processes as they appear in the context of analysis. I believe that the precursor of the capacity for symbolization, and by this I mean the capacity to utilize thought, image and emotion in an integrative manner for the purpose of psychological growth and development, has as its foundation the sensorial development of the infant during the first year of life. In this regard the development of sensorial differentiations through the use of touch, smell, taste, sight and sound and the infant's experience of the skin as a defining boundary between what is experienced as internal as opposed to what is experienced as external to the self, are fundamental to psychological development.

I would like to focus in particular upon the psychological experience of the skin in infancy and its

relationship to the development of a concept of an internal space where symbolization processes take place. I think of this internal space as being able to contain imaginal functions such as occur in states of dreaming, reverie and imaginative activities (such as active imagination). My interest in the psychological function of the skin began when several years ago I was doing research into Jung's infancy and childhood, and the impact that this had upon the evolution of his psychology (Feldman 1992). In Memories, Dreams, Reflections(Jung 1961), Jung's autobiography, written when he was eighty-three years old, he talks about his infancy and childhood with a great deal of candour and insight. When Jung was three years old his mother was hospitalized for what appears to have been a severe depression. She was hospitalized in a Swiss psychiatric hospital for several months, and Jung says that her hospitalization was related to difficulties that were surfacing in the parental relationship. During his mother's absence he was taken care of by a maid. He also developed a severe skin disorder, eczema that he connected with the separation of his parents and his mother's hospitalization.

I thought it probable that Jung's severe eczema was linked to the sense of psychic catastrophe

that he experienced upon his separation from his mother. It was as if he was unable to contain tortuous and painful emotions within himself and they burst out in a somatic form as a severe skin disorder. Jung states (1961, p. 8):

I was suffering, so my mother told me afterward, from general eczema. Dim intimations of trouble in my parents' marriage hovered around me. My illness, in 1878, must have been connected with a temporary separation of my parents. My mother spent several months in a hospital in Basel, and presumably her illness had something to do with the difficulty in the marriage.

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These skin difficulties were a precursor of other emotional difficulties that I would relate to problems in maternal containment. The child Jung suffered from what appears to have been a childhood depression (Feldman 1992), resulting in self-destructive fantasies and behaviours. He reports having a serious accident while crossing a bridge over the Rhine Falls at the time of his mother's hospitalization. He notes in his autobiography that ʻ the maid caught me just in time—I already had one leg under the railing and was about to slip through. These things point to an unconscious suicidal urge or, it may be, to a fatal resistance to life in this world ʼ (Jung 1961, p. 9). His accident proneness could be related to a feeling of being uncontained in the mother/child relationship and to a sense of rage that was directed against the self and not at the emotionally unavailable and abandoning mother. Jung (1961, p. 8) states that

I was deeply troubled by my mother's being away. From then on, I always felt mistrustful when the word ʻ love ʼ was spoken. The feeling I associated with ʻ woman ʼ was for a long time that of innate unreliability.

I think that this attitude of Jung's indicates insecurity in his attachment to his mother, resulting in anxieties around the experience of intimacy and the acceptance of dependency needs. Fordham (1987) notes that Jung was a suspicious and phobic child with persecutory trends and occasional hallucinations. Fordham also relates these anxieties to difficulties in the relationship between Jung's parents, as well as to his mother's hospitalization for depression. It is my belief that Jung was able to begin to construct a solution to these difficulties through his active dream and imaginal life. His earliest remembered dream of the underground phallus, which he places between the ages of 3 and 4, is both a symbolic rendering of the birth of his creative genius, as well as an attempt to construct a symbolic narrative about his early relationship with his mother, his fascination with his own phallic excitement, and his experience of the maternal unconscious. The dream offered him an imaginal container for his most important internal and interpersonal experiences. At the age of 12 Jung recalls constructing the fantasy of God defecating on Basel cathedral. In this fantasy Jung gives symbolic expression to the destruction of the father's world. Jung experienced his father, a minister filled with self-doubt about his spiritual calling, as unable to provide him with an adequate model for spiritual identification. He felt that his father did not have experiential knowledge of the living presence of God, and therefore he felt that his father's religious faith was based on empty beliefs. Jung needed to experience and know, and not merely to believe. The imaginal experience of God defecating on the cathedral was Jung's way of giving shape to his profound doubts and disappointments about his father's world. This imaginal experience formed a kind of skin within which Jung's identity development could proceed. It gave him a framework in which he could begin to understand himself, and it gave him a belief and faith in the healing aspects of imaginal/archetypal experience that was to aid him after the painful rupture with Freud. Jung's descent into the archetypal realm, his nekyia, a journey into the realm of the unconscious, offered Jung an experience of the containment possible through a profound knowledge of the imaginal realm leading to an experience of the self. The images of the circular mandalas Jung painted during this period can be viewed as containers providing him with a psychic skin that

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helped to transform the deep anxieties triggered by the rupture with Freud into creative and meaningful experience that provided the prima materia for his later theoretical constructions.

As I began to untangle some of the autobiographical origins of Jungian thought I began to realize that his depth psychology was in part a structure to help Jung understand and transform infantile anxieties into meaningful imaginal/symbolic experience. This process of transformation involves a regression to infantile states of mind in order to integrate previously unknown and unknowable aspects of self. Jung expanded on this theme, especially in his classic work Symbols of Transformation(Jung 1956). In this work he has a good deal to say about the early infant/mother relationship from a mythological viewpoint. While I think Jung made an important and unique contribution in elucidating the nature and significance of symbolic thought as a kind of primitive and universal language, he placed less significance upon its infantile origins and hence failed to take into account the importance of analysing the developmental origins of the capacity for symbolization. Because of this lacuna in Jungian thought I was drawn to explore the origins of the capacities for symbolic thought and emotional containment within a Jungian framework. This led me to a deeper exploration of the developmental Jungian (Fordham 1985; Astor 1995; Sidoli 2000; Kalsched 1996) and object relations (Winnicott 1960; Bowlby 1969; Bion 1962; McDougall 1989; Tustin 1990; Steiner 1993) literatures. In addition to this I began to explore the possibilities and potentialities of infant observation, and the analysis of autistic and psychotic children in helping to understand infantile states of mind. In pursuing this work I found that the concept of the psychic skin was fundamental in attempting to understand these infantile states.

Freud was the first to allude to the importance of the psychological experience of the skin in his seminal theoretical work The Ego and the Id(Freud 1923). He states that ʻ the ego is first and foremost a bodily ego; it is not merely a surface entity, but is itself the projection of the surface ʼ (Freud 1923, p. 26). In the English translation of this work that appeared in 1927 he added a footnote to this statement, and noted that ʻ the ego is ultimately derived from bodily sensations, chiefly from those springing from the surface of the body. The ego is thus a mental projection of the surface of the body ʼ (Freud 1927, p. 26). Freud's intuitive insights into the bodily origins of the ego have served as a guidepost for the analytical investigations that have taken place since the time his statements were made. His metaphor focusing on the surface of the skin is an important one to reflect upon. Freud's hypothesis that the ego is a mental projection of the surface of the body implies that the ego, which provides our orientation to reality and the external world, is formed by the psychological experience of the surface of the body, the skin. In this regard the experience of the skin is the earliest foundation for the development of the ego, and hence the primary mediator of psychological experience. The skin provides the first mental scheme of the ʻ Iʼ (the self) and the first psychological experience of boundaries. The psychological skin becomes the first delineator of internal and external experience, the mediator of the first object relationships and of the first experience of the self. I think that Freud's observations have been confirmed by the work of investigators both within the field of developmental psychology and the field of psychoanalysis. For instance, Piaget's work on the origins of intelligence, play, and symbolization

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shows with ample detailed observations of infants and their development that the infant begins to organize his experience through his bodily interactions with his environment (Piaget 1962). The first schemes or internal maps in the mind are, according to Piaget, sensori-motor schemes, and the first sensori-motor schemes form the foundations for all later cognitive and emotional development. For Piaget all intellectual and emotional development begins with the sensorial aspects of the infant's experience. What this means is that the way in which the baby moves its body, the way the mouth and lips move to encounter the breast or bottle, the way the arms reach out to engage the realm of inanimate and animate objects such as mother, have a lasting impact upon the developmental trajectory of the baby. The skin is the envelope in which the body is contained, and it is the skin which provides the points of contact with the external world, and which acts as a delineator of boundaries between what is experienced to be outside and what is experienced to be inside the self. In my own observations of babies I have been struck by the infant's need to give shape to his bodily self by pushing his body up against hard and soft surfaces, and by the mouthing of and grasping hold of animate and inanimate objects. The experience of the infant being securely held in the arms of the mother or other significant caregivers, and the exploration of the body of the other, especially the touching of the skin of the breast or mother's face during breast feeding, are significant experiences that facilitate attachment and connection with mother. In addition, the ways in which the baby is handled and held, which can be viewed during bathing and diapering episodes, are all important and fundamental experiences that give rise to a stable and secure sense of self as well as a stable and secure sense of attachment to a significant other.

The first in-depth study of the psychological function of the skin was made by the Kleinian analyst Esther Bick (Bick 1968). While Bick wrote a small number of scientific articles about her work, those few that she did write are of noteworthy significance. She introduced infant observation as part of the training for child psychotherapists at the Tavistock Institute in 1948. Bick envisioned infant observation as providing a first hand experience into the development and evolution of psychic life in the infant during the first two years of the baby's life. This technique is now widely utilized as a foundation for the analytical training of Jungian, Kleinian and Freudian child analysts. Infant observation as conceptualized by Bick would help analytical candidates to conceive vividly the infantile pre-verbal experiences of their child analysands. In her article entitled ʻ The experience of the skin in early object relations ʼ (Bick 1968) Bick postulates that the psychological function of the skin is akin to a holding function, and that the skin is experienced by the infant as holding together the parts of the personality which are not yet differentiated from parts of the body. Her thesis is that in its most primitive form the parts of the personality are felt to have no binding or cohering force themselves and that the skin is experienced both as a container of psychological experience as well as a sheath that holds together the primitive psyche and soma. Initially the infant through his experience of an adequate holding relationship introjects the containing or mothering function. Until the containing maternal functions have been introjected, according to Bick, the concept of a space within the self where thought and symbolization take place cannot exist. For her the need for a containing object leads the infant to search for an object to hold the

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personality together. Optimally this is the breast, which together with the secure and firm holding of mother, gives the infant an experience of being a coherent whole. My own observations of babies indicates that there is a desire for a containing experience that involves the nipple securely held in the mouth, the sucking motions that lead to a good feed, the tactile feel of mother's skin, and the experience of being securely and firmly held in mother's arms. When this deeper connection is made between infant and caregiver it can lead to a shared experience of satisfaction, mystery and pleasure that helps to reinforce the baby's experience of security and primary (sensory and psychological) containment. I think that this type of satisfying experience for both mother and baby leads the baby to develop a primary skin function. With the development of a primary skin function the baby feels secure within their own skin and is able to tolerate periods of separateness from mother without undue anxiety.

Bick felt that the primary containing object is experienced concretely by the baby as the skin. Faulty developments in the skin or containing function can occur either as a result of deficits in the infant/mother relationship as well as from the infant's fantasized aggressive attacks upon mother that can impair a good introjection. When a faulty skin function develops, a defensive process can emerge which Bick terms a ʻ second skin ʼ function. When a second or faulty skin function develops, the infant can evolve a precocious independence from the mothering figure. A second skin defensive pattern can lead to the excessive use of thinking or muscularity to help create a feeling of containment. The infant's precocious development of speech, when the infant provide themselves with the sound of their own voice for self soothing, or a muscular development that leads to the body being held rigidly together during periods of stress are examples of this type of second skin defensive pattern.

Infant observation material—the evolution of the second skin I observed this type of second skin phenomena in Kate at five months. The following is a sequence that depicts the use of muscularity as an attempt to contain unbearable, painful emotions, and it points to the possibility of defensive elements emerging within the infant as psychic development is impeded.

When I arrive for the observation Kate is in her baby seat in the family room, mother is about to leave for work, bustling around the room, and the au pair is sitting in the kitchen. Mother goes in and out of the room several times. I notice that Kate's mouth is slightly open, and that her lower lip is out a bit and covered over by her upper lip. I am wondering if she is pouting and if she might be protesting. After a few moments mother emerges down the stairs dressed for work. She says hello to me, but does not go over to Kate who is looking at her. After a few minutes mother, who appears quite rushed, leaves still not interacting or saying goodbye to Kate. As mother leaves the room I am careful to look at Kate to see what her response is to the separation. I see that she is staring intently at the door with her eyes, somewhat immobile. Her body is taut and frozen. She is holding her body rigidly together. I start to experience a slight chill running down my spine. I wonder if this is in response to the ʻ chillyʼ separation. After a few moments Kate starts to rock her

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body back and forth in the chair and begins to make back and forth head movements. The caregiver goes over to her after a few minutes and takes her out of her chair. Kate becomes more and more fussy, starts to cry in a piercing and frantic manner, and then the caregiver places her on the floor. Kate's fussiness and crying continue while she is on the floor. The au pair then looks at me in a somewhat frightened and confused manner as if asking me what she should do. I remain in my observational role and do not respond overtly, although I begin to experience some anxiety within myself. I sense that she (the au pair) is needing to utilize me to contain her difficult and confusing emotional experience. She then rushes to the kitchen and brings back a bottle that she then gives to Kate. As she holds Kate, I see that Kate is holding on tightly to the plastic nipple with her mouth and gulping down the formula. She continues to do this in a frantic way until the formula is finished.

I think that Kate's response to mother's separation, which included a lack of transitioning, led her to utilize bodily defences of a second skin nature. Her body became rigid and frozen as a way of coping with the unbearably painful feeling surrounding the abrupt separation by mother. When the au pair came over to her she was inconsolable, and then Kate focused on the rubber nipple and ate voraciously as a way of coping with what at the time were unbearable anxieties and emotions. I think that she felt uncontained by mother and dropped from mother's mental and emotional preoccupation. Being separated from mother in this way for Kate meant being torn away from her, and her containing presence. She tried to gain control over these dreadful feelings by having her musculature become frozen and stiff. In this way she could attempt to control and stop feeling flooded by unbearable primitive affects. When she latched onto the rubber nipple and voraciously gulped down the formula she appeared to be in frantic search of an object that she could hold onto and control. By voraciously drinking the formula she could fill her stomach with a warm substance that could give her the illusion of a nourishing mother, and at the same time fill up the dark internal spaces with something good and warm that could momentarily take away the cold, empty and rageful feelings. The frantic aspect of this sequence reminded me of my work with women with eating disorders who, often in a dissociated state, binge in order to control emotional states which are filled with anxiety and dread. Often these woman talk about their binges as being triggered by feelings of disconnection, and a nameless dread that is difficult to give shape to. In the history of these women, often their mothers were viewed as rejecting of their deeper emotions, and this lack of containment led to a feeling of nameless dread.

Michael Fordham, Donald Kalsched and Gustav Bovensiepen Michael Fordham (1976) and Donald Kalsched (1996) have developed conceptual frameworks within the field of analytical psychology that address the phenomenon of the second skin that are described in the infant observation material. Fordham in contrast to Bick postulates that a primary or original self emerges at birth. For him the primary self contains all of the archetypal potential of the human being. He believes that the infant at birth has a capacity for individuality and integration, while Bick believes that the infant does not have this capacity and is hence unintegrated at birth. My own observation of newborn babies indicates that the baby does have the potential for

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integrative experiences at birth, and that these experiences are mediated through the interactive bodily/emotional dialogue with mother. The baby's innate, archetypal potential for the experience of self is facilitated through the use of touch, smell, taste, sound and sight when experienced within the interpersonal matrix of the infant and his caregivers. The baby's initial experience of self is mediated through his experience of an interpersonal environment that is sensitive and resonant to his needs. It is within this relational context that body image and identity development begin to unfold. According to Fordham the infant's self evolves through a process of deintegration. The infant's active engagement with his caregivers leads to processes of deintegration/reintegration

where experience (both personal and archetypal) is internalized and an inner world becomes structured through the introjection of relationships with significant attachment figures in the infant's life. The primary self of the infant has its own defensive system that is activated when there is environmental failure as we saw in the infant observation material. Fordham postulates that these defence systems arise spontaneously out of the primal self and are designed to preserve a sense of individual identity and intactness. These defences of the self create an impermeable barrier, like

a second skin, between the infant's self and the environment, and the processes of

deintegration/reintegration are prevented from evolving. In extreme cases Fordham believes that the infant can evolve rigid autistic-like symptoms of a second skin nature that thwart psychological development.

Kalsched (1996) agrees with Fordham's basic deintegration/reintegration model, and expands its utility to encompass and further understand the impact of trauma upon the evolving psyche of the child. According to him the child who experiences acute or cumulative emotional trauma early in their development tends to develop self-care systems that distance them from significant attachment figures, and facilitate the development of self-sufficiency and premature independence. These traumatized children utilize their self-care system to avoid dependency needs, appear avoidant in their attachment relationships, and tend to develop an outer facade of toughness that

makes them difficult to reach in analysis. Difficulties with symbolization occur as the links between body and mind are severed, and the capacity to imagine and give shape to emotional experience

is thwarted (Kalsched, 1996, p. 66). When bodily experience cannot be mentalized somatic

symptoms such as eating disorders can develop. These addictive disorders form a kind of second skin that protects the individual from the painful emotions that have their origins in the child's

experience of helplessness, betrayal, abuse and neglect which emerged at the time of the original trauma.

Bovensiepen (2002) in an interesting and important article entitled ʻ Symbolic attitude and reverie ʼ looks at the difficulties inherent in analytic work with children who have not been able to create a functioning psychic space where symbolization processes can unfold and evolve during the course of their development. He points out, and I think with a good deal of pertinent clinical evidence, that Jung's concept of the analyst's symbolic attitude can be likened to Bion's conception of maternal reverie. According to Bion (1962) maternal reverie fosters the transformation of mental content from purely sensory experience to more mentalized symbolic which in turn creates the possibility

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for the generation for meaning. Utilizing the mother/infant metaphor, Bion postulates that the mother in a state of reverie (similar to Freud's free floating attention) is able to receive, via projective identification, the infant's unthinkable and often sensory experience and transform it through her striving for understanding, into a bearable and for the baby manageable emotional/bodily experience. I have seen this type of interchange in infant observations where a sensitive caregiver is able to communicate to the baby both verbally and sensorially (through touch and holding) that the baby is distressed and that the caregiver is receptive to reflecting on the baby's distress, without trying to immediately change the baby's emotional or mental state. Given a healthy baby, this usually leads to the baby's becoming calmer and more secure (from an attachment standpoint) with the caregiver. Bovensiepen emphasizes the infantile origins of the capacity for symbolization, and by this he means the mostly non-verbal exchanges between mother and infant. From my own observation of babies I would include the verbal realm as equally important to the non-verbal, as the baby tends to be responsive to voice tone, and verbal rhythms. I have observed that the infant's development of the capacity for reciprocity and agency emerges largely out of verbal interchange. Some recent research by Norman (2001) supports this notion and points to the infant's capacity to respond to verbal interchange as a way of activating and retrieving those parts of the infant's inner world that have been excluded from containment. Bovensiepen, in a departure from Jung, states that symbolization processes require a matrix of relationship to develop and evolve, and that they do not develop spontaneously. In other words, symbolization can only develop within a relational and intersubjective matrix involving both infant and caregiver. This matrix is grounded in the child's earliest experience of interchange and reciprocity. This early relationship, especially when it has been problematic and traumatic, can be re-enacted and worked on within the analytical treatment situation. Bovensiepen's approach is a helpful development of Fordham's work, and integrates into analytical psychology Bion's thinking on the container/contained relationship, and the importance of maternal reverie for the emotional growth of the infant. His focus on children who do not possess the ability to contain and symbolize offers much that is important for child analysts, especially the importance of the analyst's symbolic function in helping the child understand and overcome their psychic pain through the development of a secure psychic space. I would like to expand on some of Bovensiepen's work by focusing on the evolution and development of a secure psychic space, which I call a primary skin function. With the development of a primary skin function the infant is gradually able to develop a capacity to differentiate inner experience from outer reality, and can begin to experience in a secure manner the interplay of inner and outer realities. I will elaborate on this concept utilizing infant observation material from the first year of life.

Bowlby, Ainsworth, attachment theory and the function of the skin John Bowlby (1969) and Mary Ainsworth (1967) were the originators of attachment theory, which has become the most influential theory of human development in our contemporary era. Bowlby defines attachment as an affectional bond between individuals that has a survival value. According to Bowlby, the human infant in the early stages of human evolution maintains proximity to their caregiver to help protect themselves from the danger of attack by predators. According to Bowlby

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this propensity to form affectional bonds, and to maintain closeness to those who can offer protection and comfort is wired into the human psyche and from a Jungian viewpoint can be termed archetypal in nature. I was fortunate in being able to have Mary Ainsworth as a teacher of developmental psychology at Johns Hopkins University. Ainsworth had a lively interest in Jungian psychology which she became acquainted with through her collaborative work with Bruno Klopfer, an early Jungian analyst who lived in the United States and with whom she developed the Rorschach Inkblot diagnostic technique. Ainsworth was very open to the Jungian approach in psychology as she felt it was evolutionary in nature. I thought that she was resonating to its phylogenetic, evolutionary underpinnings, as she appreciated the similarity between Bowlby's ethological/evolutionary approach and Jung's archetypal theory. She was also drawn to Jung's theory of archetypes as a kind of universal language, as the archetype can speak of man's universal longings and desires. Ainsworth, and especially her attitude towards infants and children, had a strong impact upon my development. She arranged for my first clinical internship treating autistic children at the Kennedy Center of Johns Hopkins Hospital. That was a formative experience and sparked an interest in working with autistic and psychotic children that led to my being interested in the work of Michael Fordham with whom I subsequently trained in child analysis. Ainsworth stressed the importance of seeing the healthy infant as having a sense of agency and curiosity: the infant who is able to participate in constructing his universe in relationship with the significant others in his life.

From an evolutionary perspective Ainsworth felt that the Harlows' (1969) studies of attachment processes in rhesus monkeys were of significance as they provided support for the hypothesis that the type of physical contact between mother and infant is of prime importance for the later emotional, intellectual and social development of the child. The Harlows found that sensorial skin stimulation and the comfort it supplies is of primary importance in an infant monkey's development. The strong bonds that the monkeys evolved with a Terry cloth surrogate mother as opposed to a wire surrogate mother supports the hypothesis that attachment is in part based on the soothing tactile sensations that provide the baby with a sense of comfort and security. Later studies indicated that the experience of contact with the animate alive mother was most important for the development of adaptive social interaction, and secure attachment behaviour. Ainsworth's (1967) studies in Uganda are of interest as she found that mothers who enjoyed breast feeding, and who sustained frequent physical contact with their babies had babies who were more securely attached. These African mothers were able to soothe their babies effectively through physical contact when they were distressed, and were able to time their responses to be attuned to their babies' rhythms. In Ainsworth's studies, both in Baltimore and Uganda, she found that physical contact between infant and caregiver was critical for the infant's healthy emotional development. In my own studies in infant observation I have found that secure attachment in infancy leads to the evolution of a secure internal space where symbolization processes can unfold. I think of this secure internal space as being surrounded by a psychic skin that serves a containing and holding function. The primary skin functions to protect and contain inner feelings of goodness which are generated through the sensitive feeding, care, and holding of the mother. It is through the

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incremental accumulation of these positive experiences that a coherent body image is able to form, identity development evolves, and a sense of having a separate self emerges.

Donald Meltzer, Frances Tustin and Didier Anzieu Donald Meltzer in a paper entitled ʻ Adhesive identification ʼ (Meltzer 1975) further developed some of Bick's concepts, especially the aspect relating to the second skin phenomenon. Meltzer's work with autistic children and adults who appeared to have profound identity disturbances led him to conceptualize a type of defensive manoeuvre he termed adhesive identification. He observed that autistic children often functioned as if there were no spaces, only two-dimensional surfaces. In analytic treatment they often leaned against objects, but would not go into them. They had not developed a sense of inner and outer, and a boundary defining the separateness of inner and outer spaces. In this respect they lacked a primary skin function that could help in this process of differentiation. What he observed was that these autistic children utilized imitation and mimicry as

a way of relating to others. They lacked the capacity for either introjection or projection, causing

their interpersonal relationships to be shallow and lacking in reciprocity. One five-year old autistic

child I saw in analysis focused on the sounds and the shapes of the air vents in my consulting room during the first months of his analysis. Before he was able to allow some of these defences to be modified he went through a period where he was exclusively focused on the hard objects, such as pens and toy cars, which were contained in his play-box. He relied on the consistency of these objects with their textures, shapes, and smells to provide him with a sense of stability within the analytic sessions. For many months I was treated as an inanimate object. He would physically bump up against me, but rarely engage in eye contact or verbal interchange. Later in the analysis he would both mimic and mock what he perceived to be my emotional states, especially around separation. It felt as if he were unable to have an emotional experience of his own, and that he frantically was searching for some way to cope with his emotional deficits.

Frances Tustin (1990) in her work with autistic children has noted that when these children sense that they have a skin they feel more secure and experience themselves as feeling contained within something that helps them to feel safe. They begin to be able to delineate internal from external spaces, and processes of projection and introjection can unfold. Tustin has observed that autistic

children who have not developed an experience of containment within their skin feel that their skin

is not firmly attached to their bodies and that it can peel away. Bathing, showering and other forms

of bodily care are experienced as traumatic, leading to feelings of dread and fear. According to

Tustin, the lack of psychological connection between the child and his attachment figures leads to

a traumatic sense of being disconnected from one's roots. It leads to an undue insistence on a

constant physical presence and to the over-valuation of sensation-giving material objects. Tustin is referring here to the early difficulties with bonding and attachment that can lead to the development of encapsulating defences, and a turning away from the interpersonal realm. From experience in infant observation, I have noted that when the infant has difficulty in reaching out toward the mother or caregiver, and where there has been some element of dysfunction in the infant-mother relationship, the infant will turn to the inanimate world as a way of trying to hold onto

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something that is stable and secure. It is a form of second skin that I have observed during diaper changes when the infant will focus almost exclusively on objects around him, instead of on the mother and her gaze, as if the mother's gaze does not offer security or comfort.

Didier Anzieu, the late French psychoanalyst, in his book The Skin Ego(Anzieu 1989) presents the helpful metaphor of the skin ego as a kind of psychic envelope. According to him the primary function of the psychic skin is as a container or sac which retains the goodness and fullness which accumulates through feeding, care and the bathing in words which the mother performs for the benefit of the infant. The skin envelope as a mental representation emerges from the interplay between the mother's body and the child's body. When the containing function is adequately introjected the baby is able to acquire the concept of a space within the self and he can begin to conceptualize that both he and his mother are each contained within their respective skins. When the containing function fails to develop adequately the child will need to develop secondary skin function defences to guard against feelings of having a fragile skin, or a leaking colander skin from which psychic contents can dangerously leak out and cause distortions in reality testing and interpersonal relationships.

Anzieu develops the theme of the skin envelope as an important metaphor for understanding different aspects of psychopathology. For instance, the narcissistic individual has a fragile skin envelope that can become easily bruised and wounded. The borderline individual can exhibit leaks in a skin envelope viewed as a colander with holes, where inner contents can easily leak out. The analyst will be helped in his technique by understanding the type of skin envelope within which an analysand exists. Interpretations need to take into account the nature of this skin envelope. If the analysand has a fragile, sensitive skin envelope, penetrating interpretations can be viewed as attacks against the self. The first need in analysis therefore would be to help the analysand to develop a more secure and resilient primary skin function. This development occurs through the analysand's experience of the secure holding in the analytic environment. The experience of secure holding and the development of a primary skin function would have to occur before interpretations of the unconscious infantile and psychic depths. For analysands with skin containment difficulty interpretations can be experienced as an assault on the psychic skin's protective envelope, or as a puncture in the psychic skin that causes painful emotional leaking. Imaginal processes and individuation can evolve when this primary skin function is more adequately developed within the context of the transference/countertransference relationship.

The development of a primary skin function in an infant observation I observed the evolution of a primary skin function in Carla at 5 months, one week. Carla is a Mayan/Hispanic baby whose parents had emigrated to California from Central America. When I arrive for the observation mother asks me to go into the bedroom where Carla is lying in a bassinet on the parental bed. Mother is giving her a bath. Carla appears calm, yet alert. Mother is speaking to Carla in Spanish with an intonation that echoes the rhythms of Carla's vocalizations. Mother gently covers Carla's body with warm water, and then rubs her skin and bathes her with soap.

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Carla has a small rubber ball in her hand that she holds with a certain determination and focus. All the while she maintains a gaze upon mother's face and eyes, and does not either look around the room or at me. As mother shampoos her head with vigorous strokes Carla remains relaxed and calm, allowing her head to bob up and down a bit, responding to the strokes of mother's hands and without uttering any sounds of protest. Mother then tells me that Carla remains calm when she has something in her hand, and then she does not cry. As mother is talking to me she gently bathes Carla's genitals in an unselfconscious manner. Mother goes through the ritual of rinsing Carla a number of times, each time passing her hands over Carla's head, chest, arms and legs. Carla appears to be calm as mother strokes her body, and she then closes her eyes and appears to drift into a reverie state. When mother stops touching her, Carla opens her eyes and looks towards mother, as if to orient herself after being in reverie. Mother continues the rinsing a number of times and lifts Carla onto her legs, turning her around so that her back faces me. She then turns her around again and says to Carla in Spanish, ʻ How delicious is the water. Thank you God for the water. What would happen to us if we did not have water? ʼ I sense Carla's pleasure in the moment and her close emotional connection with mother. Carla has a radiant smile upon her face, and she then looks away from mother with a strong and firm gaze. She conveys a sense of presence and embodiment in her fleshy baby's body. I feel touched and privileged in being able to be a witness to the intimacy between infant and mother. Carla's radiant smile evokes a smile in mother who then continues with the bath, as she and Carla are immersed in the pleasure of their interchange.

I think that Virginia Woolf's (1976) concept of moments of being is a helpful one in understanding the aesthetic dimension of this experience. Woolf talks about the ways in which ordinary experience can become filled with importance, and how these moments of being coalesce within us into a pattern or mosaic that forms the ʻ invisible and silent scaffolding ʼ of our lives ( Woolf 1976, p. 73). Carla's experience of being bathed in the warmth of the water and in the warmth of mother's words is such a moment of being that will help in the formation of a primary skin function that enables Carla to feel safe and secure within her feminine body image. The aesthetic dimension of the experience appears here to reinforce the evolution of Carla's sense of identity and agency. There is a shared sensuous pleasure between mother and baby that appeared to me to both reinforce the security of their bond and help in the transmission of a feminine body image. Mother touched Carla's skin in a sensitive and at times vigorous manner, all the while bathing her in words and sounds. While I was observing this scene I had the feeling that mother was conveying to Carla something about the beauty OF her body, especially her skin and genitals which were often the focus of her touch. I felt privileged to be a witness to this significant and evocative interchange between mother and daughter.

At the level of feminine sexual and body image development this observation helps us to understand the importance of the integration of vaginal sensations into the infant girl's body image, and how this takes place in the relational space between mother and baby, what Winnicott (1971) and Ogden (1986) term a potential space. It is also interesting to note the ongoing touching of the skin during bathing, and the use of touch to help define body boundaries. All of this took place in a

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small container of water, which we can see at a symbolic level as a vessel of transformation. Basin (1982) in an article on the creation of positive schemes of feminine development emphasizes how woman's experience of her body in infancy is the basis for her construction of her sense of inner and outer reality in later years. According to Basin inner space and core feminine imagery may be related to the experience of early vaginal sensations. These experiences coalesce to form a scheme of an inner space that evolves and develops into a sense of an inner space as a holding and containing vessel that can receive both self and other. The boundaries of this inner space are defined by the sensations of the surface of the skin. I think that this core feminine sense of self evolves, as does the primary skin function, within the relational and potential space of mother and baby. The interchange between Carla and her mother illuminates this important area of feminine development. For Carla, the evolution of a primary skin function within the area of potential space leads ultimately to development of her capacity for play, creativity and empathy. I was able to observe this development over a period of two years of weekly observation. From a post-Jungian viewpoint we can look at this feminine containing inner space as an imaginative construct that involves the interchange between archetypal as well and bodily experience. In observation of infant boys I have found that the little boy's focus on his genital phallic sensations as something external to the self could account for the difficulty that boys often have with acknowledging the existence of an inner space where symbolization processes take place. It takes the little boy a longer time to develop this sense of interiority.

Clinical material from an adolescent analysis I would like to demonstrate the usefulness of these theoretical concepts through the exploration of some clinical material from the analysis of an adolescent who presented with a severe eating disorder (bulimia). I was fortunate in being able to discuss this case in depth with Michael Fordham before his death and appreciated his insight into the analysis of early symbolization difficulties. During my years of training at the San Francisco Jung Institute I established a mentor relationship with Fordham, and he later became one of my control analysts. I had been at the time very interested in training as a child analyst, and as there was no training in this area at the San Francisco Institute I asked Fordham if I could pursue some of this training with him. He consented to this and I spent time with him every year, mostly in London, but also in San Francisco where he enjoyed lecturing, going over my clinical cases and pursuing a deeper theoretical understanding of his work. I am very grateful to him for his generosity and warmth. Fordham introduced me to the Tavistock infant observation, and I enjoyed being able to attend infant observation seminars with him at the Society of Analytical Psychology. I subsequently pursued Tavistock infant observation training with Pamela Sorenson of the Tavistock Clinic. Fordham had a very intuitive and imaginative approach to understanding infantile development, and he often linked his understanding of babies to clinical work with adults and children. While Fordham did not either write about or work extensively with adolescents in analysis he was interested in understanding both the developmental components as well as the transference and countertransference difficulties in work with adolescent analysands who have difficulty with symbolization processes. Fordham helped me to see the infantile origins of symbolization difficulties, and he stressed to me

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how they could only be resolved within the matrix of the transference/countertransference relationship. In this regard I felt that he was able to work at two different levels simultaneously when thinking about the clinical material. From the developmental level Fordham stressed to me that difficulties with maternal reverie and containment were at the root of my analysand's difficulties. He felt that the clinical material indicated how severe was this problem, and that it could only be treated within a more structured and intensive analytic framework that involved at least three sessions per week. He encouraged me to see my analysand more frequently and we both felt more hopeful when five times per week sessions were started. I felt that Fordham was trying to convey to me that deeper healing could take place only through the experience of infantile, non- verbal, and sensorial states in the transference/countertransference. He also indicated to me the need to maintain an analytic/symbolic attitude with my analysand where I could begin to experience her mental states within myself through projective identification, and then reflect upon these emotional/sensorial states to gain a deeper understanding of the analytic material. Fordham's analytic approach appeared to me to provide a needed framework within analytical psychology, where infantile conflict, early object relations, and the focus upon the transference/countertransference could be integrated with more traditional Jungian ways of working with symbolic material, such as active imagination.

I began to see Jane in analysis for the treatment of bulimia nervosa when she was nineteen years old and in her second year of university. Jane was in analysis for four and one-half years and attended five times a week, until the ending phases when she reduced her visits to four and then three times weekly.

Attractive, athletic, and slender, Jane came to my consulting room dressed in neat, ʻ preppy ʼ clothes. She appeared nervous and began to talk about her difficulties in a detached and muted manner. She spoke as if she was talking about someone else, and it was difficult to form any emotional connection with her. During my first sessions with Jane she described feeling empty and hopeless about her bulimia. At university Jane had tried to maintain the outward appearance of normalcy socially, but this pose was difficult to maintain since it made her feel unreal and false. She was a member of a sorority but did not like it. Because she felt alienated and separate from the others as a result of her bulimia, Jane found it difficult to go to the social meetings and to participate. None of her friends knew about her bulimia, which she wanted to keep a secret because she feared rejection.

Jane felt tentative about entering analysis. While she was pessimistic about embarking upon analytic treatment, she also felt she had little alternative as her bulimia was controlling her life. She felt enslaved and imprisoned by an addiction she could not control and which she did not understand. My initial evaluation of Jane led me to think that her capacity for symbolization was severely damaged. She reported early on that her parents were divorced and that she had a difficult relationship with both of her parents. She did not feel close to either parent, nor did she feel she could turn to them for emotional support. She subsequently felt lonely and isolated. She

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appeared to feel insecure in her primary attachment relationships and felt that she had no place to turn for support in her time of great need.

The initial phase of analysis Jane knew little about her birth history. She had been told by her mother that she was a planned baby and born at full term. There were, as far as she knew, no problems at the birth and she was a healthy baby. When Jane's parents divorced they had been married for ten years, Jane was seven and she had two younger siblings. After the divorce she lived with her mother and spent weekends with her father. She did not like the visitation arrangements and often felt that she was being controlled and manipulated by her father. Her mother worked full-time, and Jane remembered being left with two younger siblings and baby-sitters on numerous occasions when her mother was away on business. Jane felt inadequately cared for by both parents and unable to establish a stable emotional bond or secure attachment with either of them. It appeared to me that there had been a basic and early failure of the deintegrative-reintegrative processes of the self, and that the bulimic behaviour and the atypical use of food as an addictive substance were utilized as defences of the self against further emotional impingements. The bulimia represented a second skin or self- care system that both gave Jane the feeling of being psychologically held together, but also prevented her from being able to utilize experience for the purpose of psychological growth and development.

In her first sessions, Jane described becoming withdrawn and suspicious during her bulimic episodes. She felt profoundly guilty about her bulimia and often had self-destructive thoughts, but she saw no other way to control her chaotic states of mind. Excessive anxiety and depression often triggered the bingeing episodes which, at the beginning of treatment, often occurred up to six hours a day. Jane also described her intense anxiety. She felt profoundly isolated from others, her disconnection compounded by her withdrawn, disconnected mental state. She felt that the bulimia was like an impermeable wall, a second skin that kept her encapsulated in a world of food preoccupations.

It became clearer during the initial sessions that Jane used her bingeing as a form of escape from difficult, anxiety-evoking internal and external situations. She described her behaviour as an ʻ escape from the pressures in my mind ʼ . Bingeing and purging became the mechanism by which she could control states of disorganization, confusion, depression, and anxiety. At the same time, she had punitive thoughts and feelings after the binge/purge episodes, so the system was never completely effective. She described looking for calmness through her bulimia, but she often found it difficult to soothe herself. During the binge/purge episodes she got into and out of control, frenzied states that ended with a feeling of momentary calm. She said, ʻ I escape from the feeling of hardness by bingeing, and after a binge I feel dead and drained outʼ . Her bulimic behaviour seemed to take place while she was in an altered state of consciousness when there was minimal ego control. Jane spoke of the bulimia as helping to provide her with an intense focus to keep away some highly intrusive and painful thoughts. It served as a means of exerting profound control

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over her states of mind and affect. The bulimia was a form of psychic retreat (Steiner 1993) that provided Jane with a way of protecting herself from the intrusion of painful emotions and anxiety laden interpersonal relationships.

Jane described an experience of having a disordered appetite in her childhood. When she was seven years old she had a fantasy of having worms inside her body. This fantasy, she thought, was the only possible explanation for her enormous and insatiable appetite. She felt at the time that something was eating her up from within, and if she did not feed the worms they could eat up her insides and eventually her whole body. Her own consuming need to be emotionally fed was being turned against herself and filling her with terror. Feeding herself food became a way of fending off this terror and creating a boundary, a kind of second skin, so that she could experience some momentary feelings of safety; vomiting became a way of trying get rid of the worm and its potentially devouring presence. Jane appeared at this stage of the analysis to be fearful of intimate relationships with others and myself. Sexually she spoke of her fears of penetration, fears of being invaded by men, including her father, and her difficulty in erecting psychological boundaries. Bernstein (1990) speaks of these anxieties as being related to early body image formation, where the little girl needs to be in the process of developing a sense of agency and identity in order to be able to relate to an intimate other.

The therapeutic alliance and the transference relationship During the first stage of treatment Jane began to talk more openly about her bingeing and purging episodes, and I tried to help her to elucidate the meaning of her experience. I attempted to help her gain some understanding of what meaning the bulimia had in her current life. Jane stated that before the bingeing/purging episodes began a depressed empty feeling consistently emerged. She felt depersonalized and robot-like, yearning for a close interpersonal contact she could not have, trapped and imprisoned in a world she did not understand, a world of racing, uncontrollable thoughts and emotions which could only be contained through bingeing and vomiting. I felt she was defending herself against a fear of paralysing depression and psychological breakdown. Her experience of disconnection from others was complete during these periods. In an autistic-like manner, she encapsulated herself in a sensation-dominated universe where food and bodily sensations were her sole preoccupation. Her binge/purge episodes often lasted several hours and could be repeated several times a day.

In early sessions, Jane was often secluded in her own thoughts, difficult to reach, and I often felt helpless and ineffective, as if my own capacity for thought and reflection had been attacked and destroyed. I felt unable to make meaningful contact with her, and felt that her retreat into a protected yet secluded emotional space was constructed to keep me emotionally at a distance. She described in these sessions how much she enjoyed being alone on a sailboat, and how the aloneness gave her pleasure. During an early session I described the impact that her emotional states had upon my thought processes, how she protected herself from contact with me, like her experience of being alone on a sailboat, and how she gave me the feeling that she could not utilize

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my analytic help. She was relieved to hear this, as she felt my having an emotional experience in response to her meant that there could be a connection between us, and that her feelings and thoughts did have an impact on others. She slowly began to realize the power of her destructive and rageful feelings, and her need to isolate herself from others. She was attempting to make me understand through my own inner experience the potency of her feelings and the devastating impact they had upon her own psychological functioning. Because of her difficulty in articulating her emotional experiences, she needed to have me experience the nature and intensity of her destructive affects through my countertransference response. At times I felt possessed by her, filled with toxic emotions I needed to expel. Frequently I felt enormously hungry after our sessions. At one point after a session my hands were trembling and I felt filled with Jane's presence, a state of possession which I could only abate by actually leaving the consulting-room and making space for reflection. Jane needed to utilize my capacity for thought and containment of her emotional experience to help in the development of a symbolic space where she could begin to reflect upon her own experience wihout being immediately driven to engage in bulimic behaviour. She needed help in developing a primary skin function that would help her to construct a safe and secure inner space that felt bounded and protected, yet still able to be engaged in the inter-subjective space of the transference/countertransference relationship.

Between these sessions I felt anxious and concerned about Jane, a preoccupation which made me feel that something was happening at a deeper emotional level and that I was the one who was experiencing, via projective identification, her own warded off emotional needs. I experienced ambivalent feelings in my countertransference: frustration in not being able to make a coherent connection with her as well as a preoccupation and concern with her fragmented emotional states. I felt she was too much to handle, that she needed too much of my care, that perhaps some of my other patients would suffer because I was too preoccupied with her, and that eventually I would become emotionally depleted, and unable to give her what she so deeply needed. Her unfelt needs were beginning to have an impact upon me. I felt that she was beginning to emerge out of her psychic retreat, that the rigidity of the second skin defences were loosening their tyrannical grip upon her emotional life, and that a meaningful interaction was taking place at an emotional level, not yet articulated in words or symbols. It seemed to me that some of the early emotional interchanges that I have observed in infant observations where the caregiver is able to contain and tolerate an infant's unbearable cries of distress, and through patience and persistence begins to feel more attuned to the distressed baby, were beginning to emerge in the context of the analytic relationship.

Therapeutic regression within the transference-countertransference relationship As the issues in the transference-countertransference relationship began to revolve more around the maternal-infant relationship, the development of a sense of security, trust, and the containment of Jane's rage and destructiveness became paramount. Memories of the early mother-infant relationship came to the fore with ever-increasing intensity. Her memories were of a mother during infancy and childhood who denied the appearance of negative emotions in their relationship. Jane

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felt that she was made to feel guilty, strange, and wrong for feeling depressed. She did not think that her mother could understand her, and because of this past pattern, she felt hopeless about the possibility of finding solace or union in the analytic relationship.

She felt at this point that her bingeing was something that she needed because it was the only thing that had been consistent for her during the past years and served a self-mothering function, as she could nurture herself by bingeing and give herself the illusion of being fed by a mothering figure. She described having the image in her mind of a breast that would nourish her, but she had strong ambivalent feelings towards this internal breast because it also aroused feelings of frustration, anger, and despair. The rage that had its origins in infancy was finally able to be expressed in words, and memories gradually emerged of a relationship with her mother where she felt emotionally distant, neglected and unseen. She viewed her mother of infancy as preoccupied with herself and unable to tend to her emotional needs. Her mother of infancy was seen as a dark and ominous presence in her life. At the same time she yearned for a close relationship to her mother and all that her mother represented to her in terms of potential support and emotional holding. While Jane believed she could not turn successfully to a real maternal relationship she felt she could turn to the inanimate world for a sense of security. She yearned to be close to the sea, to ʻ mother nature ʼ , and to recreate in a sensory manner the soothing and contained feeling of her early childhood when she spent holidays near the ocean. She experienced a need for a connection to an archetypal ʻ earth mother ʼ which was difficult to quell. It was as if she were attempting to hold herself together by adhering to sensory images and experiences of a time long ago, to an experience of an impersonal force of ʻ mother nature ʼ .

The anger and rage Jane felt towards her mother of infancy became more pronounced as the infantile memories continued to emerge. In the transference she needed to have my total attention, and she was acutely sensitive to the times when my attention veered away from her. I, then, became the rejecting, inattentive mother who did not have the patience to hold her securely in my mind. What became clearer as the analysis delved more deeply into the period of infancy was that she did not experience her mother as being able either to think about her or hold her emotionally in mind in a stable, ongoing manner. In analysis, she was attempting to create this experience with me. This infantile relationship needed to be experienced within the transference/countertransference relationship before she could feel its significance. While she experienced a strong need to be admired and acknowledged, Jane kept feeling that her mother was largely unavailable or needed Jane to mirror her own largely unfulfilled emotional needs. A safe place inside my mind was intensely desired. Despite her yearning for care, she expressed anger towards her mother of infancy and towards me in the transference whenever she began to feel close. Under the surface there was seething conflict focused around feelings of rage and despair and a hopeless feeling that no relationship could possibly take care of her insatiable emotional needs. She feared that any connection in the analytic relationship would unleash her rage and fury. As a result of her contradictory, strong impulses, she felt suspended between a withdrawn isolation and an interactional intimacy that would unleash the destructive fury aroused

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by a helpless dependency that could make her feel weak and vulnerable. This was enacted by her never missing a session, and always being on time, and then after the session going to the toilet to purge. She experienced difficulty in both holding within and digesting the analytical nourishment.

As more space was given to reflection upon her emotional responses stemming from the infantile and early childhood periods, aggressive impulses towards her mother and me emerged in violent fantasies. She described wanting to rip us apart and tear us to pieces. In these fantasies, we were to be made to feel worthless and helpless, disarmed so that she would not feel that anyone could have any power or influence over her. As her violent fantasies were explored and as she began to tolerate their presence in the analysis, she started to report dreams and fantasies of a highly symbolic nature. It seemed as if her internal symbolic development had been thwarted by the suppression of her aggressive impulses. Once these were freed within the context of a more secure analytical relationship she could begin to use imaginal processes: dreams and imagery as an expression of her internal states. She was able to slowly develop a primary skin function within the context of the transference/countertransference relationship that led her to experience an increased capacity for emotional containment.

Jane's capacity to both symbolize and become more deeply involved in the analytical relationship increased as she began to generate more thoughts about the meaning of her condition. She realized how much she needed her bulimia to stabilize her fragile sense of self. She began to acknowledge that through bingeing and purging she was attempting to eject bad parts of herself, especially rage, anger, and self-destructive thoughts. These feelings and thoughts were difficult to bear and bingeing helped give her the illusion of coping. Yet the most difficult feeling to bear was that of no feeling at all, a kind of inner deadness, a black hole that was cold, vast, empty and devouring. It was a hole into which she could fall and become lost in an ominous void of non- being. She felt that if she did not binge she would ʻ either burst and go crazy, or else fall into the black hole ʼ . These fears were related to infantile anxieties of an overwhelming nature. Winnicott (1960) relates this anxiety of annihilation to the infant's experience of impingements in the early mother-infant relationship, especially as a result of the mother's inability to be empathically attuned to the infant's needs. At times, Jane felt completely incapacitated like a baby who was dropped down a cold, dark well. Her experience of disconnection was total. She spoke of her mother as being a snake inside her that she could not get rid of. The snake was related to the childhood fantasy of having worms eating up her insides. Her hatred and rage were consuming her emotionally.

It was at this time that Jane had a dream of being with her mother in a boat which capsized. In the dream her mother was steering the boat and apparently had made a terrible mistake. We explored the meaning of the dream as it related to her infantile emotional reaction to the inconsistency of maternal care. She felt like an infant who had awoken from a bad dream and was left in her crib to cry. Her experience of the catastrophe of her early infancy filled her with an unbearable pain.

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Emergence of a capacity to symbolize As emotions from infancy continued to emerge, Jane experienced an increased need for emotional holding in the transference. She felt anxious about the weekend breaks and feared becoming self- destructive and suicidal. I also found the breaks stressful and became filled with a sense of helplessness and fear about her condition. She longed for a close, soothing relationship, yet feared the dependency and intimacy engendered by the analytic process. Her emerging needs terrorized her, especially when she realized how unsatisfied they were. At this point in the analytic work Jane began to understand her deep suspicion of relationships, her fear of intimacy, and the strain she felt in recognizing her needs for support and dependence as having their roots in infancy. She described a relentless search for a lost breast which, if found, could restore a feeling of wholeness, but what she found was only a substitute, food, which could not satisfy her deeper emotional needs.

Her experience of herself during this time was erratic, and she had a ravenous emotional appetite that she could not satisfy. She imagined envious attacks upon her internal mother and myself who in her mind contained some inner goodness which she was entirely deprived of. Her fear of

breakdown intensified and she began to feel that I was crazy to continue analysis with her. She was convinced that I was angry with her because she sometimes did not want to listen to my interpretations. While she at times felt rejected, misunderstood, isolated, separated and detached from me, she also thought that I was too much inside her; that I knew too much about her. In order to create some boundaries between us, she binged before and after the sessions. She would not allow herself to ʻ feed ʼ on my interpretations and she needed to eject them before they could be

ʻ digested ʼ .

Her desire for closeness in the analytical relationship was mixed with the fear of fusion, and loss of personal identity. The bingeing magically held her together and blocked the feeling that she was falling apart. Although she never missed a session and was consistently prompt, she spoke of hating having an internal analyst and being controlled by the analysis. She felt that it was the analysis that was exacerbating her problems and contaminating her life, yet she yearned for a closeness to me that would enable her to feel safe. Recurring dreams and waking images of falling down dark holes and being inside empty caves pointed to her terror of disconnection from a supportive maternal/analytic milieu. The daily ritual of analysis and the consistency of the analytic frame were essential features that ʻ held ʼ her together and provided the foundation for the development of the primary skin function.

It was at this time that Jane started to study studio art and art history. She developed a deep interest in the work of Frida Kahlo and Jackson Pollack. She was drawn to Kahlo's self-portraits that were depictions of her deep physical and psychic pain. Kahlo, a Mexican painter, had been severely injured in a bus accident as an adolescent. During the bus accident Kahlo had been impaled by a pole that had penetrated her vagina and damaged both her uterus and spine. She was unable to bear children and had numerous operations throughout her life. She spent much of

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her adult life painting self-portraits that expressed her anguish over her physical injury. Thus her body became the symbol of both her anguish and her art. Jane felt a kinship to Kahlo's focus on the body as the arena for the expression of deep psychic pain. Similarly, Pollack's abstract and expressionistic work seemed to echo Jane's own chaotic internal states. She began to paint self- portraits and abstract paintings with large quantities of paint layered on the canvas. It seemed that in her self-portraits she was attempting to define her body image while in her abstract paintings she was attempting to create a sensation of having a skin that could contain her tortured self- experiences. Her artistic interests eventually became an important nucleus around which her sense of self evolved. Her art provided her with a way of digesting, assimilating, and giving shape to her inner experiences, a means of giving expression to her self in a direct way. During this period her art began to take on more meaning for her, and it was utilized to contain, give shape to, and clarify her emotional states. While painting, her desire to be bulimic decreased, and she felt more in control of herself. In her paintings an important dialogue with the self was conducted, one which gave Jane the feeling that something worthwhile was taking place inside her. This process helped to consolidate her own identty. The painting provided her with a ritualized and protected space in which she could allow her imagination creative and artistic freedom.

During the last phases of the analysis Jane and I focused on the meaning of her art, her desires for the future, and her eventual separation from the analysis as she was about to graduate from university and enter art school in another locale. While we both realized that the analytic work had not been completed, she felt strongly a need to be autonomous and independent. I encouraged her in making her own decision about art school. The decision was a difficult one for her, but once made she was able to deal with its repercussions. The separation was a painful one, yet filled with hope and a sense of accomplishment for us both.

Conclusion The course of Jane's analysis indicates the depth of emotional pain and despair that resides beneath bulimic symptomatology. As I think the course of Jane's analysis indicates, bulimia is utilized defensively to help cope with unbearable anxieties stemming from the infantile period. It is only through a working through of the defensive, second skin nature of the bulimic symptomatology and the emotional reactions to early mother/infant deprivation that the relationship to the self can be repaired and a more functional dialogue with the self can evolve. A primary skin function can then develop that can be utilized to contain imaginal/symbolic experience.

Jane utilized defences of the self when she attempted to nullify the analytic process by rejecting me. It was during these times of psychic retreat that she appeared to be emotionally encapsulated, completely withdrawn and impossible to reach. She experienced me during these moments as a threat to her very sense of psychological intactness. As the analysis progressed Jane utilized projective identification increasingly as a primitive means of communication of her emotional states and was slowly able to give up the total use of encapsulating second skin self defences. It was through Jane's use of projective identification that I slowly began to gain an understanding of her

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internal life and help her articulate her often chaotic emotional experiences.

Over the course of her analysis Jane was able to develop both a capacity for potential space as well as a capacity for reflective functioning. As Jane became more available for reflections on the transference/countertransference relationship she began to be able to paint and play artistically. She created a primary skin in which she could experience and contain her affects without feeling overwhelmed and boundary-less, and she was able to create an inner potential space that became the source of her creative expression. She slowly began to evolve a capacity for reflective functioning (Bram & Gabbard 2001) where she was more intrigued about her own and others' mental states, thoughts and feelings. Her art work became a way of mentalizing her experience. She was able to both paint verbal pictures to me of her art work as well as utilize the process of creating art to aid in the processes of the integration of psychic trauma and somatic experience.

Jane's analysis uncovered and clarified the severe and early damage to her symbolic function and her capacity for thought and reflection. During the initial stages of her analysis, she had virtually no ability to symbolize and primarily utilized her sensory/bodily functions via her bulimia to help her to contain her psychological conflicts. This represented the second skin defences that had been constructed to contain her intense anxiety and often out of control emotionality. In Jane's case bulimic episodes were utilized to ritualistically ward off the feeling of emotional deadness and numbness. With Jane, creating a safe space where the emotional reactions to the early infant/mother relationship could be re-experienced and worked through in the analytical interaction was critical. Jane benefited from my allowing space in my mind for the experience of her rage and aggressive fantasies. I was able to offer her an analytic skin where she could experience enough security and safety to elaborate her feelings and construct a coherent narrative of her early development. The analytic skin provided a space for symbolic thought and transformation, a potential space that became a centre for her creative expression. Helping her to link her turbulent emotional experience to its origins in her infantile past allowed her to work through the defensive second skin nature of her bulimia, and created a possibility for her to develop both a primary skin function and a viable connection with a more creative, alive, and intact sense of self.

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Acknowledgements I would like thank both Jean Knox and Angela Connolly for their generous help and commentary on this paper.

[Ms first received June 2002; final version August 2003]

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