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Rey, J.H. (1988). That which Patients Bring to Analysis. Int. J. Psycho-Anal., 69:457-470.

(1988). International Journal of Psycho-Analysis, 69:457-470

That which Patients Bring to Analysis

J. H. Rey

It is a truism to state that what patients think they are coming to treatment for and that which emerges in the course of treatment could be very different. It may be useful to mention what are the main aims of this paper and thus possibly facilitate keeping up with the unfolding argument.

The main theme is how very frequently, if not always, help is asked with regard to improving oneself, whilst the real request is how to bring about the reparation of important damaged inner objects without which reparation the subject's self cannot function normally and happily. The patient does not know how to do it, cannot do it. He seeks help with regard to those objects without a conscious realization of what he is looking for. A central aspect of the problem is that theatened and dying objects have to be kept alive for this purpose by the use of mental manoeuvres of a very complex nature. An attempt to describe the mechanisms used will be made. The contrast between concrete repair and psychic reparation proper appears to be fundamental in the failed efforts to repair, and resulting difficulties.

I believe that in very ill patients, borderline and psychotics, the detection of such psychic behaviour is relatively easily achieved. However, the same processes expressed at different levels go on in psychosomatic, hypochondriacal, neurotic and less ill patients. Therefore, I will give examples of various kinds of patients functioning at various levels of pathology, including patients treated in a group.

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