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A STATE OF INBETWEENNESS: THE
CHALLENGES OF WORKING WITH
DISAVOWAL
STEPHEN BLUMENTHAL
A presentation of emotional detachment is sometimes encountered in
working with challenging patients. The term ‘disavowal’describes a par-
ticular 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 percep-
tion, 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 chal-
lenges 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 feel-
ings 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.
KEYWORDS: DISAVOWAL, PSYCHIC RETREAT, DISSOCIATION,
DISTORTION, EMOTIONAL DETACHMENT, FANTASY, IMAGINATION,
SPLITTING
INTRODUCTION
When S leaves the room following a session, the tissue on which he rests his head
on my couch looks unused; his head has left no impression. Yet something about
him left an impression and I offered him twice weekly therapy, a scarce resource
in the publically funded National Health Service (NHS). S who is 51 is an able
man, but he whiled away his time and his talents working in the adult sex indus-
try. He took pleasure in the benefits illusion provided and suppressed reality, along
with his creativity. He suffered increasing bouts of depression prior to his referral
‘A state of inbetweenness: the challenges of working with disavowal’was jointly awarded the 2021 Estela Welldon
Prize.
© 2021 BPF and John Wiley & Sons Ltd.
British Journal of Psychotherapy 00, 0 (2021) 1–13 doi: 10.1111/bjp.12699
as midlife lifted the veil on his sense of failure to achieve what he knew he could.
S treads lightly on the world, but as his therapy over eight years progressed, he
found himself tied to it, which he experienced both as an anchor and an
encumbrance.
1
A dissociative split in consciousness is often described in working with challeng-
ing patients. No less common is a presentation such as S, of emotional detachment.
The person is felt to be out of reach, in a psychic retreat (Steiner, 1993) of sorts.
This creates a numbing atmosphere, which can provoke the clinician to withdraw.
The thwarting of our efforts to make emotional contact has the potential to induce
an anti-therapeutic response, which risks derailing the therapeutic journey. Dis-
avowal as described by Freud (1925, 1927, 1938a, 1938b) is a helpful conceptual
tool to orient ourselves. This involves a distortion of emotional significance, rather
than a distortion of perception, as in the case of a dissociative split in consciousness
(Basch, 1983).
I will describe the way in which two realities can be maintained simultaneously
through the distortion of emotional significance. This particular defensive constella-
tion acts as custodian, offering protection from contact with the other, which is
experienced as potentially overwhelming. Contact risks creating awareness of an
inner sense of devastation and feared breakdown. Safety is achieved, but at the cost
of denuding mental life of meaning.
CLINICAL MATERIAL
S is an embodiment of contradiction. He is present, yet remote, his affective states
a mystery to him and me as we struggle to grasp what makes him tick. The clock
indicates the passing of time, but an atmosphere of timelessness pervades his ther-
apy. Softly spoken, mild mannered and intellectual, S wears the tweed jacket of
an academic. Parsimony describes his manner and his slim physique. Left to his
own devices, he would consume books not food, and he has a deep rooted convic-
tion that he can satisfy himself. He has a vast knowledge of literature, and he is
an accomplished artist and musician. He has a passion for Old Master drawings,
and has spent time copying certain works with absolute precision, describing the
need to enter into the artist’s very being to produce the exact angle and pressure
of the pencil in order to produce the perfect facsimile, which he emphasizes, is
not a copy.
S quotes and lives by Flaubert’s (n.d.) maxim: ‘anticipation is the purest form of
pleasure’. Like the lightness of his touch, he claims little, and so conceals his rapa-
cious self, which is left outside the therapy in his interaction with prostitutes where
his insatiable appetite is apparent. I could count the number of times S has made a
demand on me on one hand. One of these took place the first time I met him, when
he cried in despair when reliving the catastrophe of his adolescent breakdown, cul-
minating in two failed suicide attempts. Another occurred when he became fleet-
ingly aware of his desire to connect with his partner and child and cried out in
© 2021 BPF and John Wiley & Sons Ltd.
British Journal of Psychotherapy 00, 0 (2021) 1–13
Stephen Blumenthal2
anguish: ‘but what do I do?’, provoking a rare emotion in me, a state which gradu-
ally became more familiar.
I have an oddly contradictory experience with S of being on the outside looking
in; yet I am involved. Making a demand causes him to feel that he gives something
of himself away. He experiences intense and unbearable loss; and the dangerous
feelings of dependence. I feel viscerally his efforts to keep me at bay. His wishes
become intertwined with mine, and the more fulfilling life he desires is transformed
into my aspiration. This is a repetition of the over-libidinized relationship he had
with his mother who was voracious in her unremitting determination for his success.
Her unfulfilled ambition to use her mind was transferred to her precociously bright
son. The way in which I am held in the therapeutic relationship shows clearly the
transference anxiety: like his mother, I will set up my garrison within him, so S
ensures his safety by carefully constructing a fortification of his own.
S’s work as an essential cog in the machine of the sex industry was for a good
period of his life, the perfect metonymy for the cocktail of desire and negative feel-
ings towards his mother and the triumphant reversal of being colonized by her. He
played a pivotal role in arranging sex parties and marketing brothels. He functioned
as an indispensable middle man, where he could indulge his appetite for sex and
domination with the illusion of being on the inside, with privileged, special access
to a harem of attractive young women. They treated him as a dignitary, wanting to
make an impression on him as the gatekeeper to his prestigious establishments.
At an intellectual level, S acknowledges sadism, although the emotional aspect is
unavailable to him. He enjoys sex with a stranger, but cannot bear to know the person
he touches. In a disclosing moment, he told me that he gets pleasure from knowing that
they are beautiful now, but they will be ruined, and he was there before their demise. I
feel chilled by his declaration and check my impulse to retaliate with criticism. This
unusually candid statement evokes a strong emotional reaction in me and a vista of
potential work opens up to explore together. I glimpse the possibilities for analytic work
if I am able to translate my countertransference into a shared understanding which could
be helpful to him. If I could just harness this moment of S’s emergence from the pri-
vacy of his solitude. This gradually dissipates, as a numbing inaccessibility draws a veil
over a potentially explosive eruption.
Shortly after starting therapy, S met a woman 15 years younger who paid for her
studies by working as a prostitute, in search of a rescuer and a father to herself and
the children she craved. At first, I considered the relationship an enactment to avoid
too overwhelming a contact with me. Yet they developed a surprising closeness and
I had to re-evaluate my formulation. He was initially opposed to her coming into his
home; he never permitted anyone into his intimate space. But after an agonizing
back and forth, she moved in. They had a baby boy, who is now four and the apple
of his eye.
At the start of the relationship they had blood tests for STDs and S discovered
that he had hepatitis C with significant liver damage, a disavowed fact of which he
was vaguely aware due to feelings of discomfort in his abdomen. This is a concrete
metaphor for his psychological state: he never allowed himself to know about his
© 2021 BPF and John Wiley & Sons Ltd.
British Journal of Psychotherapy 00, 0 (2021) 1–13
A State of Inbetweenness 3
damaged self; he has known but not known, turned a blind eye, allowing the pathol-
ogy to establish a foothold. He allowed himself to hope that a new wonder drug
would cure him, not least because he saw a future with and for his son. This was
successful, but the damage may have gone too far.
S expresses gratitude for the positive impact the treatment has upon his life.
I confess some gratification in the apparent dramatic reduction in his work –he now
only has one client, the owner of a brothel. Yet a disquiet remains that his ‘one
client’is a half-measure and signifies an eternal attachment to his pathology. Like
the hepatitis, the treatment can reduce the virus to ‘barely-detectable’, but this may
be the harbinger of a ferocious return.
S’s background is one of strict and pious Christianity, where excess was shunned
and frugality celebrated. He is a committed atheist, but carries this prudent attitude
in his body and in his being. His mother is described as a dominating figure, preoc-
cupied with her son’s precocious talents, a narcissistic extension of herself. He feels
she took an interest in what he did, but not in him. She controlled him with emotion
and if he did not do as she wished, she punished him with emotional withdrawal.
He withdrew into books and drawing in the secret world of his attic room. He devel-
oped a studied obduracy in response to her over-cathexis of his intellect and the
rejection of his emotional needs. Father had a difficult early life; abandonment by
his birth parents, an orphanage and adoption. He was apparently present, but
emotionally distant.
S was always top of his class. But in adolescence, he became increasingly opposi-
tional, defiantly sitting in class, reading complicated theoretical texts and refusing to
comply with the syllabus. He devised a plan at 15 to deliberately fail his O’levels
and commit suicide in a secret, dark Gothic pact with himself. He set about failing
his exams, but passed one subject, because he could not resist answering a question
offering a critique of the education system. S took two potentially fatal overdoses a
week apart and waited to die, reporting this to nobody. He dropped out of school
where he had been popular and good at sport. He withdrew to the public library for
two years where he read complex, intellectual tomes with a feverish intensity, and
he lost all his friends.
S then set off with a guitar and a backpack, and spent years travelling the world
on a shoe string and taking a keen interest in the historical sites he visited. After his
eventual return, he obtained a series of good jobs where his promise was noted and
there was some success, but he always left before this was realized. He then studied
art and was tipped for success, but once again withdrew. S finally found his home
when he began attending swingers’parties. He soon discovered that he could put
his artistic and marketing talents to use and he was quickly adopted by people who
saw his potential.
Disavowal and Retreat
S’s disavowal of reality and his retreat are epitomized by the following dreams: in
one he was leaving Russia by plane. It was dark and raining, and there was a
© 2021 BPF and John Wiley & Sons Ltd.
British Journal of Psychotherapy 00, 0 (2021) 1–13
Stephen Blumenthal4
strange stormy light. In the other, he was leaving his home shire on a bus; again it
was dark and raining. He saw a teddy bear belonging to his son. He felt anxious,
there wasn’t enough time and he felt he should not have put off his departure for
so long.
S’s thoughts went to the romantic pull of Russia, the literature, the deep and mysteri-
ous countryside and the immense open landscape. He once flew across this vast coun-
try. He had a window seat and the sun did not set; it was an eternal day. He became
lost in the landscape; rivers like intertwining snakes, forests for thousands of miles. The
rain in the dreams reminded him of magnificent thunderstorms he saw, it was dark and
light at the same time, a darkness not of night but of thunderstorms in the day.
There is a sense with S that awareness begins to open up for him, as is his life
particularly with his son. Yet there is a terrible sadness about the time lost and a
question as to how long he has to live. Like the recounting of the dreams and his
associations, a pattern emerges in sessions when he expresses a sense of alarm and
makes emotional contact with me, but this is transitory and I experience a sense of
disconnection from the intensity of apprehension I had thought was evident. As he
elaborates his dream thoughts, he gets further away from his anguish about his
losses and the darkness within himself. There is an urgency about the passing of
time, but his associations lead to a limitless eternal day. I feel drawn in to the
strength of his feelings, and then imperceptibly I am disorientated. I find myself the
detached observer once again, wondering what occurred between us.
Such drift is evident in a session following a holiday, when he talks about how
worried he feels. He then drifts off into a memory from the holiday. He is on a jetty
with his son and he notices his son is frightened of the sea. I say:
I notice in coming back an atmosphere of being like the sea. There’s nothing
solid, there is a feeling of drift, of meandering. It is hard to focus upon the
thing that concerned you, on a darkness in you. The sea was frightening, but
not any longer.
This strikes a chord and he lets me know that he lives in a dream world and does
not really notice my absence. He says:
I just drift away, into another world. It’s something that I’ve always done. I was
always a daydreamer, somewhere else, on a planet of my own …I spent endless
time in timeless places. I’ve created these timeless places around me; like the
brothels. You enter a different world where there’s no time …I’m not even
aware I am doing it. Sometimes I suddenly realize how destructive my work is.
Should S leave this retreat or stay in it? In the dreams, what at first appeared a
place to leave, a place of darkness, becomes a remote refuge in the aeroplane, remi-
niscent of his attic room, where he is omnipotent and self-sufficient. He disavows
conflict and anxiety; and is insensitive to the suffering of the young women whose
youth is squandered. He feels no craving as he looks through a pane of glass, cut
off from the storm. Time stands still. I too feel distanced, looking through a trans-
parent barrier at the transferencecountertransference storm.
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British Journal of Psychotherapy 00, 0 (2021) 1–13
A State of Inbetweenness 5
Then to my surprise and his he says in a sudden eruption of despair:
Why do I put things off? When I do, they just get worse and worse and cause
me more suffering. I am desperate …Life is finite. How much of (my son’s)
life will I see? With a child, it’s different. Everything you do doesn’t end in death
…Ineedtobethereforhim…I need to leave something good for him …
There is a momentary window in which he expresses an appetite and makes a
demand upon me, and there feels to be the potential for a stormy engagement. After
these rare statements, I call time and S rises to leave. I look down to see the tissues
on the pillow in a dishevelled state.
DISCUSSION
The temporary suspension of reality and of the constraints it imposes provides the
basis for imaginative fantasy. The child at play believes wholeheartedly that they
are a superhero, for example, whilst perception remains intact. Fantasy is a building
block of thinking and disavowal of reality plays its part. But the flight into fantasy
signifies a distinct mental manoeuvre which can derail psychic development. The
child left ‘alone’may take refuge in a world of illusion to manage the unbearable
void and this can become organized as a pathological structure (Colombi, 2010). In
this psychic vacuum, falsehood masquerades as truth, omnipotence triumphs over
dependence, and love is diminished.
S seemed able to represent his internal world. He has a prolific dream life, an
abundant imagination and a good knowledge of literature which he seems able to
use as metaphor. S is undoubtedly creative, but he channelled much of his imagina-
tive capability into establishing a solipsistic parallel world. He inhabited a remote
place on the cusp of creativity and of retreat in which time did not pass. There he
straddled two realities and kept secret his pleasure in the demise of youth and vital-
ity; a self-imprisonment which was both gratifying and tragic.
Blass (2015) enumerates the different meanings of splitting within psychoanaly-
sis, and distinguishes dissociative and disavowal types. The dissociative kind
involves splitting off whole personalities, whereas disavowal splits off awareness of
disturbing realities or their meanings. This non-psychotic form of denial involves a
‘displacement of value’rather than hallucination.
‘Two psychical attitudes’, writes Freud (1938b) of disavowal, ‘have been formed
instead of a single one –one, the normal one, which takes account of reality, and
another which under the influence of the instincts detaches the ego from reality. The
two exist alongside each other’(p. 202). Disavowal, according to Basch (1983), ‘is
not a distortion of perception per se, but only a defence against that percept’s per-
sonal significance’(p. 145). Disavowal eliminates the significance of things rather
than their perception.
S’s splitting off and projection of aggression maintained his psychic equilibrium.
The disavowal of enmity protected him from acknowledging an inner sense of
devastation and consequently of a feared breakdown. Disavowal functions to keep
© 2021 BPF and John Wiley & Sons Ltd.
British Journal of Psychotherapy 00, 0 (2021) 1–13
Stephen Blumenthal6
disparate and contradictory parts of the self separate from one another in order to
preserve a psychic reality in which antipathy is both hidden and idealized
(Steiner, 1993). This comes at a price. It restricts emotional life by preventing the
working through of the traumatic significance of negative experiences (Basch, 1983).
S’s evasiveness with me corresponded with his account of a mother who he experi-
enced as over-cathecting his intellect. He feltshedemandedanindependencehecould
not sustain. He learned that feelings of dependence and vulnerability were dangerous
and shameful and so gave up his reliance on anyone other than himself. The retreat he
established took a physical form in the way of his attic room as a child, the brothel-
world of adulthood, and ultimately, a place within himself where time stood still.
S’s perception remained intact and he recognized the veracity of different realties,
but the emotional meaning was altered. When disavowal is prominent, says
Britton (1998), knowing and not knowing exist side by side and a state of inconse-
quentiality prevails. S maintained two psychical attitudes simultaneously; one in
which he experienced no conflict about the ‘useful’service he provided, and another
that he was wasting his time and contributing to net harm in the world. In a disclos-
ing moment, he told me that his work was ‘destructive’, yet he continued this with
indifference. S turned a blind eye to the calamity of his adolescent breakdown. He
concealed it from the eyes of the adults around him, ensuring their impotence, and
of course from himself, at an emotional level. He thereby maintained the hidden
breakdown into adulthood and remained temporally frozen.
Steiner’s (1993) concept of the psychic retreat is an umbrella term for a variety of
pathological organizations. Whilst splitting and disavowal are a fundamental aspect
of any retreat, there appear to be some retreats governed by more dissociative ele-
ments and others in which the use of fantasy is rooted in disavowal, as S illustrates.
S did not repress his impulses, rather he inhabited two realities. In one he experi-
enced his sexual and aggressive appetite unabated and another he embodied his
mother’s religious abstemiousness and her prohibitions.
As the work progressed, S emerged from his retreat and became more available.
Yet disavowal was so strong and worked so well that he repeatedly returned to his
aeroplane world and maintained a foothold in the brothel. It seemed engagement
threatened him with a feared catastrophe. This pattern of emergence and retreat was
evident in those poignant moments when he made contact with his emotions, which
then rapidly dissipated, such as the return from holiday. A moment of potential
emotional intensity, such as his son’s fear of the sea, washed away like the tide.
I experienced a sense of dislocation; questioning myself as to the veracity of his
involvement. His associations to the dream did not elaborate the latent content;
rather they took him away from his feelings of time being short and of loss. He
hung on to a trace dose of the world of prostitution with his one client, just as there
was always the trace of the ‘barely detectable’virus.
Fetishism, says Freud (1938b), is a particularly favourable subject for studying
the question of disavowal. There is a distinctive quality to the way in which the con-
crete fetish object contains a density of meaning, a true metonym. In ‘Splitting of
the ego’(1938a), he describes the case of a boy who developed a fetish. This
© 2021 BPF and John Wiley & Sons Ltd.
British Journal of Psychotherapy 00, 0 (2021) 1–13
A State of Inbetweenness 7
followed his seduction by an older girl and following this, masturbating and being
discovered by his nurse who threatened him with castration. Through the mecha-
nism of disavowal, he continued masturbating with apparent boldness, yet simulta-
neously and in contradiction, he developed an intense fear of being punished by his
father. In a similar way, S was indifferent to his work in the adult sex business and
the moral conflicts, guilt and shame associated with it. At the same time, he experi-
enced persecuting anxieties relating to his unfulfilled potential. There was a marked
sense of inconsequentiality and unreality, as Britton (1998) describes it. He was
indifferent, yet S experienced a sense of dread that caused him persistent and at
times overwhelming suicidal depression.
S’s disavowal was his means of managing a powerful and dangerous maternal
object unfettered by the intervention of a robust paternal object. He was driven to
defeat me by remaining remote. At times I was forced to participate as an observer,
who knew his patient was elsewhere.
FURTHER CLINICAL MATERIAL
A dream towards the end of S’stherapyillustratessomefurther aspects of disavowal
relevant to our discussion. After seven years of therapeutic work, S’s situation
improved. He described a more satisfying and loving relationship with his partner, there
was a warmth and kindness in his description of her, an engaging relationship with his
son, who was apparently thriving, and improved work prospects in the form of an
online art business. He was distinctly less remote and more emotionally engaged with
me. He expressed real worries about his health and he managed to sustain engaging
with these anxieties rather than characteristically disavowing them. S began to realize
his dream of moving to the countryside, to the area he came from. He wanted to estab-
lish a life there with his family. He was now a man situated in time, with a past and a
future. We discussed an end-date a year hence. He then had the following dream:
I was fishing off the beach and I hooked a salmon. This was strange because
salmon are not caught off the beach, but I thought: perhaps it was an estuary;
that place between the sea and the river. I reeled the salmon in and just as it
was getting up onto the beach, a man fishing next to me picked it up and
threw it over to me and I caught it and struggled with it. I took an implement
which is used to kill fish, called a priest. I used to fish with my uncle in York-
shire and we used the priest to kill the fish we caught. It is weighted with lead,
like a club, and I hit the fish on the back of the head. But in the dream the fish
didn’t die, it was now in a half-alive state. It continued to struggle and some-
how it got into the water. I looked for it, but the water was rough and murky.
I managed to grab hold of it and bring it back to the beach, but it was half
dead and had lost its lustre. Salmon are such beautiful, regal fish, but this
was now half dead. I wasn’t sure whether I threw it back in or if it got back
to the water itself, but it just drifted, half alive and then it disappeared.
© 2021 BPF and John Wiley & Sons Ltd.
British Journal of Psychotherapy 00, 0 (2021) 1–13
Stephen Blumenthal8
S’s associations were to beaches on the north-east coast of England. Although it
is technically Yorkshire, the people there talk with a north-eastern accent: ‘So it’s
kind of not really Yorkshire any more …’He thought about rivers in Scotland
where the salmon go to lay their eggs. He said that there are dwindling stocks of
salmon. His thoughts kept returning to the cruelty of the act of killing the fish; he
had done it hundreds of times. But this was a long time ago, he is a vegetarian and
he could not bring himself to kill a fish now.
In the months that followed the dream, S and I talked about the many themes con-
densed into it and the connection with ending his therapy. The beautiful, regal salmon
which had lost its lustre was reminiscent of what he said many years before about how
the girls were beautiful now, but he was seeing them before their demise. The salmon
conveyed his thinking about himself: He was acutely aware of his physical health prob-
lems and his mental state of half-aliveness. But he could now allow his therapy to come
alive and he had regrets about his use of it previously. At that moment, I think the end-
ing of the therapy felt to him like a death and I was the presiding priest. S always occu-
pied a place between things, neither one thing nor another, he was always between
places, Yorkshire or the north-east, in the surf but not in the sea; in the estuary. He lived
in the fresh water and in the salt water, in the world and in a brothel. With the ending
of therapy, he worried about his being a fish out of water.
The dream showed an emergence from his retreat and signified the way in which
the aeroplane world protected him from psychic conflict, from the shame of vulnera-
bility and from depressive anxiety. In the dream his aggression is present but it
becomes split off as he associates: he used to kill fish, but not any longer. I was con-
cerned with a detail he left out of his associations; namely that salmon return to
where they are from not only to reproduce, but also to die.
I think S was able to convey through the dream the sense that he felt hooked by a
cruel, vengeful object who wielded a priest behind him. Perhaps equally so, the
salmon could swim away, albeit in a half-alive state. Regardless, I was left anxious
about S’s departure. After all, he made two serious attempts on his life, and he had
never properly left home, so to speak.
In the course of these discussions, S experienced a profound melancholia as he
thought about the imprint he had left upon the world in the form of his work, and the
lack of influence he had in relation to his potential for creativity. He thought about his
son, and his sincere wish to leave something positive and edifying behind as his legacy.
He experienced intensely the sense that not ending suited him. He said:
It’s like I want to keep something open. Like anticipation, something that
never ends. It’s kind of endless …But then I actually do want a resolution,
I can’t bear this state of inbetweenness …
DISCUSSION
This state of inbetweenness protected S from knowing about his aggressive
impulses, which are disowned; placed in a self, belonging to a-long-time-ago.
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A State of Inbetweenness 9
It forestalls the experience of the dangerous, shameful feelings of dependence. He
conveys a wish to prolong the therapy indefinitely and to avoid experiencing loss.
In the course of this work, S became acutely aware of his reliance on his mother.
He had never properly left home. He may have done so practically many years
previously, but his parents acted as the fulcrum of his activities since then. He cre-
ated a life which was like a negative photographic image of his parents’, doing
exactly the reverse of what they aspired for him.
The qualities of S’s attachment became more evident in this last phase of therapy.
It was clear that he remained tied to his mother, he was reliant upon her. His retreat
was an attempt to establish a prelapsarian paradise, in which time did not exist. This
anaclitic attachment, based upon dependence, signified the transference relationship.
Disavowal denuded S’s relationships of meaning. This is perhaps a defence against
an overwhelming invading/abandoning maternal object (Glasser, 1979, 1992). S
existed side by side with the object, but he protected himself from engaging
emotionally. Basch (1983) captures the way in which this distortion of significance
manifests in the transferencecountertransference:
…the person who consciously disowns or disavows his presence is not really
saying ‘I am not here’, but, rather ‘Just because I am here does not mean
I have to talk to you, so, for practical purposes, and as far as you are con-
cerned, it is the same as if I were really absent’(p. 134).
The use of disavowal, which distorts significance and meaning has an impact on
symbolic functioning. Whilst S’s dreams were powerful in signifying his conflicts,
there was a manner in which these representatives remained in the dream. Whilst
they could be apprehended, they could not be owned by consciousness and thereby
integrated into his self.
This is reminiscent of Bion’s (1957) description of the psychotic person who
‘moves, not in a world of dreams, but in a world of objects which are ordinarily the
furniture of dreams’(p. 269). However, there is a crucial difference in quality to
psychotic thinking. In the case of disavowal, the capacity to use symbols does not
break down completely. It is based upon distorting significance rather than percep-
tion. The dream symbol becomes an object, it becomes furniture because it is
robbed of emotional significance. The ‘priest’in the dream has a concrete, furniture-
like quality and S struggled in a wakeful, conscious state to sustain an emotional
engagement with what his dreaming mind produced.
The parallel world S created for safety impeded artistic creativity because the cre-
ation of the artist is not the object represented, it is its own, distinct ‘creation’,a
symbol, not the thing symbolized. In this sense, S’s creations were concrete objects,
a kind of symbolic equation, though different from that described by Segal (1957),
which she based on the splitting characteristic of a psychotic process. In this case,
the symbolic equation is based on disavowal.
The dream of the half-alive salmon is indicative. It is a partial symbol, but it is
half-way to a representation of himself and of his disavowed aggression. Like the
half-measure of disavowal Freud described, so too the symbol is a semi-symbol.
© 2021 BPF and John Wiley & Sons Ltd.
British Journal of Psychotherapy 00, 0 (2021) 1–13
Stephen Blumenthal10
S forcefully projected his anxiety about leaving, which led me to doubt the possibil-
ity of ending therapy. In so doing, time itself was stretched out. He thereby realized
the timeless places he inhabited. S’s psychic retreat enabled the denial of the passing
of time, one of the facts of life, as described by Money-Kyrle (1971). It took consid-
erable work to confront his mortality and the ending of his therapy.
CONCLUDING REMARKS
Disavowal and splitting of the ego are ubiquitous and varied in their manifestation.
This can be relatively benign and is the basis for creative imagination and play. It is
a necessary means of protecting the psyche from the exigencies of the demands of
external reality. But this form of splitting can take on a more troubled character in
which reality is profoundly distorted by altering significance and meaning. This is
the crucial difference between fantasy and imagination in how we elaborate what
we perceive.
The retreat based upon disavowal is powerfully protective in maintaining psychic
safety. The purpose is to deny need and the passing of time. Yet such an organiza-
tion is also limiting of engagement with self and others, and with creative potential.
In making a momentary demand upon me, S fleetingly became aware of feeling
unbearable and intense loss as he experienced the dangerous feelings of dependence.
Whilst a degree of integrity remained in relation to his retreat, there was a reversibil-
ity of projective identification, which arose from the working through of mourning,
and the regaining of parts of the self which had been scotomized and lost.
In cases such as the one described, the evident suffering arising as a consequence
of analytic work can be experienced as the catastrophic loss of an ideal state
(Steiner, 2013). Undoubtedly there is excitement in concealment, but it is ultimately
based upon hiding shame. Thus not only does one need to relive in the trans-
ferencecountertransference the experience of the loss the infant experiences of the
ideal state, but also the shame of revelation, the removal of concealment, and being
observed as small and needy, as omnipotence is exposed as illusion (Steiner, 2006,
2011, 2013).
Two parallel worlds existed: one a facsimile, the other reality based; one timeless,
the other bound by time; one in which he was omnipotent, and the other in which
he needed and depended on others. These worlds began to collide and S was able to
communicate to me that, like his mother, I should not mistake his apparent self-
containment for self-sufficiency.
ACKNOWLEDGEMENTS
My thanks to Heather Wood, Stan Ruszczynski and John Steiner for their comments
on earlier versions of this paper.
© 2021 BPF and John Wiley & Sons Ltd.
British Journal of Psychotherapy 00, 0 (2021) 1–13
A State of Inbetweenness 11
NOTE
1. S provided his full consent to the use of this clinical material. All identifying information
has been altered in order to protect confidentiality.
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STEPHEN BLUMENTHAL D.Clin.Psychol., F.Inst.Psychoanal., is a psychoanalyst and clini-
cal psychologist in private practice and at the Portman Clinic, Tavistock and Portman NHS
Foundation Trust. He is a Fellow of the British Psychoanalytical Society and an Associate
Fellow of the British Psychological Society. He has a particular interest in understanding the
© 2021 BPF and John Wiley & Sons Ltd.
British Journal of Psychotherapy 00, 0 (2021) 1–13
Stephen Blumenthal12
connection between the mind and behaviour, and the risk of acting out in ways which are
harmful to self and others. He is interested in the public understanding of psychological ideas.
He is author of a number of books, including Assessing Risk: A Relational Approach. He has
published many peer reviewed research papers, as well as articles in the popular press.
Address for correspondence: [sblumenthal@tavi-port.nhs.uk]
© 2021 BPF and John Wiley & Sons Ltd.
British Journal of Psychotherapy 00, 0 (2021) 1–13
A State of Inbetweenness 13
