Years ago on a panel entitled Clinical Gray Zones focusing on those times when abandonment of traditional neutrality was the better part of valor, Hedda Bolgar was asked how active she would be in the treatment of a seriously ill patient.  She replied: “All our clinical work is about protecting the future of our patients. When the future’s in doubt, what becomes the work of the analyst?”

 Her answer reverberated for me when a patient in an established analysis was diagnosed with Huntington's disease.

This presentation takes up the question of what permits the analyst to stay therapeutically alive when the continuity of being with the patient is disrupted.  Analytic resilience and mutual vulnerability - both experiences  that vacillate between autonomic arousal and imaginative reconstruction - will be elaborated on as instruments available to counter the impulse to retreat  in the face of relentless somatic assault.

Learning Objectives

At the completion of this program, participants will be able to:

• Explore the impact of genetic disorders on representations of a good object.
• Define manifestations of analytic resilience as it applies to a diagnosis that impairs bodily integrity and symbolic language.
• Discuss countertransference experiences encountered by the analyst in the treatment of somatically degenerative conditions.