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The Dying Patient in Psychotherapy
The Dying Patient in Psychotherapy is a powerful account of love and death
within a psychotherapeutic relationship. The narrative traces one man’s journey
in psychotherapy and that of the analyst who accompanies him.
The full-length description of an analysis demonstrates the developmental path
of an erotic transference from its origins in infancy, through fantasies of sex and
violence to mature erotic intimacy. The countertransference is considered with
exceptional honesty as the analysis intensifies following the diagnosis of a life-
threatening illness. A series of dreams rich in symbolic imagery traces the psycho
logical situation as death approaches. A precursor to Schaverien’s acclaimed book
Boarding School Syndrome, the single case study demonstrates the enduring impact of
early boarding. This second edition also includes an updated literature review, and
new material regarding training and supervision, making it a valuable resource for
training institutions.
The Dying Patient in Psychotherapy will be essential reading for psychoanalysts,
psychotherapists, counsellors, arts therapists and all professionals working with
the dying. The poignant story will also engage the general reader, curious
about the process of psychotherapy.
Joy Schaverien PhD is a Jungian psychoanalyst, a Training Analyst of the Society
of Analytical Psychology (London) and a member of the International Association
of Analytical Psychology. Her many publications include the best-selling Boarding
School Syndrome: The Psychological Trauma of the ‘Privileged’ Child (Routledge 2015).
“The author is a wonderful story teller and the journey she describes is an excellent
representation of the experiences of a psychoanalyst working effectively with a
dying patient. She captures the challenges of this special analytic situation and
describes the counter transferences that treating a dying patient elicits exceptionally
well. She recommends supervision to aid the analyst with the problematic counter
transference reactions. She also recommends flexibility with regard to the analytic
frame and a focus on the here and now of the patient’s struggle to live. Finally she
permits the relationship to become more real by revealing more about her reac
tions to the work but with great care not to burden the patient with her grief.”
Norman Straker, MD, DLFAPA, Clinical Professor,
Weill Cornell Department of Psychiatry,
Consultant at Sloan Kettering Cancer Center
“This…excellent book…combines in a unique way theoretical issues, clinical
insights, analytic technique, therapeutic skills in the context of a most moving
and human story of life, love and death. This book is the finest example of Joy
Schaverien’s characteristic style of writing which includes all these facets of an
analytical encounter in a touching and most readable way.”
Professor Renos Papadopoulos, Jungian psychoanalyst,
University of Essex and Tavistock clinic
“A detailed account of a successful psychoanalysis with a dying patient…
Because death is an extreme event that brings all of life into focus, Dr Scha
verien’s examples of transference and dream interpretations reach far beyond
the case she recounts. I recommend this book to any psychotherapist who
wants to understand the therapeutic uses of the erotic transference.”
Polly Young-Eisendrath, PhD, author of Women and Desire,
editor of The Cambridge Companion to Jung
“Once again, Joy Schaverien has provided a brilliant combination of a rarely dis
cussed subject, the case of a dying patient in psychoanalysis, together with an in
depth examination and commentary of psychoanalytic theory and practice. Joy
includes exploration and analysis of dreams, her valuable modern up-dated the
ories of boarding school trauma, and of course her expertise on counter-
transference and erotic transference. This second edition surpasses the first in all
respects and will appeal to experienced practitioners, trainees from many profes
sions and populations, and participants in therapy.”
Professor Helen Odell-Miller, OBE, PhD, Director of
The Cambridge Institute for Music Therapy Research
Anglia Ruskin University
The Dying Patient in
Psychotherapy
Erotic Transference and Boarding School
Syndrome
Second edition
Joy Schaverien
Second edition published 2020
by Routledge
2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN
and by Routledge
52 Vanderbilt Avenue, New York, NY 10017
Routledge is an imprint of the Taylor & Francis Group, an informa business
© 2020 Joy Schaverien
The right of Joy Schaverien to be identified as author of this work has been
asserted by her in accordance with sections 77 and 78 of the Copyright,
Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or reproduced
or utilised in any form or by any electronic, mechanical, or other means,
now known or hereafter invented, including photocopying and recording, or
in any information storage or retrieval system, without permission in
writing from the publishers.
Trademark notice: Product or corporate names may be trademarks or
registered trademarks, and are used only for identification and explanation
without intent to infringe.
First edition published in 2002 by Palgrave Macmillan
British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Cataloging-in-Publication Data
A catalog record has been requested for this book
ISBN: 978-0-367-33867-1 (hbk)
ISBN: 978-0-367-33869-5 (pbk)
ISBN: 978-0-429-32251-8 (ebk)
Typeset in Bembo
by Taylor & Francis Books
In memory of Hymie Schaverien
1910–1999
‘Like a projectile flying to its goal, life ends in death. Even its ascent and its
zenith are only steps and means to this goal.’
(Jung, 1935b, p. 408)
Contents
List of dreams ix
Preface x
Acknowledgements xi
Definition of terms xii
Introduction to the second edition xiii
PART 1
The therapeutic relationship 1
1 Psychotherapy with the dying patient 3
2 Intimacy revealed: Establishing a therapeutic relationship 16
3 The house and boarding school: Intimacy and exile 27
PART 2
Dreams and the erotic transference and
countertransference 35
4 Dreams 37
5 Dreams and diagnosis 46
6 Dreams and the erotic transference 53
7 The erotic transference and countertransference 66
8 Sexual attraction and erotic violence: Men who leave too soon revisited 75
9 The inner-world parents: The paternal function and the maternal realm 88
10 Talking about love, sex and death 103
viii Contents
PART 3
Mourning and moving 119
11 Boundaries and the bereavement of dying 121
12 Envy, contamination and countertransference 130
13 The link between psychotherapy and cancer 140
14 The problems of ending when the end is death 150
PART 4
The final phase 163
15 Breakdown, boundaries and hospital 165
16 The hospice and medication 174
17 Home 185
18 Supervision, training and countertransference bereavement:
Research questions 193
Bibliography 199
Index 207
List of dreams
1 The golden egg, January, Year 1
2 The tooth dream, March, Year 1
3 The burglar, April, Year 1
4 The tongue, April, Year 1
5 Table tennis and the tree, May, Year 1
6 The fortress and descent, May, Year 1
7 The eggs, July, Year 1
8 Row with mother, July Year 1
9 The male environment and the checkout, October, Year 1
10 The bull dream, November, Year 1
11 The giraffe dream, November, Year 1
12 Talking of sex with mother, December, Year 1
13 Danger, December, Year 1
14 The journey, January, Year 2
15 The audit, January, Year 2
16 Territory dispute, January, Year 2
17 Crops and baby, January, Year 2
18 Driving car up mountain, January, Year 2
19 Stuffing man in pit, January, Year 2
20 Car conks out, February, Year 2
21 Ice on roads, February, Year 2
22 Re-birth, February, Year 2
23 Mike Tyson, February, Year 2
24 Losing things, March, Year 2
25 Losing travel documents, March, Year 2
26 Shooting party and fish, May, Year 2
27 Exploding lymph nodes, September, Year 2
28 The man who invented ‘it’, December, Year 2
29 Taxi, December, Year 2
30 The round white bed, April, Year 3
Preface
During the course of our lives certain people touch us in a particular way; they
make some difference in our lives. The effects of a meeting may be evidently
life-changing but sometimes it is merely a passing remark or a momentary
gesture that leaves a lasting imprint. It is similar in the work of the
psychotherapist. We are privileged to meet people at transitional times in their
lives; they seek help because something is amiss for them. We come to share a
little of their life’s journey; it is as if our paths run parallel for a while, and so
we travel together. Then, inevitably, we part, each of us a little changed by the
encounter. When, during the course of this, the person who has come, seeking
help, is faced with a life-threatening illness, this is brought acutely into focus. It
was so with James. James came into my consulting room and my life, making
an immediate impact, and by the time he died, two and a half years later, we
had both been changed by the encounter. This book is the story of his journey,
but it is also the story of my journey in his company and what I learned from
the territory that we travelled together.
Joy Schaverien
Rutland 2001 and 2019
Acknowledgements
This book is dedicated to the memory of ‘James’. Although his true identity
must remain hidden, I am indebted to him for sharing a little of his journey and
for his permission to write about it. I am grateful to his family for their
permission to publish. During the analysis, on which this book is based, the
support of Warren Colman, Shielagh Finlay, Katherine Killick and Andrew
Samuels was indispensable. However, writing has been a solo enterprise. I take
full responsibility for all inclusions and omissions, but there are a number of
people who have helped along the way. The Omega Foundation provided a
grant, which gave me that most valuable commodity for a writer: time: my
thanks to Ralph Goldstein, for his belief in the project. Alison Caunt was a
sensitive and insightful commissioning editor at Palgrave. I am grateful to Tessa
Dalley, Renos Papadopoulos and Penny Pickles for their comments on the
penultimate draft of the first, Palgrave edition. Jane Schaverien and Peter
Wilson read and commented on the earlier draft and contributed in numerous
ways throughout: to them, and to Damien Wilson and Galia Wilson, my very
special gratitude.
My thanks are due to Kate Hawes and Charles Bath for believing in and
commissioning this second edition for Routledge and encouraging me to add
new material. As always, the book is my own responsibility but to Caroline
Case, Patrick Casement and Helen Odell-Miller I am hugely grateful for their
reading and very helpful comments on this new edition.
Definition of terms
The terms for the person in analysis, psychotherapy or counselling reflect sen
sitive professional issues.
Analysand: Person undergoing psychoanalysis.
Patient: A person receiving or registered to receive medical treatment. Origin
Middle English: from old French, via Latin: patient ‘suffering’, from the verb pati.
Client: A person or organisation using the services of a lawyer or other pro
fessional person or company. The term originally indicated a person under the
protection and patronage of another (The New Oxford Dictionary of English).
The term ‘analysand’ is clearly the most appropriate, but it is cumbersome so I
use it interchangeably with the term ‘patient’. ‘Patient’, meaning a person who
is suffering, is more in keeping with the treatment offered in depth psychology
than the term ‘client’.
‘Analyst’: an abbreviation of psychoanalyst, (in this case Jungian) and ‘psy
chotherapist’ are also used interchangeably.
Note for the second edition: The treatment at the centre of this story took
place in the era before the ubiquitous use of mobile phones, texts and emails.
Therefore, there are times in the story when landline phone numbers were
given or letters sent, whereas today emails and texts would probably have made
this communication rather more immediate.
Introduction to the second edition
The Dying Patient in Psychotherapy was created out of a need to understand an
experience that had been professionally challenging as well as personally
demanding. A man suffering from depression had consulted me for psy
chotherapy and, very soon after analysis began, he was diagnosed with a term
inal illness. The first edition of this book was written not long after the events
recounted. The social and psychological landscape has changed in the years
since then; awareness of the importance of psychological approaches to death
and dying has grown in acceptance amongst health care professionals as well as
the general population. However it is rarely a topic that is addressed as part of
the curriculum in psychotherapy, psychoanalytic or counselling trainings.1
Therefore I am delighted to have the opportunity to update the book, to take
account of some of the more recent literature and to provide a resource for
professional courses and Continuing Professional Development trainings.
Working in psychotherapy with a patient facing a terminal illness makes
many, often unpredictable, demands on the analyst. There may be a sig
nificant emotional impact on the clinician when the outcome of psy
chotherapy is the death of a patient. This is an unusual end to psychotherapy
but it is an ending all the same. The confidential nature of the work means
that, although this may be a form of bereavement for the analyst as well as
patient, it is a very private one. This is why supervision is so vital as the one
place where the nature of the relationship and its emotional impact can be
explored in depth. During the course of the work, described in this book, I
was fortunate to have the support of colleagues and also more formal super
vision. Psychotherapy theory very often develops out of clinical practice and
it was the need to map the territory that led me to write this book. Self-
supervision, often takes place through making notes after a session and these
notes formed the basis for the book. Keeping a kind of professional diary can
be a way of finding meaning in material that can sometimes seem perplexing.
The extra emphasis on training and supervision for analysts brings fresh
material to this second edition.
Culturally and professionally many changes have taken place since this book
was first written. The general population is more aware of the psychological
xiv Introduction to the second edition
impact of facing a terminal diagnosis on both patients and their carers. Talking
about death and dying is more accepted than it was; and some notable books
written in recent years have proved to be surprisingly popular considering the
topic is end of life (Gawande 2015, Mannix 2017). Prominent journalists have
contributed to the debate too by bringing their own terminal illnesses to the
fore in newspaper articles and in broadcasts. There is a burgeoning literature on
working with the dying and the Hospice movement has expanded and con
tinues to offer psychological approaches as part of palliative care packages.
There is now an international field of study known as psycho-oncology, of
which I was unaware when I wrote the first edition. This field of study, which
produces several journals,2 started about the time the book was first published.
It combines attention to psychological, social and cultural issues faced by those
who are dying, their families and professionals. In the literature today many
cross-cultural issues are addressed, particularly from those working with stig
matised groups. Where it is relevant, I have added references to these publica
tions. However, none of the updates alters the main story: the original narrative
still conveys the universality of the human issues confronted by those facing a
life-threatening illness and their psychotherapists.
The main challenge addressed in this book is how to work in psychotherapy
with a dying patient. However, there is another equally central theoretical
thread woven into the narrative and this is the meaning and purpose of an
intense erotic transference and the associated countertransference. Discussion of
these twin themes is aimed at helping to provide a map of sometimes, difficult
terrain, that psychotherapists may encounter, unsolicited, in their work. Finally,
a major sub-theme is how the lasting psychological damage that I have called
Boarding School Syndrome may impact on a life.
Psychotherapy with the dying
Working in psychotherapy with death in view challenges both patients and
analysts. The stresses and distresses of this awareness inevitably alter the ther
apeutic dynamic. It takes courage for the patient to face the powerful emotions
sometimes evoked. For the clinician, whilst remaining open to the experiences
confronting the patient there is a need to be realistic about what can be offered.
The boundaries of the professional relationship inevitably come into acute
focus and the need for the reflective space of supervision increases. The chal
lenge is in thinking creatively, not adhering too rigidly to boundaries and at the
same time maintaining appropriate distance. The complexities of this dynamic
relationship are discussed throughout the book.
Erotic transference and countertransference
The Dying Patient in Psychotherapy offers an exploration of the intensity of the
emotional bond that may form between the patient and analyst. Threaded
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