PubMed · 634674
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J S Miller. 1978. Hyperactive children: a ten-year study.. https://pubmed.ncbi.nlm.nih.gov/634674/
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Patients with pathological organisations of the personality present the analyst with considerable technical difficulties. One of these problems arises from the fact that, in such patients, dreams frequently are not being used for communication of unconscious meaning, but instead for purposes of manipulation of the transference situation. They then represent attempts to identify the analyst with a part of the patient's self or with a particular internal object in order to draw him/her into collusive enactments. Following the work of Bion and Segal the paper presents a two-dimensional model in order to clarify the structure and use of dreams in this situation. The model may serve as a background orientation for the analyst in the clinical situation, as is subsequently illustrated in a detailed clinical sequence with a borderline patient. To conclude, the author suggests that whenever tendencies towards acting in are predominant, the interpretation of the enactment should generally be given preference over the interpretation of the dream content. The possible advantages and disadvantages of both strategies of interpretation are discussed. Finally, the author highlights consequences that arise when dealing with countertransference.
In group processes, acting-out has diverse functions, all of them equally important. It has an intrapsychic, interpersonal, and group dynamic function. Not only may it be understood as a form of resistance, but also in its communicative and reparative potential. The authors investigate the thesis that acting-out also contains the seed for change, thus helping patients divest themselves of pathological behavior. Using a group process as an example, this article shows how boundaries can be drawn between past and present experiences while using the communicative and reparative functions of acting-out. Unconscious psychodynamics can then be transformed from acting-out into dreams.