A sexual violation in an analytic treatment and its personal and theoretical aftermath

SEXUAL VIOLATION  IN AN ANALYTIC TREATMENT 

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patient the lesser on bottom.

6

 Sullivan’s (1953) two-person model tried to 

heal this binary inequality between analyst and patient by relativizing the 

pair: the former as comparatively well, the latter as comparatively ill. Re-

lational psychoanalysis continues this equalizing deconstruction by both 

validating patients’ wisdom and acknowledging analysts’ influence and 

participation in enactment, not to mention iatrogenesis (Boesky, 1989; 

Mitchell, 1997; Renik, 1998).

I add another step. I would like to undo the dissociation and hierarchy 

that structure the internal categories, the “self-states” (or “subject posi-

tions”) of analyst and patient. Each analyst has had at least one analyst, 

each has therefore been a patient, each of us is, therefore, both top and 

bottom, empowered and abjected. Yet even though we know that much 

of what we learn about treatment comes from our own treatment(s), we 

find it strange to imagine that there are, in effect, two self-states alive in 

us at once, each with different knowledges. Instead, a no-person’s land 

seems needed, because of the analyst-patient hierarchy and its toxic traf-

fic in power and shame.

Can we inhabit the space between (Bromberg, 1996)? If analysts can 

hold themselves as wise and ignorant, powerful and weak, can they also 

imagine themselves as both self-contained and abject, and continue 

working? What state of mind would that balancing act entail? Some com-

bination of the depressive position and skepticism? I speak at once as 

both recognized, dignified clinician and desperate, mute patient who has 

found her voice. I am an insider who has trained and studied and writ-

ten, entered second and third treatments, and wants to confer with her 

colleagues about a personal dilemma in terms of the complications mark-

ing our field. And I am outsider, perhaps standing in for all the patients 

whom we have all damaged in lesser or greater ways and who insist on 

recognition and empathy.

More than one colleague, crumbling under the weight of this demand, 

has resorted to rationalization. Often, for example, I have been congratu-

lated for my courage in telling this story. One time, I dared look a gift 

horse in the mouth and asked why I was being praised. “Because,” my 

colleague replied, “you put yourself in a bad light.” Talk about regulatory 

practice. In her view, telling this story made me look bad because, when 

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 That the analyst has less power than the patient both structurally (as the patient’s em-

ployee [Dimen, 1994]) and dynamically (as, for example, the patient’s transitional object 

[Winnicott, 1953]) is of course true but not my point here.

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MURIEL DIMEN, Ph.D.

the sexual transgression happened, I was an adult, 31 years old, not a 

virgin, married. I had entered psychoanalytic treatment of my own free 

will. Which, of course, was true.

Except, of course, it also wasn’t. What my friends couldn’t entertain 

was a not uncommon paradox: like other free agents driven by suffering 

to our offices, I too was desperate, a shameful thing to admit among ci-

vilians and, it may be, even among professionals. And (or but) as we 

know, desperate patients cannot be asked to be responsible in the way 

analysts are. A central feature of “professional [analytic] responsibility,” 

writes Mitchell (2000, pp. 51–52), assessing Loewald, is to bridge the pa-

tient’s organized and disorganized mental states. This bridge helps the 

patient, now relieved of that mature psychic labor, to enjoy “freedom 

from conventional accountability” in which states of “unintegration” may 

be productively mined.

I do not think I am alone in forgetting, on a day-to-day basis, how at 

risk patients feel, how frightening it is to denude oneself of the defenses 

that protect but also construct and constrain, to be the unhappily ill one 

longing for the state of grace embodied by the happily cured analyst, the 

gosling worshipping the god. Might we see writ large, in my history with 

Dr. O, the mundane hazard of being a patient? When your doctor breaks 

the faith, your own faith trembles. And when you are, as I was, psycho-

analytically uninformed, greatly distressed, and much regressed, you 

cannot afford to lose your faith in the process. So you don’t notice, and 

you don’t notice that you don’t notice, and you don’t bring it up, because 

you fear he will either disavow or acknowledge his role: if he’s bad and 

denies it, then you’re crazy, and if he’s good and cops, then you have no 

right to be angry and your anger makes you bad and so it’s your fault 

and, voilà, you’ve no right to speak at all. And you don’t tell anyone else 

because you don’t want them to tell you to leave the analyst whom you 

need beyond reason.

Primal Crime

That the hardships and humiliations of being a patient linger, unre-

marked, amidst the gratifications (Smith, 2000) of being an analyst cre-

ates a certain personal difficulty, if not also a professional opportunity, 

that has been insufficiently addressed. Maybe the moral hierarchy be-

tween analyst and patient, the us/them dynamic, issues from the shame 

and stigma of being a patient in the first place, the enormous comforts of 

treatment to the contrary notwithstanding. Maybe this explosive combi-

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