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Ruthless Compassion

Reflections on the Treatment of an Alcoholic

Pacifica Graduate InstitutePeterson{at}pacifica.edu

Although addiction helps control overwhelming instinctual affective states, it also rises out of the premature need to take responsibility for one’s own existence that results from a deficiency in the containing function of the mother/infant relationship. This case presents a patient who was vulnerable to addiction because of this deficiency. The roles of narcissistic rage and annihilation anxiety are examined. Alcohol was used to avoid human dependency and to restore a sense of power and control these unbearable feelings. Addiction is used to sustain the fantasy that the addict’s internal space can be omnipotently controlled. It is argued that if the goal of therapy is to help the alcoholic better tolerate powerful affective states and attain or regain healthy narcissism, then there is a need to help the addict develop a sense of dignity based on real relationships and accomplishments in place of fleeting feelings of omnipotence supplied by the alcohol.

Key Words: psychoanalytic psychotherapy • addictive disorders • addition treatment • treatment outcomes

Clinical Case Studies, Vol. 3, No. 3, 234-249 (2004)
DOI: 10.1177/1534650103259639


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