The Basic Fault: Therapeutic Aspects of Regression

Michael Balint's book, published in London in 1968, distils four decades of clinical work into an account of why some analyses stall and what the analyst can do when they do. It begins from an observation: with certain patients, at certain moments, interpretations stop working as interpretations. They are heard as attacks or seductions, or do not register at all; the analyst's most casual words and gestures take on enormous weight; and a patient who is not understood does not become angry but sinks into emptiness and futility. For Balint these are signs that the work has left the level on which Freud's technique was built. Part I sets out three areas of the mind. The Oedipal area is triangular, organised by conflicts that interpretation can resolve, and conducted in ordinary adult language. The area of the basic fault is strictly two-person; what operates there is not a conflict but a deficiency, a fault in the geological sense of a structural flaw, and conventional words are unreliable in it. It originates in a marked lack of fit, in the earliest phases, between the infant's needs and the care and affection available. The area of creation contains no external object, only 'pre-objects'; it is the place of artistic and scientific creation, of insight, and of the first phases of falling ill and of spontaneous recovery, and its processes cannot be hurried from outside. Part II replaces Freud's primary narcissism, which Balint finds contradictory and unproductive, with primary love: an original relationship to an undifferentiated environment, a harmonious interpenetrating mix-up comparable to our relation to the air, in which the environment is simply taken for granted. Objects with firm contours, and with them narcissism, hate, ocnophilia and philobatism, emerge only once this harmony is disturbed. Adult love tries to restore it through the work of turning an indifferent object into a cooperative partner. Part III describes the gulf between the analyst and the 'child in the patient', and the problem of language: every analytic school teaches its patients its own idiom. Balint weighs three responses to regression. Classical technique keeps the work at the Oedipal level and so depends on careful selection of patients. Consistent, confident interpretation, associated with the Kleinian school, teaches the patient the analyst's language at the price of an inequality between an all-knowing analyst and a weak patient. The management of regression, associated with Winnicott, risks an unending spiral of demands. The cautionary case is Ferenczi's late 'grand experiment', which Balint watched at close range, in which Ferenczi tried to meet one patient's every need. Part IV, the heart of the book, distinguishes two forms of therapeutic regression. Benign regression aims at recognition: the patient needs an environment that tacitly consents to be used, a trusting, unsuspecting ('arglos') atmosphere forms, and the regression ends in a 'new beginning', the discovery of freer ways of relating. Malignant regression aims at gratification through the analyst's action: trust repeatedly breaks down, desperate clinging appears, and ever-renewed demands of suspicious intensity drift towards addiction-like states; Balint links it with severe hysteria. Because regression happens inside a relationship, its form depends on the analyst's response as well as on the patient. Balint reads the Freud–Ferenczi disagreement through this distinction: Freud generalised from malignant cases, Ferenczi from benign ones. Part V draws the technical consequences. At the level of the basic fault the analyst should avoid becoming a mighty, knowing, omnipotent object, whether through incessant transference interpretation, through gratification, or through promises to see the patient through. The analyst should let the patient use them as a primary substance is used, the way water carries a swimmer, and should provide time and a quiet setting in which the patient can find a personal way to objects. During the regression interpretation is used sparingly and acting-out is accepted as communication, to be worked through once the patient is back at the Oedipal level. The fault itself cannot be analysed away: at best it heals with a scar, and a successful treatment includes mourning for the original defect.