From the Treatment of a Compulsive Spitter: A Psychoanalytical Approach to Profound Disability

Every practicing psychotherapist will have ample experience of patients expressing rage and hatred during the course of a session. In virtually all cases, patients emit their fury in a verbal form. But what happens when an angry, traumatized patient lacks the capacity to spit out nasty words and, instead, spits saliva? While most adult psychotherapy patients have developed a well‐internalized ability to keep their bodily fluids contained inside their bodies (with the possible exception of tears), severely and profoundly learned disabled patients can drool, vomit, urinate, defecate, ejaculate, and spit in the midst of a psychotherapy session. In view of this little‐discussed, yet not infrequent, clinical phenomenon, how can a psychotherapist function when under attack from the patient and his or her actual bodily fluids? In order to explore this aspect of disability psychotherapy, the author will discuss an eight‐year treatment with a psychotic, brain‐damaged psychogeriatric patient who spat compulsively in an aggressive manner. The author will describe the way in which he endeavoured to use classical psychoanalytical approaches in order to create an environment of safety in which the patient could begin to experience greater mental containment as well as bodily containment, and eventually arrive at a state in which her spittle could be transformed into feelings and even rudimentary words.