Joining technique in psychotherapy with pre-oedipal patients: a model of clinical navigation between intervention forms

Abstract

The joining technique is widely used in psychoanalytic practice when working with patients at a preoedipal level of personality organization. However, in clinical work, therapists regularly face the necessity of choosing between different forms of joining, primarily ego-syntonic and ego-dystonic, depending on the current psychodynamic situation. This article proposes a process-oriented model of clinical navigation between forms of joining, focusing on ego-syntonic and ego-dystonic joining based on the analysis of the patient’s affective presentation, the therapist’s countertransference reactions, and the phase of the psychotherapeutic process. Drawing on the theoretical foundations of modern psychoanalysis in the tradition of H. Spotnitz and the authors’ clinical experience, the article analyzes the mechanisms of the technique, including ego-syntonic and ego-dystonic joining, as well as their role in reducing resistance, facilitating narcissistic transference, and safely processing intense affects. Particular attention is paid to the differences between these forms and the logic of clinical decision-making in their application. Using clinical vignettes and examples from individual and group psychotherapy, the conditions for the effective application of the technique are demonstrated.