The “skinless self”: a psychoanalytic case study

In this paper, I explore a clinical case through the lens of psychoanalytic theory, drawing on the works of Anzieu, Bick, and Kernberg. By integrating theoretical insights with clinical observations, I aim to illustrate my patient’s struggle with the sensation of having thin, wounded skin—lacking its protective upper layer—a ‘skinless self’ marked by profound vulnerability and self-injury as a means of regaining control and establishing a sense of grounding. Furthermore, I examine the therapeutic process, emphasizing the roles of transference, countertransference, and the creation of a holding environment in reconstructing the Skin Ego. This paper highlights the necessity of establishing a containing environment before engaging in deeper interpretations, demonstrating how psychoanalytic psychotherapy can help stabilize a fragmented self. Ultimately, this case underscores the importance of addressing fundamental deficiencies in self-containment when working with patients experiencing severe personality pathology.