Case presentation: Jean.

Abstract

This symposium was devoted to the consideration of Dr. Mary Libbey's treatment of a 22-year-old woman. The unfolding of the analysand's symbiotic attachment to her mother, the devastating sequelae of her having been the stable center of a pathological family that devoted itself to the care of a severely handicapped sibling, and her immersion in unresolved mourning form the center of this richly detailed and carefully reported case study. In addition, four verbatim sessions are reported, one from each year of the first two years of treatment, and two from the third year of treatment. Dr. Epstein's discussion, praising Dr. Libbey's therapeutic skill, makes note of the issues in the patient's family of origin that served to prepare her to feel endangered in the treatment. Dr. Epstein's view is that the analyst has created an analytic situation that, because it is minimally impinging, allows the patient to become increasingly aware of her unmet needs in a way that is tolerable and minimally "destabilizing to the symbiotically based organization of her internal self and object world." In the climate of safety created in the treatment, the patient can begin to complete the work of mourning for her sister, friend, and aunt, a process of mourning that would be impossible in the context of her nuclear family, centered as it is on a mother who cannot tolerate separation. Limit-setting in the treatment is seen to be reassuring to the patient, facilitating as it does the analyst's commitment to maintaining the integrity of the analytic situation. Dr. Schafer's discussion, while in agreement with Dr. Epstein in recognizing the excellence of the presentation and the sensitivity and hard work that had gone into both the treatment and the clinical presentation, included some specific and focused observations about the transference and countertransference situations prevailing in this treatment and also some suggestions for creating a more consistently safe analytic atmosphere for this particular patient and others like her. Dr. Schafer proposes that the therapist acknowledge to herself and accept as well as possible the inevitable feeling of helplessness such patients provoke. In a more concrete vein, he advocates talking in the first person declarative as much as possible, preferring "I don't understand" to the more standard "What do you mean?" or "Why?" The therapist is encouraged to eschew interpreting what the patient says about the therapeutic relationship for a long time, and, further, he suggests not quickly connecting or easily reducing the therapeutic relationship to childhood prototypes.(ABSTRACT TRUNCATED AT 400 WORDS)