ABSTRACT
Dr. Greenman has provided a beautiful and moving case study of a patient who is severely narcissistic, but more specifically gripped by her pathological identifications, what Leslie Sohn has called the "identificate" which is in contrast to those identifications that are more flexible and integrated within the ego. Dr. Greenman's description of Mariah's return to her sessions after one of her "vacations" took author's breath away with its provocative quality. A significant development in the treatment occurred when Dr. G was able to accept the inevitability of the patient's transformation of her interpretations into sadomasochistic exchanges. This required that the analyst gain a level of comfort with author's own sadistic impulses in order to work with her effectively. Dr. G has just given Mariah an impassioned statement reflecting her concern and interest in her patient—Mariah bats it away, obliterating the words she has just heard from her analyst, thereby attempting to maintain her victimisation by the analyst.
