ABSTRACT
Chapter 2 presents a detailed illustration of how reflecting on the patient’s presenting problems in the language and enactments of the first sessions allows the analyst to see the way in which these crucial problems unfold, shift, and change over time. The patient, a young professional woman, moved from a dangerous polyamorous lifestyle to a married life with a baby. In her internal life, she had identified with her depressed mother, with split-off memories of early trauma and repressed conflicts over dependency and over Oedipal and sibling rivalries. Ms C’s metaphors for her painful female bodily experiences, with affective states from which she was dissociated, were addressed by the analyst, often in the transference, and led to improvements observed in her psychic functioning. The chapter tracks the underlying clinical thinking guided by the three-level model. The six-year analysis of Ms C is explored with detailed observation and a bottom-up perspective, to show real, rather than idealized, changes in specific dimensions of psychic functioning: relational patterns with the analyst and others, and structural aspects of mental functioning. Through examining what the analyst interventions focus on, we discover the implicit theories with which she worked to promote the therapeutic action.
