ABSTRACT
When I First Thought About discussing longer cases, I had some discrete categories in mind: different chapters would depict the four pathways to symptom formation, a particular patient demonstrating each one, or perhaps I would order the material by specific symptomatic problems as I did in the last chapter. The complexity of working with real human beings rather than general concepts has confounded all my proposed organizational schemes. The patients I present here typically have multiple symptoms originating in more than one pathway. They are quite varied in their symptoms, the level of need and usability they demonstrate pertaining to symptom-focused interventions, and their overall functioning, including self-cohesion and attachment style. None of these conceptual formulations, however, provide a useful heuristic device by which to differentiate one patient from another in isolation. Therefore, my discussion of the following four cases does not delineate neat categories, but it does underscore the complexity and comorbidity of psychopathology and the fact that symptoms must be understood in relation to the whole person who suffers from them. I hope this case material conveys some measure of the individuality and specificity of each patient, our relationship, and the ways in which I tried to tailor interventions accordingly.
