ABSTRACT
In this chapter i discuss a patient whom I have treated for about 10 years. The first phase of my work with Ann involved intensive psychotherapy with three sessions per week; this stage was followed by several years of less frequent and sometimes sporadic meetings. The patient's chief symptoms related to generalized anxiety, with hypervigilance, physiological overarousal, and excessive worry. Ann had a history of anorexia nervosa, and, although her weight was normal when she entered treatment, she continued to experience some body-image disturbance and to restrict her eating. Ann's symptoms predominantly correspond to the pathway I have described as anxious vulnerability to fragmentation. More specifically, she attempted to cope with the inadequate self object milieu in her family by disavowing need altogether, including need for food and for relationships. Unable to trust, she tried to control interpersonal interactions. Hoping to disconfirm her pathogenic beliefs that she had to take responsibility for everything because no one else was competent, and that vulnerability would be punished, Ann engaged in many transference tests. A successful symptom-focused intervention early in treatment was instrumental in convincing this young woman who had abjured trust that I could provide her with competent help.
