Discussion of the Case of Otmar Presented by Dr. Gion Condrau

I want to thank Dr. Condrau for his very interesting narrative of an apparently paradoxical therapeutic process. This patient, Otmar, achieved sufficient release from his severe neurotic imprisonment to gain relief from a crippling physical symptom and to develop sufficient freedom in matters of love and sexuality to be able both to marry an apparently loving woman and, later, to father children. Otmar made this progress in spite of presenting massive resistance, from beginning to end, to the kind of give-and-take between analyst and patient that we think of as necessary for analytic work. In this discussion, I shall attempt to make some sense of this apparent paradox from what I would loosely term my own interpersonal-object-relational perspective, a perspective which I have found applicable to a large number of treatment situations involving borderline and narcissistic patients.

Although I have had to fill some gaps in Dr. Condrau's narrative to develop a more complete understanding of how he might have facilitated his patient's therapeutic progress, I have been mindful of the danger of unwittingly reshaping his narrative to create a new narrative that might better conform to whatever preformed concepts of theory and practice with which I might have approached this task. I hope I have been reasonably successful in evading this pitfall.

From an interpersonal-object-relational perspective, I would understand that to the extent that the emotional growth achieved by Otmar is enduring it would signify that his treatment had a profoundly mutative effect on the pathological internal self-and-object-world with which he entered treatment. As a result of his unfortunate experience growing up with such unstable caregivers as his psychotically controlling and abusive father and his weak abandoning