Discussion of Karen Martin's Clinical Case

Martin's description of her work with Holly has a biphasic before-and-after-the-enactment quality that I think often characterizes our retrospective analysis of a lengthy treatment process. Although these behavioral events, with their dramatic intensity and reorganizing impact on both the patient and therapist are important nodal points in organizing a compelling narrative, it is upon the earlier bit by bit construction of an environment in which they can unfold that I wish to focus. Within that context I briefly discuss the multiple transference meanings inherent in both the chronic and discreet enactments that occur between Holly and her therapist.

Martin beautifully describes the disregulated deadened state in which her patient entered treatment and which plagued them from time to time throughout their work together. Holly's efforts to vitalize herself through drugs, alcohol, and, later, addictive liaisons to transiently idealized but flawed women were only temporarily enlivening. The repetitive cycle of obsessional fantasy and relentless pursuit of her love objects, followed by crushing disappointment and withdrawal, Martin suggests, had its roots in Holly's adaptation to her explosive alcoholic mother. In an attempt to garner her mother's highly contingent attention and approval, Holly had become a one-way mirror—reflecting flattering air-brushed images of her mother, but sequestering her own needs and affects behind a vertical barrier of disavowal. Her father, a “not not idealizable figure,” warmhearted and friendly, after years of “endless availability” for his wife's excoriating attacks, abandoned the family when Holly was 13.

Holly's lengthy (11-year) psychotherapy was dominated by her need to feel supported, affirmed, and special in the eyes of her therapist. From her earliest hours, her approach was to “entertain … touch … and impress” Martin, whose “playful, affectionate” response evolved into a stabilizing appreciation of this young woman's “brightness an