Reply to the Discussions

I am grateful to Salee Jenkins and Beverly Keefer for their thoughtful responses to my clinical case.

Jenkins has broadened and deepened my understanding of my work with Holly. She looked at my case through the lens I was using and discovered things there I had not seen. She has provided me with important additional ways of thinking about and understanding my patient, myself, and our treatment. Jenkins elucidates complexities in my case that I missed, and she generously suggests that my unconscious awareness of these may well have informed my work. Jenkins's major focus in her discussion is on “the bit by bit construction of an environment” in which what I identified as a crucial turning point in Holly's and my work could develop. The turning point to which I refer was the bursting into consciousness of an unconscious vertical split in myself that mirrored that in Holly and that had “trapped” us for years in an enactment. In so doing, Jenkins has contributed a great deal to my own appreciation of the “unfolding” quality of my work with this patient. Although she acknowledges that specific enactments by the therapist constitute “important nodal points” in a psychotherapy, she argues throughout her discussion for a more sensitive and deeper understanding of the “multiple transference meanings inherent” in the interactions that precede and facilitate such major enactments.

Jenkins suggests that a period of time, even an extended period, during which the therapist finds herself not interpreting the resistances may in fact be less collusive with a patient's avoidance than responsive to the patient's need for paranoid-like control of the treatment relationship. Although I welcome this idea and even feel that I can in retrospect value its merit in helping me to understand the early period of the treatment with Holly, I also find myself a bit apprehensive about latching onto it, fearful that such a notion offers an “easy way out” of potentially valid therapist guilt for not h