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Firstly I must state that this patient, her scant history and her treatment plus the detailed two sessions left a sad impression on me. I already sensed the impotence, disturbance and aggression felt by both, patient and therapist, when I read the introduction and history, even before reading the details of the two sessions.
The first problem I encountered was that I could not find any working hypothesis regarding diagnosis, personality structure, defences, aetiology and treatment plan. There was a good description of the patient in general and of the interaction between patient and therapist but no plan or formulation about the understanding of the case. I myself feel uneasy if at some stage in my work with a patient I have not established some working hypothesis about a possible aetiology, the involved dynamics, the external and internal factors and a foreseeable prognosis.
After reading the therapist's account, Miss X seemed to me very ill, adopting a passive-aggressive stance that made her almost unreachable. Her ability to provoke a negative and angry counter-transference reaction in the therapist made her in my eyes a sadistic person but, of course, with the complementary masochistic elements. After reading the details of both sessions I was left with the impression of having witnessed a tug of war with no winner. From a classical psychoanalytical point of view, the therapist uses the right technique and interprets the transference correctly adhering strictly to the rules of good training and correct understanding of the here-and-now