Commentary by a Group Analyst and A Psychoanalyst

All in all Clara is doing very well, given her history of catastrophic, cumulative and strain trauma, made worse by the way in which her experiences were ignored and trivialized by the people who were close to her and by those in authority. It can be assumed that she is very anxious about being let down by people on whom she depends and on whom she might depend, and especially about her own aggression towards them. Her ‘farting phobia’ constitutes an unconscious microcosm for her life history, and it would be appropriate to analyse this within the transference/countertransference relationship. However, it is not clear whether her symptom is a phobia or that she farts in the ‘wrong’ situations.

I wrote the above paragraph before reading the report of a ‘recent’ session. I am aware that one or twice weekly sessions may well be all that can be managed by the patient and the therapist. However, the patient is telling the therapist that it is very hard to digest her psychic food and to eliminate her psychic waste when it is also necessary to wait so long for both what comes in and what goes out. She is very angry, not so much about being dependent as about the consequences of this, e.g. feeling frustrated, lonely, uncontained and unheld. She feels the painful absence of affective attunement with her therapist, as she did with her mother and other people on whom she depended for nurturing of various kinds. Clara's challenge is to make creative use of ‘flatulence’, which can be an expression of a wish for attunement as much as it can be an act of aggression.

I suspect the therapist has not seen him/herself as an ‘American’, but it is likely that Clara does, at least in some respects, and this should be explored. Clearly, Martha and Angela are not ‘Americans’, which is why they cannot ‘put up’ with Clara and vice versa, if by ‘put up’ we mean ‘strong enough to tolerate’ her unconscious aggressive feelings.

Clara fears that the ‘Indonesian’ man will exploit her. Perhaps in more