A Question of Absence

This paper was written in an effort to process rather extreme countertransference reactions to an ‘absent’ patient, i.e. one who attended her twice-weekly psychotherapy only sporadically. At times she did not come for up to several months and consequently a serious debt would accrue. However, it was not so much the amount owing but rather the constant cancellations, with seemingly ‘rational’ excuses about her non-attendance that would provoke an intense frustration accompanied, at times, by furious, almost sadistic countertransference feelings. The patient kept her therapist ‘dangling in uncertainty’ (Brenman Pick, 2002), which the author considered to be a reflection of the patient's inner sado-masochistic object world. The author attempts to make sense of her countertransference in the light of the patient's early relationships and subsequently forms a hypothesis that the absences have been necessary to convey, very powerfully, experiences that may not have been communicated by regular attendance. Finally, the author offers her ‘Afterthoughts’ in the light of developments since the patient has read the paper and given her permission for publication.