Discussion

MY COMMENTS on this paper are based on my supervisory work with Dr. Ortof as she struggled to get this difficult patient into a workable analytic relationship. The patient was originally accepted for treatment because she presented primarily her depression and deepseated need for personal help to the screeners. However, the beginning months of treatment were very discouraging. The depression lifted rather readily on a transference basis when she sensed the presence of a helping person. She then became preoccupied with external realities, the lack of a husband, the lack of money, the burden of raising her children alone and focused on her need for help with external problems. Especially, she seemed to want therapy to help her get married to her boyfriend. It was quite clear that she wanted her new and better mother to find a replacement for her absent dead father as seen in Dream A. In Dream B, actually the first one after she started analysis, she showed little hope for internal change. It is as though she would settle for a new facade, for superficial change, for better "make-up." After her father's death when she was 12, she experienced her mother as increasingly critical. External appearances were stressed by such degrading remarks as, "Put on some make-up, you look like you're dying." (a good background for Dream B.) Her ambivalence about treatment, her fears that a woman near her own age could not possibly satisfy her inordinate needs became clear as a second stage of regression occurred. She quit her job and for a short time could not pay even the low established fee. She found her dreams baffling and irrelevant, seemed unable to interpret them, showed little ability to use her dream images as symbols and seemed to have a restrictive way of thinking. It was hard to get her to look inside herself because the outside dilemas in her life seemed so pressing. Some of the catastrophes such as a fire in her apartment (which occurred before treatment)