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DURING THE PAST SEVERAL YEARS I have been engaged in the process of treating deeply disturbed, hospitalized patients with long-term intensive psychoanalytic psychotherapy. In reviewing my work, as well as the reports of colleagues, I have found increasing confirmation for the idea that significant change in a patient's understanding of himself and his world is inextricably bound to a parallel process of questioning and growth on the part of the therapist. The formation of an intense therapeutic relationship with a very troubled individual necessarily leads the therapist to a painful questioning of his traditional theoretical posture and accepted technical procedure, often ultimately stimulating considerable uncertainty with regard to aspects of his professional and personal identity. This paper provides an account of the first year of treatment with a young woman hospitalized with the diagnosis of "schizophrenic character disorder." The clinical material presented here illustrates how one therapist's effort to engage in radical inquiry into, and modification of, his own theory, technique and personal response in the clinical situation facilitated subsequent inquiry and similar efforts at integration by the patient.
During the course of this therapeutic endeavor, I participated in a study group which considered in detail some aspects of the work of Jacques Lacan. In the midst of mounting confusion with regard to the patient and her psychotherapy, my discovery of Lacan was a serendipitous event, providing a fresh conceptual framework and personal stimulus for modifying the understanding of this patient's difficulties, making possible a reorientation of practice. In particular, the impact made by encountering the work of Lacan, in the