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I IMMEDIATELY THOUGHT OF this patient when I was asked to participate in this conference, though upon later reflection I came to the realization that the "long haul" of this particular analysis started right from the beginning. While the initial consultation struck me as a reasonably good one, and I remember looking forward to working with this patient, I cannot recall a honeymoon period, or that slow, steady buildup of mutual confidence and collaboration that one expects to occur, however minimally. My task, as I came to see it in the early years of our analytic journey, was to "make" the analysis alive, so to speak, and not yield or submit to the patient's despair. There seemed to be a fundamental interaction between the patient and myself that kept dragging us both down, and that seemed intractable to whatever attempts I made to understand and clarify what I saw as transpiring between us.
Yet in the seven years that we have worked together, there have been significant improvements in the patient's well-being; I hesitate to say of a fundamental nature, though I think so. How to understand them? As I thought about those long, difficult years which I shall shortly describe, a number of questions emerged.
The first thing I became aware of was that my memory of those first years was one of bleakness and frustration that, in fact, echoed the patient's state, whereas in looking over the patient's dreams for those years, I found that many of them were filled with people, activity and aliveness, however troubled and conflictual the context. The people in her life were constantly interacting in her dreams, playing out her feelings of being excluded and uncared for. I, too, became a figure in her dreamlife where her fears about my competence and caring predominated and to a lesser degree her wish for closeness with me. What to make of this discrepancy?