The Woman Who Hurt Too Much to Talk: Unconventional Psychoanalytic Therapy with a Deeply Schizoid Woman1

I have presented the following case at several conferences over the past year. My conscious reasons for doing so include the following: First, Sarah, the woman I will describe, presents fewer problems of confidentiality than most of my current and former patients, partly because of her reclusivity and partly because she died of a sudden illness during our therapy. Second, Sarah is a fascinating example of a high-functioning person whose psychology was profoundly schizoid and whose inner world had never been exposed to anyone before she started to try to open it up to me. Third, talking and writing about her allows me to process my grief about her death and the abrupt cessation of our work. The more I got to know Sarah, the more I admired her courage and appreciated the internal suffering that she had kept entirely private for all of her 55 years. It was painful to lose her before I could know her better.

Most centrally, however, I believe that the story of her therapy illustrates a theme about which I have been speaking and writing for many years — namely, that what is most valuable about psychoanalysis and the psychoanalytic approach to treatment is not a particular technique or process but a set of values and a body of knowledge that can inform and give shape to any kind of therapeutic effort. Other practitioners may have worked differently with Sarah, but any sensitive therapist would have been confronted with the need for a creative solution to her unique predicament. The short version of describing the therapeutic challenge includes a life-threatening depression, a consuming obsession, a personality structure so schizoid as to constitute a diagnosable personality disorder, and an eventual medical crisis that put the therapy in jeopardy. The solution that she and I crafted for her complex dilemma expressed the idiosyncratic interplay of our respective personalities and is a good example of a treatment that I consider quintessentially psychoanalytic despite being