Clinical Approach to a Narcissistic Aspect

I should like first of all to welcome the IJPA/IRPA Editorial Board's excellent idea of illustrating through these presentations how psychoanalysts in different parts of the world work day after day and session after session with patients.

I begin my paper by introducing the case, giving the reason for consultation and some personal information about the patient; I also add some information gleaned during the course of the analysis, which helps to convey the climate of the sessions, but omit other points on grounds of discretion. I then transcribe two sessions from consecutive days, Tuesday and Wednesday.

When the 43-year-old female patient came for consultation, she had had an analysis lasting several years and wanted to continue with a view to solving the problem of her frigidity, which she presented as the sole reason for consultation. Once this had been said, I felt that I had lost the patient, as her attitude was rather as if there was nothing else to talk about and it merely remained for me to set the days, times and fees.

My countertransference feeling was of the kind of patient who comes to a medical consultation, explains the symptom and expects in response the immediate supply of the drug that will solve the problem. I could not discern any emotional commitment whatsoever in what she was requesting or looking for, and I therefore considered that the isolated aspect of frigidity brought by the patient would assume a more serious dimension as a personality disorder in the transference-countertransference relationship.

At first I could presume that what she called frigidity was a devitalization of the link, or a non-link. I began to ask questions: she had been married for 15 years and had no children; the reasons she gave were very confused; sometimes she said it was because her husband had told her he was not prepared to have any, while at others it was she who did not want them because she was afraid of not knowing how to treat a baby. At yet other