Analytical Dialogue and Psychic Change a Clinical Perspective

In this paper I endeavour to illustrate the clinical vicissitudes of the analytical relationship with a patient who at the time of the first consultation presented many problems of therapeutic approach, which were tackled in different ways. Practically all the changes which occurred in his internal and external world were the result of a fruitful psychoanalytic interchange that was made possible by analysis of the transference and countertransference.

I shall try to convey the dynamics of the relationship solely through the channels of the analytical dialogue itself. I shall not be advancing any theoretical hypothesis despite the many implications of the clinical material.

The paper is constructed as follows. I begin with a summary of the development of the therapeutic relationship and of the patient's history. I then reproduce two complete sessions separated by three months. For comparison, these two sessions are preceded by fragments of a session dating from three years earlier. The paper ends with a separate section containing some notes on the material presented.

HISTORY

I shall call the patient who is the subject of this paper José. He came for consultation on the recommendation of his family therapist. He did not seem to have any idea of the reasons for the recommendation. He lived with his wife and only son, aged 14. His wife had for some years been suggesting that they should separate because it had become impossible to live with him; José could not agree because, he said, he had nowhere else to live.

At the time of the consultation, the patient was 42 years old. When I showed him into the consulting room, I was faced with a tall, slim person, conspicuous by his dress, his clothes old and shabby, their colours dull and clashing. From what he said and from his general attitude, I realized that he was aware of the negative aesthetic impression he made on people.

He claimed that there was no cure for his trouble because it was due more to the