A Terminating Case

Dr B, a physician, was 39 when I evaluated him. He was married and childless, due to his wife's sterility. A couple of years later they adopted a baby girl. Twelve years before our initial meeting, he was in treatment with a practitioner of ‘direct analysis’. He decided to put himself in treatment for his intense anxiety, hypochondriacal symptoms, voyeuristic and exhibitionistic perverse tendencies, obsessiveness, social awkwardness and inability to speak in public. During this analysis the patient's symptoms worsened so much that he needed in-patient treatment for a month. Upon discharge, one of the psychiatrists in the hospital referred him to another analyst. Subsequently, Dr B was in a three-times-weekly analysis (45-minute sessions) with this second analyst for ten years. Throughout this analysis he experienced feelings of ‘reverence’ towards his analyst. Dr B's anxiety level diminished and he was able to work. However, neither his hypochondriacal concerns nor his social phobias abated. This analysis ended when the analyst died of cancer. Since Dr B needed to continue in treatment, he obtained from the analyst's daughter the names of several colleagues—myself among them.

I saw Dr B for six sessions of initial interviews before deciding to start a four-times-weekly analysis (50-minute sessions). I found him very anxious, avoidant, angry, inhibited and not particularly insightful. Nonetheless, some data of his history—especially his earlier level of functioning—made me inclined to think that he could benefit from a third analysis. In the beginning, and for many months, he could not contemplate thoughts of disagreement with parental figures. His father was a prison officer described as ill tempered, humourless and thoroughly unempathic. His mother seemed more understanding, but she used to paint a grim picture of all the dangers