Two hours at work, with Amanda

When we inaugurated the Analyst at Work series three years ago, we recognized that publishing process material from a psychoanalytic treatment might present formidable problems to colleagues who wish to share their work in this format. Hence, we decided to offer the option of publishing clinical material anonymously for analysts who felt that the usual approaches to the problem of confidentiality—asking for consent, thick disguise etc.—were not entirely satisfactory. Prior to this number of IJP, we had not encountered a colleague who wished to exercise this option. However, we publish here for the fi rst time an account of two sessions by an analyst who wishes to remain anonymous. We believe that this approach is a useful way to convey what actually happened in an analytic process while also protecting the patient's right to privacy.

Amanda is a 32-year-old woman who has been in analysis for about six months. She is a compliant patient, in the sense that she comes on time, pays her bills promptly and respects the analytic frame. Nevertheless, she finds many things, most minor but some major, to complain about.

One detail to which she has turned her attention and that has subtly if pervasively shaped her sessions is the placement of tissues in my office. There are several boxes available, but none is near the couch, which Amanda uses. This omission, which I am somewhat at a loss about how to correct, has been noticed by many analysands. Most have hit upon the solution of picking up a box that sits on a table that they pass on the way to the couch, then either returning the box at the end of the session or leaving it to me to do so. Amanda, somewhat bitterly protesting the absence of the tissues, said that she knew she could take the available box, but that it didn't seem right, because it would feel humiliating—as if she was announcing at the beginning of a session that she was going to become tearful. Of course, she could bring her own ti