Four sessions with Lisa1

Lisa is a patient aged 34 in her 10th year of analysis, begun because of panic attacks and serious agoraphobia sometimes accompanied by moments of depersonalization and derealization. During the sessions of the early years, she suffered manifestations of hallucinatory-type phenomena (waking-dream flashes rather than true hallucinations) that caused confused states. She had stopped studying and lived shut up at home with no relationships at all.

Alongside analysis at four sessions per week, she began taking medication prescribed by a psychiatrist, who was also a psychoanalyst, who followed the analytic work in tandem, with the agreement that this person would deal with any problem inappropriate to analytical treatment.

The first years were extremely difficult, even in getting Lisa to accept the need for a setting with sufficiently established rules. After some years, Lisa acquiesced to lying on the couch, which previously had caused her such unbearable anguish that I had had to accept the face-to-face position (the session after Lisa lay down for the first time, it had been so agonisingly distressing for her to lose visual contact with me that she dreamed she was on a child's slide made of sharp blades cutting into her).

During childhood, Lisa had been traumatized both by the lack of the most elementary attention from her parents and by the extremely violent intrusions of her seriously psychically disturbed brother. This caused me not a few technical problems: in Lisa's eyes, I was always in the wrong whether in deficiency or in excess. For a long time I felt myself to be treading a fine line between Lisa's catastrophic anxiety of being abandoned and her equally catastrophic anxiety of violent intrusion that alternately invaded her.

Much work followed, carried out with great commitment, passion and even pain by Lisa, which gradually permitted her to develop a capacity for containing emotions without them expanding the whole field (she had innumerable dreams of flooding,