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Dr Yardino gives us three glimpses of her three-year analysis of Ignacio: first, the initial meeting; then, a session in the first year demonstrating the negative transference and its challenges; and, finally, a dramatic countertransference enactment in the third year, immediately followed by a deeply gratifying session for both patient and analyst. Ignacio later refers to this crucial session as the ‘break point’ in their work. This term ordinarily defines a point of discontinuity, change, or cessation, or a situation in tennis where one more point is needed to break the opponent's serve. Either meaning might apply. A formidable, seemingly impregnable narcissistic structure characterized by isolation, devaluation, and aggressive omnipotent control appears to hold the advantage, but suddenly yields to its disadvantaged opponent, object love. Ignacio poignantly describes this remarkable and pivotal development as the emergence of ‘acts of love,’ which include ‘affection’ and ‘generosity.‘
The case report conveys sincerity and emotional immediacy. Both participants are portrayed with clarity and precision. Their encounter is simply and directly placed before us, as if in a story by Chekhov. Importantly, there is no sense of a hidden theoretical agenda, further contributing to the sense of aliveness and quality of transparency. The author marks in italic type the phrases of Ignacio that had portent and impact for her, and she is consistently open and honest about her feelings and fantasies toward her patient. I was quite taken with the story of Ignacio and his analyst from the start.
Despite the pessimism for the future expressed in the initial interview, I found Ignacio appealing during my first reading, even though at that point I lacked knowledge of the positive turn that would follow. Dr Yardino elicits from Ignacio momentary seeds of reflection and feeling. For example, Ignacio reveals during this first hour that he knows he is difficult to live with, that nothing c