Comments on the Case of Raquel

Clinical material can always be looked at in many different ways and, having been given a free hand by the editors, I have chosen in this instance to look at the patient's attitude to the setting and the structure of the analysis. The importance of the setting, or as some people have called it the analytic frame (Bleger, 1967), has been widely recognised. It plays an essential role in containment because if the patient is able to feel confident in the stability, adaptability, and humanity of the setting he/she can, within its protection, feel contained and hence free to express him/herself both positively and negatively. Segal (1967) has emphasised that the most important aspect of the setting is the attitude of the analyst and it is this that is expressed by the various practical aspects, such as the layout of the consulting room, the frequency and timing of the sessions, the fee, etc. Klein (1936) suggests that the most important aspect of the analytic attitude is that “our whole interest is focused on one aim, namely on the exploration of the mind of this one person who for the time being has become the centre of our attention. Correspondingly everything else, including our own personal feelings, has temporarily lost importance”.

We all recognise that such an attitude is difficult to sustain and that the analyst will invariably enact his own conflicts as other preoccupations occupy his mind. Indeed, part of the analytic attitude is to accept how difficult it is to sustain and preserve the setting. Moreover, we must also recognise how difficult the patient finds it to be contained within the setting and this was true of the patient described here, who was often assailed by claustrophobic feelings and felt the need to attack the structure in what seemed to her to be a bid for separateness and freedom. I thought that the patient found the setting quite persecutory at times, but that she was also greatly appreciative of the analyst's struggle to preserve it in a human