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Ellen is a 34 year-old doctor in training as a psychiatrist. She had her first three-year psychoanalysis with a woman about ten years ago. She sought treatment because of her dislike of sex and because she was anorgasmic. Often she felt depressed, especially at weekends when alone. Separations from her boyfriend Thomas after weekends made her sad and left her in a distressed state, crying for much of the day.
Ellen was born in another country and spent her first years there. At about the age of one or one and a half she started attending a day nursery. Both her parents were scientists and she had an older brother. Her parents got divorced when she was 8, when her father fell in love with a woman in another city, left the family, and moved away. On his rare visits, her father seemed unenthusiastic with the children, mostly walking around with them for a few hours. Ellen missed his attention and acknowledgement, and mostly felt criticized by him when they were together. When she was 12, her mother moved the family to another country where Ellen felt rather isolated in her new school.
During these years the mother seemed to be rather depressed. Years later she told Ellen that she had thought of suicide during those periods of despair. After a few years the mother found another man and married again. Soon after the marriage the mother gave birth to a daughter. With the mother's marriage and new daughter Ellen felt even more lonely. At the age of 16 Ellen started dating the man who was to become her husband some years later. Thomas became the person she could be intimate with as she sought solace away from the family.
In those years, Ellen consciously wanted to be a boy. She was tomboyish and loved to participate in sports. Two years into the relationship with Thomas, at the age of 18, she became sexually active. At the age of 18 she graduated from school, moved to another city close to where Thomas had started his professional training, and lived in a family with young chi