Ending analysis: The case of Karl

Karl is a tall, attractive man, a designer, who was in his early fifties when we met. He was in a state of turmoil. His wife and he had been in a roiling crisis for at least a year. Now, she was about to move out. She had told him that she needed a break from being a wife and mother. However, she would stay if Karl would only say he loved and wanted her. He felt terrible about the possibility of a divorce and feared he would “starve without her.” However, he complained that if he were to say he loved her, she would have power over him that she would turn to her advantage in the future to threaten him with leaving. In the first few sessions, Karl had a striking tic that involved his right shoulder and head. It disappeared after a few meetings.

Karl felt himself to be caught between feeling dependent on his wife and resenting her criticisms. If he were single again, he imagined finding a more physically attractive woman, a calm woman who wouldn’t scream at him and their two children. The problem was that, among other things, he relied on her to tell him which of his design projects were well conceived and which wouldn’t work. Though she had no training in his field, he relied on her stamp of approval. To the degree that he relied on her, he was extremely sensitive to her disapproval. On the other hand, where he tried to convince me that he was an inadequate lover, she reassured him the opposite was true.

While Karl and his wife slept under separate rooves for about the first month of treatment, they communicated regularly. He suspected she might be unfaithful and she later confessed to having had the same worry about him. When she returned, he felt for a time that she was more loving. However, they continued to clash over the children and he now added her having moved out to the items he held against her.

Karl had married in his mid-thirties. Following two miscarriages, his wife had conceived their son in the midst of arrangements to adopt an infant daughter. Consequentl