You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
Thinking about my case history I remembered the famous story by Ernest Hemingway: the struggle of an old experienced fisherman for his captured marlin, which finally ends with sharks destroying his precious prey. Hemingway’s story does not serve as an allegory but rather symbolically expresses a characteristic of the analysis which I will report on below. In the following encounter with a patient an old analyst exposes himself to the depths of impending hopelessness and wrestles with the question of whether destructive dynamics will ultimately gain the upper hand.
I first saw the then thirty-eight-year-old patient, Mr A, in 2015, when I was seventy-five years old. Mr A came to the outpatient clinic of our psychoanalytic institute. A training candidate conducted the initial interviews. Due to legal regulations, I had to see the patient once. I then also took over the supervision of this initial interview process. Mr A had just completed a lengthy analysis and was suffering from a worsening sleep disorder. Clinical treatment had been unsuccessful. Three years later, Mr A contacted me again, having not found an analyst among the members of the Institute who was willing to take him into treatment.
This raises the question of whether I would have accepted him as a patient had I been younger. It was clear to me that it would be a long analysis which would go beyond the scope of the public health insurance. I would then only be able to continue the analysis at a significantly reduced fee. Would I have done the same as a young analyst who had to support a family and finance a house purchase? As an old, well-off and experienced analyst I felt more secure and could also fall back on something that I consider to be important. I was tempted to take on the challenge of what was probably a very difficult analysis with an uncertain prognosis and probably problematic countertransference entanglements.
The patient was born as the only child of parents