Analyzability and the Average Regrettable Environment: A Discussion of Lucyann Carlton's “Struggling Out of the Box”

This article explores the psychoanalytic treatment of Renee, a patient with a history of trauma that far exceeds the “average regrettable environment” and posits that this case rests on two assumptions. First, the analyst's belief that reliving affects experienced during multiple childhood rapes and beatings by her father is a necessary experience for her to stop dissociating during her present emotional life, and second, the analyst's belief in the significance of a loving, accepting relationship with her analyst. Because Renee appeared to be living in a state of equilibrium prior to treatment, it appears that her disorganized and near fatal behavior may have been catalyzed by the very existence of her treatment. A more structured approach to treatment is recommended. The long-term “hold” of the therapeutic gains is considered in light of the fact that Renee conformed to the desire of previous others in her life. The apparent positive result is questioned, considering that it may not take into account the potential limitations of Renee's options for further relationships. I question whether more could have been accomplished with less trauma related to the therapeutic regression.