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At the 220th session of his 370-hour analysis, Shawn informed his analyst that he had noticed profuse “night sweats,” prominent lymph nodes in his groin, and at blood testing was HIV positive. A number of questions arose in the midst of the analyst's clinical bewilderment and pondering:
Should he present alternative psychotherapy recommendations to the analysand in light of this devastating development? If so, how would this recommendation be timed and presented?
Should the analyst himself conduct supportive psychotherapy and/or adjunctive family or couples sessions?
Should the analyst function as a psychiatrist in the ongoing liaison with Shawn's attending physician and internist? Should he refer to a colleague for this? Would not any such referral represent a profound symbolic rejection to the analysand?
Shawn had joint custody of his 5-year-old son and his first welter of anxiety-laden associations focused on what to tell, what not to tell, and how to deal helpfully with his beloved young son. Should the analyst suggest prompt consultation with a child-analyst colleague?
Shawn had minimal ARC (AIDS-related complex) symptoms, so the analyst asked himself if he could in fact continue in an analytic process to a usual or unusual termination. Could this be done with or without “parameters?”
If Shawn developed dementia early in the course of ARC or inevitable AIDS, how would this be detected and what parameters or major changes in the analysis would need to be made?
How would the analyst deal personally with the inevitable countertransference reactions and personal sorrows, anxieties, fears, and practical problems in this case?