Sandra Kopit Cohen, M.D.

I will present details from one analysis and a short vignette from another as a basis for addressing the three questions posed by Dr. Willick.

S., a thirty-six-year-old single, depressed woman, came to me for consultation after leaving a seven-month psychotherapy with an analyst who had become severely ill. S. informed me that I was one of many therapists she had consulted during the previous two months. In the first session she wearily repeated a synopsis of her life history and the events of her last therapy. She readily linked her mother's protracted struggle with cancer to her own difficulties in handling the secrecy and uncertainty surrounding her therapist's illness. The mother's illness began when the patient was five and ended in death when the patient was twelve. S. was currently taking antidepressants, a tranquillizer, and a sleeping pill, all of which she had been on for many years.

In the second hour, S. appeared tense and angry. She exploded with rage about the coldness of my greeting, my office decor, and my educational background. She remained mocking and critical throughout the session. She began the third hour as if she had never been angry at me. When I drew her attention to the shift in her affect she paused, as if surprised, and then said she no longer felt angry since I had passed the test of tolerating her rage without having withdrawn or retaliated. I recommended that she begin treatment with any of the analysts she had seen, rather than continue to pursue additional consultations. I told her that along with her manifest efforts to find the perfect therapist, I thought she was using the consultations to publicize her last therapist's mistreatment of her. She responded that while she relished the thought of punishing the therapist, she also worried that the therapist would be unable to support herself if too many patients left. This last treatment had been S.'s first exposure to an analytically oriented psychotherapy. S. sadly recalled that she h