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Ms. M first sought help from me in 1988, when she was 25 years old. We began working in analytic psychotherapy, meeting three times a week and face to face. After two years, in 1990, I converted the therapy to analysis, meeting five times a week and using the couch. This is the current arrangement.
Ms. M was a tall, slender, blonde young woman, who described, in intense, dramatic terms her despair, depression, and anxiety. She could not give a starting point to these, stating that she had been unhappy all her life, that she was “born unhappy.” Recently, she often awakened at night in terror, filled with desolation and with the conviction that she was growing old, deteriorating, losing her looks, and would certainly be alone and unloved all her life. Sometimes these states of terror were accompanied by the idea that she would soon die. She had recently moved to New York and begun work at an advertising firm. She hated New York and her job, but had no feeling for where she wanted to go or what she wanted to do. She felt adrift in the world, unconnected to anybody and anything. She wanted help in determining where she should live and what occupation she should follow, but she didn't want to remain in New York, and she wasn't sure I could do anything for her in the short time she could bear to stay.
This sense of drifting and unconnectedness had characterized Ms. M's life since her mother died from breast cancer when she was 15. She stayed at home with her father while completing her last years of high school, then went away to college. It took her six years and several moves to complete college. She experienced those years as