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Following Dr. Wright's and Dr. Grayson's prepared discussions a lively exchange took place amongst the members. It was generally agreed that this was a most challenging case.
Dr. Stephen Rittenberg asked if there might be alternative ways of understanding the case that might have allowed for different technical approaches. Specifically he wondered if the patient might have had what Etchegoyen describes as a perverse transference in which the pleasure in destroying the analysis, and, in fantasy, the analyst, outweighs the pleasure of getting well. Dr. Rittenberg thought that such a patient might well have had an inhibiting effect on the analyst, and that early active interpretation of the aggression was thereby blocked.
Dr. Carl Kleban was also struck by the enormity of the patient's rage and felt that everything the analyst said or did was viewed as a threat as he externalized his own aggression. Also Dr. Kleban observed that the patient communicated very little about his everyday life. Mostly what we know about him is communicated in his exceedingly violent and perverse fantasies. There is evidence of early disturbance, including childhood phobia and early anal preoccupations.
Dr. Richard Gottlieb felt this was a profoundly disturbed man whose early problems with his mother made him terrified of being like her. Dealing with that early disturbance would be crucial for treatment to have a chance.
Dr. Lipton emphasized the anal material and the need with such a patient to reconstruct the traumatic experiences of childhood. He wondered if the patient may have been enuretic.