Discussion of Dr. Epstein's Case

I should like to begin by suggesting two condensed formulations: the patient's view, and that of Dr. Epstein, of the patient's central psychodynamic constellation at the outset of treatment. Such a statement is one way to derive the clinical theory that informs Dr. Epstein's thinking and her technical approach to analytic work.

Here is the patient's initial view of herself as told to the analyst: she allowed herself to be repetitively “mistreated” by men, to suffer and endure a painful therapeutic situation for six months, to find herself victimized and helpless in professional situations—because—she had been sexually abused by her brother when she was a child. The organization of Dr. Epstein's initial view of the same clinical picture reflects her psychoanalytic emphasis on her patient's internal conflicts around “sexual and aggressive issues.” She notes that “these were increasingly unsuccessfully handled by her long-standing inhibited masochistic stance.” In other words, Dr. Epstein's view, consistently maintained, developed, and elaborated in forthcoming years, was that her patient's masochistic relationships to objects, her guilt, and her inhibitions were attempts to control and express in disguised form her own partly unconscious sexual and aggressive drives.

During the initial period of psychotherapy, she interpreted the patient's fearful belief that in supporting her growth and in assisting her to loosen her dependent ties to her mother, the therapist would cause her to betray her mother and her own moral scruples. Such interpretations helped the patient to achieve insight into her anger