Discussion of Dr. Dunn's Case

To begin my brief discussion of Dr. Dunn's report, I should like to consider the meaning for Dr. Dunn's patient of the couch and of lying on the couch. This theme runs through all the material, from the beginning right to the end of the second vignette. That the analyst is a candidate, carries particular meanings from the patient's point of view as she begins analysis. This fact gives her a sense of protection. With several people knowing about the analysis, the institute can be invoked to warn the analyst that theirs is not a secret relationship as hers with her father has been (see her references to the social worker and Dr. T, for example). In fact, I suspect that in the beginning, the analyst really became the incestuous father for her, and we learn much later that she had a near delusional certainty that he also would make sexual advances to her. From the analyst's point of view, being a candidate put pressure on him to turn this patient into an acceptable case as quickly as possible in order to graduate. How much this explanation covers or is merged with what countertransference inclinations, we cannot say. I agree with the analyst that his comment to begin the analysis now or sit up and talk about it more, included a challenge or manipulation. It also conveyed his belief, taught as doctrine in those days in some institutes, that analysis begins only when the patient lies on the couch. Additionally, the pressures of being a candidate under the perceived superego authority of the institute with its rules became, I think, an impetus and a rationale for his assuming a parallel role to the patient. Feeling his own choices were somewhat preempted could inevitably limit the analyst's ability to pick up and respond sensitively to what beginning analysis means to any patient, but crucially to this one.

The “requirement” of the couch was interpreted through the filter of the patient's fantasy life and it influenced the intensity and