Discussion of Dr. Stilman's Case

It was a pleasure to read this vividly presented and richly detailed account of the difficult analysis of the middle-aged Mr. X, whose independent wealth allowed him to sustain a lifelong pattern of regressive acting out, in which his various infantile fantasies pervaded relationships that otherwise might have been satisfactory and stunted his professional work that might otherwise have been more accomplished. Patients like Mr. X are among the most difficult to analyze: the Fantasy-Enactors of Great Wealth. Dr. Stilman is to be commended for her perseverance in this analysis, as well as for the refreshing honesty with which she communicates her countertransference concerns. The content of this analysis is so rich that it is not possible to do it justice in a brief discussion, so I will focus on a couple questions that seemed to me particularly interesting: (1) What turned Mr. X into a lifelong Giggle Baby? (2) How to handle the chronic acting out of this fantasy in the analytic situation? (A problem compounded by Mr. X's previous treatment with an actively responsive and sell-disclosing therapist.)

In regard to the first topic, the question might be asked: Was there something that happened to Mr. X in his childhood, in addition to his parental constellation, which included an aggresively seductive and overintrusive mother, and a powerfully impressive but distant father—both of them survivors of families that perished in the Holocaust? As if this parental combination wasn't enough, was there something particular that happened to Mr. X? I'd say yes, he did suffer an important trauma, a mammoth one-two punch in his fourth year of life, when his baby sister was born, and he was banished to summer camp. In one fell swoop he was displaced in mother's affection and was removed physically from her presence. All this must have been