How to grow up or (nearly) die trying: developing trust in one’s own capacity for growth

This paper is a single case study describing intensive psychoanalytic psychotherapy with an adolescent girl, an apparently bright and capable girl who was struck down at 15 by a double blow of trauma and loss. She cracked along her fault lines which, it is argued, were created during the ordeal of her psychic birth in the first year of life. It is proposed that ordinary Oedipal humiliations precipitated anxiety about dependency. While any adolescent is likely to have to grapple with these difficulties, the terrible life events that befell this girl compounded her dependency just when she might have been moving towards independence. In addition, the ordinary task of mourning childhood and familiar family relationships was obscured by the new and devastating losses that needed to be mourned. Unable to face this task, she spurned the support of her loving family and any potential good object and instead became dependent on manic over-achievement and grievance. The paper traces how the intricacies of the patient’s internal world slowly unfurled through the transference and countertransference and through her story as she told it to her therapist. The therapist describes the slow and difficult process of making links between that story and their experiences together in the consulting room. The theoretical concepts that enabled these links to be made are outlined and the ways in which they guided the therapist’s technique are discussed.