Adult Case: The Case of Amelia: (The presenter has asked to remain anonymous)

Amelia, now 55, has been married thirty-five years and has two daughters and one grandson. She is employed in the human resources field and has an advanced degree. She is now beginning her ninth year of four-times-a-week analysis, which followed two years of psychotherapy. At first meeting, Amelia presented herself as self-assured, with an air of bravado and an easy, joking laughter. I recall my first impression of her those many years ago as a more androgynous version of the television character “Maude.” Time has shown how much this persona protected a much less confident and quite fragile sense of self—as well as a considerable intellect. Amelia is short and, when treatment began, was rather stout in build. Her then gray and very curly hair was cut in a short, severe style, and she wore no makeup. Amelia's preferred clothing at the time was blue jeans, a sweatshirt, sneakers or penny loafers, and a unisex flight jacket. She found carrying a purse awkward and so usually arrived jangling loose keys, sunglasses, and other paraphernalia. At times she adopted a somewhat masculine gait and gestures, which together she described as her “swagger.”

When Amelia first consulted me she was experiencing increased stress over two major issues. She had been unable to make the necessary decision to move her then 85-year-old mother, who had been living with Amelia and her husband for twenty years, into a suitable nursing facility. She felt too guilty. I knew that her failure to act was eroding her marriage, driving her crazy, and contributing to an escalation in her problem drinking. The second source of upset for Amelia was what she described as “the sudden breakup” of an intense four-year friendship with a female friend, Rhoda. Amelia became nervous, indirect, and rather vague about their relationship, saying that they had been soulmates, seeing each other almost every day and talking on the phone for long hours. Rhoda had broken off the friendship, telling Amelia only that she w