Case Response III

The case of “Patricia” stirs up many different emotions for me, more on each reading. I will wend my way through them, starting with the sting of recognition. Patricia reminds me of several former patients, about whom I could say, along with the writer, that whenever “I offered a comment that I felt was compassionate … she responded in a murderous tone.” My training analyst spoke, once, about the difference between jealousy and envy—jealousy, she said, is wanting what the other has, and deciding to work hard to get it for oneself; envy is wanting what the other has, and lashing out to hurt the other because of it. Jealousy, in this formulation, offers the opportunity to learn or try something new; envy insists on the familiar and rejects change.

In my experience, much of the work of analysis consists of moments of meeting that are relational and satisfying, i.e., they feed us “good food.” We get to be present with profound, intimate transformation, receive the look of gratitude on a patient's face and their obvious mutual care in response to the holding and careful putting-into-words that we offer, and witness the positive effect on a life over time. But just as much of analysis is, as the writer says, “long periods of darkness when we don't know where we're going nor why we continue to walk together.” Patricia was caught up in a pattern of attacking the “good food” of analysis, out of a reasonable fear that it would only cause more hurt.

On a practical level, when a hateful transference is aimed at us, it's difficult to gauge what being “helpful” even means. It's one thing to experience hate occasionally—then we can celebrate it as a widening of emotional potential. But ongoing hate is a difficult, confusing project. I remember a case consultant saying, once, in response to yet another hour about one of these

challenging patients, “Well, I can see that you know how to tolerate hate!” I felt pride, at first, hearing this, but later a cold fear crept in and took its