3. Breakdown of Communication between Patient and Analyst

In Chapter 2 I briefly drew attention to some of the things which can go wrong to undermine the analyst's therapeutic efforts. In this chapter I want to illustrate some of these difficulties more thoroughly by examining in more detail some of the material about the patient, Sylvia, mentioned in Chapter 2 and presented in one of my seminars. The analyst presenting the case had previous psychiatric hospital experience but had not previously attempted a psychoanalysis of a psychotic patient. She got into considerable difficulties with Sylvia's treatment, and the patient eventually broke it off. In the seminar we came to be aware that this outcome occurred partly because the analyst had not obtained a clear enough assessment of the patient and so had not arranged adequate support for herself and her patient, but also because the analyst was not able to bring the therapeutic factors in the treatment into effect. Specifically she became preoccupied with her own line of thinking and was unable to hear the patient's warnings that she was pursuing a wrong line. To illustrate what I think happened I shall interpose reports about Sylvia's sessions (made by her analyst, Dr M., and printed in italic type) with my own comments printed in roman type.

'In May 1974 Sylvia was twenty-seven and had come five years ago, with her husband and first child, who was then six months old, to England. In the first consultation she told me that one month before Christmas 1973 she mentally collapsed and could not do anything. She suddenly had a feeling that she was never going to see her parents again and there would be no more aeroplanes, so that she felt it was like ‘dealing with the dead’. She first attributed her breakdown to the fuel crisis in England. Only later on did she