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Alexander treated—during thirty-six interviews extending over a period of ten months—a twenty-three-year-old university student who had suffered from a duodenal ulcer for five years, and manifested a deep-seated personality disorder. The patient's psychodynamic conflict consisted of repressed dependency needs, against which he defended himself by overcompensatory aggressive competitiveness and a sham independence. His sexual behavior aimed solely at conquest. Studied casualness and a inability to feel emotion served as a further defense against the dependency longings.
The treatment utilized the development of a transference neurosis of low intensity to effect a shift in the dynamic forces. The patient was consistently made conscious of his wish to be taken care of by the analyst. Through acceptance of his dependency needs in the transference relationship, the patient became more tolerant of a certain amount of dependence on others which, in turn, lessened the need for the character defenses. By a process of working through, he freed himself of his various defense mechanisms and allowed more mature attitudes to come to the fore. With the development of the transference and the beginning of alteration of the patient's character structure, the ulcer symptoms disappeared and had not recurred in the half year following termination of the treatment.
The technique employed in this case differed in some significant respects from customary analytic procedure. Interviews were conducted face to face. At the beginning, twice-weekly interviews were employed to facilitate establishment of the transference and more quickly alleviate symptoms; later, sessions were spaced at weekly intervals. The transference neurosis was not permitted