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The patient described in this article was treated for two years nine months, first at home, then in the office by face to face psychotherapy, and finally on the couch. The clinical and analytical material is divided into five stages. In the first stage, the patient was listless, mentally and physically retarded, unable to leave her bed, and suicidal; she also suffered from 'visions' of her daughter who had died in an accident. After learning of the tragic death of this girl, her only child, the patient appeared to be identified with her daughter. The second stage was primarily devoted to stimulating the patient to speak (her speech was impaired), and during this period she had epileptiform fits upon leaving the doctor's office, at her home, and elsewhere. In the third stage, the patient was able to establish a relationship with the therapist mainly by projecting upon him her own internalized object imagoes. She showed complete dissociation of her transference feelings—love for her father and conscious rejection of him; hatred for her mother and for her father's attacks upon the mother. The patient's feelings were strongly ambivalent. The fourth stage showed a patient more capable of handling her conflicts verbally and emotionally, without the need for conversion symptoms such as skin rashes and metrorrhagia. In the fifth stage she made many gains, some of them dramatic, by her psychological understanding and acceptance of facts.
The author further describes the dynamics and structure of the patient's personality. He discusses the countertransference and its therapeutic value, the method of interpretation, and the reasons for the lack of dream material.