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DISCUSSION: Dr. Stuart Asch questioned how the therapeutic relationship is established in cases where little or no suffering is present. He compared certain specific phenomenology of Dr. Zavitzianos' patient to other groups of patients: mothers involved in the 'battered child syndrome'; the anhedonic syndrome seen in young women who complain of total lack of pleasure and feelings of emptiness; and the 'as if' type of patient.
Dr. David Milrod discussed the therapeutic alliance, the nature of object relationships, and the transference. Although depersonalization is very common in delinquents, these patients find it difficult to effect the 'benign' split of the ego essential for analysis. A factor threatening the establishment of a therapeutic alliance is the importance of the oral root in the genesis of delinquency. All these patients, he feels, have a defect in the ability to internalize that results in a poorly differentiated self- and object-representation and an underdeveloped superego. Dr. Milrod felt that the essential reason for the successful analysis of Dr. Zavitzianos' patient lay in ego resources which were greater than in typical cases of delinquents, making it possible for the patient to form a therapeutic alliance and to develop mature object relationships.
Dr. David Abrahamsen felt that the basic diagnosis in this case should be in terms of ego strength rather than delinquency. Dr. Walter Stewart stressed that the therapeutic alliance is very difficult to maintain in patients with symptoms of