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Analyses are likely to contain silent gratifications even when they are being conducted with orthodox technique. Such gratifications most often become manifest when termination is contemplated; when the patient faces the loss of the secret gratifications, derivatives appear which finally unmask them. In the incident to be related, however, a silent gratification made itself known at a time when there was no thought of termination; its appearance was precipitated by an adventitious event.
The health insurance provided by the large corporation for which her husband worked paid eighty per cent of the cost of the analysis of a woman in her late twenties. The remaining twenty per cent, in part a tax deduction, represented a trivial expense for this couple who each had come from a comfortable background.
The patient detested being a woman. As she was a college graduate and highly intelligent, however, she considered herself 'the best of an inferior breed'. She was angry with her obstetrician for putting her to sleep during the delivery of her two children, both of whom were boys. She said, 'For once in my life I wanted the feeling of having something male down there'. At the time of the incident to be described, the analysis was well advanced and the patient's phallic strivings had for a long time been recognized, acknowledged, and worked over.
One day the patient announced that the insurance plan was to be changed so that it would no longer cover the analytic fees to such a generous degree. She wished to know what I would do about it. I explained that my fee had not been based on the fact that this insurance was available to her and that, therefore, there was nothing for me to do.1 She became angry and there ensued