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The patient was a scientist in her late twenties who came for psychoanalysis with a presenting complaint of vaginal anorgasmia that had persisted throughout her marriage and that had proved refractory to counseling. She had not been similarly disabled outside of marriage. She also suffered from an inhibition to publish her work under her own name; she therefore had not completed her doctoral dissertation. She was, however, readily capable of doing outstanding research which she permitted her immediate supervisor to present as if it were his own.
Extended evaluation confirmed the presence of a stable neurotic character structure with marked obsessional features which were residua of a painful childhood obsessional neurosis that had never been treated. Psychoanalysis appeared to be the treatment of choice, and it was consequently instituted.
The initial associative material suggested the presence of phallic oedipal concerns, but these did not seem to condense into a meaningful pattern. In the second year, the patient reported a dream.
I was preparing to give a dinner party with [my husband]. I was setting the table, and I went to the cabinet where my party dishes are stored. I found they were all broken. It was frightening. I woke up and found my period had begun. I was bleeding profusely.
This dream failed to preserve sleep, in part because the profuse menstrual flow impinged on the patient's awareness, but, as the accompanying affect of near terror suggested, in larger part because it could not guard against the emergence of the memory of a primary anxiety-provoking experience.
The first association to the manifest content was that the