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It is a sign of the times, but also of this analysis, that Dr. Lombardi's account begins with a countertransference disclosure. Before we have anything but introductory information about the analysand, we have a sense of how her analyst feels about her—the frustration and disenfranchisement that we can feel with patients who act out and externalize, as this patient certainly does. And even the “diagnostic” introduction itself is laden with the analyst's affect; consider the emotional impact of the categories eating disorder, claustrophobia, agoraphobia, incipient alcoholism, and tobacco addiction.
And throughout the presentation, it becomes clear that any commentary on this material is, more than usually, a commentary on Dr. Lombardi. This is not only because he reports his participation with great openness, but also because of the way he has chosen to structure the presentation itself. The first of the reported sessions occurred fully five months before the next, and the last two, although from the same week, are not consecutive. This is a reasonable way to present, but not the only way. The effect is very different, for example, when an analyst chooses to present, come what may, the second and third sessions of the next week with a particular patient. Under such circumstances, the discussant is not engaging a text constructed by an author who has any particular narrative agenda (I say this, of course, holding in mind the appropriate caveats).