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Paul William's paper documents the heroic analytic treatment of a profoundly ill patient. Initially Williams, bombarded with disconnected images and affects, struggled to find firm mental ground. Together, he and his patient moved earth around, creating an island in this sea of confusion. With a different therapist, a different island would form. Williams stayed with Miss A without rebelling against her attacks on his thinking, forcing his reality on her, or abandoning her as “unanalyzable.” I sensed an instantaneous maternal transference, in which Miss A desperately tried to get her mother's (Williams's) attention (Kramer, 1996). Chronically, Williams had to contain his apprehension, reassuring himself that, if she had survived this long, she would probably be there for the next appointment.
Most impressively, Williams remained curious about how his patient understood his remarks. Rather than relying on “Let's see what comes to mind” and assuming his words were understood, Williams found that “exploring the fate of [his] interpretations was [his] main activity.” This provided an alternative to the “Director's” dogmatism. Rather than hearing “Do as I command,” Miss A heard, “I made an observation. I recognize that a powerful part of you blocks you from listening. Did you understand me? What is your opinion?” Gradually incorporating this attribute, she could negotiate with her own warring mental components. Thus, Williams demonstrated that there are better defenses against anxiety than dissociation.
Williams did not react fearfully, even when Miss A came armed with razor blades or knives. She sought praise for her bravery but found