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Most striking, in this moving clinical paper, is that the patient comes through as a likeable, even admirable, very real three-dimensional personality. This reflects Mrs. Sandford's respect and genuine concern for Elsie as a person. That such a severely traumatized patient was willing to accept the therapist's admission of error in rejecting her “gift” and return to therapy speaks well for the rapport the analyst was able to establish with her.
I question the therapeutic value of analysis when for Elsie it was not enough to give interpretations. One cannot work through resistance and transference feelings, i.e., work analytically, with a patient for whom interpretations are not enough. Since the therapist was aware of this, why play the “May I give you an interpretation” game? How can one expect a patient who cannot differentiate herself from the outside world (from the “not-me” person) to possibly utilize transference interpretations which require the capacity for such differentiation.
I suspect analytic uncovering technique would be antitherapeutic for such a patient, and may have been responsible for her psychotic paranoid-anxiety break after two years of analysis. I believe Elsie wisely defended herself from analysis by bringing her “impedimenta” to the couch (thereby misusing it, and negating its analytic function). She sensed that she needed a meaningful encounter with the therapist and converted her enforced position on the couch into a real relationship by shouting “Stop!” whenever the therapist would “interpret” instead of being such a real person.
The parameters introduced by the therapist at the patient's insistence were the therapeutically effective modalities. Elsie could only master her traumatic memories by reenacting them with the therapist. For example, only by the analyst “becoming” Spooty and allowing herself to be overstuffed, i.e., by a non-verbal reexperiencing in action, could any meaningful resolution be accomplished. Similarly, the therapist ha