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Dr. Sperling offers us her extensive and rich clinical observations as a basis for her dynamic formulations with regard to somatic symptomatology in phobia.
She states that fixation to the anal-sadistic phase also has implications for the vicissitudes of object relations in her cases. My attention is drawn to the comment about vicissitudes of object relationships, since I believe this may be fundamental to understanding her excellent therapeutic results.
Mahler (1972) states as a “Freudian tenet … that object relationship” is the most reliable single factor by which we are able to determine the level of mental health on one hand and, on the other, the extent of the therapeutic potential.
Dr. Sperling seems to establish increased awareness of self- and object representation, particularly when she works with mother and child. She writes of a “fuller understanding” in the mother-child relationship. I would assume that Dr. Sperling's own clear image in the transference is basic to that understanding.
It may well be that adequate sphincter control is related to separation of self- and object-images on a relatively constant, objective level. For example, Lisa's ulcerative colitis subsided when she became interested in other children and developed a life of her own.
A brief account of a patient with symptoms and phobias (agoraphobia and claustrophobia) might offer some basis for discussing one of the therapeutic aspects of Dr. Sperling's paper. The case is that of a young woman who lived with her mother and who could rarely leave her home or travel even a short distance. She feared losing bowel control before she got
to a “safe” toilet. In the first part of her analysis she concentrated on her gastrointestinal distress and rarely spoke of her phobias. As the analysis progressed she had fantasies of losing her abdominal contents and replacing them with part objects of her mother and of me. These fantasies were related to another fantasy of being alone, as a small child, helpl