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In my opening remarks I shall try to illustrate not only how I think about this or any other patient, but also why I think as I do.
My main point is this: conflict and compromise formation are of central importance in psychic functioning. All psychic activity, including neurotic symptoms and character traits, is a compromise among drive derivatives, anxiety and depressive affect, defense and superego. In this patient, staying away from men, hating them, clinging to her parents and to her analyst, her masturbation fantasy about the mad scientist and his nurse — all are so determined. One cannot ask, therefore, “Is this defense? Has this to do with castration or with loss of love? Is this gratifying? Is this self-punitive?” The answer will always be “Yes” to each such question. What one wants to know is the answer to the question, “Which determinant of this compromise formation is it most useful to interpret to this patient at this time?” To answer it for any patient at any time one must know much more than what that patient said in this or that analytic hour. One must have an overall understanding of the patient's dynamics. One must understand what that patient's most important conflicts are, and one must follow a line of interpretation which is based on that understanding. One doesn't just interpret this today and that tomorrow, forgetting about yesterday and the day before, as though each day something quite different bubbles up to the surface