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Dr. Fosshage and his patient have earned our gratitude by their willingness to share with us a portion of their therapeutic work together. As is to be expected, it was not an easy decision, given the inevitable impact on the analytic process, as well as the concern about publication of sensitive material. In deciding to make this contribution they have provided us with an unusual opportunity to clarify some of effects of theoretical stance on the conduct of an analysis.
In this fascinating clinical material we hear an echo of “The Two Analyses of Mr. Z.” (Kohut, 1979). Again a first analysis, while helpful in bringing some order in the patient's life, ended in an impasse and the patient in a state of chronic depression. This result appears to have been related to the patient's demands for expressions of caring from the analyst, whom she reported as evasive and “a walking corpse.” While making allowances for possible distortion in the patient's report, the analyst as described appears to have been unnecessarily constricted and less than empathic, apparently unwittingly entering into an enactment of a major transference fantasy, some elements of which were to become clear in the analysis with Dr. Fosshage.
Forewarned by this burden carried by the patient, and forearmed by his more empathic theoretical orientation (and perhaps