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The treatment process of a patient with Crohn's disease (Enteritis granulomatosa regionalis) is presented in order to illustrate the therapeutic-technical approach from the standpoint of psychoanalytical self psychology. Crohn's disease is a chronic, inflammatory gastrointestinal disorder that can involve all regions from mouth to anus, but predominantly affects the lower intestinal tract. The disease, now considered to be autoimmune, progresses in stages and responds to immunosuppressive drugs. Yet neither the etiology nor the pathogenesis has been entirely elucidated, although there are indications of a genetic predisposition. Immunological processes that sustain the inflammation argue in favor of a predominantly IgG2 antibody response to an exogenous, possibly microbial-bacterial antigen that triggers an as yet unknown initial event. A significant role is attributed to nutrition; during acute phases artificial feeding is necessary.
Referring to the treatment process, I want to illustrate how painful attacks of diarrhea, to some extent accompanied by fever, which occurred during therapy, were triggered by disruptions in the therapeutic process and overcome by its restoration (Wolf, 1988) and how the tendency of the patient to react to personally taxing situations with