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I WOULD LIKE TO EXPRESS MY APPRECIATION for the thoughtful comments of Kluft, Lewin, and Saakvitne in reviewing my clinical protocol of three consecutive sessions with a very complex and challenging young woman. Each response deserves its own response, but in the interest of space I would like to note some connecting themes among the three responders and give clinical examples of the therapy with S to support these themes.
Lewin and Saakvitne comment on attachment as central to the work with S. To this day, S reenacts her early disrupted attachment and traumatic attachment in her relationship with me. There have been many times when I have struggled to find the optimism Saakvitne expressed in her final paragraph regarding my relationship with S. More often, I am seen as the complex other, a threat and a promise as Lewin stated. During one of my separations from S, which occurred during her hospitalization at another facility, S recounted to her therapist at that hospital a fantasy of mutual acting out as if it had happened. The therapist understood this was fantasy, and I was able to confront S with her wish to have me be closer to her and also her wish to destroy me. The scenario was consistent with the possibility that S may have wished to destroy me in order to somehow possess me forever, as Dr. Lewin posited.
Saakvitne writes of S's fear of being left, her need to leave, and her need to control those who might leave her as central in understanding her actions and impulsivity. In fact, a series of impulsive actions on S's part resulted in a lengthy stay at a state hospital. I have maintained contact by phone with both S and her treatment team, at their request,