This case describes the treatment of a middle-aged woman with a history of extreme physical and sexual abuse seen in psychoanalytic psychotherapy two and three sessions per week. Dissociation and enactment are two salient features of the therapy. Detailed clinical vignettes that occurred over the eight-year period of treatment highlight co-created sequences involving intensified affective moments experienced by the analyst as often challenging, perplexing, and surprising.

I have never worked with a patient as denigrated, as humiliated, as falsely blamed, and as sexually and physically abused as Ann. We are still working together, so you are hearing work in progress. This is not only Ann's story as I understand it, but it is also my story of experiences that Ann and I have co-created together. Naturally, Ann would have her own version.