When Only a Jolt Will Do: The Crunch, a Case Discussion

I was well aware of the fact that analytic patients were made, not assigned, when I was approached by the intake committee member about Ray. “Do you think he might be interested in coming more frequently?” I asked. “Hmm, maybe.” She seemed somewhat cautious, not her usual welcoming self. I brushed it aside as something not to be wondered about openly because this would be my first potential analytic patient.

She gave me a brief history of a 33-year-old man who described himself as depressed and anxious his whole life. On the intake form he wrote that he felt “caught in a holding pattern,” that he could “no longer keep playing the game,” and that he was “seeking to understand the cause of why I live in fear.” The form detailed numerous serious suicide attempts, a long history of drug use and periodic binge drinking. The final line read: “Needs experienced therapist.” Educated I was; experienced I was not. I felt intimidated, but I needed him for my training requirement. How bad could it be, I thought. With over 10 years working as a nurse on an inpatient psychiatric unit, I certainly was no stranger to these issues. So armed with my curiosity, I met Ray. He appeared younger than 33. Perhaps it was the baggy worn clothes, long hair tied back in a ponytail, and straggly goatee that made him seem