This paper explores the coincidence of two substantial difficulties: where gross external interruptions to the psychotherapy (caused by the psychotherapist's miscarriage and subsequent pregnancy) paralleled circumstances of violence and abandonment in the patient's childhood and adulthood.

When two such difficulties coincide and are added to by time constraints, the question of what can be salvaged from the treatment arises. Two risks are discussed: that of withdrawing into a purely supportive, potentially collusive mode of treatment and, second, the risk of challenging the patient's denial (of damage to the therapist as well as evidence of any other damage) in a manically reparative, intrusive, way that is more to do with the therapist's wishes to avoid her guilt at letting the patient down.