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Every psychoanalyst is occasionally confronted with the baffling and uncomfortable situation presented when one of his patients, some years after conclusion of a successful analysis, returns with a new crop of “old” symptoms. After overcoming the feeling of disappointment, the analyst's thoughts most center around one problem: the advisability of continuing analysis, either by himself or by a colleague to whom the hapless case would be referred.
The disappointed analyst postulates the following explanations for the situation: 1. The transference situation has not been solved. 2. Deeper layers, not analyzed, were involved. 3. The analysis tapped the dynamically decisive layers, but not thoroughly enough, hence more “working through” is required. 4. The diagnosis was wrong in the first place.
It is easy to understand that possibilities 1 and 3 are emotionally preferred. Further analysis frequently reveals that possibility 2—deeper layers have been left untouched—is involved.
Assuming, however, that all four possibilities can be excluded in a specific case, and the analyst did a good and thorough job, the fact that the symptoms recurred must still be faced and explained. Aside from the theoretical problem, there is still the matter of a patient who has to be helped—if possible.
To adduce a clinical example:
A woman in her early thirties entered analysis because of street fear which had left her almost entirely incapacitated. She had had two previous analyses. One was with a psychotherapist of a split-off group (three years), the other with an acknowledged analyst (two years). Nothing had changed during these treatments; on the contrary, the symptom had become worse. These experiences left the patient completely skeptical about her chances of being helped. Before giving up for good, however, she took a rather unusual step. She had