Discussions of the Case Study

Dr. Karme has presented us with a moving account of a beautifully conducted and, I believe, eminently successful psychoanalysis. One can sense the patient's deep gratitude in her metaphorical depiction of her evolving subjective world as a painting wherein her formerly

dominating fear and distrust are becoming transformed into a barely noticeable red speck amidst an array of newly acquired affective colorations. I could not ask for a more evocative illustration of Atwood's and my (1984) conceptualization of structural change as a process whereby “the ossified …forms that have heretofore structured the patient's experiences are progressively …reorganized” (p. 60), opening up an enriched and expanded personal reality.

Dr. Karme's clinical material richly illustrates the central points of my earlier theoretical paper. This case clearly illustrates the bipolar structure of transference, as well as the continual shifts that occur in the figure-ground relationships between its conflictual/resis-tive/repetitive and selfobject dimensions. In her formulations of the analytic process, however, Dr. Karme places her emphasis on the working through of the conflictual pole and largely overlooks the enormous therapeutic action of the concomitant establishment and strengthening of the selfobject dimension of the transference. While Dr. Karme's emphasis is consistent with classical tradition, I believe that the consolidation and transformation of the selfobject transference bond, even when this is silent and largely unanalyzed, is a vital therapeutic component of every analytic cure.

With these general remarks in mind, let us take a look at some of the clinical material. With a history marked by traumatic losses, abandonments, and dislocations, replicated with uncanny precision in her previous treatments, Mary immerses herself early in her analysis with Dr. Karme in an intense idealizing transference. Dr. Karme recognizes in Mary's early dreams her “underlying fear of abandonment” a