Is There A Role for the Psychoanalytic Psychotherapist with a Patient Dying of Aids?*

Reporting this case is a chance for me to evaluate my therapeutic stance with a woman dying of AIDS, and to communicate with colleagues who have been or will be faced with such a crisis. My theoretical appreciation of working within the transference-counter-transference was essential in treating this case as in any other. However, as the body's demise became more and more an issue, I had to go beyond the usual therapeutic parameters and trust in another therapeutic communication. In continuing this treatment, I had to believe in and use a type of communication between two inner selves. I had to be willing to gratify a symbiotic connection with my patient as we attempted to disengage from her rapidly dying external reality and to enter a living vibrant internal reality.

Arthur Robbins (1989) describes the therapist's dilemma in his report of a supervisory session with a therapist treating a patient dying of AIDS:

A therapist's solutions and experience with a dying patient presents its own therapeutic parameters that must come into contact with the therapist's professional ego ideal, the flexibility of a therapist's boundaries, and his or her theoretical notions regarding the place of gratification and responsiveness in treatment. I would like to suggest that if we perceive normal development to involve the movement from the inside to the outside, that perhaps it is also fitting to entertain the possibility that at a certain point in development there is a redirection of energy from the outside to the inside, (p. 248)