Katherine: A Long, Hard Case

Abstract

This article memorializes my long-term therapeutic relationship with Katherine. In reconstructing our work, some general ideas about long-term therapy became clear. Most important, as life contexts and needs changed for both patient and analyst, so, too, did the therapeutic work. As our respective contexts shifted and interacted, new therapies emerged unbidden, complete with new players, new roles, and affective responses and altered therapeutic tasks. It turned out that, in this work, flexibility with theory and clinical procedure was a frequent challenge and necessity. As Katherine's and my relationship deepened over time, achieving what I call "analytic intimacy," my personal bond with and sense of responsibility to Katherine also intensified. This long relationship, then, raised this question for me: What is the therapist's relationship-affectively, practically, and morally-to her patients' suffering?

Developing a reflective self in cyber space.

“…This included face-to-face sessions, crisis telephone calls as needed, occasional sessions with Donna and her partner, and eventually cyber communication. This array of options made it possible for us to observe, and engage with a range of Donna’s affects and self-states that may not have been available if there had been rigid adherence to a traditional treatment frame (Weisel-Barth, 2011). I believe that my availability and a flexible treatment frame was fundamental for Donna’s treatment, though it also presented considerable challenges, as will be discussed below.…”