Patient “Cathy” Wednesday week 1 Hour 1 Page 1

Copyleft Psychoanalytic Research Consortium

Patient/Therapist Conversation

Therapist Comments

1                       T:    Sit over there on the couch.

2           P:    I never expected it to look like this.

3                       T:    You did or you didn’t?

4           P:    Didn’t.

5                                   T:    Oh.

6           P:    It’s beautiful.

7                                   T:    It’s a nice office.

8           P:    I….I’m nervous.

9                       T:    Yeah. I see you are but just take it easy and tell me a little about yourself. (->)

10          P:    Mmmm – well, I don’t know what *Kenny told you.

11                      T:    Very little.

12          P:    Very little. Okay. I’m married. I’ve two children. I don’t work. I’m a housewife – but that’s work.

13                      T:    Yes. I know it is.

14          P:    Mmm – want to get right down to what the basic problem is?(->) I mean, everything else is okay except this one thing. Just, uh–you know, like when you’re supposed to go somewhere–an enjoyment–like, uh, someone’s house or a party or a movie–just something like that–I have–to me it’s an ordeal. I’d rather stay home and, uh, it’s like, uh–my husband doesn’t ask me to go anywhere because it’s like he puts me through the wringer to get to go where I’m going, you know. (laughs) And I’m just kinda tired of getting that upset, you know, just afraid togo and that one little part of my life, I don’t want it anymore. I’m getting very depressed, you know, before it used to happen and I was too involved with the happening and now I’m getting depressed about it happening and I kinda envy people, uh, just going and having a tegood time. When I’m there, I want to come back home, you know, it’s just (sighs) I don’t want it like that anymore. Everything else is fine–working around the house or doing things with my husband or the children, that’s fine.  I’m very happy but Id like to go out and then come back and enjoy that more. I think going out and–if I enjoyed going out, when I’d come back, that’d be even happier, you know what I mean? But, uh, I am very nervous to go places. (laughs)

15                      T:    You are.

16          P:    Very nervous or afraid to go places that’s….

17                      T:    To go places.

18          P:    Yeah. That’s the problem. (laughs)

19                      T:    Just to go to a party or something. How about going shopping?

20          P:    Well, that depends. If I’ve been in the house like say–well, I do all the shopping mostly myself – uh, like if wintertime comes and you’re not out that often, I get sort of stagnant about going out. If my husband says, “Let’s go shopping,” I might get upset, you know, but pretty much, going shopping isn’t too bad. The one time he took me out to dinner–it’s like a year or two years ago and I was holding my own through the whole dinner but I wanted to ho home–that was enough–and he suggested going to Korvettes shopping–that did it, I was in the bathroom and the whole dinner was up and I was a wreck. (laughs) You know, I was just–I’ve tried giving myself the third degree when it happens. All I can hear myself–is, uh, “I don’t want to go. I don’t want to go.” and I keep asking myself why, you know, and that’s–I don’t know why.

21                      T:    Have you any idea why?

22          P:    No. Not really. I-I think of a lot of things (->) that have happened in my life and my mother and father’s attitude toward things and I say–well, I understand that but I shouldn’t be, you know–let that influence me about certain things, you know.

23                      T:    What about their attitudes? (->)

24          P:    Well, they don’t believe in friends. That’s (laughs) a bad thing right there, you know. Friends are–growing up, that was kinda hard to adjust to and my father’s a very, uh–well, he’s kinda miserable but he’s a very over cautious man–like when the children are playing or running–: “Don’t do this–don’t–you’re gonna hurt yourself” type of a man, you know and that reflects, you know. I’ve–I can see that now grownup and, uh – that–I thought–well, maybe I got brainwashed, you know, about, you know, when you go somewhere, you gotta be cautious or something terrible is going to happen, you know. Just, uh–like I told *John, (->) uh–he asked me the first time it happened that I can remember and I told him fourth grade–like my mother was having fits at me, first, second, third grade–every time I’d go to school or someplace, I’d end up throwing up in the bathroom all the time and the first time I realized that I was afraid of something was in fourth grade when like me and this other girl were supposed to go to a movie with a nun and my mother sent me off to go meet the nun at the convent. Well, I never made it there. I walked around too scared to go (laughs) and came back home. Well, she wouldn’t let me in the house, she was just fed up, right? I mean, all these years of me constantly, you know, throwing up and not wanting to go places. So…

25                      T:    When was this? (->)

26          P:    Fourth…

27                      T:    When you were just a little, uh…

28          P:    Fourth grade. Yeah.

29                      T:    She was already-already fed up.(->)

30          P:    Yeah. She was already fed up. (laughs) To me, I didn’t realize I was afraid of anything and when she locked me out, I walked around a little more and I thought–gee, why was I afraid. I was afraid to go to the show with the nun. There was nothing to be afraid of but I didn’t make it to the convent because I was afraid to go there or something and that’s the first time I realized there was a fear but then, uh, like I told **Frank–later on, like sixth to eighth grade and high school, occasionally that would occur but not often and now, like the last six years of my marriage, you know, it’s-it’s getting worse, you know–it’s really getting worse (tears in voice) Uh, *John saysB@well, maybe it’s ’cause you’re getting close to your husband. You know, like you  were very close to your mother and now you’re getting close to your husband so you’re afraid–you know@, he thinks it’s abandonment or something. I read so many books and ego things and I tell myself–you got confidence–go–right? Doesn’t work.

31                      T:    What kind of books have you read?

32          P:    Oh, I forget the names of them. It’s just things to build your confidence and, uh, just have confidence in yourself type things, you know.

33                      T:    Mmm hmm.

34          P:    Never finished them because they just didn’t hold my interest. You know it just wasn’t the basic thing–but then I thought__well, maybe it’s recurring now because I have a daughter seven years old. I thought maybe me seeing her growing up is reminding me of something when I was little. I don’t know. I’ve given myself the third degree but I can’t–it’s like…

35                      T:    That’s an interesting thought. How old are your children? (->)

36          P:    Uh, I have a boy four–going on five in November–and a daughter, seven going on eight and she’s in third grade now and the boy is just in kindergarten in the afternoon and I know when I had to go to school, it was too much, you know. I just–I don’t know….That part–everything’s fine except–he could say “Let’s go to the movies.” and I’m in the bathroom. I mean, I’ve got…

37                      T:    Sick to your stomach, you mean?

38          P:    I’ve got–I have–I could be constipated and have instant diarrhea, you know, it’s just–between the vomiting and the diarrhea–that’s what’s going on in a sphere and I keep trying to come out of it–come out of the bathroom and go where I’m supposed to go and I run back in, it’s just a fear and I don’t–and when it’s happening, you know, I really say–what’s the problem. You know, I really try to say–what are you afraid of. I don’t know. I really don’t know. I’m like hitting a block wall and then, uh – we had a block club party in August–if you know what those are. All the houses sort of get together and we had a very nice one. We had a–Mayor *Jones’s youth club came out and drew up this big jumping jack and volleyball and everything and, uh, I was doing pretty good in the morning but the afternoon, I was in the house. I couldn’t get back out. I was–I couldn’t–the fear was there and I was all upset and it wasn’t until later in the evening, I was in control again and went back out and, you know, it’s just–that-that’s when I got mostly depressed about the situation. (->) Other than that, I never got depressed about that thing happening. I was too busy with it happening and then I realized, you know, like, uh–you know, (laughs) someone’s gotta help me.

39                      T:    Someone has to help you…

40          P:    ‘Cause I can’t–I can’t figure it out, you know (laughs)

41                      T:    Did you ever ask for help before? (->)

42          P:    No.

43                      T:    How come?

44          P:    I don’t–well, I never took it seriously. I just–see, it only happens when I’m going somewhere and that’s–the rest of the time, it’s fine–right. (tears in voice again) And kind of Kate I love selflike because our  family thinks psychiatry is something not really, you know–they don’t believe in it, that’s part of it, you know.

45                      T:    But you have relatives in psychiatry, don’t you?

[material omitted here]46          P:    Right. And *John is a friend and, uh–but they say friends and relatives shouldn’t get involved, you know–you should have some, uh….


47                      T:    But, in general, your family doesn’t believe in psychiatry?

48          P:    Well, my mother–I don’t know if she’s changed–she’s changed a lot, uh-uh, she knows I’m coming here today. I asked her a bunch of things of where I was when I was little and boy, we really skipped around and, uh, she told me a few things today that–you know, I thought–holy Christmas–everything, uh–see, I don’t I don’t know what it is. If I knew–I don’t know. Uh…

49                      T:    What about your husband? How does he feel about it? Treatment? (->)

50          P:    Well, he knows what it’s like when I’m going through this, you know. He-he doesn’t ask me to go anywhere, you know, or take me anywhere because he feels like he really upsets me too much. He’d rather just avoid, you know doing it and that kinda hurts ’cause there are a lot of times–gee, I want to go here. I want to do this but when it comes right down to it, it’s–it’s very difficult to get there, you know. It’s, uh–I’ve got a tremendous fear and I just–the whole body just goes up for grabs. You know, the mind–like, uh, I have tranquilizers *John gave me and, uh, to go to this wedding when–a family wedding, I took four–they’re 30 milligrams–I started like in the morning every four hours (tears in voice) well, still by the wedding, I still wasn’t relaxed and it wasn’t until after like the second highball that I started to just calm down and, uh, I was godmother just two weeks ago for my niece–well, I started Saturday evening and I even got up all during the night to take these pills every  four hours and my insides were calm but my head was still kinda, you know, like I was at the party afterwards and I still wanted to get home and that’s–you’re not supposed to be that way, right? (laughs)

51                      T:    It’s not that you’re not supposed to be that way but it’s certainly pretty miserable.(->)

52          P:    Yes. Yeah. That’s for sure. See, like, uh, there are things coming up, you know, like my children will  be–my daughter’s going to be making her first holy communion and they’ll be graduating and if I can’t even go to the ceremony, you know (tears in voice) that can hurt them and I don’t want to do that. All last year, I didn’t go once to the assemblies for my daughter and, you know (tears closer) it’s kinda rough.

53                      T:    You’re a practicing Catholic?

54          P:    Yeah. But they go to public school this year–we can’t really, uh–I hope next year we can, uh, send them to the Catholic school. I don’t know if that’s good or bad or what but…..that’s what we’d like to do, you know. But they have assembly once a month where they go on stage and they sing and you know, I’m too nervous to even go to that, (crying) and that’s, you know–when *John called last week or so and said, you know, I got you a doctor (laughs) to me, all the places I had to go was over with and I had these pills I depended upon–there’s nothing happening until Thanksgiving so I had like two months I was gonna relax and—right? And then I gotta come here today (laughs) …

55                      T:    I see. You feel you might have been better off not coming….(->)

56          P:    No. I-I–it’s gotta be solved. I-I can’t go through the rest of my life like this. It just…

57                      T:    But it scared you a lot to have to come here.(->)

58          P:    Uh, it really got to me.

59                      T:    Did you know what you were scared of?

60          P:    Uh, no. Just meeting you mostly and seeing if we would hit it off, you know, (laughs) and if you could really–and then sort of in my mind likeB>well, maybe he can really help me–maybe you’re gonna be on the road to recovery or something like that,= you knowB>at least to find out your problem and then you’d be a happy person, you know, to go out, you know.=

61                      T:    Your relationship with your husband otherwise, is okay? (->)

62          P:    Oh, yeah. We’re very happy We’re hard workers. (laughs)

63                      T:    What does he do? (->)

64          P:    He’s a salesman for *Stone Company. We’re in a dilemma right now. He’s changing jobs and, uh–when he was gonna change jobs, he was gonna get more at the second job and he told the first job he was quitting and now they came with a raise in pay and now he’s caught in the middle, so he’s in his own traumatic  decisions right now too. I’m not telling him one way or the other–we talked about it but I’m not making his dec-decisions for him so, uh-he’s going through his ordeal and I’m going through mine today. He’s supposed to call the second employer and tell him about the first employer giving him a-a better raise in pay, you know–after four years, he should have got it before but ( sighs)….

65                      T:    If you’re a practicing Catholic, what do you do about not having anymore babies? (->)

66          P:    Well…..I take the birth control pill. (laughs)

67                      T:    I see.

68          P:    I, uh–that part of it, uh–I don’t know–*Janey and *Nick came from a family of nine–*Janey’s the oldest.

69                      T:    *Nick is, uh…

70          P:    The second oldest.

71                      T:    Your husband.

72          P:    Yeah.

73                      T:    His name is *Nick.

74          P:    *Nick. *N – i – c – k.

75                      T:    I see.

76          P:    And *Janey is the oldest and *Nick is the second and my mother had four and I don’t know–I just want two–like one of each. I’ve seen things where when the first ones are growing up, everything is so strict and by the time the other ones come up, they’ve mellowed and it’s not evened out. Me, I want like to try to keep them equal and if I’m strict, the both of them are gonna get it, you know (laughs) Try–you know, just–’cause we my family I was the  oldest and they were very strict and my brothers–what they’re doing now–at my age, you know, I would have gotten killed, you know. It’s really–you know, they don’t keep the–they mellow and they change attitudes and they get a little looser, you know–I guess through understanding.

77                      T:    Mmm hmm. How long have you been taking the pill? (->)

78          P:    Oh, about five years. (laughs)

79                      T:    Do you feel guilty about it?

80          P:    No. No.

81                      T:    Do you confess?

82          P:    Yeah. At confession?

83                      T:    What did the priest say?

84          P:    Uh, well, he had a little sermon and they kinda tell you you really shouldn’t do it but mostly the priests–Father *Harry we go to–he’s young and he’s very liberal in a way, he doesn’t holler and scream or anything like that. Uh, he’s very understanding. Uh, some–it depends upon the priest too. Some are very strict and they’ll holler and give you the third degree but Father *Harry tries to talk to you, he’s young and, uh–but we’re not in that parish anymore so–now we’re switching so I don’t know what to expect. Depends…

85                      T:    You’re gonna take it no matter what the priest says, huh?

86          P:    Really. Yeah. Really. Because, uh–well…

87                      T:    It’s okay with your husband, I gather then…

88          P:    Oh yes. (laughs) Definitely. He’s spoiled. He comes from a….

89                      T:    What do you mean?

90          P:    Well, you know, every once and awhile, I go off of it, you know, to make sure I’m regular, you know, or make sure nothing and, you know, then you get your Pap test and, you know, it’s an ordeal for him to be, uh – careful, you know, he’s spoiled. It’s, uh…

91                      T:    Oh, I see what you mean. How is he careful? Does he pull out or what?

92          P:    No. Well, uh, prophylactics…

93                      T:    Oh, he uses rubbers.

94          P:    Right.

95                      T:    I see. But he doesn’t like to. (->)

96          P:    No. It turns him off. It’s so much simpler just to go at it without stopping, you know, after you get in the habit of that. Uh, there’s no problem with our sex relation or anything like that. It’s, uh…

97                      T:    Do you enjoy sex?

98          P:    Oh, yeah. (laughs)

99                      T:    Do you come?

100         P:    Oh, yeah. (laughs) Really. Yes. He helps. It’s-it’s–now I guess our marriage is…

101                     T:    What do you mean he helps?

102         P:    Well, he helps, you know. He just–he doesn’t just lay there and do nothing, you know, he’s involved too, you know. We’re both involved in that–it just doesn’t happen automatically. You both have to get involved, you know. Care–it’s sort of a caring for each other and, uh – I forgot what I was going to say. That there’s no problem in that category.

103                     T:    Mmm hmm.

104         P:    None whatsoever. It’s just that, you know, we’re getting older and tireder and there are times when by 10:30 we’re both sound asleep but you know, the next morning–during the day, you think about it but by the time the evening comes and you’re tired, it, uh–you know, you’re tired (laughs) and nothing happens but then it’s sort of like, uh–when it does happen, it’s better if it hasn’t happened in a longer period of time–like say, two weeks, or a week and a half, you know–then it’s  even better, you know. When you do it more often sometimes it’s losing it’s, uh–it’s excitement or something like that.

105                     T:    Mmm hmm.

106         P:    Uh, it–we work on it, you know. I’ll meet him once and a while for lunch and he’s a salesman so he can come and go when he pleases and we’ll have a good dinner and a few drinks and we’ll come back home and, you know, the kids are in school and, you know, then after two thirty, he might leave back for work, you know–we’re still getting it in even during the day when we’re not tired by the evenings.

107                     T:    I see.

108         P:    There’s no problem with that at all. Not that I know of.

109                     T:    The kids–there’s nothing special about them.

110         P:    No. They’re very active. (laughs)

111                     T:    They have no fears.

112         P:    Not that I know of. I –  not that I know of. Uh, our youngest is very open. I mean – it’s–he’s been getting out of hand, so we’ve been kind of trying to talk to him and tell him–and tell him, you just don’t do things like, uh–last Thursday–he was talking–he’s only in kindergarten–he’s talking about bringing his friend, *Lou home–told *Lou his address–he’s got a black and white garage and everything and that he wants him to come over and play. So that whole afternoon, he says–“*Lou didn’t come–*Lou didn’t come.” and I says, “Well, you guys are too little.” you know, “You just don’t do this without mother’s consent, you have to know where you are and you have to get his mother’s consent and his mother and I don’t even know each other because you two do in school doesn’t mean, you know, that we know each other.” Friday, he brought him home (laughs) and we live across a busy street–the policeman crossed the children–*Maple–and, uh, after giving the boy the third degree trying to understand the last name–he didn’t know his address–he didn’t know his phone number–we got in the car and we took him back to school and–“Now which way do you go home from here?” you know. The mother’s sitting on the front porch, frantic, you know. Uh, really wondering where he’s been, you know, so – like that kind of, you know–trying to make a four year old understand you don’t do some things, you know. But, uh, other that-that–that’s normal, I think (laughs)

113                     T:    Sounds normal to me. (laughs) Did *Kenny tell you anything about treatment? (->)

114         P:    He said some–he said three of four times a week and taped and, uh-uh, he said that way it could probably be solved quicker, you know, that say once a week for a year or something like that. Uh, that’s mostly just what he told me.

115                     T:    You don’t know anything about different types of treatment like psychotherapy or psychoanalysis or….

116         P:    No. Never got into that.

117                     T:    What’s the money situation?

118         P:    Well, we’re not rich. (laughs) We’re not poor. Uh-uh – should I say he’s making $9,000 a year which isn’t…

119                     T:    He’s making $9,000?

120         P:    Yeah. Which–having a house and two children, you know, where it’s going. It’s–we’re living from paycheck to paycheck and every once and a while we’ll buy a little something special, you know, like we just ordered a vanity for the bathroom we remodeled and, uh–well, anyway you look at it–even one of the jobs he’s gonna end up with, he’s gonna be getting a little bit more so–but we haven’t felt that yet and, uh–but by October, something should be settled about that and there should be an increase in, uh-uh, financial…..

121                     T:    What kind of insurance have you got?

122         P:    I don’t have anything that covers psychiatry.

123                     T:    You looked at that, huh?

124         P:    Yeah. *Kenny mentioned that and I says I know we didn’t. We have *Aetna but it’s mostly for medical – maybe I should check into it–I don’t think it covers psychiatry. I have the brochure at home. Then if he changes jobs, I don’t know what that’ll cover either. I have the *Aetna form at home I could pull it out, but I doubt seriously whether they cover that aspect of it.

There are many that cover outpatient psychotherapy. You might look into it.

125         P:    I will. I’ll pull the form out tonight and check it, uh–they’ve got everything listed–broken legs, babies, tonsillitis–they’ve got it all listed so that would be listed too then so much….

126                     T:    Mmm hmm.

127         P:    I just took it for granted that it didn’t but I can check it.

128                     T:    Yeah. Four times a week seems like an awful lot to you, huh? (->)

129         P:    Yeah. I never thought–I was thinking once a week but four times, I never thought, uh–but see, like–now, it’s like desperation, you know, like I don’t know which way to turn. I don’t know how to solve it, you know. I was depending on these pills just when–I would know in advance when something would be happening. I just–and like, uh, we went to pick up *Janey at the airport–she was coming in from *Arizona–and I took two that evening to get there–just to go to the airport. I mean, nothing special–just to get there. Well, the second one must have really hit me ’cause we went–we stopped by another sister’s house–*Tara–uh…

130                     T:    You’re one of how many, did you say?

131         P:    *Nick and *Janey are one–they’re nine.

132                     T:    They’re nine.

133         P:    Right.

134                     T:    And you’re one of four.

135         P:    Four. The oldest of four. And, uh–well, we stopped there–I guess it was already 10:30, 11:00 and we had cake and soda–well, I don’t remember coming home. Those pills must have really hit me ’cause I was very calm, very relaxed but like for other things, like for going to that wedding and I was still, you know, just–inside–and for being godmother, I must have taken six starting Saturday, you know, to get to Sunday and, you know, they’re supposed to be strong and it’s–you know, if they’re not calming me down, something’s really bothering me.

136                     T:    Could you make it four times a week? (->)

137         P:    Anything. I just gotta get this over with. It’s–It’s the only thing that’s really bad in my life, you know. Like my husband wants to go to a dinner-dance with other employees, you know–and it’s hard for me, you know, to…

138                     T:    Mmm hmm. See the time I might available would be like eleven o’clock in the morning – four days a week. I wondered if you could work that out.

139         P:    Well, my mother works–she doesn’t leave until 2:30, quarter to three. And if I asked her, I think she’d come over and get the children off to school at lunchtime or maybe…

140                     T:    They both go in the after–no, one goes all day but you mean after lunch to go back….

141         P:    Right. They come home for lunch. That’s the only thing, you know. Uh, see like, uh – I think it’s the end of January, they rotate and then he’ll go for the morning session and get out at noon.

142                     T:    Oh.

143         P:    See….

144                     T:    Then it would be easier for you.

145         P:    Yeah. Then all she’d have to do is like pick them up and take them for lunch and I’d be back in time to get the daughter off to school.

146                     T:    You think she might do that for you?

147         P:    Yeah. We’ve talked it out like, uh…

148                     T:    Have you already talked to her about it?

149         P:    Oh, yeah. I said, “Ma, I need….”

150                     T:    When did you talk to her? What?

151         P:    …any help you can give me, ” you know. I said, “I’m getting fed up with the situation.” She knows what it’s like. She went through with me in first, second, third grade. (laughs)

152                     T:    How do you get on with your mother?

153         P:    Uh, we have disagreements. She’s got funny ways but, uh, sometimes I don’t like her and sometimes I like her but, uh, we could work it out, you know.

154                     T:    See, if you had an appointment at this time, then you  could do it yourself, huh?

155         P:    Yeah.

156                     T:    But I can’t do that on Monday and I can’t do it on Tuesday. I can on Wednesday but Thursday isn’t good – nor is Friday. This is just not a good time for me but 11:00 in the morning, I could make it.

157         P:    I’ll get somebody to work it out. Like on Wednesday, my sister is off all day–she’s a medical assistant and that definitely could be worked out–Wednesdays 11:00 in the morning could definitely be worked out and I’m sure my mother would try to help.

158                     T:    You see, the money is not a problem. (->) Now the reason for that is that I do research and what the research consists of is that I record the hours on tape on that machine there-

159         P:    Mmm hmm.

160                     T:    …and then I’m gonna study them and someday I might publish something from it but I would try very hard to disguise it and it’s not likely that your friends would read that kind of thing. I suppose it’s possible that *Janey might, would that bother you?

161         P:    No. We talked about that. I even called *Janey after *Kenny….

162                     T:    Who is….

163         P:    Uh, *Janey.

164                     T:    You phoned her?

165         P:    Yeah. (laughs) I called her right after I made the appointment with you–after *Kenny had talked and then I had called you and, uh, it was mostly to ask her, you know, like financially, how do you work out these things, you know…and she said, “Well, talk it over with hem. Talk it out with him. He’ll be understanding.” And, uh, she said, “Aw (gasp) you got him!” you know. (laughs) (next three words–tone so high inaudible) (dr. laughs) That didn’t help any, you know. No. “He’s the top one,” you know. She says, “He’s tremendous in his field.” I said, “Oh, boy.” (laughs) I says, “Well…

166                     T:    That scared you even more.

167         P:    When I first heard it–yeah–but then after thinking about it, I thought–well, maybe it’s better that way. He’s got experience. He can solve it, you know, or find out what it is, you know. I don’t know. When it happens–sometimes I’m too busy trying to control myself to think but I had given myself the third degree and okay this time I said, “Okay. What is it?” and all I can do is “I don’t want to go. I don’t want to go.” That’s all that’s coming out.

168                     T:    Yeah. Did you talk with her then about the research part of it–is that what you meant?

169         P:    No. *Kenny talked to me about the research part–that it would be taped and stuff like that. I did mention that part of it to *Janey and she says, “Really, no one would really read it except the higher up doctors, you know.” That, uh–I says, “Well, I know I can’t be that terrible a patient,” you know. It’s probably just one problem somewhere bothering me and it’ll come out and whatever it is, can’t be that terrible, you know. It just–I’ve read things about children and phobias and stresses during their life–the whole thing– I’m forever reading–and, uh, I was reading this one–and so many things happened in my childhood that I could apply to these things, I thought–holy Christmas, you know, like there was an abandonment, eh, people–children get very scared of diseases and losing organs and, uh, I read one part of that. I had my tonsils taken out about that time when everything was going through – uh, that so that could have been a big fear or something. Uh, like I told *Kenny, I remember the few things when I was very young, uh, like I had a great grandmother and I didn’t like her–to me, she reminded me of a witch and–’cause she used to say–like if you look in the mirror long enough, you’ll see the devil or if you paint–she was from *Eastern Europe, you know–she was very….

170                     T:    Are you of *Eastern European background?

171         P:    Yes. And, uh-uh, you paint the fingernails red, the devil’s coming out of you and all that–I didn’t like her. She scared me. That’s what it amounted to. And, uh, I found out, uh–sometimes I think it’s gotta be involved somewhere there, uh, I had a collie–a puppy–that was growing up by my grandmother’s house–they –my mother and father were going back and forth in the service and staying at my grandmother’s house and buying a home and this and that and, uh, there were quite a few hectic things going on. Uh, the collie stayed at my grandmother’s house–it grew up and I remember sitting on the front porch and it jumped over the fence, got hit be a car and was killed–hit and run.

172                     T:    And you saw that?

173         P:    Yeah. I saw that.

174                     T:    How old were you?

175         P:    Uh, I wrote it down. I asked my mother all these inform–I remember things and then I try to put things together and, uh – I had to be about five years old and my mother told me today, that was the same day my grandmother died–my great grandmother and we had been going back and forth to that house three times a day–I thought–oh, boy, and I remember a few things, you know. I remember it getting killed and everything and-and I –well, maybe it’s got–and I remember going to the funeral and I didn’t want to go up there–so I’m trying to think–well, maybe it’s something in that line, you know.

176                     T:    You’re in your late twenties, are you?

177         P:    Mmm hmm. But I can’t understand why it should bother me that much younger–then sort of nothing–occasions of being nervous–then now…

178                     T:    Worse again.

179         P:    Yeah. That-that-that I can’t understand.

180                     T:    Well, I don’t either but I think we probably could find out. If you want to try, I’ll be glad to try.(->)

181         P:    Would you please ’cause I don’t know where to turn anymore. You know, talking to your husband or your mother or *Kenny or *Janey, they haven’t got the time, they don’t really want to get involved because they’re close to you. My husband, he couldn’t–I mean, he couldn’t really help me, he-he just doesn’t understand things like that, you know. He puts up with them (laughs) but he doesn’t understand because to him, you know, he’s normal (laughs).

182                     T:    Now as far s the money is concerned, you talk it over with him and see how much you think you could afford.

183         P:    Well, we were talking about that and I says, “Well, let’s see how many times he wants me to come and like if it’s once,”  I….was, you know–I don’t want to be cheap (laughs) you know, that’s…

184                     T:    Listen, you’ve got a house and two kids and a husband making $9,000, you can’t spend much money, I know. (->)

185         P:    No.

186                     T:    What figure did you have in mind?

187         P:    Well, like when I go to a doctor, it’s only $5 but that’s like for fifteen minutes, you know. This is gonna be an hour and then four times a week, you know….I would–really, we could–gee, even if we could do it $5 a treatment or something–a les–an occurrence and if you’re going five times a–or four times a week, that’s twenty dollars a week–that’s like $80 a month already right there. That’s-that’s a good chunk (laughs)

188                     T:    That’s more than you can afford. (->)

189         P:    That’s–we can afford that but anymore than that would seem to really start hurting. I mean, we just–to afford that we would just not, uh, do some plans we have but–such as remodeling the kitchen–that could wait, you know, and then if I got over this, you know, maybe-maybe I could even go out and get a job, you know, and help then, you know, and make up for anything.

190                     T:    Mmm hmm.

191         P:    Uh – I don’t know. Talking to *Janey once before and she wa saying like $12 and I said, “Oh….” you know, that was kinda-kinda high.

192                     T:    But you think you can swing $20 a week.

193         P:    Yeah. If it’s like 4 times.

194                     T:    Yeah. Four times a week.

195         P:    Is that-is that reasonable or is  that too low?

196                     T:    It sounds all right to me. Naturally, I couldn’t do it if I were in practice. (->)

197         P:    I know (laughs) she told me that. She said, “You couldn’t touch him with a ten foot pole.” (laughs)

198                     T:    But you know, if you went to a private doctor, you wouldn’t have to put up with the taping and all that kind of thing so you give me something and I’ll give you something. Uh, and whatever we decide on for the money, it doesn’t have to stay that way. If it turns out that that pinches you terribly so you’re eating nothing but hot dogs everyday, we can drop it some or if it turns out that your husband gets a raise or some money-

199         P:    Yeah. That’ll work out real good.

200                     T:    …comes to you from someplace you hadn’t expected it from, we can raise it. So you don’t have to feel, you know, that it’s fixed forever.

201         P:    Yeah.

202                     T:    But–we can start out and $5 a time…

203         P:    Oh, that’s really–I really thought–after hearing about you, I thought–oh, gee, that’s kinda cheap, you know.

204                     T:    No. That’s not too cheap to me. As a matter of fact, it seems like it might be too much and if it is, we’ll drop it.

205         P:    Well, we can work it out, you know.

206                     T:    I’ll have to make some arrangements with the–well, there is the problem of insurance, that could change, see, so we’ll have to…

207         P:    Yeah. I’m gonna check that. I’ll check it this evening.

208                     T:    We’ll have to know about that and, uh, I’ll have to make arrangements with the clinic either this one or the clinic downtown but that would just be the business of going there once or twice and making the arrangements, that’s all—’cause it would be with me that you’d be working and we won’t do anything about that yet and if it turns out that, uh–let’s just forget about that for mow. Uh, ’cause I–I’m not sure of it anyhow. It might just be that you’d stop at the desk downstairs on the way up. When would you like to begin?

209         P:    Well, as soon as possible–I could have put this off until January ’cause nothing was happening to  upset me, you know, but-

210                     T:    You-you-you….

211         P:    …I know it’s gonna keep happening. It’s like, you know, like it only happens….

212                     T:    You had hoped that you’d sort of be free now until Thanksgiving time, huh?

213         P:    Yeah. (laughs)

214                     T:    Party planned for Thanksgiving, is that it?

215         P:    Yeah. *Janey’s even flying in at one of the relatives but there are like–I’m sure *Ericka’s gonna be having an assembly hall and then, uh, — ummmm–well…. (->)

216                     T:    Uh huh. Well, it just happens that I have time–we can start next week if you want to.

217         P:    I really want to get this over with. I-I think this is the only–if this doesn’t work, then I’ll just keep going through the rest of my life avoiding places or taking tranquilizers to get there or…, you know…

218                     T:    Yes. No. I think something needs to be done. You’re absolutely right.

219         P:    I just can’t put it off anymore. I, uh–I–oh, the day after the block club party, I was so upset, I stayed in bed all day Sunday. I wouldn’t–I said, “I’m gonna lay here and die.” I really was–I said, “I’ve had it, *Nick. I can’t go out there and be normal, I’m gonna lay here and die.” And he said, “Well, we’ll help you, we’ll call *Kenny or something” and that was all he said. Well, Monday morning it was already getting to me and I called him up on the phone and told him–this was it, it was gonna get solved or I was gonna–(clicking sound with tongue) do away. I was really-really….

220                     T:    You were gonna what? Do away with yourself?

221         P:    Yeah. I was really pretty upset.

222                     T:    You felt that bad.

223         P:    That bad ’cause I said this–I can’t take it. It really wrecks you when it–when you go through this, I mean…

224                     T:    Have you thought about doing away with yourself before? (->)

225         P:    Yeah. But that was just-

226                     T:    Just playing with the idea, huh?

227         P:    …depressed. Yeah.

228                     T:    Yeah.

229         P:    And–but I took off–I told him, “Come get the kids. Call my mother.” I hung up. I took off in the car and I went off to the forest preserves just to be alone and-and that’s what my mother says–she says, I’m the type of person that lets things build up and build up and the only way–and then I take off for a couple hours or a couple days and, uh, get myself calmed  down and come back and, uh, I had called–I had called *Kenny and I said, “I gotta see you. I just can’t….” Now I didn’t explain anything to him–I don’t think he even knew this. He sensed a few times when we did go to parties by his house that I was, you know, uneasy.

230                     T:    Did you socialize much with him and *Janey? (->)

231         P:    Well, twice–we went to two parties. Yeah. And we had *Kenny at our house once for a party for the children’s birthdays ’cause they’re a day apart and, uh, he’s a very nice person. Very nice. And he explained to me that’s it better off if I get someone I don’t know and (laughs) the way he kept putting it–someone who wouldn’t abandon me and…

232                     T:    Do you have any feelings about their relationship?

233         P:    *Janey and *Kenny’s? Uh…

234                     T:    What did you make it out to be?

235         P:    I was kinda sorry that they didn’t really hit it off. I really was. I thought *Kenny was a nice person and I know *Janey’s kind of a lonely person and, uh, I’m just sorry that nothing could be worked out for happiness, you know.

236                     T:    You thought they might get married?

237         P:    Yeah. I really did. I thought something would work out nice but it didn’t. It just, uh–and then *Kenny told me a few things about *Janey I don’t know if I should believe–things that I don’t know if I should believe or not but, uh, she’s got her ways set, you know, to marry someone who’s gotta be (laughs) qualifications–certain qualifications according to her, you know, but, uh, *Kenny’s found someone else now, I understand.

238                     T:    Yes. I understand he’s going to be married.

239         P:    Yeah. So I’m really happy–he sounds happy. I hope it works out. I think marriage is good.

240                     T:    Then-then Wednesday is a day you want–Monday, Tuesday, Wednesday and Friday. That’s four times at 11:00 o’clock.

241         P:    That often. (laughs)

242                     T:    You mean, did I really mean four times?

243         P:    Yes. That’s hard–I watch this show on t.v.–one of these soap operas–and there’s a girl going to see a psychiatrist now too and she went once a week and this last time she went, uh, the doctor felt she broke a barrier and now he wanted to see her everyday and I said, “Oh, my God! What if this man says, you know, he wants to see me everyday.” I never thought that was possible, you know, and *Kenny had said three of four times a week. He did say that-that so….

244                     T:    Well, I think ought to make it clear to you that I think you probably could be helped once a week but, uh…

245         P:    Yeah. But it would take longer, right?

246                     T:    I don’t know. I really don’t know. The point is that psychoanalysis is a particular kind of treatment that I generally work with and that is four times a week so that is what, uh…

247         P:    I’m very willing–I mean, I’ll tell you all my failings and things I remember and maybe you can come up with something. I mean…

248                     T:    Well, let me tell you a little about how it’s done then. I suppose–do you know the patient lies down?

249         P:    No. I-I’ve seen that in the movies but I never really….

250                     T:    You thought (inaudible) (laughs)

251         P:    That did just–can anyone really think lying down, I mean, don’t they get a little…

252                     T:    We’ll see what happens. I don’t think you’ll have much trouble with it. (->)

253         P:    I’ll practice at home thinking. (laughs)

254                     T:    You lie down there and I sit here and then the idea would be that you speak as freely as you can and when I feel I have something to say then that might clarify something, I’ll say it.

255         P:    That, you know–*Kenny said a few things that made me think, you know. Uh…I don’t–I don’t know how to help myself. I have to go to someone who can, you know–someone who…

256                     T:    And do yo know that the session lasts fifty minutes?

257         P:    Yeah. Fifty. I thought an hour–well, fifty–yeah.

258                     T:    It’s fifty.

259         P:    I mean…

260                     T:    All right?

261         P:    Okay.

262                     T:    I’ll expect you next Monday?

263         P:    Eleven.

264                     T:    Eleven o’clock.

265         P:    Yeah. Well, I will work out something definitely.

266                     T:    Yeah.

267         P:    It’s just that–I, you know….

268                     T:    If you find that there is some insurance coverage-

269         P:    I’ll check tonight.

270                     T:    …phone me so we can talk about that because that would influence the kind of arrangements I would make here but the treatment doesn’t depend on that. You understand?

271         P:    But it could help from the financial status.

272                     T:    Yeah. If you–some policies pay 50%–if they pay 50%, uh–there is an arrangement whereby if such money comes in, it goes into a special fund for my research so I would gain from it too, you know–and it wouldn’t cost you anything–so if there is some insurance benefits, phone me and tell me what it is and if not, forget it and I’ll just–I’ll see you Monday.

273         P:    Okay. Just…

274                     T:    Yeah…

275         P:    Relieved.

276                     T:    Not as bad as you thought, huh?

277         P:    No-no. I got it over with.

278                     T:    Okay. Goodbye.

279         P:    See you, doctor.

280                     T:    Bye bye.


This is the first meeting of this housewife in her late 20s with an experienced male psychoanalyst recommended to her by a family member who is in the field. The treatment took place in the early 70’s.




The analyst, noticing how uncomfortable she is, immediately introduces a supportive element so that she may be able to engage.  A number of similar remarks by the analyst may be seen below. A major study by Wallerstein published in 1986 demonstrated that supportive elements are just as important as interpretations aimed at insight in promoting positive developments in psychoanalysis and psychotherapy (Wallerstein, 1986; Waldron, 1989).

Her initial self-description focuses on only one problem, and the analyst=s task is to understand how this problem fits into her personality and life.

















Reflective function has been shown to be helpful in mastering painful or disruptive emotions [Lane & Garfield, 2005]. In these first few minutes of the session the analyst immediately seizes the opportunity to encourage patients reflection.

In this earliest of sessions, the analyst is consistently encouraging elaboration, both so that he may understand better, and so that the patient experiences him as someone who can understand her.

A family friend she knew in the field, who made the referral and also gave her some anti-anxiety medication.




The analyst is encouraging elaboration by joining in a natural way in the conversation with this question.



As it happened, the analyst picking up on her mother’s feeling fed up, which incidentally reflects the patient=s own feeling of being fed up (hence seeking treatment), leads to a rich description by the patient of what she remembers of the onset of symptoms. This ability of the patient to respond so productively is an early indicator of her potential to benefit from the therapeutic relationship.










Already a very small instance of positive feedback to the patient’s self reflection, for a patient who feels very self doubting. An element of potential corrective experience here, as we hear very soon thereafter that her father was always so critical.





Not surprisingly, although she mentioned anxiety before, as so often we find that it is mixed in with depression as well, as she is feeling quite defeated in her efforts to master difficulty.





The analyst feels free to take the initiative in context to obtain more understanding of her attitude toward treatment now and in the past.











The analyst carefully exploring whether the conditions may be right to support an ongoing treatment.







The therapist emotionally tuning in and sharing with the patient her discomfort.









He quickly verbalizes the feelings that she is having with him at the moment.


And makes a follow-up comment when she doesn’t directly address her own feeling.




The therapist allows himself to follow his reflection that she may be minimizing other difficulties in her primary relationship (with her husband).

Continuing to fill in a more complete picture of the patient’s life.






At this point, the analyst takes off on exploration which reflects his theoretical notion that the patient=s agoraphobia may very well reflect a displaced sexual impulse of which she is frightened. Nowadays most analysts would not be as intrusive at such an early point, and would allow the material to unfold more naturally.












The analyst continues on an exploration based upon theory. With this particular patient, subsequent hours gives some evidence that his being so forthright about sexual matters made her feel more comfortable, even though that was unlikely to have been his reason for pursuing this line of questioning. He may be unconsciously positioning himself as being a person much more accepting of sexuality than her parents were. By the fourth session, the patient will have become able to make an important confession.















As we will see in the next few sessions, the analysts down-to-earth attitude appears to have made the patient feel more comfortable.

































Again, the comfortable supportive attitude for this very anxious young woman.























The therapist again paying close attention to and addressing the patient’s feelings of the moment.













In this whole part of the session in which the analyst is negotiating plan for treatment is very respectful of the patient’s autonomy.



























In addition to being respectful, the analyst is not hesitant about sharing his point of view and his needs for the treatment plan. What we call sharing one=s own subjectivity, which turns out to contribute to patient=s openness  and productivity in the next session (Waldron at al. 2015).









































The analyst is warm and emotionally responsive, which we have found to be associated with patients being more productive (Waldron et al. 2018).






The analyst is being straightforward and taking her point of view, which builds the therapeutic alliance (Waldron et al., 2015).





The analyst not hesitating to express his point of view.










The analyst is sensitive to her issues of self-esteem in view of her limited financial means.


























*Ericka is her daughter.













 The analyst, in responding, directly approaches her painful and despairing feeling, a crucial ingredient of good psychotherapy..









Now the analyst is clarifying the nature of the referral pathways and the feelings that she might have about them.

































Again, the analyst is supportive, but in the next few sessions it turns out that she has quite a few feelings about lying down in the company of a stranger. well know is pretty fast second thing is very rigid Times Square boys you finally got his