Abstract
Disappointment is a universal theme in human experience. Essential to child development, which requires us to give up the infantile omnipotence that we invest in ourselves and our parents (Jacobson 1946), disappointment shadows us throughout adult life as we strive once again to satisfy unquenchable desires (Schafer 1999). In addition to these universal losses, and often linked to them, the work of the analyst brings with it its own set of disappointments, as the analyst struggles to manage his wishes for the patient and the process within the constraints of his method (see Cooper, this issue) and as he is induced by the patient’s use of projective identification to bear the patient’s disappointment, either as the representative of an early object the patient wishes to disappoint or as the representative of the patient’s own disappointment (Joseph 1982).
I wish to explore here a particular kind of disappointment that I have observed in in the course of doing analysis. This kind of disappointment is a soft-spoken state; it does not announce its presence sharply in my thoughts but is a kind of sad fog that settles on the process, leading me to lower my expectations for the outcome of the analysis. Of importance, this kind of disappointment has tended to reside in the analysis as a shared state, felt at the same time by both members of the dyad. Often it has been the patient who has given voice to the disappointment, and although I have explored the meaning of the patient’s lament, it has been hard for me to interpret either the implied aggression or the implied sense of loss as effectively as I might have because the patient’s complaint has seemed to me to be in part an accurate observation.
This kind of shared disappointment can usefully be viewed as a kind of bastion—an experience of the field that is felt to be shared by both analyst and patient but may be found on second look to have a different dynamic significance for each (Baranger, Baranger, and Mom 1983). With disappointment, as with other bastions, both the content of the shared state and the quality of shared-ness protect analyst and patient against individual experiences that are more conflictual and against the sense of separateness and loss that each may feel in recognizing that she is alone in these. In the analytic process, shared disappointment appears to form a particularly stubborn bastion, one that requires of the analyst a difficult and painful work of self-analysis. In order to consider the properties of the shared disappointed state and its key role in analysis, it is helpful to tease apart a trio of related states—disappointment, disillusionment, and despair—to consider how each fits with the others and the particular significance that each has for the analyst.
Disappointment and disillusionment are closely linked states, which can be seen as blended or even identical, or as quite distinct. Jacobson (1946) observes that the German word Enttäuschung, which is translated in English as “disappointment,” conflates both terms, reflecting in its etymological derivation the idea that the disappointing object has been found to be an illusory one. In English the etymological derivations of “disappointment” and “disillusionment,” and their dictionary definitions, are quite different from one another (OED online 2014).
“Disappointment” has the meaning of a wish or expectation that is unfulfilled; there is the idea of a story that unfolds over time in an unfortunate way. This kind of narrative holds the idea that it could have come out differently and perhaps, with some dramatic turnaround, it might still. Disappointment bears the hallmarks of the depressive position: an experience of self and object that maintains some sense of hope in the face of anger and loss, and a line of narrative that is continuous over time.
“Disillusionment” has the meaning of removing a false belief. It describes a different kind of narrative, one that reflects not so much a story in which wishes are unfulfilled but rather a story in which the very basis for wishing, the qualities of the characters who figure in the story, must be radically revalued for the worse. The change that takes place is like going off a cliff: the shift is abrupt and feels irreversible, and the newly discovered story feels discontinuous with the old one. This development bears the hallmarks of the paranoid-schizoid position, and splitting plays a key role in the preservation of a sense of the good self and the good object. If disillusionment represents an abrupt shift to the worse in one’s apprehension of the object and one’s relation to it—with the implication that the earlier object was an idealized one, itself the product of splitting—this catastrophic change is potentially limited by further splitting to a single object and a single object relationship. A disillusioned patient may come to the belief that his initial hopeful view of the analyst was entirely wrong but may move on (in what may be a triumph of hope over experience) to a new analysis with another analyst. Similarly, a disillusioned analyst may reject his former view of a patient as analyzable, but splitting confines the damage to a single patient and the analyst’s work with her.
In despair, by contrast, no hope can be found for any object; splitting has failed to protect the sense of a good object and of a self that can, through reparation, make the object whole and good; and there is a feeling of all-encompassing bleakness. The patient can no longer imagine getting better in any treatment, and the analyst has lost hope in her capacity to help any patient.
At some moments, disappointment, disillusionment, and despair may occur as shadings of a single experience—notes within a single chord that may be recognized in sequence or all at once. And fluctuations between the three states occur as part of the necessary process of working through loss, as the need to come to terms with external and internal reality requires us to come to terms over and over with the gap between the objects we wish for and the objects that reside in our inner world. In the paper in which she introduces the concept of the depressive position, Klein (1935) poignantly describes the way some patients hold within them an image of the good mother that is felt to be only a beautiful picture, one that wards off a view of the mother as irreparably damaged and dreaded. For these patients, the process of working through disillusionment and experiencing the splitting that underlies a seemingly realistic view of the object world, and further seeing that this splitting wards off melancholic despair, is particularly clear, but the need to work through disillusionment and despair in order to attain, or re-attain, the depressive position is a universal one.
At certain moments, and chronically for certain individuals, the three states—disappointment, disillusionment and despair—may operate together as a unified defensive bulwark against more hopeful states. We are all familiar with the turn toward the negative—toward faultfinding and self-criticism—that often accompanies a success that is felt as oedipal triumph. Schafer (1999) describes the use of chronic disappointment as a defense against hopefulness that threatens both loss and punishment or, if it is fully acknowledged, rage against the past objects who had crushed early hopes.
At other moments, and for other individuals, the three states may be held wide apart, and each may be used defensively against the others. We may hold on to disillusionment—and complain chronically that our objects are not as we thought or wished—rather than accepting them as they are and creating a new narrative that includes this. And holding on to the state of disappointment—to the belief that things should and could come out differently—may protect us from the radical revision of our internal objects that accompanies disillusionment, and, in addition, to the sense of melancholic despair that we fear will follow this disillusionment.
Disappointment, disillusionment, and despair are felt by the analyst to be particularly painful states because they reflect disturbances in her belief in her own capacity for reparation—a capacity that is central to the analyst’s identity as analyst and that often has been central to her choice of this profession. The presence of a good, intact, external object serves as reassurance that our internal objects are also intact and good, and that our love for them has prevailed over our destructive hatred (Klein 1935, 1940). When she is succeeding in doing analysis, the analyst feels that she makes her objects whole, and her sense that the patient is whole reassures her that she is giving her love to the patient, and that she has love to give. The three states—disappointment, disillusionment, and despair—in sequence reflect an escalating sense of danger. For the analyst, the narrative of disappointment is one in which a particular attempt at reparation has failed, but reparation remains a possibility in the analysis of this patient. With disillusionment the damage is more profound: the analyst feels lacking and damaged in whatever is necessary to help the patient, but splitting limits this damage to a single relationship and protects the analyst’s belief in her essential capacity. With despair, the analyst believes herself incapable of helping any patient. More fundamentally, she loses faith in her capacity to restore her own internal objects and make them good.
In the analytic situation, the patient’s disappointment may set off a resonating cycle in which the analyst is threatened with a loss of faith in her own goodness, and where the patient in turn senses the analyst’s felt incapacity and further loses hope. The patient’s projection of her own sense of hopelessness into the analyst, as well as the patient’s destructive anger at the disappointing analyst, intensifies this cycle. In this situation, disappointment often serves, for both analyst and patient, as a kind of holding operation, one that protects against a regressive slide to the two more painful and dangerous states. For this reason, the quiet, steady shared disappointment that I have observed in analysis can thus be seen as a kind of key signal state (Smith 2000). For the analyst, disappointment is a dangerous idea, one that she may first project into the patient and recognize in the patient’s experience before acknowledging it in her own.
Like any endeavor, analysis entails disappointment—the idealized expectations of patient and analyst can never be met—and this disappointment must be worked through by both. However, a state of disappointment that settles in is often an indication that the analyst cannot grapple with the patient’s disappointment because doing so will open up the patient’s underlying disillusion and despair, and these in turn will evoke corresponding affects in the analyst. In order to engage the patient effectively in the analysis of the patient’s disappointment, the analyst must first, through self-analysis, come to terms with her own disappointment, disillusionment, and despair.
Clinical Vignette
A clinical vignette illustrates this approach in an analysis where disappointment had become the dominant theme.
Anna, a divorced academic in her thirties, entered analysis in order to understand the difficulties she encountered in establishing a new relationship and moving ahead in her life; as our work continued, it became apparent that these difficulties extended to her career, where she felt blocked in producing the original work that would be necessary for her to earn tenure.
At the beginning of the analysis, 1 Anna had seemed to me to be only tentatively engaged with me; she was critical of me and compared me unfavorably to the therapist she had seen at college. After I had linked this idea of a second-best replacement to the relationship problems that had brought her to treatment, the analysis had deepened and begun to feel promising to both of us.
But at the end of the second year, the analysis felt stalled, and Anna’s life did as well. She remained quite blocked in her work. For many months she had been involved with a man, Al, who loved her and wanted to marry her, feelings she did not fully return. The process often felt dull, and I found myself missing the creativity and liveliness that Anna had earlier brought to our work. The sessions had a repetitive dynamic. Most often they centered on her indecision about Al. Should she settle for this man? Was he wrong for her, or was she simply unable to love, to replace the husband who had left her? She wanted my help in deciding. In the countertransference I was struck by the way Anna’s declared uncertainty about her feelings for Al seemed out of synch with the sense of the man she conveyed to me: he appeared to me, as she described him, to be clearly a bad match for her, uneducated and not smart, while she was highly intelligent and intellectual; at moments I also felt a deeper uneasiness about Al, a sense that he was frightening in some way. But when I brought the contradictory quality of her communications to Anna’s attention, I became for her a forbidding mother who did not wish her to have a man, like Anna’s own mother, who had been unusually strict about dating and sexuality. Anna complained about my failure to help her resolve her conflicts in love and work and spoke regretfully of her growing disappointment with me and the analysis. We made little progress either in understanding Anna’s conflicts about Al or in exploring the deeper meaning of her complaints about me. Unlike Anna’s transference to me as a forbidding oedipal mother, which both of us identified, this sense of me as disappointing did not lead productively to memories or associations that would link it in a meaningful way to the past.
I began to feel disappointed in the analysis as well, and gradually I became aware that my expectations for what the analysis might hold had become lower. I could no longer fully access the memory of our earlier lively sessions or imagine their return. In effect I had become disillusioned with Anna and myself. As I explored my countertransference, I found that this disillusion bordered on a kind of despair. When I was with Anna I felt a lack of vitality in my work. I was reminded of a time when I had returned to work after a medical illness, consciously confident that I would recover fully but uncertain in my heart that I would ever operate at my former level. By accepting my lowered hopes for my work with Anna, I was in a sense walling off that fear and despair, restricting it to that single analysis and preventing it from spreading to my entire sense of myself as an analyst.
In the sessions after I became aware of these aspects of my own disappointment, I paid particular attention to Anna’s disappointment. Gradually, as her disappointment became a focus of our work, I came to realize that, like my own, Anna’s disappointment also covered over elements of disillusionment and despair. I will present the series of sessions in which these elements became clearer and were interpreted; the long-standing disappointment, which both of us had felt, lifted; and the analysis began to move again.
First Session
Anna began the sessions by speaking about her hopelessness at work. She had gone to her office the day before and felt completely blocked. She felt she did not have what it took to do academic work. She thought she should consider alternative work she could take with her degree, where she might not have to publish.
I pointed out how she saw her block as monumental and final and asked why this was. Anna affirmed this and looked a bit into her hopelessness as something she brought to the situation, but then returned to simply declaring that she did not have the ability to do her work.
Returning to her opening words, I said that these feelings at the office must have been after our morning session the day before. Anna dismissed the link that I attempted to make to our situation, and said that she had not gone to her office directly after the session—or else she wouldn’t have felt so bad. She returned to her usual lament about Al and her indecision. However, perhaps prompted by the connection I had suggested between her despair and her feelings with me, she shifted to a new tone of escalating anger. She was furious with me, she said. Why didn’t I give her the help she needed? Her voice sounded truly angry and attacking, and she spoke at length about her complaints. I listened without making any intervention.
Comments
Anna begins this session, in a way that has become characteristic of the analysis, with a declaration of hopelessness about herself and her capacities. Temporally, these feelings must have emerged sometime after her session with me the day before, but initially neither of us is willing to confront the link between her hopelessness and her relation with me.
I pursue instead the melancholic, final quality of her experience. Then—and I believe this is a result of the work I have done in the countertransference, in understanding the personal despair that Anna’s despair evokes in me—I do make the transference connection.
Anna initially rejects the connection—“not directly after the session”—and returns to complaints about Al, creating a familiar situation where Al is the disappointing one and Anna and I can feel aligned in our shared disparagement of him. I think though that the link I had made between her disappointment and the transference, as well as my listening without intervening as she continued her prolonged attack, signaled to Anna that I was now better able to tolerate her anger and disappointment with me; and she is able to express these with me much more strongly than she has before. Her disappointment feels to her to be a legitimate response to my work, and I am able to tolerate this and resonate with it.
Second Session
Anna began her next session by saying she had gone to her office after our session the day before and for the first time in a long while found herself excited about what she was writing. She was enjoying herself and at the same time felt some other emotion—a sense of something complex and darker. She felt alone when she was working, with a sense that she could have only the work or closeness with me, not both. She had to leave me to work. And all the time she was working, she felt as if she were running away from a voice telling her that she couldn’t do the work, that she had no ability, the way she had felt yesterday.
I said that I thought those were complaints she had about me—that I did not have the ability, or enough to give her. When she had gotten angry at me yesterday for not giving her enough, she had been afraid that the truth was that I did not have anything inside to give her.
Anna agreed vehemently. Her therapist at college had made her feel alive. Although she worried that she couldn’t engage, there were some people she could engage with and some she couldn’t. That was the problem with Al: he wasn’t one of those people who made her feel alive—there wasn’t enough substance to him. It was painful, but she had realized this in talking to me about him. She continued talking about Al.
I said that although she was speaking to me about Al, I thought that she was also, or even more, speaking about me—that she felt I did not have enough to give her—and talking about Al to me was a way of disguising how much she felt I was like Al.
“Yes, that’s true,” Anna said. “I’ve felt for a long time that you are not enough alive. There’s a kind of obtuseness, a way you don’t pick up on things or make connections the way my earlier therapist did. I have been feeling for a long time that you do not have the talent or the life that I need in order to make a connection.” She spoke at length with both sadness and anger about her disillusionment with me—her sense that this was an important phase of her life when she needed help and that the opportunity for change would be lost because she was working with me.
Comments
I think that my own countertransference analysis and Anna’s subsequent more direct expression of her anger and disappointment with me in the last session has begun to break up an impasse in which each of us felt our mutual disappointment to be a legitimate, ultimately unanalyzable assessment. Anna is now able to move out of this state for a bit, and as she moves back into it, we begin to be able to see the dynamics of the shifts and the defensive purposes that the stuck, disappointed state serves for her.
After the last session, she felt more hopeful, and she indicates with her opening line that she is now able to connect the change in her mood to our session, as she could not the day before. She had the sense that there was goodness and creativity inside her. However, unable to tolerate her destructive feelings toward me and the loss of me that these feelings threaten, she has taken into herself the empty depleted image that she has seen in me. It is as if, as Chasseguet-Smirgel (1984) has formulated, only one of us can be repaired, and she must sacrifice her own creative capacity in order to maintain a sense of me as whole and present.
At this point, feeling myself freer of the impasse, I am able to interpret Anna’s movement back into it, pointing out the way she has managed her anger and disappointment at me by turning them upon herself, taking back into herself the empty depletion that she had felt to be in me. This interpretation brings Anna back to a state where she is again able to tolerate her anger at me and begins to elaborate her experience of me as depleted.
Then once again, Anna moves away from her anger at me, this time into complaints about Al. It now becomes clearer to me that in many ways Al is the target of Anna’s displaced criticisms toward me. The triangle between Al, Anna, and me has in a sense been a pseudo-triangle in which Al and I have reflected split aspects of the same object. I interpret the displacement, and Anna is able to return to her exploration of her feared disappointment with me.
Anna ends the session with the assertion that her view of me as empty and useless is realistic and her disappointment with me entirely legitimate. And Anna’s concerns are in fact resonant with the concerns I have had for myself and my capacities following my illness. Nevertheless, I think that both the content of my interpretations and my renewed ability to interpret have brought both of us closer to the recognition that Anna’s disappointed view of me as depleted is most importantly a transference—that the stronger analytic self to which I have returned, confronting and interpreting, is not identical to the image of the depleted analyst that had emerged between us.
Third Session
Anna’s tone had changed dramatically when she arrived at the next session, the last I will report. Her voice was full of life and excitement. She said she had had a strange and painful dream: A woman was telling and showing her a true story. Anna felt overwhelmed with terror as she waited to find out how the story would go. There were two parts to it. In one part, a woman was in the apartment Anna had shared with her husband. He had just left and the woman was looking around, feeling the finality of the separation. Then, in the second part, the same woman was in another apartment, one Anna had shared with her college roommate. The woman was now completely different, not all the person she had been in the first part; now she seemed terribly upset and disturbed. The woman put on a black coat and went out into a dark and lonely street. Anna was watching the woman and felt terrified of what would happen to her. She called out the window to her, but the woman did not hear and went off into the night.
The dream felt very real, Anna said. Very moved, she said she felt that it was I who was telling her the story, that that had begun at last. She had felt hope for the analysis, she said.
Continuing to associate to the dream, Anna said that both parts portrayed real events. The first part recalled the intense pain and loss that she had felt at the time of the divorce. The second part drew upon a much earlier time. The roommate had in fact been quite disturbed, even suicidal; Anna had tried with only partial success to protect and help her. But the story of the woman in the black coat, who went out into the night, was Anna’s own: As a teenager, living on her own for the first time, Anna had put on that coat and gone out alone into the night into a dangerous part of the city, where she had been held up at gunpoint by a boy who had forced her against a wall. In terror, she had thought she would be raped or even killed, but he had taken her purse and that coat and fled. She felt shaken even by the memory of her terror.
I said that she was telling me about this for the first time and letting me know in an alive way some of the terrible feelings she had had.
Anna said she was afraid I couldn’t see how she felt.
I said I thought that was a way of backing off from the terrible things she was feeling and from feeling connected with me, going back to the disconnected way she had felt.
“We were stuck in the muck before,” Anna said, “but the muck is safer. That is terrible anxiety I feel in the dream, waiting to hear the story. Terrible things have happened to me, and I have let them happen. That seeking out of danger, that self-destructiveness is the flip side of the anger I’ve felt toward you.”
Comments
This session was different from any we had had for a long time and reflects, I think, the lifting of the impasse that had held us immobile. It is key both to the dream Anna reports and to her associations that the dream establishes, or reestablishes, a frame for the analytic work, one in which we are making and telling a story that feels true and important, in which fears and wishes from the past can come alive and become known. We often speak of the analytic frame in terms of the setting and the arrangements for the analysis, but in a working analysis the frame is also centrally a frame of listening, where the analyst can assume the role of an early parent who listens to and imagines the patient’s evolving experience. It is only within this listening frame that the patient can safely permit the unconscious dimension of experience to penetrate awareness and become known as part of the here and now, yet at the same time as distinct from it; here the patient can see what happens between analyst and patient both as real and present and as a transference (LaFarge 2014; Birksted-Breen 2015).
Recognizing the reestablishment of this listening frame, Anna is now able to feel hope for the analysis, and to bring a dream through which we can begin to explore her fantasies and experiences of loss and destructiveness. The dream depicts a story in which the loss of Anna’s husband at the time they divorced (the first scene of the dream) can be understood in part as the loss of a figure who reassured Anna of her own capacity to love and be loved and who protected her against fears of destructiveness from within and without. Her failure to keep the marriage intact has revived for her old memories of failing to protect others—here the roommate—and herself as well (the second scene of the dream).
As terrifying memories and fantasies come to light, Anna reinstates the situation of the impasse—seeing me once again as an uncomprehending, unempathic listener. However, I am now freer to separate here and now from fantasy—to see the transference as transference—and I am able to interpret this retreat as defensive, Anna’s way of warding off both her own awareness of her feared destructiveness and self-destructiveness and the meaning of my listening to these things and hearing them. In response to my interpretation, as the session ends, Anna is able to return to an attitude of analytic exploration, recognizing the anger she has felt toward me as something that has come from deep inside her and is tied to the long-standing hatred and cruelty that she has turned upon herself.
The blurring of the figures in the dream, where the woman who goes out into danger is both Anna herself and her roommate, whose threatened destruction Anna witnesses, reflects important aspects of the impasse from which Anna and I are now emerging. Certainly the blurring is connected to Anna’s use of projective identification, to her constant projection of the figures of a depleted, unprotective mother and a destructive daughter into me and her own reintrojection of the same figures. At the same time, the blurring of the two figures has to do, I think, with Anna’s preconscious awareness of my receptiveness to these projections, her correct apprehension that my anxieties resonate with her own. Indeed we both feel damaged, assaulted from within and without, uncertain whether we can be revived or can revive others, or whether our destructiveness will prevail. The resonance of these fantasies for both of us has kept us in a bastion of mutual disappointment. At the same time, as the bastion has been resolved, it has become clearer that some areas of fantasy and reality are shared between us and others are not. It seems likely that the bastion, with its sense of oneness, has protected both of us not only against feared object loss and failed reparation, but also against the meaning for both of us of the aspects of our inner world and external reality that we do not share; this will be an important theme as the analysis continues.
Conclusion
In the clinical material I have presented, I have tried to show the multiple meanings that a prolonged, shared sense of disappointment had for me and my patient Anna. For both of us, disappointment warded off still more painful states of disillusionment and despair. Anna’s disappointment set off a cycle of painful affects—shifting states of disappointment, disillusionment, and despair—that resonated between us and brought the analytic process to an impasse. To break this cycle and help Anna understand her sense of disappointment, I needed to do considerable work in the countertransference, to recognize the underlying disillusionment and despair that were warded off by my own sense of disappointment, and to trace these painful feelings first to their sources in my personal unconscious and then to their sources in Anna’s transference to me—in the internal objects she projected into me. My analysis of the two sources of my countertransference—in my personal unconscious and in the current analytic process with Anna—allowed me to begin to distinguish between these two currents and likewise allowed Anna to begin to explore her painful feelings more freely and to look at their sources in her past unconscious and in the analytic present. Although beyond the range of the material reported here, this exploration ultimately led to Anna’s reconstruction of a specific early memory, of a time when her mother’s acute illness and hospitalization had triggered her angry withdrawal, the analog of my own illness during an earlier period of the analysis.
Analytic impasse may be seen as a situation where for both patient and analyst the two currents of past unconscious and contemporary experience have for a prolonged period become blurred and are felt to be the same, and the psychic space between them, which is necessary for analytic work, has collapsed. In my clinical material, I have shown the way Anna’s projection of a depleted, damaged maternal object resonated with my own fantasy of myself as damaged; this blurring led to a situation where both of us saw Anna’s view of me as damaged as an accurate perception and prevented the unconscious dimension of Anna’s transference from emerging. Seeing myself as damaged in turn, I was unable to interpret as well as I might have otherwise, and this failure confirmed for both of us my damaged state.
I will close with a few words about analytic reparation and disappointment.
It is of note that the disappointment that Anna and I felt, and that threatened to defeat the analysis, appears to have been linked to a shared fantasy of the way reparation occurs in analysis. Both of us saw the analytic situation as a meeting of minds, in which reverie and imagination are key, where my containing imagination would create a place where Anna’s own unconscious experience could emerge, become known, and potentially be modified. This idea of analysis as a containing reverie, and of my analytic role as one in which I both create and represent a frame where this process can take place, so corresponds to my model of analysis that it is easy to pass over the recognition that it rests on a specific fantasy. At least in broad outline and on the surface, this vision of analysis was shared by Anna, and her view of me as lifeless and unimaginative—a view with which I identified during the period of impasse—depicted an analyst who was damaged in this essential analytic function.
Reparation may take many forms in fantasy: we restore our objects through love and sexual intercourse, through undoing specific damage we feel we have done to them, through rescuing them from dangerous bad objects, and in a host of other ways. Any or all of these fantasies may be actualized for the analyst through her work, and both patient and analyst may consciously or unconsciously experience disappointment in any of them. It seems possible that for the patient, and particularly for the analyst, who holds her model dear, the stubbornness of analytic disappointment reflects, in addition to the other functions I have described, an insistence on a specific (analytic) mode of reparation as a defense against other, more dangerous modes of reparation that are represented for each in fantasy—of reparation as a meeting of bodies rather than of minds, for example, or as a masochistic surrender or method of narcissistic appropriation. There is a glimpse of such a latent meaning in the second session, where Anna conveys the sense that reparation entails sacrifice of the self for the sake of another. The nature of these multiform fantasies, which are concealed beneath analytically sanctioned forms of reparation, would become known only as the analytic work continued.
Footnotes
Training and Supervising Analyst, Columbia University Center for Psychoanalytic Training and Research; Clinical Professor of Psychiatry, Weill Cornell Medical College; North American Regional Editor, International Journal of Psychoanalysis.
1
Anna’s analysis was conducted on the couch at a frequency of three times a week.