I agree with Richard that it is imperative we recognize the patient's healthy tendrils that are often embedded in their pathology because this is really the only thing we have to work with and build upon. Focusing on pathology often feels humiliating to the patient and provides little more than intellectual insight. The issue of empathizing with oneself is also crucial, but unfortunately not written about in the literature and a therapeutic goal. Carolyn and Amy, what can I say except thank you for your kind words! And being medium is pretty good for patients. Jessica, I agree completely; working from a connectedness perspective comes with its own complications and risks and requires more of the therapist/analyst than using a "technique" that keeps us somewhat distant, but safer. But, as you say, it also requires that we are very careful that what we are doing is in the service of the patient's needs not ours. Kristine, you're probably right there will be some criticism and you're right that I was enamored with my patient, but I think in the way that parents tend to over value their kids--and feeling slightly over valued as a patient is not such a bad thing. Barbara, I hadn't thought about it that way, but of course you're right that sharing the information with her was in itself an action, in this case I think in the service of welcoming what I perceived as an emerging twinship selfobject need. But again it is important as you point out to make sure we at least think we are acting in the service of the patient's needs. Steve, those patients who resist closeness require the same empathic understanding of their overwhelming fear of being close (and often the emotional traumas that have resulted from it). If we can allow them to remain distant while understanding the necessity for it, I have found eventually they will allow themselves to come a bit more connected. Christine, I think you're right (as was Pam); there were sexual undertones, but I didn't feel they were the central theme in terms of her sense of self. If they had been, I would have responded more directly to them. Ernesto, I think you're right; affect is central to connectedness and empathy as well as selfobject function. Perhaps I took this too much for granted rather than spelling it out.
Richard Geist, Ed.D.