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Fonagy, P. Denis, P. Hoffman, I.Z. (2004). Miss A. Int. J. Psycho-Anal., 85(4):807-814.
(2004). International Journal of Psycho-Analysis, 85(4):807-814
Peter Fonagy, Paul Denis and Irwin Z. Hoffman
Miss A was an attractive and vivacious 22-year-old, totally immersed in the wake of turbulent adolescence and the developmental tasks of young adulthood. She behaved somewhat immaturely for her age. She came to her first session dressed as if for a job interview. Although cheerful and highly eloquent, her anxiety to be accepted was immediately apparent. We made contact at a superficial level; she told me of her very high achievements, both sporting and academic, but of no sadnesses or disappointments. She painted an idealised picture of a perfect past but mentioned no close friendships, or any appropriate sexual relationship, although I later learned that her relationship difficulties were her primary reason for coming to me. Still, there was little to indicate, in this initial interview, any serious or deep-seated disturbance. She seemed pleasant, energetic and engaging. I was struck by her ambitions to achieve prominence in the corporate world, verging on grandiosity, but felt that given her past remarkable achievements, and her age, this was understandable.
She was the eldest of four daughters, all quite close in age. Her father was a self-made property developer, her mother an ambitious young courtroom advocate who was preoccupied with establishing a remarkable public career through much of Miss A's early childhood, leaving her in the care of a nanny and a housekeeper. Although Miss A was extremely successful at school and was a champion swimmer, she had some difficulties in finding friends even as a child and was offered an educational psychological consultation by her parents which she refused. At university she made a number of spectacularly unsuccessful relationships, both sexual and social.
Her failure to establish a successful relationship, and her sense of isolation, eventually drove her into therapy. After unsuccessful attempts with a college counsellor, a clinical psychologist and an organic psychiatrist, she found her way to her first analyst. He helped her with her anxiety about her exams, but he chose to address only a selected set of issues as their relationship could only continue for two years, and she made no progress in terms of finding more appropriate relationships.
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