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Epstein, S. (2000). Case Presentation: The Case of Kathy. J. Clin. Psychoanal., 9(4):420-435.

(2000). Journal of Clinical Psychoanalysis, 9(4):420-435

Case Presentation: The Case of Kathy

Dr. Susan Epstein, Ph.D.

I am presenting here material from the first five years of an analysis with a young woman whom I will call Kathy. First, I will present background information and a description of the fifteen-month psychotherapy that preceded the analytic treatment. Following this introduction, I will report a number of clinical vignettes that illustrate central motifs in the analytic work and highlight the nature of the therapeutic interaction.

Kathy was a single, white assistant professor in a social science department at a liberal arts college. In her twenties when she originally sought consultation, she appeared physically slight and very thin, and her close-cropped hair and lack of any adornment whatsoever gave her an almost boyish appearance. She was also strikingly plainly attired (in too large, ill-fitting business clothes) for a young woman of her sophisticated educational and professional background. She seemed emotionally constricted, almost cramped, weary and somewhat depressed.

Kathy told me right away that she was worried that I would be like her previous therapist, Dr. L, who had told Kathy that she was to do all the work, and that there was something wrong with her because she was never able to “chill out” and free associate while lying on the couch, a requirement beginning with the initial consultation session. Kathy had felt unable to question this “requirement,” despite her discomfort, confusion as to how this once-a-week treatment might help her, dislike of the therapist, and eventual sense (after six months) that she was feeling hopelessly worse. Unable to discuss any of her concerns, she began missing sessions, and finally

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