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Orgel, S. (2013). A Patient Returns. J. Amer. Psychoanal. Assn., 61(5):935-946.

(2013). Journal of the American Psychoanalytic Association, 61(5):935-946

A Patient Returns

Shelley Orgel

This paper about patients who return to treatment several years after their analyses ended explores a few of many questions that arise for most of us. First: out of what conscious and unconscious needs do some patients come back while most resist the universal temptation to do so? Second: what has the unexpected experience of renewing a treatment and relationship with particular individual patients meant to me after an absence in which both of us may have moved on to different stages of our lives? We analysts and therapists at work are solitary people, and need the corrective of sharing our experiences and the kinds of feelings we tend to keep within the confines of our private offices. This essay is such an attempt.

I will begin by quoting parts of a recent clinical presentation of Ms. X that focused on how my fantasied relationships to the patient's central objects may have affected the outcome of a very long, terminated analysis:

What remains unanswered is: Did her alliance with me, partly based on my significant degree of support for her perceptions and feelings about her objects … advance or hinder her becoming able to experience erotic desire imbued with trust and intimacy toward a male love object of her own? …

In the course of years her insatiable need for an external mother figure became more and more our focus. The prospect of termination was painful and frightening, even though her ability to deal with the demands of her life, to use her mind thoughtfully and effectively, to become an appropriately loving and steady mother to her children have become easily available and gratifying. However, conflicts over sexuality and her relationships with men remained. Her wishes to castrate phallic-exhibitionistic, sadistic men, the ones she was most attracted to, the theme of numerous dreams, remained at least partially unresolved at the end.


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