Wallerstein, R.S. (2000).

Forty-Two Lives in Treatment: A Study of

Psychoanalysis and Psychotherapy. , 1-768. New York: The Analytic Press.

Analysis of the English Professor

Background and Prognosis

The English Professor came to psychoanalysis because of anxiety attacks

fear reactions that gripped him in almost every social and professional
situation. Things had deteriorated to the point where he had begun to dismiss
his classes early, to avoid seeing his friends, and to spend his available time for
the most part aimlessly driving around in his car. He finally had abruptly
resigned his position and had started in a hospitalization that lasted 7 months,
and a psychotherapy that lasted over a 4-year span (with a succession of
therapists). During this period he was evaluated at The Menninger Foundation,
and on psychological testing a pervasive paranoid condition was revealed that
had not been detected on clinical interview. His projective test responses were
full of a consciousness of being watched, being sought after to be punished for
misdeeds unknown to him. With irrational persistence, he saw eyes and
masked, disguised men staring out at him from the Rorschach cards. Because
of the assessment then of his illness picture as representing an encapsulated
paranoid state in a decompensated phobic-obsessional personality, the
treatment recommendation at that time was for an expressive-supportive
psychotherapy, to be initially very cautiously pursued. This therapy went on for
the next 2 years and led to enough reintegration and improved functioning
(i.e., a return to college teaching) that he finally felt he could strike out on his
own and left for free-lance writing in his home town, living with and taking
care of his widowed mother. When this did not work out, however, for a
variety of reasons, he came back to Topeka and to his previous faculty position,
with the intention of seeking more definitive (psychoanalytic) therapy. This

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time the psychological test picture was that of a much better integrated
individual; the paranoid coloration was no longer dominant, and was now also
quite egoalien. He seemed at this juncture to be a typically neurotic, well-
compensated, compliant, obsessive-compulsive individual suffering from
phobic and anxiety attacks.
The treatment now recommended was psychoanalysis. Among the major
difficulties anticipated for the analytic work (alongside the tremendous
inhibition of affect and impulse) were the patient's strong passivity, his deep
dependent wishes, his willingness to suffer if he could in turn hope for
gratification of these wishes, and his combined masochistic-passive tendency,
which could all fit into a willingness to stay indefinitely in the analytic
situation and to resist mightily efforts to change the dynamic constellations
involved.
Course of the Analysis
The patient was in analysis for 6 years (1145 hours); the treatment effort was
classical psychoanalysis. The patient made no major life decisions during the
course of the treatment. In fact, procrastination was for him a chief character
symptom; it had the meaning both of avoiding commitment with all its dangers,
and at the
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same time of affording the very eroticized gratification of sustained tension.
Through the course of the treatment, the patient made steadily progressive,
undramatic, but consolidating changes in almost every sphere of his life
functioning:

1. He was finally able to settle into a home of his own, and furnish it, with the
implications of commitment and responsibility.
2. He was able to accept and settle into a tenured professorship, and felt
improved enough in his public functioning to say, Even though anxious, I can
now stay with a big classit's like leaving my penis in (an allusion to his
analogous difficulties in the sexual sphere).

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3. He came to reasonable accommodations in his family relationships,
including disentangling from an undue neurotic dependency upon his mother:
I have had to give up my immature dependence on my mother. I had had the
idea that you can be in psychoanalysis and become a happy fellow and still be
going home to Mother. He quoted Thomas Wolfe's You Can't Go Home Again
many times in this connection.
4. He even worked out a stable relationship with a steady girlfriend for the first
time, albeit in a mutually neurotically inhibited equilibrium. They had actually
been with each other constantly (often five evenings a week) for 3 years before
sexual relations were attempted. And then these consisted regularly of varieties
of mutual masturbation, since he feared intensely the loss of control (and of
identity) in sexual penetration with orgasm. In his analyst's words, sexual
intercourse remained the last refuge of the patient's phobias and defied further
change via analysis. The patient was content to terminate his analysis this
way, and was pleased that he had found a very special kind of woman willing
to (masochistically) endure this situation indefinitely, hoping eventually that it
would be overcome and that they would be able to marry.
The main themes of the analysis have been implied in this summary of the
patient's life changes (and their sharp limits) during treatment.

1. The phobias were a central issue from the start. They were gradually (and
with great difficulty in getting past the patient's vagueness and elusiveness)
revealed as barriers against fears of fusion and annihilation. When pushed at
this point, the patient was liable to quasi-depersonalization experiences; hence
his borderline quality. By the end of treatment, the incapacitating phobic surges
had remitted: The patient could comfortably enough do most of the things that
scared him, (socialize, teach, etc.). His sexual inhibition, the last refuge of the
phobias, remained.
2. The patient's work problems and sexual problems were equally central to the
treatment and linked to the phobic symptoms in the manner just indicated.
3. The patient's passive-phallic and oral-dependent (and orally frustrated)

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relationship toward powerful authoritiesthe analyst, the mother and so on
was a central focus. In connetion with his fears of rejertion and aloneness, to be
expected at the hands of powerful adults, the patient recurrently brought three
paradigmatic childhood memories: one of turning out not to be wanted by a
woman who he thought had called him; one of being pushed out of his mother's
bed when he put his hands on her breasts; and one of not being wanted by his
father when he tried to help on a walnut-picking expedition. Linked to the fear
- field:pgn 280 field: -
of rejection for attempted closeness was the concomitant fear of fusion and loss
of himself should the move toward closeness be successful. Yet by the end he
could overcome his fears in interpersonal relationships enough that he could
step out of the ever-submissive role. He could say (and do) as follows: I'm 42
now. I pay my taxes. I don't owe anyone anything, so I should be able to go to
the toilet. If my bladder is full, I have a right to make a proper excuse to you
and go. (This was a measure of the increase in his self-confidence and sense
of being grown up, but it was still expressed in childhood, immature terms.)
Within the transference, all these themes were played out. The patient brought
a deep dependent yearning (matched by a counterpart fear of rejection). As the
distrust of the analyst was overcome, the patient settled into an anaclitic
dependent relationship within which the work of the analysis progressed, but
which also became ultimately itself a major source of gratification and a barrier
to further analytic resolution. The whole analysis was felt as a probing,
homoerotically ringed assault at the hands of a tremendously powerful figure
a very threatening, but at the same time a very gratifying, process to the patient.
He began to become fearful of admitting further therapeutic progress, as
measured by the mastery of his phobias (e.g., the stubborn phobic sexual
symptoms); the therapeutic relationship might then have to be ultimately given
up. Here was the evolved insoluble transference neurosis.
Termination
When the analyst, feeling that a plateau of improvementand an impasse as
far as further improvement was concernedhad been reached-moved to bring

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the analysis to termination, the patient turned on him with his feelings of being
let down; he asserted that he still had his phobic potential, that nothing had
happened. This of course was his deeper perception. He had given his all, had
tried to do everything that was required, had in turn not gotten everything he
wanted, and now was being asked even to give this up. He felt like a stranded,
helpless child. Thus a full-fledged transference neurosis had developed but
could not be fully worked through and resolved. At the end, the patient felt a
repetition of his fate with his frustrating mother, who didn't respond properly to
his affection and his plea for closeness and could send him off.
The way in which the analyst terminated the treatment by use of a parameter
or a manipulation has already been stated in detail in Chapter 10 (see pp.
187-188). Basically, it involved spending a fixed amount of time (3 months) in
discussing whether indeed there was any purpose to further treatment or
motivation toward further change. The patient's bitter and even paranoid
outburst over this, and his ultimate acquiescence to the termination pressure,
have already been described. The treatment ended with the analyst conveying
to the patient that they both ought to consider this an interruption, and a trial at
life without treatment, since they both knew that there were considerable
conflicts not yet analyzed. The patient said of this in his Termination Study
interview, I'm dedicated to psychoanalysis and after it's over, it leaves me
without anything to be dedicated to. And he added, Analysis sounds good in
theory, it looks good to a desperate person, it feels good while you are in it, but
it's unproductive of a real change in feelings
- field:pgn 281 field: -
(patient's emphasis). And because of this, he felt that some special
arrangements should be made for those who have terminated analysis, for even
a successfully analyzed person might be lost in the first year after treatment. A
guy could shoot himself without anything to cling to.
Status At Follow-Up
At Follow-Up Study, the patient's life and adjustment were sustained, and even
more consolidated than at termination. He now really accepted himself as a

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professor, not one of the boys any more. He was still closely involved with
the same girlfriend, was engaging now in a kind of half-intercourse with her,
and was talking about setting a marriage date. He had given her an official
engagement ring because people were beginning to say that she was a fool for
going with the patient forever and she needed something really tangible to
show. At the time when he gave her the ring, he told her that he was not quite
ready to get married, but that it did look pretty promising.
The most striking change from treatment days was the patient's feeling that his
life was now his own affair; there was no one to take over his responsibility for
that. He now felt terminating his treatment when he did to have been the
correct thing to do, because nothing but termination could have succeeded in
driving that point home. Right after the termination he had been confused and
in a vortex. Yet he had gotten up each morning and found that he was still
alive, and gradually he came to feel that he could stand on his own feet. He
found himself searching less and less for a mother. (His mother had died
suddenly during the follow-up period and he could cry at the funeral, in
contrast to his inability to do so at his father's earlier death.) He felt no desire to
come back and throw himself upon the analyst's mercy. Evidently he had
needed to terminate in order to show himself that he could live without
treatment. In regard to the treatment, the patient mused about what a more
successful 6-year analysis would bethe maybe still childish and naive idea of
it making a real change, leaving one with no nerves, no anxiety. But the
illusion of that kind of cure was now gone. He had been waiting for it for 2
years now after termination, and he was by now finally convinced that it would
not come. Analysis, he said, tried to promise too much: It's as though a fellow
had his leg cut off and a group of individuals with a great deal of dignity and
solemnity about themselves, and doctors' degrees after their names, would say,
We are going, by this process, to regrow your leg. He would be all full of
false hope instead of just adjusting to the fact that he had no leg.
We have additional follow-up information to the time of the present writing, 24
years after the treatment termination. The patient did marry on schedule 3

6
months after the official Follow-Up Study. A year after that the patient sought
out his ex-analyst for a consultation. His wife had an important job in the
business world; though he was proud of it and of her capacity to handle it, he
resented the inordinate pressures and time demands of the job, which all
conflicted with his natural expectation that she should be home to attend to the
marriage and to him. He was happy to receive the analyst's suggestion that he
talk this whole issue out frankly with his wife, as if he needed the permission
and this push to overcome his own procrastinating tendency before taking such
a simple and logical step. Two years further along, the patient again sought out
the ex-analyst to present
- field:pgn 282 field: -
him with an inscribed copy of a book of literary criticism he had just had
published; he used this opportunity to complain about his life, and to state that
his wife had not become pregnant after now 3 years of marriage. At the end of
the visit he asked the analyst whether the latter thought he should come back
for more treatment. When the analyst looked quizzically at him in response, the
patient stated hastily that he personally saw no need for it, since he was doing
so well. Somewhat over a year beyond that, with the patient now aged 48, his
wife (who was only 32) became pregnant and a son was born; this happened
about 5 years after the Follow-Up Study.
This account covers then, a 13-year span from the beginning of a 6-year
analysis that the patient was manipulated out of (or weaned from) at a point of
satisfactory achievement, and that otherwise might have bogged down into an
insoluble transference neurosis. It was also clear that the treatment outcome
was sustained and even consolidated over a considerable follow-up span.
Beyond that point, for the 17 years since, up to the present writing (24 years
since the treatment termination), the patient has kept in touch with his analyst
through an annual Christmas letter of varying length and confidingness. (The
patient has lived on permanently in Topeka, while the analyst has moved to
pursue his career in a distant city.) The patient's life has been monotonously
stable, with the patient in the same job and home ever since. The marriage has

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been stable; the one child is now a college student. The patient is now close to
retirement; he has over the years become a fairly well-noted expert in his area
of specialization and has published substantially (publication had been another
phobic inhibition). There has been no further therapy; the ex-analyst has
usually responded briefly to the annual letter of report.