The case of Joan : a classical approach

The case of Joan : a classical approach

from The Cambridge Companion to Jung.  Edited by Polly Young-Eisendrath and Terence Dawson. Cambridge University Press 1997.

A classical approach     JOHN BEEBE
An archetypal approach     DELDON MCNEELY
A developmental approach     ROSEMARY GORDON

In the following pages, three experienced and accomplished Jungian analysts comment on where they would focus, what they would do, and what they imagine to be the course of treatment for "Joan." Joan is a pseudonym for a patient whose printed case material each analyst received and read closely before writing a response. Each received the same case report, summarized from the actual records of a forty-four-year-old female patient at the Renfrew Center for Eating Disorders, a private hospital in the Philadelphia area. Renfrew generously made available this material, which had previously been used in the public domain at a national conference on eating disorders.

Each analyst was asked to see things primarily from the perspective of her or his "school," each one being a prominent representative of that approach. Dr. Beebe writes from the classical approach, Dr. McNeely from the archetypal, and Dr. Gordon from the developmental. The analysts did not consult with each other on the case. As you read their responses, you may note how they highlight the model sketched out by Andrew Samuels in the Introduction in which he weighs the importance of the archetype, Self, and the development of personality as well as the clinical issues of the transferential field, symbolic experience of Self, and the phenomenology of imagery for each of the Jungian schools. What he has sketched as an interpretive model for the three schools of analytical psychology (see Introduction, pp. 8-11) works very well in understanding the interpretations of these authors. It must be remembered that none of the three analysts ever met the patient and, consequently, their essays should not be seen as comparing therapeutic practice. Rather, they are designed to illustrate different approaches to a real case. Apart from a few necessary instructions for thinking about the case, the following is all the information the authors received.

Joan

Referred to Renfrew by her primary-care physician because he was concerned that she had an eating disorder, Joan weighed 144 pounds at 5' 6" at the time of admission to the hospital. She was bingeing and vomiting at least three times a day.

Six weeks prior to admission, Joan was extremely depressed and anxious. She said "I'd like to jump in a river." She also reported waking in the early morning hours, full of anxiety. She reported hitting herself in the head or stomach or biting her fingers in episodes of emotional pain.

During the admissions interview, Joan expressed a desire to "work with the feelings I've been stuffing down." She described herself as "really fat" and worried that her husband would leave her, wondering why he had even married her. Recently she had become more acutely aware of memories of incest with her father, something she had known continuously, never having successfully addressed it. She wanted to address it in treatment now. She also expressed the desire to eat properly, to stop her bingeing/purging addiction, and to improve her communications with her husband of four months.

Joan lives with her third husband, "Sam" (all names used in this report are pseudonyms), whom she married just four months before entering the hospital. She had become friends with Sam and then lived with him for two years prior to marriage. The couple currently live with Joan's daughter Amy, age twenty-six, and Sam's son David, age fifteen. David's mother died of diabetes when he was three years old. David is a source of conflict in their marriage because he gets into trouble at school and threatens to leave home.

Joan is employed full-time as a cashier and food service attendant in a local convenience store where she has multiple duties and responsibilities. In addition to her work, she has recently organized a women's self-help group for eating disorders and is very enthusiastic about it. Her long-term goal is to become an addictions counselor. She has plans to begin studies when she finishes treatment.

While Joan was at Renfrew, her mother, age eighty-one, became seriously ill with kidney failure. Even so, Joan found it difficult to discuss her anger at her mother's failure to protect her from an abusive father in the past. Joan's mother lived with her briefly, but Joan found it so stressful that she advised her mother to return to her home, which, being in a different state, was distant from her.

At the time of admission, Joan complained of heavy menstrual bleeding, usually every three weeks. Although she has a gynecologist, she had not scheduled an examination with him, claiming that she didn't consider her condition to be "serious enough" to warrant a doctor's help. Often when she was ill or injured, Joan would hesitate to take time off work and/or to seek the medical help she needed.

At the age of eighteen, Joan left home to marry her first husband. She had one daughter, Amy, in this marriage. Joan described the marriage as "painful and abusive." Amy has a history of chronic depression and has been diagnosed as having bipolar disorder. Joan left the marriage after two years. In her second marriage she had two more children, a son, Jack (now seventeen), and a daughter, Lynn (now twenty-one). Both Amy and Lynn were sexually abused by Joan's second husband, for which Joan feels very guilty. "I wish I could have protected my daughters, but I just didn't see the signs."

When Joan was five months pregnant with Jack, she took in a foster child named Johnnie, sixteen months old and afflicted with cerebral palsy. Eventually she adopted him.

Her second husband was unfaithful and abusive, one day abandoning the family without explanation. Because Joan was unemployed and unprepared for this sudden loss, she lost everything at the time: her home and all of her children except Lynn. Joan and Lynn lived in and out of a shelter for a year. During this time, Joan acquired a position as a waitress and prepared to reunite her family.

When she met Sam, her current husband, she found it extremely difficult to trust him, but things have ultimately worked out well.

Joan grew up in a four-room wooden house in rural Arkansas (USA). Her parents and only sibling, a sister eleven years older, lived at home. Her father was a "sanitary engineer" and was strict and emotionally distant. Most of the time, food was scarce and comfort was unavailable. Joan recalls her father being absorbed in repairing his automobile when he was at home and commented "it was more important to him than we were." Her mother was "always depressed" and very obese. Joan recalls feeling ashamed of her mother, who weighed over 300 pounds.

Joan reported that she had been sexually abused by her father, beginning in early childhood. She usually slept in the same bedroom with her mother and father, while her older sister slept in another. Her father would fondle her genitals in the morning before he left for work and when Joan complained to her mother, her mother did nothing. She also had some memories of being urged to fondle her mother's breasts during this time when they shared a bedroom. In general, Joan describes her childhood as "unsafe and full of fear."


 

JOHN BEEBE
A classical approach

The first thing I would ask myself in approaching the case of "Joan" is what I think I know about the patient. That is, I have to discover what my own more conscious fantasies and expectations are, then inquire, more deeply, as to what my unconscious may have already done with the imminence of her upon my psychological scene. And, because I am about to function as Joan's psychotherapist, I shall be looking for what I can relate to naturally in her - what I can immediately gravitate to in her from my own center.

Let's start with a shared interest. Reading the case, I was not feeling anything in particular, beyond a certain drabness, until I noticed that Joan is "employed full-time as a cashier and food service attendant." Somehow this detail grabbed me. I have a long-standing interest in the ways in which food is implicated in the activities of our culture, and particularly in how food may serve as a medium for interpersonal communication. I enjoy getting to know people who sell, prepare, and serve food. And I love to eat, and even to diet, which gives me a new relation to the pleasures of food selection.

In the "classical approach" the analyst's lead is the Self's; that is, one trusts one's psyche to provide the libido - the energy - for relating to the patient - and brackets off considerations of "narcissism" or "appropriateness," letting fantasy toward the patient run its course until a pattern is established which can then be scrutinized. The classical Jungian tradition of analysis of the transference is by way of permitting the countertransference of the analyst its say, and this the analyst does primarily by attending to spontaneous reactions to the client, and only secondarily subjecting them to evaluative self-analysis. It is this approach I am following here.

That Joan has an eating disorder had started to turn me off, but that she works in a food-related employment piques my interest in her: perhaps she values food positively, or at least can relate positively to my instinctive interest in food, and this might form the basis of a spontaneous connection between us - provide a sort of glue, based on a shared mystery, a secret pleasure and passion between us. (At a more thought-out level, I recognize Joan's perhaps affirmative connection to food as the potentially creative side of her neurosis: the resourcefulness that accompanies her oral problem, the "purposiveness," in Jung's sense, that would give her symptoms meaning.)

I find myself also taken with the statement Joan made during the admission interview, expressing her desire to "work with the feelings I've been stuffing down." I like the way her mind moved to this metaphor - although I recognize she may have been echoing the rhetoric of her self-help group for eating disorders. On the hopeful side, it was she who formed the group, and her having done so is another sign of her resourcefulness in the face of her adverse and regressive "oral" symptomatology.

I think I like Joan's energy; I feel that it augurs well for the psychotherapy. It's important, in the classical approach, that the analyst be able to find something to like in the patient, or else one has to conclude that the energy won't be there in the analysis to affirm the emerging selfhood of the client. In that event the client would be far better off - and safer - in another analyst's hands.

For me, as I read Joan's case, it is a particular plus that her memories of incest have become more available to her recently. The classical analyst "likes" signs that the personal self is taken seriously, as something to be honored and not violated - for this little "s" self is the core of integrity upon which analytical psychotherapy will build in reaching out to the wider Self to integrate the personality. (This honored personal core is sometimes referred to in the psychoanalytic self psychology that has so many resemblances to the classical Jungian approach as the "self that knows what's good for itself.") It is as if Joan's sense of the worth of her self is heightened just now and her imagination is working, ready to tackle the violations of integrity that have compromised its functioning in the past. Perhaps this is part of the honeymoon glow from marrying Sam.

I imagine Sam to be a positive figure for her, yet when she reports that she wonders why he'd even married her, I think she is expressing her difficulty accepting that she deserves the caring of another. In more classical Jungian language, Sam - with whom "things have worked out well" - would represent, or evoke within Joan, the image of the caring animus, the inner "husband" of her life resources. He would open her up to the possibilities of a more focused connection with herself, aimed at taking better care of the person she is.

At this point I would begin to criticize the fantasy I have so far simply allowed. I am trained to reflect on the assumptions I have been making: such reflexio is a critical next step in the classical Jungian handling of countertransference fantasy if inappropriate action is to be avoided (CW 8, p. 117).(1) I notice that the fantasy that has developed so far imagines Joan at a positive turning point in her life, having married Sam. It has given me hope that a therapy undertaken at this time will be more fruitful than the long history of dysfunctional living and repeated disappointment in relations with others would seem to predict. I have to admit to myself that in taking up the positive, I have, in terms of Jung's theory of psychological types, revealed my own characteristic attitude toward a new situation. A classical Jungian would not fall to note that I have moved toward the case in accord with my extraverted intuitive nature - that is, sensing the longshot possibility at the expense of a more realistic focus upon the client's limitations, which are everywhere underscored in the facts of the bleak case history. Nevertheless, I trust my intuition and feel ready to go out on a limb and tell myself that, despite appearances, this is a therapy that can work.

Joan will soon, however, be a real person talking to me in my office. I wonder how much to share with her of my experience reading the intake summary. Usually, I like to begin a therapy by telling the patient what I know of her and by letting my own reactions to what I have heard and read about her case come through. But should I tell Joan about my liking for food or speak of my respect for what sounds healthy in her marriage to Sam? Jung is clear that he gave himself permission to tell a number of patients how he felt about them, as early as the first session. He found it particularly important to share his unbidden reactions, since in his view these were governed by the unconscious itself. "[M]y reaction is the only thing with which I as an inpidual can legitimately confront my patient" (CW 16, p. 5). So, early self-disclosure would be an option for me in building the transference relationship with Joan. But even as my fantasy runs toward how to create a relationship to this new client, I begin to recognize a certain seductiveness in the way I have imagined an easy merger of our natures around a shared, unambivalent aspiration for her betterment, as if there could be no problem between us in the psychotherapeutic collaboration.

It dawns on me, as I examine my initial fantasy more critically, how much my connection to her - so far - is on a narcissistic basis. I have no fantasy as to what she is really like. Am I already behaving like the incestuous father, who must have related to her almost exclusively through his own needs and preoccupations? I recall what a long time it took Joan to trust Sam. I realize that Joan will not trust me if I make a series of moves to "merge with" her - even (or especially) if she initially complies with them. Probably she would defend against my extraverted enthusiasm with increasing messages of discouragement. Even if I succeeded in becoming a good object to her - that is, someone whom she perceives as ideally positioned to foster the emergence of a potentially healthy self in her - there is no evidence that Joan will be unambivalent about merging herself with such a good object. From the number of self-defeating choices that pervade her reported history, I suspect that Joan may suffer from what I have elsewhere termed "primary ambivalence toward the Self," and I realize that I am going to have to make room for her ambivalence toward people who might be able to help her to thrive if I am going to function effectively as her "selfobject" (Beebe 1988, pp. 97-127).

Interpolating from the history both of parental neglect and abuse and, later, of self-destructive behaviors, it is likely that in her own fantasy life part of her is still identified with parental figures who did not always want what was best for her and that she therefore will find it hard to embrace wholeheartedly a program for self-improvement. Further, even if she has already decided that she wants to be helped, this choice could only be accompanied by an uncertainty as to whether any caretaker she might find could fully share her purpose. I know, therefore, that I will be tested to see if I can be a good doctor who doesn't put his own needs ahead of hers.

I also realize that, although Joan has the goal of becoming a therapist and will sometimes enjoy seeing how I go about doing my work, she is more than just another adult caretaker in the making, who might learn by merging with me in an apprentice mode. In that mode, I could talk to her continuously, instructing the therapist in her as I would do with a junior colleague in supervision. With Joan, I think such an approach would backfire. There is a far more fundamental need to be cared for that shows through her history, which particularly suggests maternal abandonment. I could not indefinitely adopt the mode of even a good father without recapitulating this maternal abandonment: after a period of compliance with my guidance of her conscious efforts toward self- betterment, Joan would probably begin to get severely depressed.

Probably she would not ask for relief of the depression within the therapy sessions themselves, but would signal her need more indirectly, possibly through canceled appointments or intercurrent illnesses of a physical nature. I have noted that she has characteristically had difficulty asking for help directly. (She did not think her heavy menstrual bleeding was serious enough to warrant a doctor's visit.) It may be hard to get to the abandoned child in Joan. I will have to be careful not to ally so directly with the seemingly adult part of Joan that the child in her continues to starve and to feel abandoned. Were I to ignore the child, she would be forced to ask for help in symptomatic ways, including perhaps a return to the suicidal behaviors mentioned in her history.

For a therapist working in the classical Jungian tradition, the habit of trusting the psyche to shape an attitude toward a client means allowing one's clinical fantasy to develop its own tension of opposites. If one lets the natural ambivalence about how to approach a treatment emerge, one avoids the danger of a one-sided countertransference stance. Here, my initial identification with the good father role gives way, spontaneously, to a maternal anxiety. This tension of opposites is a sign of the analyst's self-regulation, which will operate reliably if the analyst has been analyzed sufficiently to be comfortable in allowing the compensatory function of the unconscious to do its work, and if the analyst has learned to bear the conflicts that emerge. Thus, even when one starts as I did, to shape a stance toward Joan by trying to transcend her deep mother problem and to encourage the "flight into health" represented by merger with a progressive analyst-father, if the clinical rumination is allowed to proceed, a maternal anxiety for the abandoned child in this client will eventually surface in the fantasizing therapist.

Finding myself now thinking about Joan's mother problem, I begin to focus more consciously on the signs of the wounded child. I immediately see, along classical Jungian lines, the prospective meaning - the value - of the child image. Could the child be the way to the maturity that I sense is possible for Joan? Joan's desire to jump in a river, the closest to archetypal imagery we are given, could be heard as her desire to reenter the intrauterine condition, to be reborn in the mother's bloodstream, through what Jung calls the "night sea journey." Perhaps I can help her realize this ambition in the therapy through an immersion in the unconscious. This would mean attention to her dreams and fantasies, but not in too verbal a mode, which would again be meeting her prematurely at the level of the father and the patriarchal order of words.

Here I have made use of the classical Jungian method of amplification in attending to Joan's stated wish to drown herself, taking this alarming threat as an archetypal motif, scanning it, with the image taken less literally and more symbolically, for a clue to what her own psyche may think is necessary to heal her. But again the clinician in me rises up in opposition to the archetypalist: I realize that her immersion in the river, even if indicative of a baptism into a new being, is more likely to be accomplished if I accept a period of regression in which a less organized, maybe less verbal, Joan appears as a precursor of her transformation. I may have to contain her through a period in the therapy in which she can't say much. It occurs to me that she might like to draw, or at least be shown where I keep crayons and paper so that a way of communicating in a fluid medium while she is "underwater" in the unconscious is made available to her. Above all, I can't expect her to be conscious of what she's doing in therapy. She may for a long time need just to be safely there in my restrained presence. An underappreciated strength of the classical Jungian position - exemplified by Jung himself, who maintained his strong grounding in psychiatry alongside his interest in "religious" healing through traditional symbolism - is its ability to straddle clinical and symbolic modes in the service of fostering a patient's recovery.

Whatever the process that eventually turns out to help Joan most, I know that I will have to respect my own nature in following it: classical Jungian analysis conceives itself as a dialectical procedure, a meeting of two souls, each of which must be respected if the exchange is truly to be therapeutic. As Jung says, the analyst is "as much 'in the analysis' as the patient" (CW 16, p. 72). There is no way for an extraverted analyst like me to participate in a client's period of maternal regression except interactively. In the classical approach, this can occur in a verbal, face-to-face mode simply by listening to the practical particulars of the patient's day-to-day life - her struggles paying her bills, finding the energy to keep the house clean, and dealing with her relatives. It is classically Jungian to take patients where they are. If as therapist I submit to the mundane reality of Joan's situation and respond without attempting to make interpretations that force her into a higher symbolic understanding at a psychological level, I may succeed in getting into the healing river with her. There, I will have to stay with the current of her affects, mostly mirroring them back to her and rarely pushing for their illumination. I will have to say very simple things back to her like, "That's particularly hard," or "that's lonely" or "that's scary," to go through the river which in her suicidal fantasy she imagined as the way to bring her chronic dysphoria to an end.

As this second wave in my fantasy of what it would be like to work with Joan overtakes me, I realize that I am trying to will myself into becoming the accompanying mother Joan never had. Once again, I am led to reflect on what I have imagined. I realize that by colluding in principle with Joan's imagined wish for this kind of mother, I have entered another trap, fallen into a subtler failure to accept Joan as my patient than my earlier attempt to be her good father. For it is not possible simply to undo the wounds of the past by compensating for them now with a corrective regressive experience in the present. Indeed, I suddenly get the feeling that Sam, her good husband, may be trying to do just this: he sounds to me very much like a maternal caretaker, who saw his last wife through diabetes and is now carrying Joan through her ambivalence about deserving his help. Or maybe that's a projection onto him of the maternal role I now fear falling into.

In any case, I realize what I am going to have to do is harder than being Joan's good-enough mother. It is to help Joan grieve over the fact that she didn't have this kind of mother and, in a definite sense, never will - certainly not at the developmental stage when a mother like that would have been most needed. I have to let Joan grieve the lack of that needed mother, and rage at the lack of the needed father too.

Suddenly I see the way (and now it feels like the only way) to work analytically with this wounded woman. I will make a space in which she can tell me or not how it has felt to be her - as a person whose father and mother were both inadequate to the task of taking care of her needs - and in which she can begin to articulate how she proposes to go about being her own mother and father. At this point I feel suddenly released from my own fantasies and ready to hear from Joan's psyche in an unprejudiced way. This emergence of a new attitude out of a tension of opposite, incomplete solutions was called the transcendent function by Jung (CW 8, pp. 67-91) and it is this function the classical analyst relies upon in developing a sound approach to a client. The appearance of the transcendent function is signaled by a release of creative energy for the therapeutic work itself.

Sooner or later, Joan will tell me a dream. Without a need to make that dream a transcending symbolic solution to all her difficulties, or the occasion to foster a regression into a less conscious state in which I can nurture her back to greater psychic health, I may be able to hear it as the authentic statement of Joan's psychic position toward the person she has been and the possibility of the person she may yet be. My lob will be to hear that dream, to take it in. It will be the authentic vision of who she is, not the fantasies I can't help bringing to that lacuna in the case, which is only a report of successive abandonments and partial restitutions, not the authentic vision yet of the psyche, which can only be supplied by the patient herself. In classical Jungian analysis, the treatment plan is dictated by the patient's psyche. Any real planning for Joan's treatment will have to be shaped by us on the basis of what her dream suggests is possible, and I would expect the dream to create an unconscious role for me in her life which will have a most inductive effect on my unconscious attitude toward the treatment and a major effect, therefore, on the treatment planning. In the absence of that dream, I can only supply a very approximate guess as to the course of treatment with Joan.

I imagine that I will offer Joan once-a-week psychotherapy, explaining that this is a place where she may come to say what she would like to about her life. I might explain that I have no fixed way of working, but that I too will say what I want to say as we go along, and also that I am open to her comments and questions about what we are doing as we proceed. I would let her sit either on a chair facing mine or on the two-seater couch at right angles to me. My expectation is that she would be sitting up. For the time being, I probably would not show her the drawer with paper and crayons nor would I suggest that she might like to lie down on the little couch, as I feel either of those behaviors, upon reflection, would be to encourage a regression I have not established is fully in her interest. Equally, I would not make too much of the fact that I listen to dreams and fantasies as well as to more consciously produced communications and associations, because this could commit me to making more interpretive commentary than I might like to get into at this early stage. Mostly, I will try to make room for this woman to tell me what she wants to and for me to respond out of my sense of what I would really like to say in return.

I would predict that Joan spends most of the first hour communicating her shame at having to seek treatment for herself once again, and that she guesses that it's just a case of like mother like daughter, she just can't lick being fat. And I think I would say that it sounds as if, along with the selfhate, she has a lot of energy toward doing something to get past this problem - even that it seems to be her task at this time to solve many of the problems her mother left behind. I would try to convey that I could accept Joan's sense of having inherited the weight problem, even though she is not literally as fat as her mother was. If I felt a glimmer of interest in me, I would probably say that I know what it feels like to be engaged with food and that there are worse things to be occupied with. If she asked me what I meant, I would say that a struggle with food can be creative, in addition to being a pathological problem. I would hope in this way to provide a kind of inclusive context for ongoing discussion at the very beginning, indicating that my office could be a place of creative ambivalence.

I would expect Joan to feel held by this approach, and to engage in a committed way with the work. I would expect treatment to go on for a number of years. I imagine at the start that there would be many tests of my ability to accept her ambivalence toward treatment, mostly in the form of suddenly canceled appointments following the more "integrative" sessions (on the model of bingeing and purging). My main response would be to continue to "be there," to accept the cancellations calmly and to say to her at the next meeting, I think it's clear that you are still trying to figure out if there is anything nourishing here and if you can truly accept the feelings associated with the therapy as meaningful parts of yourself.

Gradually, as she begins to understand her ambivalence, she would, I imagine, come more regularly. Then it might be possible to identify more specifically the ways in which I seemed to her like an unresponsive mother or like a frightening, intimate, too-good father. I might be able to facilitate some recognition of how she needed to distance herself from me when I was in the overly enthusiastic father role, and how, when I assumed the role of a more distant mother for her, it plunged her into a sense of despair over felt abandonment. In this way, we might "work through," over a very long time, the transference to earlier self-objects.

But I would also be watching for moments when I seem to her to be interesting in a new way, for those would be times in which I am incarnating the person she might be in the process of becoming. I would particularly look for stretches of untense "meeting" between us, in which I feel naturally accepted for being the therapist I am and I can glimpse a part of her that hadn't lived much anywhere else. (At those times she might look like a "new face" in a movie, and I would be experiencing the unique dimension of her personhood.) At those moments I would not be afraid to laugh with her or to respond with enthusiasm toward her developing sense of psychological life.

I will not know for a long time in this therapy whether I am taking care of the mirroring needs of the very young one- or two-year-old self or supplying a measure of Oedipal (and therefore erotic) appreciation to a five-year-old self who can also feel safe that I will not preempt its sexual development to gratify my own need for intimacy. In short, I would not know if, in the transference, I was an appropriately interested mother or father, and I would not be surprised if instead I turn out to be neither, but rather a kind of transference brother, a fellow sufferer enjoying a respite from the arduousness of adulthood, and a model for the animus that will relate to some creative aspect of her personhood. For at those moments Joan and I would be experiencing the Self in its function as what Edward Edinger (1973, P. 40) calls an "organ of acceptance." These would be times at which we transcended ambivalence toward the Self in favor of simple gratitude for the possibilities of being human. It is my belief that such moments can provide the glue for the many years we would be working together, which would very likely include suicidal periods, times when I would hate her for her stubbornness or lack of movement, and periods when she would experience contempt for my limitations in understanding or accepting the inevitable slowness of her path to healing.

Letting fantasy help to structure the treatment planning, as a classical Jungian analyst does, inevitably means experiencing the problem of opposites, and in practical terms, a refusal to embrace either artificially curtailed forms of treatment, such as time-limited brief psychotherapy, or rigorous prescriptions to guarantee depth, such as insistence on multiple-sessions-a-week on the couch. In classical Jungian analysis, the frequency is dictated by the analyst's experience of the tension between too little and too much. Probably with Joan I would not increase the frequency of sessions, as that would upset the balance between promising too much and offering enough. I would feel compelled to hold this tension for the work to have sufficient integrity; and so I would resist trying to force a deepening of the work. What would increase would be my depth of commitment to the work and my availability to Joan as someone who could engage with her personhood each time we met, regardless of the level of her distress.

Jung says (CW 16) that the doctor "is equally a part of the psychic process of treatment and therefore equally exposed to the transforming influences." I would anticipate that my own relation to food would become more conscious during the period of my work with Joan. For Joan to complete her analysis with me, I will have to make a space in myself to examine my own ambivalence toward food, perhaps getting in touch with a part of myself that is suspicious, controlling, and devouring in relation to sources of nurture. This self-analysis might free Joan from the necessity of having to carry that for me as an eternal patient.

I hope Joan will realize her goal of becoming an effective counselor to people with eating disorders. I imagine her becoming a pillar of her particular self-help food-community, maybe even starting a business like a health food store. As she becomes less dependent on Sam and thus less the carrier of the wounded anima for him, I imagine Sam will eventually have a serious depression, but that Joan will see him through it, and that he will begin to get in better conscious touch with the needy side of himself. I predict she will have made reparative connections with all her children by the end of her treatment, and that she will value her contacts with them and will discover that she can be nurturing.

NOTE

I. "Reflexio is a turning inwards, with the result that, instead of an instinctive action, there ensues a succession of derivative contents or states which may be termed reflection or deliberation. Thus in place of the compulsive act there appears a certain degree of freedom, and in place of predictability a relative unpredictability as to the effect of the impulse" (CW 8, p. 117).

REFERENCES

Beebe, John (1988). "Primary Ambivalence toward the Self: Its Nature and Treatment." In The Borderline Personality in Analysis, ed. Nathan Schwarz-Salant and Murray Stein. Wilmette, Ill.: Chiron Publications.

Edinger, Edward (1973). Ego and Archetype. Baltimore: Penguin Books.

Jung, C. G. (1960a). "The Transcendent Function." CW 8, pp.67-91.

     (1960b). "Psychological Factors Determining Human Behavior." CW 8, pp. 114-128.

     (1966a). "Principles of Practical Psychotherapy." CW 16, PP. 3-20.

     (1966b). "Problems of Modern Psychotherapy." CW 16, pp. 53-75.