Katherine: A Long, Hard Case

Abstract

This article memorializes my long-term therapeutic relationship with Katherine. In reconstructing our work, some general ideas about long-term therapy became clear. Most important, as life contexts and needs changed for both patient and analyst, so, too, did the therapeutic work. As our respective contexts shifted and interacted, new therapies emerged unbidden, complete with new players, new roles, and affective responses and altered therapeutic tasks. It turned out that, in this work, flexibility with theory and clinical procedure was a frequent challenge and necessity. As Katherine's and my relationship deepened over time, achieving what I call “analytic intimacy,” my personal bond with and sense of responsibility to Katherine also intensified. This long relationship, then, raised this question for me: What is the therapist's relationship—affectively, practically, and morally—to her patients' suffering?