FROM HOPELESSNESS AND DESPAIR TO HOPE AND RECOVERY: PSYCHOANALYTIC PSYCHOTHERAPY AS EFFECTIVE AGENT OF CHANGE IN THE TREATMENT OF A PSYCHIATRIC PATIENT

In this paper we present the main features of a 10-year, twice-weekly psychoanalytic psychotherapy with a female subject (Clare) who presented with severe depression, self-harm and suicidality. Serious traumatic events in her upbringing led to the formation of a pathological defensive structure based on a rigid identification with the aggressor, used as a dysfunctional means of protecting her against the threat of severe anxiety and psychic annihilation. Although the prognosis appeared bleak, her motivation for greater self-understanding, her resilience and her therapist's commitment to analytic work allowed for a strengthening of the therapeutic alliance. Gradually and painfully, Clare succeeded in recognizing the difference between her cruel primary figures and the figure of a caring and containing psychotherapist, which in turn allowed her a more robust internalization of a benign object. The change in the nature of the transference towards greater trust coincided with improvements in her life, in the quality of her interpersonal relationship and external functioning. Psychiatric medication was gradually withdrawn and Clare found a part-time job. Improvements were maintained by follow-up consultations. The positive outcome confirms that long-term psychoanalytically oriented therapy is an effective approach for the treatment of subjects presenting with severe emotional difficulties.