The case of Caroline and its management by Dr. Edmund provide impressive confirmation for the theories Dr. Broitman has begun to explain here and on her own Control Mastery Forum. A young woman whose precarious adaptation to life outside her family circle had placed her on a road to personal destruction asked Dr. Edmund for a "quick fix" from psychotherapy not unlike the transient relief she had learned to obtain from street drugs and casual sex. No matter how desperate we may be when we seek help, we begin the interaction with the possible therapist by testing to see whether we are in the right place. Caroline's initial test involved a brilliantly conceived metaphor within which she asked for help in deciding whether her course in life was appropriate. Dr. Edmund won her spurs immediately by answering the test question first on the concrete and then at the deepest level possible.
My colleague Vick Kelly, who trained first as a child psychiatrist before he began to work with couples, once pointed out to me that "Parents who don't set limits for their children don't love them." Despite their considerable intellectual equipment, Caroline's parents treated her as if she were a theoretical child rather than a person; they drove, ruled, controlled her life in such a way that none of their instructions could be useful. Where her biological parents may have set new standards for chronic empathic failure, Dr. Edmund offered Caroline sensible limits and controls that might allow increasing safety and increasing personal power within an atmosphere of reasonable and remarkably empathic discourse. In Dr. Edmund's hands, AA and NA offered parenting Caroline could test constantly, and which split the inevitable transference into chunks that turned out to be quite manageable. In praxis, the therapist said "If you continue this fight with your parents you will die. I will fight with them, you will fight with me, and together you and I will build a new Caroline."
The therapist who is interested in affect will find much to study in this case. We might say that Caroline's parents provided reasonable intellectual understanding of whatever situation they discussed with her, but taught her little about affect modulation. I suspect that there was so much noise going on inside her head that Caroline tried to block it with noise outside her head. Risk, danger, thrills—these provide affect over the range from fear to terror. I see cocaine, alcohol, and casual sex as tools for the management of shame. It has been my experience that the patient's attempts at cure can provide us with excellent clues to nature of the hidden pain. We professional therapists know that Caroline was on a path that might lead to accidental death, fatal disease, or a host of more minor ailments, but although she knew such behavior was "bad" for her, I doubt very much that when involved in it she saw it as "self destructive" and had any intention of ending her life. Even suicide is more an effort to end unbearable affect than destroy a self; Caroline had been looking for her own personal Mr. Goodbar in hope of gaining relief from emotional pain she would only come to understand from competent therapy.
I'd be curious to learn something about the nature of her previous psychotherapy. The material presented so far would lead me to speculate that the therapy had either been rather intellectual and too divorced from her affects, or that it had somehow become too much like the system offered by her family. A cliff-hanger of a case; thank you both.