I think we've all been a bit taken aback by the violence of Caroline's home life. It is axiomatic that no mother can calm her child to a level more calm than she is herself---selfobject function is partly skill and mostly a reflection of what you are inside. Caroline's mother, herself a child of unempathic parents, knew precious little about the inner peace that results when a parent knows how to provide good affect modulation. In such situations, as Kohut said so well, father appears as a "second chance" for empathy. Not here! Father seems to have been a shame-bound man who lived at the Avoidance and Attack Other poles of the Compass of Shame, reducing the self-esteem of anyone who made him feel the least little bit inadequate.
Not surprising, then, that in the process of therapy Caroline has wondered constantly about her worth or value; it is the aim of any outburst of Attack Other behavior to make the recipient feel disvalued and unworthy so that the attacker can at least feel bigger and better than someone! I would suspect that one of the major transference issues has been Caroline's certainty that Jamie had to fit within the shaming system of the family. Prediction: Caroline expected Jamie to see her as defective, to use the tools of therapy to demonstrate her weaknesses and inadequacies, to prove why she was unlovable, to point up her intrinsic ugliness, to ensure that Caroline would understand just how ungainly and devoid of skill she really was. A question for Jamie: Did Caroline ever trigger feelings in you that fit her transference? Was she successful in getting you to think of her as a sniveling brat or an ugly child or a real pain in the ass? With someone who has grown up in so severly shaming an atmosphere, it is hard not to resonate with the self-disgust and self-dissmell broadcast by such patients. When this does happen, of course, we therapists are mortified that we have thought any such thing, and usually quite defensive inwardly.
Further question: did she give up the substance abuse easily as you taught her affect modulation, or were there many periods of recidivist behavior? I would suspect the latter, for as the patient grows in therapy this very growth exposes her to new levels of painful affect for which she has no modulation skills and for which she knows only her world of drugs and danger.