First of all thanks to Gil Levin for solving the mystery of the disappearing comments. And thanks to Ginger Schenck for repeating her observations. I'd like to begin with the key concepts of attachment in the therapeutic relationship. The main focus, in the section on Kathy's refusal to recover, is on Kathy's mastering, through my modeling, that she was not to blame or responsible for her family's depression following her brother's death. And the therapeutic work in this section was emotionally demanding for me. What I mean by emotionally demanding is that I WAS pulled to feel blame and responsibility for Kathy's impervious depression. However, none of this crucial work could have been done without the basic foundation of trust and safety in our therapeutic relationship. Many, many, many interactions between me and Kathy built this foundation. I can mention some of them that occurred to me and other people could probably notice others. I should also add one piece of Kathy's history that I don't think I mentioned earlier. You might remember the maternal grandmother that Kathy's brother went to live with before he died. Well, she was a major matriarch in a large family. Kathy, her nuclear family, and this large extended family lived together on a big ranch for the first 2 years of Kathy's life. Kathy spoke with great joy of her memories of much love from many people early in her life. Kathy and her nuclear family moved away to promote her father's business when Kathy was 2. Kathy missed the larger family and lost the benefit of having many loving caretakers. In addition to this, when Kathy's brother died, the entire extended family ceased all celebrations and never recovered from the depression. (The maternal grandmother had also lost a child many years earlier.) I mention this history to point out that Kathy was likely very fortunate to have formed some early attachments during a healthier time for both of her parents. Those added attachments, of course, made the family depression all the worse when her brother died, since Kathy felt responsible, in certain ways, for the loss of her brother and thereby the depression of the entire family.
But now, back to the interactions that built the trust, safety and attachment in the treatment. From the moment Kathy met me she tested to see if I COULD MAINTAIN THE FOCUS OF OUR RELATIONSHIP ON HER NEEDS, unlike her parents. Now, from birth to age 7 when her brother died, her father had been very close to Kathy. Yes, he used her to satisfy his own emotional needs, but Kathy did get some early attachment to him before she realized how she was being used (and before father became competitive with her). So in our relationship it was crucial for me to be alert to the ways Kathy might feel used. One of the ways that came up periodically in the treatment was about the research study. When she would say she wanted to make a contribution to the study, I would raise the issue of her trying to help others instead of herself. She was always relieved to be reminded of this. Also, remember her constant, repetitive inability to focus on her goals and her continual need to ask me to focus. I responded in differing ways, sometimes questioning why she couldn't focus and sometimes interpreting that she felt uncomfortable focusing on her goals due to her relationships with her family-of-origin members. But frequently I would summarize for Kathy what we had been talking about. I would remind her of what we talked about very deeply - bringing up main themes, how they were important in the big picture, and also many tiny supporting details. Kathy desperately needed to see that I really was GENUINELY INTERESTED IN HER. Even in the refusal to recover section, at first Kathy was worried that I thought she did not take our work seriously and was not performing for me (or for the study). It was important for me to maintain my absolute focus on Kathy's well-being and to forget the study and the videotape and how the study might reflect on me and my work. Another relevant interaction was around the short stories Kathy wrote and the aggressive stance I took with Kathy about her talent. Instead of my overlooking the stories, and focusing on the argument she had had with her father, I listened and attended to that data AND THEN SOUGHT OUT THE STORIES, READ THEM, AND TOOK MY "AGGRESSIVE STANCE" with her.
Ginger Schenck's comments on the importance of the father are well stated. Kathy's relationship with her father did play an important role in Kathy's psychology and I probably have not presented enough about him yet. One of the issues related to her father was her deeply disparaging attitude toward human emotions (which derived from her father). Since the father had such early abandonment issues (his father deserted him and his mother; his mother died of alcoholism when he was 12) he explicitly espoused a philosophy of "strength" derived by "overcoming" emotions. One time, he instructed Kathy to NOT CRY, and then proceeded to verbally abuse her so she would cry! By the way, she did NOT cry. And, of course, the father also berated the mother for any feelings she ever had. And so, after Kathy's brother died, Kathy's mother went into a kind of robot, functional, no-feeling state that lasted a long time. During the treatment Kathy gained a great deal of insight into these issues which I think will become evident in the final section where she brings her dreams, fantasies, and stories into the treatment.
In terms of attachment with me, her mother, and her father: Kathy DID use her attachment to me to work on her relationship with her mother both during and after treatment. She used her insights in therapy to remain fairly detached from her father. She came to understand his severe limitations with her, but chose to protect herself from him at the possible expense of any closeness. She did, however, confront her mother about many issues and has built a fairly good relationship with her. Kathy's attachment to me (and mine to her) has remained. She is in touch with me by mail, phone, or visits over the years.