I appreciate the detailed account of the clues leading to putting together Kathy's puzzle. As I read through the case I am attempting to "see" Kathy but also to catch a "glimpse" of the therapeutic process. The flavor of the approach helps "theory come to life". If you will continue to describe your thought process along with the content of Kathy's sessions, it will provide me with a vivid picture. Through the course of therapy you appear to have gained a deep understanding and respect for Kathy and more importantly were able to convey this to her. This genuine caring and interested allowed for the emotional growth she experienced. I am wondering about several othe tidbits. When you described Kathy's father as competitive and her mother with feelings of being inferior: are those her own words or the picture she painted with her stories? If they are her words, she is indeed quite insightful. Yet even with these insights she did not appear capable (at the beginning) of realizing that these parental attitudes (or faults) were not a reflection of HER but of her parent's own inner issues. She seems to have ingrained very deeply inside her the belief that other people's happiness-somehow rests on her shoulders. Would it be possible to hear more family history? I am interested in the grandparents (both paternal and maternal). Do you ever use genograms in your work with clients? And did you do so with Kathy? I realize that knowing "why" one's parents are as they are, in no way negates the pain for Kathy, so I wonder if you believe it is an area worth exploring with clients? In addition, the grief that affected the family after the brother's death seems to be "frozen". If the "unreal, numb, not alive" feelings that she experiences are in fact unresolved grief (about her brother or her unmeet childhood needs) then I wonder how Kathy experienced or worked through this grief process in therapy? Perhaps at a later date in the case study, you will address this idea?