Title: Through a Glass Darkly: A clinical journey

Abstract

The use of the empathic mode for engaging and communicating with patients has become widely accepted by many psychoanalytic psychotherapists since Heinz Kohut’s early formulations (Kohut, 1971; Atwood & Stolorow, 2014.) However, diagnostic understanding based on ongoing empathic immersion with our patients is often complicated because it is continually being modified as we know them more deeply and as transference and countertransference factors influence our perceptions. To illustrate the complexity of diagnosis when it is grounded in ongoing empathic engagement with our patients, I describe in detail my treatment of an elderly woman who initially presented with severe and acute symptoms of psychological, cognitive, and physical impairments. As the treatment has progressed, my diagnostic understanding has been continually modified to include a combination of psychodynamic and organic factors including PTSD, intense unresolved grief, and extreme feelings of guilt and need for subsequent punishment. Adding further to this conundrum, this patent’s treatment has been challenged by the complexity of working remotely during the Covid pandemic, which will become increasingly problematic as our patient populations continue to age.