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.

Biography

Linda A Chernus, MSW, BCD, DPNAP, is a Professor Emerita of Psychiatry and Behavioral Neuroscience at the University of Cincinnati College of Medicine, where she was an active faculty member for 40 years. She is currently in full-time private practice. The author of more than 50 publications in refereed journals, she is the Book Review Editor of Psychoanalytic Social Workjournaland serves on editorial boards of Clinical Social Work Journal and Smith College Studies in Social Work. In 1992, she was elected by the National Academies of Practice in Washington, D. C. as a “Distinguished Practitioner and Member, National Academy of Practice in Social Work.