Meeting Again, Meeting Anew: A Child Patient Returns as an Adult

Abstract

While many analysts have former patients return to treatment years after termination, it is more unusual for a former child patient to return as an adult. Such situations provide unique windows into development, both the patient’s and the analyst’s. They also present special opportunities for considering the fluidity and bidirectionality of psychic time. I describe my work with Charlotte, a five-year-old patient who returned to treatment with me 20 years later. Through the case, I examine the convergence of old and new representations of self and other, and the interrelation of temporal modes as a co-constructed, emergent aspect of the analytic process. With returning patients, past meets present as old relational patterns, idealizations, fears, and wishes emerge in the here-and-now. This can result in blind spots, repetitions, and enactments, but it can also allow for new, co-created experience, as past and present shape each other in an ongoing dialectic.

Keywords:

• temporality
• time
• repetition
• returning
• internalization
• transference-countertransference

Notes

1 This idea is similar to certain contemporary applications of the term après-coup (e.g., Birksted-Breen, 2003; Faimberg, 2007).

2 An examination of why we remember what we remember is beyond the scope of this paper. While much has been written on patients’ memories, including the roles of repression and dissociation, the question of reconstruction, and the impact of later events on how earlier events are recalled and interpreted, little has been said about how analysts remember what occurs in therapy.

3 Charlotte did not want to transfer to a different student therapist, so we planned for Charlotte and Diane to be seen together in the family therapy practicum. Later, I heard that they had one or two family sessions and then stopped going.

4 Authors (Almond, 2013; Jacobs, 2013) who began psychotherapy with patients they had seen in analysis years before have noted that the more intensive prior work can confer a richness onto the later, less frequent work. While my early, twice-weekly play therapy with Charlotte was not strictly psychoanalysis, it was undoubtedly psychoanalytic, supervised by a child analyst. The adult psychotherapy began at a frequency of once a week; later, we increased to twice a week, mirroring our old arrangement.

5 Later on, it occurred to me that when Diane initially contacted me regarding therapy for her friend, she may have been preparing Charlotte for her move in advance, establishing me in loco parentis.

6 See Hoffman (1998) on how more directive or supportive moments can enrich the psychoanalytic process.

7 Charlotte’s threats also succeeded in bringing in another adult who could help both of them.

8 See Cooper (2015) on the idea that analysts must relinquish and mourn their conscious and unconscious wishes for how analyses will go.

Additional information

Notes on contributors

Danielle Novack

Danielle Novack, Ph.D., is a clinical psychologist and an advanced candidate at the NYU Postdoctoral Program in Psychotherapy and Psychoanalysis. She has supervised psychology doctoral students at the New School for Social Research and Pace University, and has published and presented on topics including analytic trust and the psychoanalytic treatment of eating disorders. She is in private practice in New York City.