Psychoanalytic supportive psychotherapy of a terrified communist: report of a 37-year treatment

This is a case report of a 37-year treatment of a victim of the Holocaust. It illustrates the use of psychoanalytic based supportive psychotherapy to enable a severely damaged person to pull himself together and live a respectable life. The case is of special interest because a careful evaluation of the patient's ego functioning was important all through the treatment, and revealed an unusual set of defences. He was able to deal with his rage by taking an extreme Maoist Communist political position, ranting and raving about it, including his hate of America, etc., but at the same time he encapsulated this and focused it in the psychotherapy sessions. In contrast to many such fanatical individuals, he was able to keep himself from acting out these political feelings in any way or to engage in any destructive behavior. This seemed to form an intermediate position that enabled him to function and adapt to our society, get married, find long term respectable employment, and finally retire with savings and a pension. Understanding these ego operations empathically made it possible for the author to tolerate his views without either challenging them or agreeing with them and enabled him to come regularly and utilize supportive psychotherapy.