Don't you know me? Mutual recognition in a case of mistaken identity

Contemporary relational theories in psychoanalysis recognize the fully two-person nature of the clinical process. Both patient and therapist bring to the encounter their internal worlds in equal measure, each exerting constant influence on the other, to create a highly complex relational field. From this perspective, clinical vignettes should provide the same level of description of the therapist's as of the patient's contributions to the treatment process. It is argued that the body of clinical relational literature, in general, has not kept up with its rich theoretical contributions. This case vignette and discussion, both in structure and content, is an in-depth illustration of the mutual construction of the clinical process. Clinical material is offered from an extended phase of analytic treatment during which the therapeutic relationship and so the patient's possibilities for growth and change shifted from seeming stasis and impasse into new realms of experience of self and others. The author's intent is to demonstrate with specificity the ways in which the experiential worlds of patient and therapist collide and influence each other to create the intersubjective field that is the locus of therapeutic action and analysis. The phase of work described in this paper was challenging and ultimately successful due both to the severe and pervasive nature of the patient's struggles along with his underlying courage to persevere in the face of them, and to the ways in which the therapist's life experiences and capacities inescapably contributed to the shape, limitations and possibilities of the therapeutic process.