The patient without a couch: an analysis of a patient with terminal cancer

The author reports an unusual clinical experience arising from the tragic circumstances of a patient who contracted cancer at the beginning of the fifth year of an analytic process. Instead of interrupting the analysis, the analyst suggested having sessions by telephone, as this patient could no longer leave her home when the terminal phase of her illness set in. The experience proved beneficial for the patient and enriching for the analyst. The patient was able to contain, work through and integrate the meaning and consequences of her disease, make reparations to her objects, and accept death with dignity. The analyst also emerged from the experience strengthened and more aware of her own vulnerability and mortality. The author brings up three relevant questions based on a review of the literature. These questions are: should the patient be told of his/her diagnosis and to what purpose? Can there be a productive analysis with such patients? What psychic structure and emotional conditions allow a patient to bear the truth?