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Faces in Relation: A Case Study

The co-construction of the intersubjective field is of interest to psychoanalysis, yet detailed clinical material illustrating the nonverbal dimension of this process remains rare. This case presentation of Dolores illustrates two themes of the 10-year, thrice-weekly treatment conducted sitting up: (1) the integration of the “faces” of Dolores herself, her multiple early attachment figures, and my own; and (2) traumatic loss and mourning. Dolores was preoccupied with the faces of her childhood, and she wanted to be able to find her own face in mine. But she could not look at me, her own face was dampened, and she was often silent. Extremely fearful, withdrawn, and dissociated, she nevertheless longed for attachment. The paper describes both the process of co-constructing our attachment, as well as her difficulty in using our attachment, in large part because of her difficulty in mourning the traumatic loss of her first mother. Although Dolores was a brilliant and accomplished professional woman, and capable at times of highly articulate self-reflection, much of the progress of creating the attachment occurred through the implicit “action-dialogue” of face, voice, and orientation. I made an unusual intervention, derived from my background with videotape microanalysis of mother—infant interactions. I took a series of videotapes of Dolores and me together, and of my face only while I interacted with her. Because she did not look at me at this time, seeing my face seeing her while she watched the videotape and hearing my sounds responding to her, heightened her experience of my response and her own visceral experience: she came to recognize herself in my face recognizing her. Dolores urgently wished not “to go dead,” and Dolores had remarkable abilities to reflect on our process, to put her experiences into words, to convey how important I was to her, and eventually to analyze her difficulties with mourning. Our respective contributions illustrate the co-construction of the therapeutic action of the treatment.