Psychoanalysis of a man with active alcoholism.

Psychoanalysis of a man with active alcoholism, who is able to resume recreational drinking, has never been described. Mr. A. began treatment in denial of his alcoholism. Analysis demonstrated an underlying splitting between his experiencing and observing ego. His analyst received a projection of his observing ego, the part that was worried about his drinking. Because this split was resolved within a therapeutic alliance, Mr. A. decided that he had been attacking and punishing himself with alcohol, and he elected to abstain from alcohol entirely. The first key event that lead up to this dramatic decision was a sense that his analyst was a separate person. The second, arriving for discussion within the analysis through a dream, was his conviction that he would have to choose either to continue to drink with loss of control at the cost of his analysis or that he would have to choose to continue analysis at the expense of having to stop drinking. Mr. A. then came to feel that his analyst was attacking and punishing him with a fee increase. After 15 months of complete abstinence, Mr. A. found that he could drink with rare symptoms, but he still felt saddled with an abusive analyst. Mr. A.'s rages about the fee came up most commonly right after weekend or vacation breaks in the analysis. But the interpretation of these rages as related to missing me were contemptuously regarded as attempts to force him into my psychoanalytic schema rather than regarding his experience as valid. There was a dramatic shift of our alliance when Mr. A. was given complete control over the fee. I was freed to interpret and reconstruct the underlying early relationship with his parents. The final part of this article describes Mr. A.'s working-through process, which stabilized his sense of autonomy and which reconstructed his early relationship with his parents. Mr. A. became convinced that it was up to him exactly how, when, and how much to drink. Drinking too much led to consequences that he chose not to endure.