The tasks pertaining to Phallus and working alliance formation in psychoanalytic psycho-therapy for female patients with hysterical personality

Dual fixation in the oral and phallic-oedipal phases of psychosexual development has been the most widely accepted concept to explain the psychogenesis of hysteria. Although psychoanalytic psychotherapy has been the treatment of choice for patients with hysterical personality, it is considered difficult to form and maintain a working alliance with those patients because of the genetic configuration, which often manifests itself in their strong tendency for regression. The purpose of this article is to propose the techniques to form an alliance with female patients with hysterical personality in psychoanalytic psychotherapy, based on the genetic considerations, especially the problems pertaining to phallus in the initial phase. A case of 34 year-old woman with hysterical personality who manifested depression and conversion hysteria was selected to investigate the therapeutic process that enabled the patient to form an alliance with a female therapist. It was found that the difficulty to handle regressive and dyadic transference in the initial phase of treatment was minimized by the therapist's clear presentation of the boundary of treatment structure to contain the dyadic wish for dependence, which provided the patient with a separate object, the therapist, for phallic cathexis, leading to the recovery of the autonomous ego functions necessary for an alliance formation.