Michael Kasdaglis,

Freud's distinction between symptoms versus inhibitions does not readily come
to mind.  Could you please offer a brief definitional review of this, if it's
not too much trouble.

Also, it seems to me that from the point of view of "compromise formation," a
symptom can also be an inhibition at the same time (and vice versa), so I'm
not certain that this isn't a semantic issue.  Her inhibition was in not
telling me who had referred her, and this was simultaneously a symptom of the
very problem which consciously prompted her to consult with me.

As far as the patient's transference being "paternal-ambivalent"--I'm not so
sure from where you derive this formulation.  I do know that _I_ experienced
ambivalence about working with this woman, for the reasons I stated;  whether
_she_ experienced me ambivalently, and as a paternal figure, is quite another
matter, and I do not have any  associations of hers which readily come to mind
which would bear out your hypothesis about this.  If she had associations
about her father, and about how he would refuse to "take her along for the
ride" when he went here or there, and how much she longed to be with him, and
how she felt she couldn't let him know how resentful she was because she
worried it would ruin her chances with him, etc.--then that might be a
different matter...

As far as your feeling that I should have taken her on as a patient, would you
hold to that even with the knowledge that her friend was in treatment with
me--or might soon return to resume her therapy with me?  I realize there are
diverging opinions about this.  Personally, if a current patient of mine
referred anyone to me (even someone they barely knew), I would be very
cautious about accepting such a referral, because I would view this as an
"action" which my patient took, as a means of both expressing and defending
against some inner conflict, and some related element in the transference.
And I would want to do whatever I could to remind my patient, through the
interpretive process, that it would be in the best interests of their therapy
if they put their feelings into words, versus such actions.  Ideally, I would
want some time to hear the patient's associations about their wish to make
such a referral to me, so that once we had the chance to carefully evaluate
what it would mean to them to actually go ahead and make the referral (and for
me to accept it or decline it), we could make the decision which seemed wisest
(i.e. one which would preserve
the integrity of the work).

At an extreme, what if a patient sent me many referrals, which I accepted?
This would make it hard for me to address certain issues in the patient
without also worrying that since my livelihood depended on the patient, I
better not say anything that might offend the patient!  Of course, there are
many times when we need to say things to patients which, predictably, will
lead to anger, ambivalence, etc., and the giving and receiving of such "gifts"
complicates this.

David Mittelman