A Portrait and Reflections on Mourning, Holding, Illness and the “Music” of the Consulting Room

Some patients, especially those encountered early in one's career, become emblazoned in memory. Such was the case for this author with Rudy. His is a moving story by virtue of who he was and what happened to him. From him, I learned of the potential for deeply mutative work with medically ill patients, even in the context of infrequent meetings. I learned how and why in supportive, dynamically oriented therapy, there are times when bending the frame is essential. Rudy taught me-and my students-how important the "art" of medicine is and about the potential for "healing" even in the absence of cure. His story conveys the deep psychological impact of childhood illness and demonstrates the potential to reverse some of that impact when illness is encountered once again in adulthood. The theme of the "music" of the consulting room provides an organizing metaphor for the dialectic of spontaneous, emotionally engaged responsiveness and disciplined restraint that optimally characterizes dynamic psychotherapeutic work.