One of the striking things about Laura (and many of the other individuals we've discussed) is the many different difficulties she brings to therapy. In the initial vignette we learn that she has an eating disorder, has a history of suicidality, recently has recovered memories of being sexually abused, encounters a variety of difficulties in her romantic relationships, has conflicts over dependency and autonomy, and has issues regarding her worth. When a client presents a variety of problems, the therapist is faced with a choice regarding whether to focus on certain issues or to try to direct the flow of the session as little as possible.
When I received my initial training in psychodynamic therapy, I learned that I was not to direct therapy but instead should let it flow freely. The assumption was that the client and I would gravitate towards the most important issues that way.
Later, I learned a more active, directive approach which assumes that therapy is more efficient and productive if therapist and client work together to choose goals for therapy and work together to achieve those goals.
Thus far, the emphasis is on Laura's eating disorder. Is this Laura's choice? The therapist's? Does it matter?