Dora lived with her parents, who had a loveless marriage, but one which took place in close concert with another couple, Herr and Frau K. The crisis that led her father to bring Dora to Freud was her accusation that Herr K had made a sexual advance to her, at which she slapped his face — an accusation which Herr K denied and in which her own father disbelieved.
Freud himself reserved initial judgement on the matter, and was swiftly told by Dora that her father had a relationship with Frau K, and that she felt he was surreptitiously palming her off on Herr K in return. By initially accepting her reading of events, Freud was able to remove her cough symptom; but by pressing her to accept her own implication in the complex interfamily drama, and an attraction to Herr K, he alienated his patient, who abruptly finished the treatment after 11 weeks, producing, Freud reported bitterly, a therapeutic failure.
Freud initially thought of calling the case 'Dreams and Hysteria', and it was as a contribution to dream analysis, a pendant to his Interpretation of Dreams, that Freud saw the rationale for publishing the fragmentary analysis.
Ida recounted two dreams to Freud. In the first:
[a] house was on fire. My father was standing beside my bed and woke me up. I dressed quickly. Mother wanted to stop and save her jewel-case; but Father said: 'I refuse to let myself and my two children be burnt for the sake of your jewel-case.' We hurried downstairs, and as soon as I was outside I woke up.
The second dream is substantially longer:
I was walking about in a town which I did not know. I saw streets and squares which were strange to me. Then I came into a house where I lived, went to my room, and found a letter from Mother lying there. She wrote saying that as I had left home without my parents' knowledge she had not wished to write to me to say Father was ill. "Now he is dead, and if you like you can come." I then went to the station and asked about a hundred times: "Where is the station?" I always got the answer: "Five minutes." I then saw a thick wood before me which I went into, and there I asked a man whom I met. He said to me: "Two and a half hours more." He offered to accompany me. But I refused and went alone. I saw the station in front of me and could not reach it. At the same time, I had the unusual feeling of anxiety that one has in dreams when one cannot move forward. Then I was at home. I must have been travelling in the meantime, but I knew nothing about that. I walked into the porter's lodge, and enquired for our flat. The maidservant opened the door to me and replied that Mother and the others were already at the cemetery.
Freud reads both dreams as referring to Ida Bauer's sexual life — the jewel case that was in danger being a symbol of the virginity which her father was failing to protect from Herr K., He interpreted the railway station in the second dream as a comparable symbol. His insistence that Ida (Dora) had responded to Herr K's advances to her with desire — "you are afraid of Herr K; you are even more afraid of yourself, of the temptation to yield to him" increasingly alienated her. [According to Ida, and believed by Freud, Herr K himself had repeatedly propositioned Ida, as early as when she was 14 years old. (Freud, "Fragment of an Analysis of a Case of Hysteria ('Dora')")].
Ultimately, Freud sees Ida as repressing a desire for her father, a desire for Herr K, and a desire for Frau K as well. When she abruptly broke off her therapy, much to Freud's disappointment, Freud saw this as his failure as an analyst, predicated on his having ignored the transference.
Two years later, Ida returned to see Freud and explained that her symptoms had mostly cleared up; that she had confronted the Ks. who confessed that she had been right all along; but that she had recently developed pains in her face. Freud added the details of this to his report, but still viewed his work as an overall failure; and (much later) added a footnote blaming himself for not stressing Ida's attachment to Frau K, rather than to Herr K, her husband.
Through the analysis, Freud interprets Ida's hysteria as a manifestation of her jealousy toward the relationship between Frau K and her father, combined with the mixed feelings of Herr K's sexual approach to her. Although Freud was disappointed with the initial results of the case, he considered it important, as it raised his awareness of the phenomenon of transference, on which he blamed his seeming failures in the case.
Freud gave her the name 'Dora', and he describes in detail in The Psychopathology of Everyday Life what his unconscious motivations for choosing such a name might have been. His sister's nursemaid had to give up her real name, Rosa, when she accepted the job because Freud's sister was also named Rosa—she took the name 'Dora' instead. Thus, when Freud needed a name for someone who could not keep her real name (this time, in order to preserve his patient's anonymity), Dora was the name that occurred to him.