Clinical Commentary 1

[This section is intended as a regular feature. A short piece of clinical material from an actual session is presented with a brief introduction about the history of the case. The material as published here was sent “blind” to three people who represent different psychotherapeutic schools of thought. They have been asked to comment from their own point of view on the material and the approach of the therapist in the session. The intention in putting these commentaries side by side is to compare the approaches of the different schools in order to facilitate the understanding of alternative terminologies and modes of practice.]

This man in his early forties, has had several previous attempts at therapy and analysis for symptoms of panic and sudden acute anxieties for no conscious reason since mid-adolescence.

The History

He was brought up in humble origins in a small provincial town but succeeded in getting to university, a professional qualification and a good job in middle-management in a state industry. Father was a regular officer in the forces and for most of his childhood a relatively absent figure. He was much closer to his mother and in fact seems to have slept in the parental bed frequently, being excluded when father was on leave. Father was an absent figure for most of his childhood. At the same time in spite of an apparent closeness to his mother, he does feel emotionally close to her. He has a brother (3′/z years younger) with whom he maintains a good but formal contact. In fact he feels he has a particular difficulty in loving and this is nowhere more painful than with his wife, who he knows loves him. He married into a close family, and is now very attached to his mother-in-law (a refugee some 40 years ago) who is one of the few people he really feels at ease with - characteristically this means he feels able to lose his temper with her. With other people he cannot let himself go in this way and experiences himself as passive in discuss