Commentary by a Member of the Hampstead Clinic

The history indicates some possible significant factors for the causation of the patient's symptoms of his difficulty in relating to people and his ability to trust them. I would pick out:

1. absent father in his early childhood

2. intermittent sharing of his mother's bed

3. the birth of a younger brother when the patient was 3'/, years old

His father's long absences could also contribute to his difficulty in relating to his own children in a more appropriate way; i.e. he is overinvolved because of the fear of no relationship at all. I would like to know something about his sexual life and the reason for their need to adopt children.

Comments on the Session

The therapist's irritation and impatience is evident in his dealing with the patient during this session. I wondered if the therapist was the disappointing father who had no time for the patient and repeatedly left him, rather than an idealised father, e.g. when after the first interpretation the therapist interrupts the patient with a rather long interpretation. In the first interpretation the therapist starts off by pointing out the patient's anger and then moves to his feeling of being neglected. It seemed to me that the patient's pain and feeling of being neglected on the return of his symptoms was more pressing to him, the anger with professionals seemed less accessible. I would change the order of the interpretation, starting off with acknowledging that he seemed to feel like the old man, neglected by me, by his professional helper. I would try to avoid using technical words like identification or internal situation, these probably encourage the patient to turn more to generalisations and intellectualisation which in its turn is so irritating for the therapist.

From the second dream I would emphasise the fear of not being understood, his anxiety and pain related to his fear. 1 would be more tentative when referring to his angry feelings which he did not seem ready to acknowledge.

Generally my interpre