Commentary by a Member of the Kleinian Group

In commenting on someone's case material sent “blind” and without the possibility of clarifying certain features, or of having a subsequent dialogue, I am aware of the danger of seeming glib or presumptuous. I may be voicing ideas that have already been interpreted without much success and am reminded that the patient has been having therapy of one sort or another for the past 15 years. However, 1 am experiencing the exercise as a challenge and feel there is usually a potential for a fresh approach when someone outside looks in.

The experience of the session preceding the one to be discussed, is only hinted at. 1 would feel better equipped if I knew more of the detail of what took place. However the following thoughts occurred to me. The patient seems to be a man who is acutely schizoid, who has never been emotionally close to anyone in his life, who is anxious and despairing but unable either to get in touch with his feelings, or to make a meaningful contact with a therapist or analyst (or anyone else, for that matter - mother, father, brother, wife) who might help him. This inability to make contact, and engage in a relationship seems to be at the heart of the problem and we are given a vivid and concrete example of it in the description of his getting on to the couch… “in his typically stiff way, keeping his hands away from the couch”. We are immediately introduced to a man who has to appear to be holding himself together, stiff, erect, potent, but who actually keeps on failing in his adult life. He cannot approach or sink into the analytic relationship with trust, despite the fact that he has been seeking help for so long. His intense concentration before he speaks seems to reveal that there is always a barrier there before he can try to make some contact, and he needs to make a considerable effort to do so. One would suspect that his disability was linked to some fundamental failure in his infantile experience and subsequent development of being a child in a fam