Clinical Commentary IV

(A short piece of clinical material from an actual session is presented with a brief introduction about the history of the case. The material has been sent “blind” to three people who represent different psychotherapeutic schools of thought. They have been asked to comment 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 forty-year old woman sought help following six months of a severe depression, characterized by agoraphobia, panic attacks, and psychosomatic complaints. For three months she was unable to work at all, and since, has worked part-time. She has been on anti-depressants until very recently. She feels vulnerable and lacking in confidence, and that she approaches life in the wrong way. She says she seeks understanding.

The History

She was raised in a tiny hamlet in the north, in what she describes as a typical working class family. Her mother was the caretaker of the local village hall, and firmly believed that as a girl, her daughter could have no hopes to be anything but a cleaner. Her father was in the Army and absent for the first two years of her life. Her first recollection of him is of his beating her when she was 21/2 years old. This beating continued until she left home at 18. Her father also beat her mother, and she often found herself in-between, trying to protect her.

She had a sister 2 years younger than her, toward whom she was also very protective, who died as a result of a car crash after a gruesome week of gangrene poisoning. Her father has never recovered from the death, for which she blames him, as her sister and her boyfriend were rushing home for the father's strict curfew. She says she has never mourned her sister's death.

School, like home, was an unhappy experience for her. She was a bright chi