Commentary by a Member of the “B” Group of Psychoanalysts

In this clinical commentary I shall attempt to construct various hypotheses from the available material. I am interested in the patient's life story and the pattern of her relationships repeated through her childhood, in adult life and now with her therapist. I also ask ‘why does she present for therapy now?’

The vignette suggests a very difficult treatment during which the therapist must endure powerful countertransference feelings: I would make the transference and countertransference analysis a principal focus of the treatment, even though this is a twice-weekly psychotherapy. I note that this is still the early stages of treatment and I would expect a considerable testing out of the therapist and treatment alliance.

For the first two years of her life, this woman had an exclusive relationship with her mother. This potentially could have been a positive experience, but she reports her mother to have been frustrating and unfulfilling and I would imagine this to be the basis of a strong narcissistic rage that has come to dominate her life. Both parents appear to have been psychologically absent and not ‘good enough’. Her mother never treated her in a positive way. Her father was violent when present. Neither parent encouraged her to see herself as worthy, likeable, or able to be cared about.

Indeed she externalises and reverses this process, attempting to protect and care for others: however, she is unsuccessful in this and the failure of this defence mechanism must be an additional narcissistic blow to her. A likely additional source of her narcissistic rage was having to share her mother with her father and sister in turn, and these multiple rejections seem to have led to repeated failures to sustain relationships through her life.

Some possible pointers to ‘why now?’ are that she is approaching her menopause and her daughter (the longest-lasting of her adult relationships) is approaching puberty and adolescence - i.e. a sexual life of her own, and i