Commentary by an Independent Psychoanalyst

When looking at someone else's clinical work I think we should always remind ourselves that we were not there; and the therapist, who was there, was subjected to the impact of the patient's presence and the pressures to speak and to be effective in the session. I therefore wish to regard the following commentary as an exercise in practising with clinical material, to recognise some different ways of responding and the implications of each.

Here we have a young man who finds himself ill prepared for life beyond home and school. Within the home he is described as having been in a mutually supportive relationship with mother, looking after a depressed father. But an alternative model for relating may have been developed through identification with this withdrawn and inaccessible father. The patient has also been deprived of relationships in which a surviving firmness could allow for confrontation and for aggression to be expressed and yet contained, which would have served both communication and relating. These tentative formulations I would hold in abeyance. I would be careful to avoid imposing these upon my understanding of the patient.

Throughout this session the communication seems to oscillate between quick-fire questioning and long pauses. If we use trial identification we can readily sense that the patient would feel put under pressure by the questioning; and the therapist may well have felt under pressure from the silences.

I therefore find myself wondering whether there may be an interplay here between patient and therapist, whereby the therapist is meant to know what the patient is thinking or feeling: a symbiotic mother-transference, perhaps? Alternatively, is the therapist being prodded into becoming the mother ‘who kept things going’ (a role-responsiveness to the patient identified with the withdrawn father)? However, there are insufficient grounds in this session for interpreting either of these possibilities. Instead, we can follow the interaction with thes