Clinical Commentary

[This section is a regular feature. A short piece of clinical material from an actual session is presented with a brief introduction about 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 is to put these commentaries on the same material side by side for comparison of the different approaches and to facilitate the understanding of alternative terminologies and modes of practice - Ed]

The therapist writes:

This patient F is a young man in his late 20's. He has been in therapy three times weekly for two and a half years. He was referred by a psychiatrist who saw him for ‘depression’ but found that he was presenting with psychosocial problems (see below). He had previously had two short bouts of ‘therapy’ in psychiatric outpatient departments of general hospitals.

The History

F is the only child of elderly parents. His mother has suffered from a chronic disabling disease since before his birth and has been confined to a wheelchair since he was aged seven. His father has done shift-work though he retired soon after F came into therapy and is at home solely looking after his wife. F had a good deal of contact with his maternal grandmother as a child and when he first came into therapy he still had daily telephone contact with her. His father necessarily played a big part in his upbringing - taking and fetching from school - and giving a great deal of what would normally be maternal care. F has been greatly over-protected by his father, never having stayed away from home, not having managed school holidays; and earlier still in his life having his father sleep with him in his bedroom, until well into latency.

F went to a boys' school, where he under-achieved although managed a diploma in business studies. He had several clerical jobs before his present work as a civil ser