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My general impression upon reading this clinical material is that this therapist has an empathic attitude towards her difficult and frustrating patient and is inspired by a genuine wish to help him; and that the patient values his therapist's commitment to him and is aware of the importance of their relationship to his emotional growth.
When I look at the session more closely, however, I find myself disagreeing with the therapist's technical approach and radically differing from her in my understanding of the material. My criticism, as I shall try to illustrate through my commentary, can be schematically outlined in the following three interrelated points:
The therapist has not fully grasped here the transference component of most of F's communications; as a result she has failed to offer him specific transference interpretations. Even in her introductory comments under the heading ‘The Transference’ I find little evidence of her comprehending F's experience of his relationship to her in the therapeutic setting as being unconscious representations of his internal objects and conflicts, his original family scenarios, his parental imagos, and so on. I am not one of the many analysts who believe that all that takes place in the consulting-room is always and necessarily related to the transference, but I still think that specific transference interpretations are the most original and powerful therapeutic tools available to us and that, when appropriate, they should be used.
The therapist asks her patient too many direct questions; in fact, more than half of her interventions in this session end with a questionmark. I think that this is not just a matter of a different style of working from my own but the reflection of a tendency on the part of the therapist to be too directive and active; I consider such an attitude not particularly therapeutic. We learn from the therapist, it is true, that F experiences her as being too passive; but the passivity, projected on to the t