Failing to Connect - Failing to Contain

Failure is important but usually unpublicised. I mishandled a case when accident compounded inexperience, so it can only be retrieved here: a reparative fantasy. Since here were only four sessions they can be reported in detail, with the added perspective of hindsight. The patient was a seventeen-year-old adolescent called Dean diagnosed as psychotic. Psychotherapy was the only form of intervention not already tried. His life was dominated by a compulsion to spin or roll on the floor. He was withdrawn and apathetic with occasional bouts of violence. When he first saw me he had just been expelled from a special Adolescent Unit after trying to strangle a nurse. There was a long history of contact with the family which I shall return to later. We had a brief meeting before our first session to set up a contract, so he had already described ‘the movements’ which he had to do in order to avoid becoming ill.

After entering my room he shambled around for a while before slumping down in a chair, facing me but with downcast eyes and looking sullen. I asked how he had been since last week and this led to him talking of what fills his time. Mostly just hanging around the house and watching television, and we also got on to his lack of ambition, or ideas as to alternative behaviour. He had brightened up when challenged before so I said it sounded almost as if he wished to avoid the future. He replied something about not counting chickens until hatched, since his habit of ‘twisting’ meant he could not begin to think about work.

He told me that his doctor had given him a certificate saying that he was incapable of work because of ‘nervous illness’. When I tried to reframe this to the less dramatic idea of having difficulties with life, Dean objected violently. His life was full of mysterious illnesses. When I tried to clarify what these were he became angry and sulked. I got the impression that he had been ill at school, something to do with being unable to concentrate, feeling dep