Clinical Commentary X

[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 Patient

Helen is a 27-year-old unmarried woman who has been in twice weekly therapy for ten months. She is slender, dark-haired, attractive and appears to be about 17. She is and presents herself as a successful, responsible professional in the medical field. Helen had wanted to come into therapy with her boyfriend (they had been seeing each other for three years) because she feared that her total dependence on him was endangering the relationship. He refused and she broke up the relationship a few days later. She felt she needed therapy to sort out why she had been so dependent on him, and why she had continued the relationship when it was making her very unhappy. Her presenting symptoms were fears of being abandoned, her passivity, and of never being able to have a relationship of equals; she saw herself as always being in a kind of daughterfather relationship with boyfriends.

History

She is the youngest of four siblings, (G + 10, B + 8, G + 6). Between Helen and the next youngest her mother had two miscarriages. Helen spent ten days in an incubator and had three periods in hospital for operations on a foot before she was four. She can recall only the last. Her mother was not with her in hospital. It causes her much distress. She has had several dreams which seem to be about her time in hospital.

Helen's brother went to a school for maladjusted children, works in a factory and still