Commentary by an Analytical Psychotherapist

The essence of this therapy is, in Winnicott's terms, the creation of a good enough mother/child relationship and the sensitive therapist seems intuitively to appreciate this. Many of the transactions and interpretations, whatever their immediate implications, must be seen in this overall context. However, let us first consider one or two of the more obvious conflicts with which the therapist is rightly dealing as she allows them to arise in their own way and time and then moves on to the very difficult issues which may eventually confront her. (I find I think of the therapist as ‘she’.)

From the description of the patient and her history, certain particulars stand out, notably the very early separations from her mother and their disturbing repercussions. In the transference area, we note the immediate substitution of the therapy for the relationship with the boy friend. Although the holiday is presumably by mutual agreement, the patient feels she is being deserted by her therapist. This emerges clearly by implication in what she says in the first session about her friend F, who may be pregnant, which means she will have less time to spend with Helen. As the therapist points out, this makes her feel like ‘a child displaced’. These feelings were also experienced in relation to other friends, towards her sister when she married and towards her boy friend. As the therapist says, the fear is of total abandonment like that which took place in infancy. Apt though the interpretation doubtless is, I think that F's pregnancy may have further significance which may become apparent or which may need facilitation. For one thing, Helen's depression at the news of F's pregnancy may be connected with her own frustrated maternal feelings or with an unconscious fear, dating from one of the separation periods, that the absent mother had not only rejected her but gone away to produce another baby to usurp Helen's place - a not infrequent fantasy in such cases.

The second session begins