Clinical Commentary XIII

The therapist writes:

[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 is a man of 40, a member of a religious community for around 10 years, and has been a practising homosexual since childhood. Following a period of exhibitionism and sexual contact in public toilets, he was seen by a colleague and then referred on as he wished to ‘unpack’ a number of issues. He expressed uncertainty with the (un)structure of therapy, but after five sessions indicated some relief, a little emotional release and a desire to continue with the work. Therapy commenced on a once-weekly basis, later increasing to twice- and then thrice-weekly at the patient's request, and has continued for some 2′/₂ years.

History/Background

J's family background is complex, and because of a problem of ‘betraying loyalty’ it has emerged only gradually. He describes himself as illegitimate - a ‘love child’ - and was raised by his mother, a fiery, possessive and powerful woman, his grandma and one or two aunts. His father, already married, was a remote, older man who visited periodically, and the family relationships were stormy, with his parents unable to have a consistent union. His father died when he was eight and his recollection of him is vague. He was prevented from attending the funeral and remembers his mother's wild grief occupying the emotional space afterwards. He has referred to his own existence as ‘a skeleton in her/ the cupboard’, of ‘not being wanted’ and o