Commentary by a Pluralist Psychoanalytic Psychotherapist

Work with a sexually abused patient is inevitably slow and difficult and I am impressed by the therapist's patience and sensitivity in holding this man's ‘skeletal’ sense of self. Although the patient has well-entrenched schizoid and sexualising defences, his internal world is by no means completely closed off, and he also sounds extremely persistent in struggling to get what what he needs from the therapy. The therapist's approach is clearly supportive and containing, but I wonder if the therapy might feel more containing to the patient if the therapist were to adopt a more venturesome interpretative approach.

It is, of course, so much easier to comment on a session with hindsight than to think under the pressure of the patient's projections and whilst keeping a part of oneself available to experience the transference/countertransference matrix. Firstly, I would like to inform my comments on how I might have managed this session differently with some theoretical speculations about the data which have been helpfully provided about the patient's background, life history and use of the therapy so far. I would want to do this also if I were preparing to sit in the room with the patient - not for the purpose of maintaining a rigid theoretical framework from which to make interpretations, but as a means of holding myself in my therapeutic role and enhancing my capacity to observe and to think in the session. I would therefore be prepared either to let go of my speculations completely or modify them considerably if I were then to experience something very different coming from the patient.

Although the actual sex of the therapist is not mentioned, the patient seems to be expressing a preference for experiencing the therapist as a ‘strong or firm’ father or substitutive penis as opposed to the much more terrifying threat of emotional engulfment by the mother. I wonder what might be the function of this transference