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This case study is both intriguing and elusive. There is so much we as readers do not know and are not told. What is the gender of the psychotherapist? Did she/he tape the session? Did she/he transcribe this session from the tape and if so, how and what was edited? (In its present form I can not see how it could be fifty minutes worth.) What is the nature of the childhood homosexuality with the neighbour and his own ‘cottaging’ with children? Why was there a move to the couch after eighty sessions and what does the therapist think is the link between that and the re-emergence of ‘cottaging’? The therapist writes of being exhausted and feeling inadequate ‘in being “unable” to gain access to what is supposed to be withheld’, we are not told who supposes this withholding - the therapist, the patient or unnamed authorities or theorists. Perhaps this absence of vital information in the presented case is a parallel process to what has been happening in the therapy, where much has been withheld and there have been many secrets.
Like the therapist we must stay aware of how much we do not know, while focusing on what we do know or can surmise by careful attention to the script.
The therapist has clearly established a good therapeutic relationship with the patient, in which difficult and painful material has been able to be gradually shared and explored. The patient in this session has not only been able to get in touch with his rage and hatred, but has also been able to mention the here and now anger towards the therapist.
If I were the supervisor of this therapist I would focus on what I see as the key turning point of this session which remains as an ‘unfinished gestalt’. The patient J brings himself to the point of confronting the therapist with his anger:
… and you were not here on Mnday (note: I was away by prearrangement) … suddenly feel very angry about that. Monday it felt OK … didn't register, suppressed… you're the focus, target … for about 30 years of rage, that's the