Commentary from an Independent Psycho-Analyst

I want to begin by noting how impressed I was by this work and the tremendous effort the therapist puts into trying to understand his patient. (I'm not sure why I quickly began to feel that the therapist is male; if this impression is wrong then I apologise. I'll refer to the therapist as he in this commentary.) I was also admiring of the therapist's honesty in describing very difficult counter-transference feelings. Much of what the therapist interprets is excellent but there is a central point that could have been focused on more in the sessions. It is a point that the therapist indicates in his overall description of the treatment: ‘… she often opens up just at the end of the session, mostly telling me something worrying about herself, thus leaving me in a state of concern for her wellbeing until I see her next’. It is interesting that there is then a new paragraph which begins: ‘Miss X seems to use her treatment predominantly to evacuate her feelings. Hence I often feel the container of unmanageable emotions of which she wants to rid herself’. The therapist goes on to describe these but I think he actually has the nub of the problem in that previous sentence. The point I wish to develop is that the patient has an unfaceable anxiety that her destructiveness is causing extreme emotional damage to her therapist. I will try to argue this point in terms of her history later but first I want to indicate how this appears to me in the clinical material.

The first session begins with the therapist's state of health as the paramount concern. The patient seems unable to investigate this very thoroughly beyond asking him if he is all right. There are then various long silences interspersed with broken, incomplete utterances and various attempts by the therapist to help the patient communicate. These interpretations gradually focus on there being something cruel and destructive, either in the therapist or in the patient, and also on an anxiety that the therapist is not strong