Clinical Commentary XVI

[The material was sent ‘blind’ to three clinicians who were asked to comment on the session and on how their way of thinking about the patient would inform their way of working with him. Although the tradition of the Journal has been that commentators gave their theoretical orientation, I have found increasingly that they do not wish to be assigned to any ‘group’, let alone to be seen as representative of a group. This seems to be a trend across the institutions. M.B.]

The History

The patient is a man in his early thirties, the third child after a gap of seven years of a professional couple. He studied chemistry at university and was expected to have a brilliant career. He hoped to obtain a research post in a good university department after he had completed his doctoral thesis but this did not materialise. He works in the research department of a specialist chemicals manufacturing firm. He feels the job is beneath him. Three years ago he married a woman a few years older than himself who is very successful as an agent in a branch of the entertainment world. She earns rather more than he does. There are no children; in fact, the marriage is virtually at an end since she has moved out and is living with a female friend. His childhood was apparently untraumatic, his parents are still very much in touch with him and helpful, but he felt his mother did not know what to do with him when he was a child. He was often sent to residential holiday schemes during the school holidays which he said he enjoyed.

He sought therapy because of his pervading sense of failure, difficulties in making relationships and sexual difficulties. I have been seeing this patient for two years thrice weekly. He is regular in his attendance although he frequently arrives late, sometimes as much as twenty minutes late.

He had considerable difficulty in associating and experiencing any significance in the experiences he described to me, which he tended to recount and then dismiss. Th