Commentary by a Psychoanalytic Psychotherapist

In this case study, the patient sought therapy because of an overwhelming sense of failure in both his emotional and professional life. The clinical material provided ends with the patient's assertion that despite the work of the session, he ‘feels empty’. Perhaps the therapeutic interaction reflects this sense of failure and, as such, is a re-enactment in the transference of the relationship between a well-meaning but unavailable internal mother and a child who, possibly, cannot make use of what such a mother has to offer. In addition, there are hints of narcissistic strivings which fail in their attempts to overcome some earlier failure in his primary relationships.

Efforts to understand the patient's internal world have made me think about the paucity of background information available. We are told that he is the youngest of three children of a professional couple, and that his marriage to an older, successful career woman has disintegrated. The absence of much biographical detail invokes many questions - about the sex of his siblings, the nature of the parents' professions, the reason for the seven year gap before the birth of the patient, and about an apparently ‘absent’ father. The patient remembers that he was often sent on residential holiday schemes during school vacations. This memory made me reflect on whether he was the child of an older mother absorbed in her own career, and on how this may relate to the patient's feeling that she was a well-intentioned but inept mother who got rid of him during holiday times because she was ‘unable to know what to do with him’. Curiosity, suggesting a lively, interested mind, appears to be absent from the patient and is projected into external objects - in this case the reader.

From the information provided it seems probable that the patient is someone who inhabits an impoverished internal world, with objects who may have been in touch with him concretely rather than emotionally. This is reflected in the scant history p