Clinical Commentary XIX

[The material was sent to the three commentators, asking them to take up areas that interested them about the content of the session or the technique of the therapist. - KA]

The patient is a lesbian woman who has been in therapy once weekly for three years. She had never had a sexual relationship with a man. The original reason for seeking psychotherapy had been periods of depression, particularly about work. The experience was of being under intense and unremitting pressure, such that there was very little scope to find enjoyment in life. She was in a relationship which had lasted a number of years and the couple were buying a house together. The two partners had very different experiences in their families of origin: one had an unusually close family - there were family gatherings most weeks to celebrate birthdays and anniversaries which were attended by 20 or 30 people from different parts of the country, while the other had a more scattered and fragmented family. Both families were welcoming to the other partner. Over the period of therapy the work situation had eased as we understood how claustrophobic the patient felt. At the same time other issues, such as future plans especially about children, had emerged tentatively, often to disappear again as work would again come to the fore. In the original discussion about starting therapy the question of coming twice weekly was raised, but was never taken up on the grounds of expense. It was at times very clear that this added to a sense of restriction in the therapy which, it seemed, had to be put up with for fear of disturbance elsewhere. The sessions tended to be full and interesting but often with the sense of limitation alluded to above.

The previous session had to be missed because of work commitments. As usual she had given warning and notice of the fact that this would happen.

When she arrived on time she took her shoes off, as was her custom, and put them neatly on the far side of my small consulting