Clinical Commentary XX

[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]

Mrs A is a 47-year-old white woman who is divorced, lives alone and has a weekend partner and a challenging job in senior management. She came for psychotherapy when her defences against unbearable anxiety broke down. She had been prescribed Prozac and sleeping pills by her GP which she felt had not helped. She was unable to rest day or night and could no longer go to work. An earlier psychotherapy seven years previously, which lasted for five years, had helped. She wanted a different therapist this time. The previous therapy, she said, helped her to come to terms with not being able to have a child with her then husband, from whom she was finally divorced the previous year after a few years' separation.

Her most important anxiety was that she would go mad like her mother did when she was a child and there was an unspoken fear that she might, like mother, kill herself. At the initial consultation she reported missing the close friendship she had with a woman friend and colleague with whom she had lived in between her marriage ending (husband left) and starting the new relationship she was now in for two years. She felt insufficiently supported by her partner. It emerged that he was wanting them to live together. She thought she could not cope with a job and a partner. In passing, Mrs A told me that she had a hysterectomy' during the previous year and that ‘it was clean - there was no cut’ and that she had made an excellent recovery.

She presented as feeling thoroughly persecuted by bad internal objects. Her place of work, which was previously a safe space where she felt important, became a polluted space in which her identity was disturbed. She felt herself to be incompetent and useless professionally and very frightened of having her worst fears confirmed by a coming government inspecti