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The interface between giving clinical comments and supervising a case is a very fine one. Thus it is inevitable that the commentator appears at times to be supervising the presenter. I therefore approach this task with some ambivalence.
In writing this commentary, I will firstly comment about this case in the general and, secondly, some ideas specific to the material presented in the sessions. A clinical commentary is always difficult to write with clarity because it is one stage removed from the heat of the moment when psychotherapist and patient are engaged in a dynamic relationship. On the other hand, although we are deprived of the immediacy of feelings and responses, we do have the luxury of time and space to reflect and think about the implications of the exchanges in the sessions reported.
In our work as psychoanalytic psychotherapists since the 1950s onwards, we have come to rely on our countertransference feelings in the broad sense to inform our thinking about the patient's internal object relations. How we are present or not present in the mind of the patient, and the reverse situation of how he is kept in ours, the way the patient is using us alongside and beyond what he is saying - these are important indications of the patient's functioning.