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Writing a commentary on ‘blind’ material is a tantalizing experience because it presents one with a host of questions that cannot be answered. This could well be inherent in the Clinical Commentary medium but it could also be a reflection of this particular piece of material which describes a very early stage of an intervention when things are bound to be quite unknown to the therapist.
Be that as it may, I cannot help wondering how the background information was selected. Was it left entirely at the therapist's discretion or were there criteria to be followed? For example, were facts selected on ‘a need to know’ basis? This in turn raises further questions. How much does one need to know in order to make informed comments? And how far can one separate clinical material per se from the external framework within which it occurs?
Lydia's referral has a disjointed quality to it. As we learn more about Lydia and her baby it becomes clear that this disconnection mirrors something of the relationship between them. We hear that Lydia's 7-year-old son, Jay, is in once-weekly therapy for depression (mother's symptom but an unusual one for a 7-year-old); and yet Lydia is, apparently, referred incidentally, due to the alarm she causes in the waiting-room rather than within the context of Jay's therapy when parental support might have been considered and set up. This seems odd given Lydia's history which presumably was known at the time of Jay's referral. Was help initially offered but refused by her? Perhaps the psychiatric input she was already receiving was felt to be sufficient for her needs? Or was the Unit's response mirroring an aspect of the family dynamics whereby Lydia gets bypassed and overlooked, with the Unit taking over Jay in the same way that maternal grandmother (MGM) takes over mother's role?
We hear something about the psychiatrist but not much about the nature of the intervention. What form did the weekly visits take? Who was present? How do we understand Lydia