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Responding to clinical material is always a difficult and challenging task. The written record of what has taken place in the therapeutic session can never entirely capture the subtleties of the clinical work. So much is unknown and unknowable to the reader and this, of course, gives rise to many questions and fantasies that may or may not prove useful. What follows is an attempt to organize some thoughts and questions that arose as I read the clinical material.
Our introduction to this case immediately plunges us into a profound state of concern. One of the first things we are told is that Lydia's extremely haggard and depressed appearance has aroused alarm in all the staff who enter the Family Service Unit's waiting-room. Her distress is such that it is spilling over into the waiting-room where her son, Jay, receives help and care. Jay has been seen at the centre once weekly for depression and, although we do not know how long they have been attending the clinic, the implication is that this reaction to Lydia is recent. What is it that is causing such alarm in the staff to the extent that various staff members approach her while her son is having his session, I wondered? It is within this atmosphere of anxiety and uncertainty that the counsellor has her initial meeting with Lydia. Unfortunately, the information gathered and the counsellor's observations during this meeting do not allay any of the initial concerns. We learn more about Lydia's and Dinitra's backgrounds that lead us to think their situation has been one of ongoing disturbance/ distress. For example, Lydia has been very depressed since Dinitra's birth and she is separated from her baby's father. Lydia has also had numerous medically unexplained black-outs. We also learn that she has been seeing a psychiatrist who has been making home visits since Dinitra's birth. The feelings of alarm that have arisen seem to be confirmed and the case must continue to be viewed as a severe one.
It seemed as if Lydia had