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It was very interesting looking at a vignette of clinical work in some detail but also difficult to comment on another therapist's work. Our ideas come from our experience of working with bulimic women at the Women's Therapy Centre, a very different environment from work in private practice although many of the clinical issues are similar.
Our first thoughts on discussing the work with this client was the wealth of material produced showing an extremely interesting relationship between therapist and client. We wondered if the therapist, through the process of writing, had absorbed aspects of the client's relationship with her mother. One of us had an immediate countertransference feeling in response to the material and felt that the therapist had already done a lot of the work in a self-sufficient way perhaps in her need to protect the relationship with B. She was almost keeping the reader out as the client had her mother when she shut the bedroom door to protect her privacy.
A further striking aspect to the work was the client's capacity for symbolization emerging through the dreams and fantasies, all of which seemed to resonate with the therapy relationship. This can be unusual with someone who is bulimic where thinking is often more concrete, finding its expression through the language of the body (fat or thin) or the eating itself. It would seem that these dreams and fantasies were the safest way for B to take in the therapy relationship without having to transform it into something that had to be ‘chucked out’.
While the therapist's focus seemed to be on the need for B to mourn her parents' deaths, it did seem to us that what mattered to B was the quality of attention and thinking that the therapist was offering. Perhaps the actual interpretations mattered less than the projected concern that the therapist held for her client. This puts us in mind of Mitchell when he uses Winnicott's material on transitional phenomena:
Personality and growth are created in the p