Commentary from a Kleinian Perspective

This clinical vignette illustrates very well the challenges all psychoanalytical psychotherapists face - when and how to address transference phenomena, particularly during assessment stages and early sessions of treatment. This is never an easy task when either too much emphasis or too little increases the probability of losing the patient. There are particular elements that need to be considered in assessment and early sessions - the patient's pain that brings them to the therapist in the first instance, their expectations of the encounter, often based on previous experiences with a therapist, as in this case, the particular personality structure that could result in the therapist being kept at an emotional distance, or allowed to get close to emotional states.

On reading the material, I felt that the therapist's doubts and vicissitudes of feeling coming through very clearly. My own countertransference, which I had to check constantly, was to push the therapist to get a move on; that she was taking too long to comment on core complexes which a sharply pointed interpretation could have unblocked. I was reminded of the strictures of my supervisor, Pierre Turquet, that, despite psychoanalytical psychotherapy being essentially an analysis of the negative transference, one needs to be cautious in the application of this principle. After all, the patient comes into treatment often for reasons that are not immediately apparent, reasons that he cannot articulate and for which he is seeking a benevolent caring figure to help him access the hidden and the unconscious.

We learn that the patient had two assessment interviews followed by a two-week Easter break and that, to date, he has had nine once-weekly psychotherapy sessions. We also hear that he had had two previous experiences of counselling/psychotherapy; one for two sessions, the other for six. His assessment of these experiences do not instil confidence that he will ‘stick’ this time. Yet, he is now in sess