Clinical Commentary XXXI

I am grateful to Valerie Minogue for translating Janine Chasseguet-Smirgel's commentary and to all the contributors. One of my intentions in commissioning the authors was to explore the way clinicians from broadly similar theoretical positions (they themselves have determined how they wished to be described) would approach the same material. As it turned out, despite the proximity of their theoretical backgrounds, they have each brought a rather different approach to the clinical material.

Clara is a young woman in her early thirties who came to this country from a neighbouring European country to work and to escape from a long history of sexual harassment and abuse from her brother-in-law. She is ten years younger than her sister who married when Clara was 12 years old. She loved her brother-in-law who during the courtship became a replacement father figure. Her father died when she was 4 years old. Her critical mother always worked and Clara was cared for by her paternal grandmother with whom the family lived. For the last six years of her grandmother's life Clara nursed her and has felt guilty ever since that she did not do more for her grandmother on the day of her death. Her grandmother died when Clara was 22. When Clara speaks of death she is tearful, and she fears the prospect of her mother's death. Clara's efforts to report the sexual abuse to the police resulted in her being asked to wear longer skirts, and in a policeman making advances to her as he drove her home. The reported sexual abuse took place from the age of 12 until the age of 24. Three times Clara moved out of home, but for various reasons was forced to return. Her sister and mother did nothing to stop what was happening, apart from her sister secretly administering medication to her husband by putting it in his tea.

Clara was put on anti-depressant and anti-psychotic medication at the age of 18 and has remained on it ever since. She has a strong attachment to her medi