You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
LM: The clinical material raises many issues. It's difficult to know where to start. There seem to be many issues raised about notes and confidentiality about what sort of notes to write and what to do when asked for them.
JS: And so many levels too - the vignette refers not only to the therapist/patient interaction but also to his countertransference and, crucially in this case, to what he felt his supervisor was saying and his difficulty in internalizing that - so the conflict is not just between the therapist and patient but between the therapist and supervisor as well.
I found myself, when thinking about it, starting to jump into an ‘action frame of mind’ - should he or shouldn't he disclose the notes - and then realizing that part of the problem is the tendency to jump into action and not to consider all the different players. I suggest we leave the action to one side and think first about the principles.
LM: Yes, and the general principles do not always fit with the given situation, especially when there are so many things going on. There seems to be a question about who is still alive. The husband has died and the therapist is trying to find a way to ensure that he is not dead and the question is raised about how he will find a way to make sure he is not dead. Perhaps, through some reparation at this stage, and the therapist is trying to grapple with the issue about how he reinstates himself?
JS: Certainly when I was looking at the case there seemed to be multiple losses cropping up - the death of the husband, the loss of her country, the end of the relationship with the old people's home, the end of therapy and the therapeutic relationship and quite possibly the loss of the potential to have children. She had been married and her husband had died. How old was she - about 43? It was not made explicit but I imagine another loss was the impending or likely loss of her ability to be a mother to a child. The other thing I was thinking about was her sense of exclusion