Commentary by a Member of the British Psychoanalytic Association and the British Psychotherapy Foundation

I read this material on the day I heard the psychotherapist, Susie Orbach, on the radio, in imaginary conversation with a ‘patient’ who declared his love for her and expressed his wish to spend the rest of his life with her. I thought of how the patient in this clinical material comes from the opposite end of the spectrum!

We are not clear whether this is a male or female therapist working with this young, well defended and resistant female patient. We are told that this is a once a week treatment, which has been in place for over two years. We are not told why this has become established; whether a more frequent therapy has been discussed, which might well, I suppose, have been rejected by this patient who is so terrified of anything pertaining to intimacy. I would hope that the therapist might be working with a more frequent model in mind and wondering all the time about the patient's resistance.

I get a sense of two people struggling to make contact and understand each other. She sought therapy ‘due to feeling depressed and anxious and unable to sustain a relationship’. The therapist chooses her material to discuss because s/he does not feel protective of her as s/he does with other patients; and later in the presentation, feels annoyed with her for arriving early, and recognizes that her tone stirs up some irritation in him/her; and at the end reports feeling ‘frustrated and somewhat hopeless’. Here is a therapist who can be honest about countertransference feelings, both negative and positive, and about how they shift during the session; and who can think about the transference/countertransference dynamics in a way that must be helpful to his/her patients as well as to this commentator. However, in once a week work it is so very difficult to work at any depth with any but the most psychoanalytically minded patient. I would