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BJP 32(3):307-310 (2016)

Commentary by a Member of the Foundation for Psychotherapy and Counselling (WPF)

Author: Celia Harding

Abstract

The first thing that strikes me about this interesting and challenging case material is the number of boundary issues arising in this one session and recent history: the patient, Holly, arrives five minutes early for her session and the therapist feels compelled to start immediately; Holly pays her therapist by handing her a named envelope containing cash without comment; we hear of several session changes, one initiated by the therapist, another by Holly; Holly cancels one session which is ‘replaced’ so she has two sessions the following week, altering the usual rhythm of her sessions.

To consider each boundary issue and possible meanings in turn:

Holly arrives five minutes early. Her therapist is ‘annoyed’ but feels unable to ask Holly to wait or return at the agreed time. The therapist feels obliged to ‘fit
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in’ with Holly's timing by starting the session on her arrival. A possible experience of the therapist ‘not-fitting’ with Holly is overridden as if too risky: as if saying ‘no’ might put the relationship in jeopardy. One way of understanding this may be that on Holly's early arrival, the therapist is gripped by a powerful projective identification, perhaps Holly's terror of what she might feel when faced with a difference from her object, a feeling (to both patient and therapist in that moment) so terrifying it must be sidestepped.
Holly wordlessly hands the therapist an envelope. The therapist is aware of returning the silence and understands this, from previous experience, as concern that Holly might feel persecuted if she passes comment. We are not told if the therapist opens the envelope and counts the cash enclosed as might be considered prudent and appropriate practice. Neither are we told about the fee Holly pays: is it a full fee? A reduced fee? A fee judged ‘fair to both’? We are told that payment has been an issue. It is implied that payment has not been regularized in terms requested by, or agreed with, the therapist. This may suggest that payment to

BJP 32(3):307-310 (2016)

Commentary by a Member of the Foundation for Psychotherapy and Counselling (WPF)

Author: Celia Harding

Abstract

To consider each boundary issue and possible meanings in turn:

Holly arrives five minutes early. Her therapist is ‘annoyed’ but feels unable to ask Holly to wait or return at the agreed time. The therapist feels obliged to ‘fit
Page 307
in’ with Holly's timing by starting the session on her arrival. A possible experience of the therapist ‘not-fitting’ with Holly is overridden as if too risky: as if saying ‘no’ might put the relationship in jeopardy. One way of understanding this may be that on Holly's early arrival, the therapist is gripped by a powerful projective identification, perhaps Holly's terror of what she might feel when faced with a difference from her object, a feeling (to both patient and therapist in that moment) so terrifying it must be sidestepped.
Holly wordlessly hands the therapist an envelope. The therapist is aware of returning the silence and understands this, from previous experience, as concern that Holly might feel persecuted if she passes comment. We are not told if the therapist opens the envelope and counts the cash enclosed as might be considered prudent and appropriate practice. Neither are we told about the fee Holly pays: is it a full fee? A reduced fee? A fee judged ‘fair to both’? We are told that payment has been an issue. It is implied that payment has not been regularized in terms requested by, or agreed with, the therapist. This may suggest that payment to