Clinical Commentary 37

We are delighted to present the second Clinical Commentary of this new series, and are grateful to the psychotherapist who has offered clinical material and to the three commentators.

Mark Budden

[markbudden@talktalk.net]

Ann Horne

[annhorne44@gmail.com]

Mr B, a single man in his late 30s, has been in twice weekly psychotherapy with me for several years.

In the early days of treatment, he was not able to develop relationships or any independent life of his own. He had no experience of any sexual relationships and his emotional immaturity was striking. Although intellectually clever, Mr B was unable to complete his postgraduate university studies, had never worked, even in a casual or holiday job, and spent a lot of his time at home. One of four siblings, he continued to live at home, still went on holidays with family members and described his extended family as almost the only other people he had social contact with. His presenting problem in starting therapy was that he was unable to complete his postgraduate degree following a number of extensions. It became clear early on that the significance of being unable to finish his studies was that he would then have to start to live his life as an adult - finding a job, possibly leaving home, starting to develop adult relationships - all of which terrified him at the time.

He has now completed his studies and, after considerable delay and difficulty, has found work in a professional capacity in a large company. He comes from a family with a complex Holocaust background and this plays a pivotal role in his sense of guilt, delayed ability to take ownership of his own aggression and liveliness, and his development as an adult potent man. He experiences great difficulty moving on from ‘the Holocaust’, both in his family's tragic experience of it, and also as an internal persecutory object which he continually re-evokes, especially during times when he is making some progress in his life.

These days, there is an inc