Commentary by a Senior Member of the British Psychotherapy Foundation

Holding in mind Susan Isaacs' statement that “Phantasy is the primary content of unconscious mental processes” (, p. 82), I shall start with my impression about the work in general and then move on to more specific thoughts and experience of the session presented. This is an interesting but complex case. My commentary takes the form of freely associating to the material provided.

First, I expected the clinical material to be more detailed. It was in fact rather short and I found myself floundering and not being able to settle down to thinking in a more focused way. I was rather surprised at the lack of the patient's developmental history in the material. Perhaps this was due to the need to preserve confidentiality, which was perfectly understandable, but might be overly cautious, suggesting a degree of anxiety of being seen/known. It seems there was something secretively child-like about this and the exchanges in the session felt intellectual and explanatory.

The clinical material suggests the presence of an overwhelmingly frightened child in the man. The patient's parents are Holocaust survivors and struggling with its aftermath perhaps in the form of a tense depressive family atmosphere suggested in the history. I think the patient is struggling with this too in the form of his internalized objects. We know that a frightened child is also an angry child, and it is this anger that the therapist is struggling to bring to the surface. My impression is that the patient is somewhat stuck in early latency, with intellectualization as a defence against his emotions. It reminds me of Meltzer's young patient who knows everything about Freud but nothing about sex; he is clever and intelligent but struggling with being human and its accompanying flaws in being so. I agree with the view that his inability to complete his postgraduate studies is due to the fear of being an adult and living an