Commentary by a Member of the Bowlby Centre

It is an especially satisfying experience to hear about another psychotherapist's clinical work, especially when, as here with Maria, the psychotherapist has presented his/her work in such an open and detailed way, providing us with moving and interesting material. However, it is also worth acknowledging that face-to-face attunement is not possible when providing a commentary on another psychotherapist's written clinical material. When one is engaged in a dialogue with colleagues about their clinical work, we are all the time making judgements about their readiness to explore the significance of what they are describing. At the same time, we are also judging whether they wish to take a step back from such consideration of their work, and perhaps whether our treatment of their work and themselves seems to need protection from what may feel like an intrusion. In addition, the commentator and psychotherapist do not know each other: they have not built up a relationship secure enough from which to explore. Feelings regarding such issues, which arise face-to-face, are significant not only for gauging the helpfulness or otherwise of particular aspects of exploration, but are also useful as a source of parallel process information (Searles, 1955). I have noticed these issues especially coming to my mind when considering my response to this clinical material, which contains signs of significant distress. It may not be coincidental that these relational themes are themselves present in the clinical material presented here: the difficulties for the psychotherapist in attuning, the question of how to establish sufficient security to allow for exploratory thinking, and the difficulties for the patient in having a two-person relationship (Aron, 1990).

I am an attachment-based psychoanalytic psychotherapist and supervisor with The Bowlby Centre in London. Attachment-based psychoanalytic psychotherapy focuses on the need of patients to develop a secure base with the psychotherapist