Commentary by a Member of Severnside Institute for Psychotherapy

I work primarily within a Kleinian object relations frame.

The therapist provides background information and detailed sessional material from work with Maria, a deeply troubled woman whose mother was sometimes ill with anxiety, whose father was asocial and autistic, and whose brother has both emotional and addiction problems. Already the scene is set for what is going to be a difficult therapy that is likely (and necessary) to be long and intensive if it is to be effective in promoting psychic change. My sense is that the therapy has got off to a good start and that Maria is fortunate to have found this particular therapist. However, although she has now been coming for at least a year, it is still early days and at this stage with such a patient I would not myself expect to have any more than several ideas about what the patient's presentation, and my experience of being with her in the room, mean with respect to her core difficulties.

One of the challenges with longer-term work is that we may have to sit with behaviours for a long time, sometimes for a very long time, without really understanding them and why the patient needs them. Such behaviours include leaving early, going to the toilet during sessions, leaving the door to the consulting room open, and many others. For Maria one such behaviour is arriving late. I think at this stage that we simply don't know why she needs to do it. It seems to have something aggressive and