Clinical Commentary 39

We are delighted to present the fourth 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]

‘Can we close the blinds please?’ The nights are drawing in now, the lamps are on low in the consulting room and, though there is vanishingly little chance of being seen, Theo feels exposed. He is 32, self-employed with his own business, struggling both financially and personally. He has been coming to see me for 18 months, for once-weekly psychodynamic psychotherapy. He was referred with a diagnosis of obsessive-compulsive disorder (OCD) and takes medication for anxiety. Theo1 has a Mediterranean name, surname as well as first name, and a decidedly Mediterranean appearance. However, he grew up in a large British city and in all respects seems thoroughly English; he does not speak his Mediterranean father's native language. As a boy his English mother told him, more than once, that he was her ‘saviour’. An illness as a baby meant she brought him for treatment in an English hospital; she used the opportunity to escape her husband, his father. He never met his father, except as a tiny infant, and so has no memory of him of any sort. He grew up the only male in a household consisting of his mother, her mother and his elder sister. His mother and increasingly demented grandmother would row ferociously. His grandmother, confined to the ground floor by infirmity, would stand at the foot of the stairs, hurling insults, abuse and imprecations at the rest of the family. Theo would cower in his room, trying not to hear. His mother worried that his father might be spying on them, might come and seize him, or his sister, and take them back to his native country. Once there was a footprint in the bath; had he broken in? The little Theo would lie in bed, worrying the house might be attacked, by burglars perhaps. He wou