Clinical Commentary 40

We are delighted to present the fifth Clinical Commentary of this series and are grateful to the psychotherapist who has offered clinical material and to the three commentators who are qualified in both child and adult psychotherapy.

Mark Budden

[markbudden@talktalk.net]

Ann Horne

[annhorne44@gmail.com]

Helen is a patient who has been coming three times a week for several years. She lies on the couch. She came referred by another professional as her marriage was failing during infertility treatment. At the time, Helen wanted a ‘space to off load’.

Clearly after all this time there is much to say but I'm struck by my internal struggle between wanting to ‘share it all’ and the feeling that I must protect my patient from being exposed. Is this what Helen feels? Is this why she has kept on coming all this time while at the same time often feeling it is pointless and complaining a lot about others not understanding her, not seeing her, letting her down. Does she feel that she wants to be seen and at the same time feels very exposed when she is seen and so scurries away?

I have presented her many times in supervision, knowing that I want to understand better what is happening between us, knowing that in giving more thought to her I might find what feels like ‘the key’ - but each time I find something and then lose it again. I get drawn back into feeling we've achieved nothing, it's pointless, I'm wasting her time, I'm not good enough, she's stuck. At other times I can feel frustrated and impatient with her; thinking that she won't or can't allow herself to grow or to change.

Helen is in her fifties with a twin sister and an older sister whom she describes as the angry difficult one and who is ever present in her mind as someone she is petrified of becoming. She has never had children, though not for want of trying, while her twin has three. She describes her mother as anxious and ineffectual, and her father as angry, opinionated and denigrating.