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We are now more than halfway through a second year of pandemic living; clinicians are more accustomed to the new ways of working and adaptations in clinical practices, and for many, this means accepting that the frame is no longer quite as it was before Covid-19.
Similarly, particularly during lockdowns, the many outbursts of violence that have occurred across the world remind us that when faced with a patient whose entire life has been one of deprivation, careful adjustments to thinking and the setting may become necessary, as the clinician who honestly shares their work in this clinical commentary decides.
Although the case presented below is not a forensic one, there is no index offence and the patient has been referred for anxiety and depression in an outpatient setting, there is a volatility present in the session, and even without learning the ethnicity or gender of the therapist (which, historically we do not give), we encounter tension around race and masculinity at different points in the material. With increasing frequency, many of us are finding ourselves working with people who present like this, patients whose complex histories involve destructive aggression, and as our third commentator points out, there is often trauma at the heart of it.
Katya Orrell
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(The clinical material has been carefully disguised to preserve the patient's anonymity and appears with the permission of the NHS setting in which the work took place.)
Thomas is a mixed race man in his early sixties. His early life was dangerous, chaotic and unsafe. The son of an alcoholic mother and violent, absent father, he grew up in severe economic and emotional deprivation. He is the eldest of three boys, all becoming involved in gangs, and whilst his siblings led troubled lives, one died from alcohol poisoning and the other became involved in organized crime,