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The initial presentation of this case must have been somewhat daunting, with depression, suicidality, little or no gainful employment and social isolation. However, 10 years of twice a week seems to have made some changes. The therapist is to be commended I believe on their patience and forbearance at having withstood anxieties about the patient and the irritation that could be provoked by this kind of session material.
The family background sets the scene for B's emotionally impoverished life, with a hostile father and seemingly ineffective mother. Notable is the absence of siblings,
which suggests a possible alternative treatment of group therapy had one to one psychotherapy not been available. More of that later, but given the inauspicious start in life, it was sadly not surprising to see that B's early adulthood was subsequently clouded by his mother's illness, her death, and the failure of his first romantic relationship. A gap ensues in the account of B's history until the death of the father and an inheritance that had the unfortunate side effect of obviating B's need to support himself.
The session begins with B's absence for a quarter of his time to which he may be drawing attention with the comments, ‘could be better’ (i.e. by being more on time?), ‘could be worse’ (by missing even more of his session?). This is not explored in the session material. Instead, B recounts the scenario of an evening with neighbours that closely resembles the family dynamic of contemptuous father, and undervalued mother. He is left feeling impotent and dismissed socially, but also in this narrative there is perhaps a movement from his habitual depressive reaction, toward more of a protest.
The dream takes us more deeply into his inner world and perhaps, behind his accustomed sense of failure toward an underlying self-destruct mechanism, represented by the microwave, and then a report of how he wakes up with a struggle against what he recognizes as a form of self-oppression, wh