Commentary by a Senior Member of the British Psychotherapy Foundation (Psychoanalytic Psychotherapy Association)

We meet Julia 15 months into a three-year, intensive psychoanalytic psychotherapy. The clinician's succinct presentation of the case suggests that by now, enough of a therapeutic alliance has been established for Julia to become ‘more curious about her feelings’, after a ‘cautious’ first year. There is a background of unhappily married parents: mother frighteningly volatile, though at times gentle; father much loved by the patient but seemingly ineffectual and frequently absent. There is a series of what may have been rather short-lived relationships with men, each evolving into a friendship when the relationship ended. It seems that ‘the void’ is always waiting in the wings for Julia, and fear of it may keep her in a relationship/friendship that she would otherwise choose to end. Importantly, we are told that Julia frequently feels angry, and that in the countertransference the therapist is ‘more in touch’ with Julia's feelings of emptiness and loneliness than with her anger.

This clinical picture brought a number of possibilities to my mind. Depression and low self-esteem, we are told, have brought Julia to treatment. We may assume that a containing warmth could never be relied on in childhood and this may have led, defensively, to the patient's very muted response to her objects. The therapist aptly notes the dismissive use to which ‘anyway’ is put by the patient; other expressions probably serve a similar function: ‘it was silly really’ or ‘I knew it was ridiculous’ or ‘according to my friend, he was very upset’, or ‘apparently he was also upset’ . All seem designed to diminish salience, perhaps to keep emotion out of the room, and out of the patient's own mind. Nevertheless, there are glimpses of a more vital conflict—the dynamic of attraction/repulsion that the therapist mentions in relation to the patient's choice of lovers—which we would expect to see represented, however fleetingly, in the treatment. With this dynamic in mind, my assumption is that the patie