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Clinical commentary by Dr Leslie Ironside – consultant child and adolescent psychotherapist working in private practice in Brighton
Wisdom or oblivion – take your choice. From that warfare there is no release.W.R. Bion (1979)
I read the notes with great interest and empathy for both the therapist and patient. It is, however, a relevant, but strangely anonymous, experience to be writing without knowing more about the therapist. Is the therapist male or female, or, given the later material of the session what is the age of the therapist? Where does s/he come from? Where does s/he work? What is his/her professional background? To which school of thought does s/he/ belong? Fittingly, in terms of the family story, the refugee comes to mind; what do I really know about this person, who am I to comment on their work, how much do I understand them, what will they feel about my comments? Will I inadvertently tread on their toes? All also very relevant issues to the material presented. How though do I, how does the therapist, manage this gap in knowledge and understanding? How do I communicate in this commentary? How does the therapist communicate? Will I be experienced as a wolf diving in with the intention to devour? Is the therapist experienced in this way by the patient? My inner panic needs to be gathered safely in, to paraphrase Leonard Cohen. Fear, now the wolf,
needs to be kept at bay. I am reminded of Bion (1990) writing of how in every consulting room there should be two rather frightened people; that, I think, is bearing the unknown. Can I, then, find a place, the creative ‘let's play’ space the therapist and patient found within the session whereby my comments can be seen helpfully to aid and not hinder the formation of further thought?
As I read the commentary, the management of fear and need for bravery seemed to feature strongly in terms of both the therapist and the patient. Indeed, is it by chance that the therapist chose the name David to maintain the confide