Clinical commentary: Clinical material

Background

Rebecca is a 19-year-old referred to our clinic for intensive psychotherapy after a private assessment by an experienced clinician.

The initial private assessment was prompted by her mother who was deeply distressed and worried about Rebecca’s self-destructive behaviour. Rebecca had been abusing drugs and alcohol and self-harming since her mid-teens. Her alcohol abuse was such that she often blacked out, could not remember what had happened during her nights out drinking and had, on occasion, been in trouble with the police for abusive and violent behaviour towards people. Rebecca’s self-harming had been kept hidden from her mother until recently when her daughter came back home with her upper thighs covered in fine, superficial cuts. During the course of therapy, she told me she would also cut her upper arms but always kept her arms and legs covered so that no one could see the damage she had done to her body.

Rebecca is a very good-looking young woman, the classic English rose, very well spoken and well presented, clearly putting effort into the way she looks, dressed in trendy clothes with a slight but calculated bohemian edge to her overall image. She is musically talented and has aspirations as an actress.

She is the youngest of three and still living at home; her siblings are away at university but they often meet or spend time together. Her relationships with her two siblings appear to be quite complex; she often feels she cannot express her grievances or upsets in an open way with them; they are described as “domineering” and it seems as if between the three of them there is always some sort of argument or discord during which two siblings pair up against the third. Rebecca often feels that, being the youngest, she is scapegoated by the other two although she is not stuck in this position. Her parents separated when Rebecca was in her mid-teens, an event that deeply affected her and with which she is still struggling to come to term