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Harry struck me as a defended young man who struggles to put his emotions into words and tends to communicate by evoking feelings in others and acting out. It is difficult to get close to him. I couldn’t help being reminded of some of the patients I have worked with and I felt this helped and hindered me in thinking about the relationship with his therapist in this session.
This was Harry’s last session before a weekend break. In view of his apparent sensitivity to change, I could see that this was likely to be problematic. It gradually emerged that he was having to negotiate several transitions at this time. In therapy, this session came soon after the summer break and there were unresolved changes of session time. This would have been his second summer break, as he had been in this therapy for 18 months, so one would expect a reaction. According to Meltzer (1967: 12) ‘the gathering of the transference is disrupted by patterns of acting out as the main stream of transference takes shape’. At work, Harry was in presumably his first job, a highly pressured one, and had just been given a new project. It is worth noting that he seemed to be in a supportive work environment with good pastoral care and that he was encouraged to get therapeutic help.
Harry is also described as having difficulty coping with even fleeting moments of meaningful contact, which tend to leave him feeling vulnerable. He diverts from feeling this way by resorting to perverse excitement about self-harming or risk-taking activities. Again, it is to be expected that his anxieties and defences in this area will increase as the transference deepens (Meltzer, 1967: 9).
Harry seems to me to be subtly acting out in this session. Perhaps it is a mark of progress in the therapy that there is not more overt acting out. Harry could bring the troubling issues into the session through discussing difficultie