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I was intrigued by the lively session material of this adolescent. A lot of work has been done and progress achieved but we get a glimpse of a girl in the difficult ending phase, just before a Christmas holiday, with a reduction of sessions imminent and the end looming. In my commentary I will mainly focus on this aspect of ending which is a familiar challenge in work with adolescents. The struggle between regressive tendencies and the wish to move forward to greater independence is particularly pronounced in adolescence. Isca Wittenberg describes the ending as:
... a tumultuous time … Analyst and patient alike will be beset by doubts: is this the right time to end? Is it too soon? Will the patient be able to manage to preserve what has been
Page 119achieved … For, having agreed on a date for ending, patients often appear to regress; symptoms which had disappeared long ago as well as infantile attitudes and behaviour may come to the fore again, casting doubt on the appropriateness of the decision. We have to judge to what extent this is a real set-back, an attempt to hold on to dependency or a wish to go over the previous phases of the work in order to ensure understanding and consolidate integration.
(Wittenberg, 1999: 350–1)
Endings are often not just imposed by institutional restrictions but also connected to developmentally significant moves of schools or to university. The therapist is easily thrown into doubt about whether the work has been enough. In this case there is a long history of complicated separations and a presenting problem of the patient’s serious inability to separate from her mother. One would therefore expect the ending of the therapeutic work to be a particular challenge but also a chance to work these issues through once again.
We are introduced to a 16-year-old girl who has suffered several traumatic separations in her childhood. She started life with a ‘traumatic birth’. We are not told how this might have impacted on her but we learn that her mothe