We are delighted to present the sixth Clinical Commentary of this series and are very grateful to the psychotherapist who has offered clinical material and to the three commentators. Mark Budden [markbudden@talktalk.net] Ann Horne [annhorne44@gmail.com] CLINICAL MATERIALI have been seeing Suli for four months, initially once weekly. He is 21 and the referral was straightforward. His mother pays for his therapy but I have had no direct contact with her. Suli told me that he was failing to produce the work expected of him on his college course and that he was feeling 'very down'.The young man I met was friendly, open and sensitive, but there was something else that made me wonder if he would resist whatever I said. In the second session he moved onto the couch, and I remember this seeming sudden, as if he was impelled or propelled to lie down. I wonder if lying down simultaneously represents a wish to 'stay in bed and not get up' (frequently reported) thus avoiding direct contact, and a hope that, freed from the need to adapt to, accommodate and simultaneously resist the other, he might discover a part of himself which can speak his own words, and find his own mind and his own desire.Whilst I have his permission to write about him and am disguising key details, I will only give a light sketch of Suli's family and his history. He was born to professional parents, has an older brother and sister, and then his father dies suddenly when Suli is 3 years old. He is not sure what he remembers and what he has been told; perhaps the lights of an ambulance or police car through the windows, on off on off. Perhaps the body being carried out of the house?Since then his mother has held her career, her family and her home together. Suli describes the family as close, remembering the three children in bed with their mother, comfortably watching television together.Suli seemed very stuck, not getting any of his college work done, while buying off his tutors (and trying to buy off himself and me) with promises. It seemed as if my job was to excavate the desperation below the surface of his intractable refusal to do

No abstract

No abstract

We are delighted to present the fifth Clinical Commentary of this series and are grateful to the psychotherapist who has offered clinical material and to the three commentators who are qualified in both child and adult psychotherapy.Mark Budden [markbudden@talktalk.net] Ann Horne [annhorne44@gmail.com] CLINICAL MATERIALHelen is a patient who has been coming three times a week for several years. She lies on the couch. She came referred by another professional as her marriage was failing during infertility treatment. At the time, Helen wanted a 'space to off load'.Clearly after all this time there is much to say but I'm struck by my internal struggle between wanting to 'share it all' and the feeling that I must protect my patient from being exposed. Is this what Helen feels? Is this why she has kept on coming all this time while at the same time often feeling it is pointless and complaining a lot about others not understanding her, not seeing her, letting her down. Does she feel that she wants to be seen and at the same time feels very exposed when she is seen and so scurries away?I have presented her many times in supervision, knowing that I want to understand better what is happening between us, knowing that in giving more thought to her I might find what feels like 'the key'but each time I find something and then lose it again. I get drawn back into feeling we've achieved nothing, it's pointless, I'm wasting her time, I'm not good enough, she's stuck. At other times I can feel frustrated and impatient with her; thinking that she won't or can't allow herself to grow or to change.Helen is in her fifties with a twin sister and an older sister whom she describes as the angry difficult one and who is ever present in her mind as someone she is petrified of becoming. She has never had children, though not for want of trying, while her twin has three. She describes her mother as anxious and ineffectual, and her father as angry, opinionated and denigrating.

No abstract