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Casement, P. (1986). Commentary by an Independent Psychoanalyst. Brit. J. Psychother., 2(4):318-320.

(1986). British Journal of Psychotherapy, 2(4):318-320

Commentary by an Independent Psychoanalyst Related Papers

Patrick Casement

When looking at someone else's clinical work I think we should always remind ourselves that we were not there; and the therapist, who was there, was subjected to the impact of the patient's presence and the pressures to speak and to be effective in the session. I therefore wish to regard the following commentary as an exercise in practising with clinical material, to recognise some different ways of responding and the implications of each.

Here we have a young man who finds himself ill prepared for life beyond home and school. Within the home he is described as having been in a mutually supportive relationship with mother, looking after a depressed father. But an alternative model for relating may have been developed through identification with this withdrawn and inaccessible father. The patient has also been deprived of relationships in which a surviving firmness could allow for confrontation and for aggression to be expressed and yet contained, which would have served both communication and relating. These tentative formulations I would hold in abeyance. I would be careful to avoid imposing these upon my understanding of the patient.

Throughout this session the communication seems to oscillate between quick-fire questioning and long pauses. If we use trial identification we can readily sense that the patient would feel put under pressure by the questioning; and the therapist may well have felt under pressure from the silences.

I therefore find myself wondering whether there may be an interplay here between patient and therapist, whereby the therapist is meant to know what the patient is thinking or feeling: a symbiotic mother-transference, perhaps? Alternatively, is the therapist being prodded into becoming the mother ‘who kept things going’ (a role-responsiveness to the patient identified with the withdrawn father)? However, there are insufficient grounds in this session for interpreting either of these possibilities.

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