Clinical Commentary XIX 131

patient will not only stay away for one session, but will find it impossible to continuewith the therapy.

Leon Kleimberg9 Dunstan Road, London NW 11 8AG

COMMENTARY BY A PSYCHOANALYTIC PSYCHOTHERAPIST

The general tenor of this session is one of insufficient empathy on the part of thetherapist and an undigested fullness which contributes to a sense of deadness in thewritten material as presented by the therapist. The style of presentation is at timesstrikingly impersonal and distancing: for example, descriptions of the patient's feelingsare put in the form of `the experience was one of . . .' rather than `her experience . . .',and such impersonality occurs several times. This reluctance to enter the patient's worldis also seen in the rather wooden and unproductive nature of some of the comments andinterpretations offered later. The therapist describes the sessions with her patient as `fulland interesting' but I can only agree with the first part of this description. It remainsquite unclear what the therapist finds interesting.

The patient is introduced as being `a lesbian woman'. We are not told whosedescription this is - the patient's or the therapist's. If it is the patient's words, we are nottold anything about the status this self-description has in her life, or any of thecomplexities that might be involved in this. The bald description suggests a fixity and adefiniteness that may or may not apply. Why, furthermore, is the patient's sexualpreference foregrounded in this way, as the opening statement? We are given no cluesabout this or its possible relevance to the clinical material to follow, and indeed therelevance, if there is any, is not made apparent. We are given no idea what the patient'spossible conflicts about her sexuality might be, or how this relates to any therapeuticissues, yet her sexuality is made into a defining attribute of her. The therapist's act inmaking this opening statement is baffling.

In the next statement we are told that the patient has never had a sexual relationshipwith a man as a follow-up to the description of her as a lesbian. Again the relevance ofthis to the clinical material that follows seems to be almost non-existent, and certainlyno connections are made by the therapist, so once again we are left wondering what thisstatement is doing here. Is this an important source of conflict or anxiety for the patient,or is this rather a concern of the therapist's? More important, however, is the implicationthat this fact is the most noteworthy aspect of the patient's lesbianism, rather thananything that might characterize the patient's actual sexual relationships with women.To describe someone thus is to make her lesbianism into a failure of heterosexuality,into a lack of relationships with men. It suggests a privileging of heterosexuality on thepart of the therapist, which is all the more problematic for not being explicitly stated asthe viewpoint from which the patient is seen.

Much of the session concerns the patient's preoccupations with issues at work andher difficulties with her boss. The boss (Marion) is the major focus of the second part ofthe session: a great amount of detail is supplied about this woman's seemingly negativeand obstructive behaviour, so that we appear to learn more about her than we do aboutthe patient. She seems to take over and fill up the session: we do not know much aboutthe patient's experience of this woman, her feelings and reactions to her,

132 British Journal of Psychotherapy (1996) 13(1)

and the material is presented so much in terms of the boss that it is hard to gain any ideaas to what the patient might be doing with it, or whom or what Marion might representin her life. This, of course, may be how it is for the patient: her world may be one inwhich she can only experience herself through the doings of other people. Alternatively,the patient's preoccupation with her boss may be an attempt to buttress herself againstexploration of other more threatening issues or against any intimacy with the therapist.

Neither of these possibilities is in any way approached by the therapist: instead sheresorts to a formulaic response, linking her patient's complaints about her boss to themissed session. The therapist's attempts at interpretation here are clumsy andinappropriate, and it is not at all surprising that the patient does not make any use ofthem, but instead persists with the topic of Marion, seemingly flooding the session withmore detail about her. At the end she remarks she must try to understand Marion,bringing herself into the descriptions of this figure really for the first time. This I wouldtake as an indirect but telling remark to the therapist: she must try to understand her. Itindicates that the patient does not feel understood by the therapist and, on the evidenceof this session, she has much ground for this.

Joanna Ryan44 Lordship Road, London N16 0QJ