Therapy in Action

Psychoanalytic Therapy

Each chapter of the textbook incorporates a novel case study involving a client presenting with a set

of concerns and a therapist addressing these concerns using the therapy discussed in that particular

chapter. Since each therapy is best suited for certain types of difficulties, each case study is unique

in order to ensure that the examples provided are as clear as possible. This session can be viewed by

watching the associated video content of the therapy session in action and this document is designed

to accompany the observation to support your understanding.

The aim of these case studies is to provide the reader with a real-world example of therapy in

action. Unlike many other fields of psychology, counselling and psychotherapy are not exclusively

academic. In order to fully understand therapeutic approaches and methods, the reader must

appreciate how these concepts can be applied in interactions with clients. The best way to present

these interactions is in the form of case studies and we hope that you are able to use these examples

in order to further your own understanding and practice of counselling and psychotherapy.

The therapy session lasts for one therapy hour (50 minutes) and it is presented as the initial session

in a new therapeutic relationship. Prior to this session, the client will have completed an initial

assessment questionnaire and the therapist will have read this paperwork to ensure familiarity with

the case (please refer to the assessment form online for more information). Please note that these

videos depict REAL interactions – although the session has been arranged for the purposes of the

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video and the sessions will not continue after the recording, the interaction within the session is

genuine. No actors are used in this session. The client was one of the authors and the problem

presented was genuine. The therapist is an experienced practitioner in the field. The only ‘fake’

aspect of this recorded session is that the client did not really seek therapy and this is not really the

first session of a series of therapeutic contacts.

After the conclusion of the therapy session, the therapist is invited to answer a few key questions

about the session. This question and answer session lasts no longer than 10 minutes, thus the video

lasts for an approximate total of one hour.

Therapist Credentials

The therapist in the psychoanalytic therapy session was Tina Usherwood.

Tina Usherwood is a psychodynamic psychotherapist and supervisor. She originally trained and

worked for Relate as a relationship and couple counsellor and completed her full psychotherapy

training with the Liverpool Psychotherapy Organisation in 2005. Tina has subsequently trained with

the Guild of Psychotherapists in London where she obtained a Diploma in Psychoanalytic and

Psychodynamic Supervision. Tina currently works in the Student Counselling Services of the

University of Liverpool and Bangor University. She also has a private practice in North Wales

where she offers psychodynamic supervision to counsellors and therapists of all modalities. Tina is

a UKCP Registered Psychoanalytic Psychotherapist.

Client Presentation

The client in the cognitive therapy session was Phil Thomas.

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Phil Thomas has been suffering with stress and anxiety over the last few months. He has recently

experienced some minor life events and these have had an impact on his mental wellbeing. He feels

particularly anxious about his tendency to procrastinate and he believes that this is contributing

towards his general feelings of stress. He has previously experienced person-centred therapy and he

is generally positive about the possible outcomes for therapy. He would like to gain an

understanding of his own behaviour in order to be able to reduce his own procrastination.

Transcript of Session

T denotes therapist, C denotes client.

T: Okay, hi Phil.

C: Hi.

T: And so, given this is our first session I thought perhaps I’d start and say a little bit about the way

I work, about how the session is going to be constructed, and then we’ll get on to the issues that are

bothering you. Does that sound okay?

C: Okay. Yes.

T: So thank you for your letter, your referral letter, erm, which tells me a little bit about why you’ve

come, but it’s important that we set a few kind of ground rules, kind of boundaries around the work.

So what I want to tell you is that anything in that, all that we talk about is confidential, okay. There

are times when I might need to talk to GPs, people like that, but that would only ever happen with

your written permission.

C: Okay.

T: My notes are kept safe, I write very kind of factual notes, so just a kind of very brief description

of what we have talked about and any particular issues that come up, and you have access to those

notes through me if you want to see them. Otherwise they’re confidential. The only time I would

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break confidentiality would be if I was seriously concerned about your wellbeing or about the safety

and wellbeing of anybody else. Okay?

C: Okay, yes.

T: Have you had a bit of counselling before?

C: I have yeah, many years ago.

T: Okay, what do you remember of that?

C: Er, I found it a really useful experience really, just to talk things through ... and I had about ten

sessions.

T: Okay, and did that end because it felt it was enough?

C: Yes.

T: … At the time…

C: Yes.

T: Okay. The way I work may or may not be different to that so if I just tell you a little bit about the

kind of things that I’m interested in and how I imagine the sessions to go. So one of the things is the

sessions are 50 minutes long, you don’t need to be worried about the time, that’s my responsibility.

But I would like us to meet on a regular basis, and I think in your referral we talked about maybe

meeting weekly for say six sessions, six to eight sessions.

C: Yeah…

T: And then we can review. So if we agree to meet at this time every week for the next six weeks.

C: Yes.

T: The kind of things I’m interested in are relationships, so our relationship I’m interested in and

how we work together, and whether that mirrors anything of what you’re experiencing in other

relationships. Either with people or maybe things, you know, your relationship with work maybe.

And I’m also kind of interested in your early relationships so how those may have impacted on how

things are now.

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C: Okay.

T: We’ll kind of see where it goes. What I’d really like in the sessions is for you to just talk about

anything, anything that comes to mind really. You know, if you have a particular dream, or a kind

of daydream or thoughts that you kind of mull over in the week, you know, bring them here and

maybe we can use those to help us understand what’s going on. Does that sound alright?

C: Yes, okay.

T: Okay, great, and if any point you’re uncomfortable with me or with the sessions it would be

really helpful if we could find a way of talking about that.

C: Right, okay.

T: Okay, so shall we begin with the issues that you put down on your referral and the issues that you

are bringing today. So what’s going on for you?

C: What’s going on for me right at the moment is I’m feeling anxious, just to get started. What I

actually, er ... the things I’m coming with are, recently I’ve been feeling a bit stressed and anxious

about, er, about things in general, which is, I think is unusual for me…

T: Right.

C: And I’m aware of the fact that I ... linked to that is that I will take things on, and I have things to

do, and I’m really good at putting those off, or putting some of the things off. So I see that those are

connected.

T: Okay. And you also connected feeling anxious here, which I guess is another one of those things

that you said you’d do, and actually now it’s a bit unnerving.

C: Yeah…

T: Yeah, absolutely. So meeting somebody new for the first time and in this setting is anxiety

provoking ... and maybe that’s similar to what you’re saying is you take on these things you agree to

do these things but actually what you end up feeling quite is anxious about it.

C: Yes, yeah.

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T: Okay, you also said this was a bit new. When does it feel like things have changed?

C: I probably ... probably a couple, maybe six weeks ago ... but I see that as quite recent, when I

would actually ... I’d get symptoms of, not exactly panic ... I don’t have a panic attack, but I can feel

a rising sort of panic here (holds chest)…

T: In your chest…

C: Yeah, yeah, and then that can feel, can end up feeling a bit sort of nauseous there and having to

really sort of breathe to just sort of calm down. Er, I’m not quite feeling that at the moment…

T: Okay.

C: But that happened, as I say, probably about six weeks ago, it happened for a couple of weeks and

then just kind of levelled off again. And that was the first time I’ve ever experienced that.

T: Okay, do you remember that very first time?

C: I’m having difficulty remembering the very first time.

T: Okay, is there a time that comes to mind?

C: I can think of a time that’s representative of that. It might have been the first time.

T: Okay, what came to mind?

C: Er, feeling overwhelmed I think. Just being aware of the fact that I needed to go and do things,

and some of the things were maybe things that I’d put off. And just feeling, just feeling as if there

was, overwhelmed, too much going on. And yet when I sat down and tried to work it out, because I

like to be able to do that, I like to be able to say 'this is connected to this', when I tried to put my

finger on was there one specific thing, I couldn’t do that, there was a collection of small things

which, when I looked at them each in turn…

T: They were all manageable.

C: … they were all manageable but the collective seemed to be a bit overwhelming really.

T: Okay. Okay. And these things that felt overwhelming were they all placed, you know, to do with

one aspect of your life or is this a kind of general…

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C: I think that they probabl ... when I think about it there were probably aspects of work, but it’s not

exclusive to work, there’s other things ... there’s things within the home, just very practical things

like, maybe, some DIY at home that I really should have done, you know that but that’s a very

simple and ... it sounds to me like a very trivial example, but it…

T: Yes, but what you’re saying is it’s not one thing ... so the individual doing the bit of DIY is not

problematic, but feels problematic because all these other things are there…

C: … because there’s so many of them. Yeah, yeah.

T: Okay. So is that something that feels new? That you’ve taken on such an array of things. Is that

something you’ve done in the past?

C: I think I’m very good at taking on things, and I’ve done that in the past. Erm, but I suppose that

they’ve always been manageable. I’ve always managed to work through them. Even though I might

have, in my head, a list of things to do…

T: Right.

C: They’ve always been, they’ve always been achievable and they’ve always been ... sort of ... I’m

struggling a bit for the words here ... erm, I suppose it’s a matter of me ... I’ve always managed to

break them down and deal with these things one at a time so they haven’t been overwhelming, but I

suppose that I can identify that I’m very good at saying yes I’ll do something ... and especially if it’s

a few months down the line ... I’ll say yes to them and then all of a sudden what was a few months

down the line suddenly is, you know, next week ... or today.

T: Sure. Okay. So that thing of saying yes is something you really resonate with and feels like that’s

part of who you are.

C: Yes. Yeah ...

T: Okay. So, do you make any sense of that? What’s your understanding of why you say yes?

C: I think that I say yes because I find it difficult to say no. And I suppose that sort of linked in with

that is ... I don’t like to sort of let people down, I don’t want to disappoint people.

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T: Okay, so I guess that that would be very alive in our meetings, that there would be a part of you I

guess that would want to get it right or wouldn’t want to let me down maybe.

C: Yes, yeah, I can see that, yeah ...

T: Okay. So that’s just for us to kind of notice and recognise really, because there may be times in

here where you do want to challenge something I say or maybe you don’t want to turn up one week,

you may want to go do something else. What might that feel like ...

C: Right.

T: ... to not make the appointment or ... not get it right?

C: Right, yeah ...

T: Whatever ... does that bring anything up for you, that idea of letting someone down or saying no?

C: Yes, as soon as you said it and as soon as I thought about it, that doesn’t feel, that doesn’t sit well

with me, that doesn’t feel comfortable.

T: So it would be really difficult to do that?

C: Yes.

T: So it must be very hard for you to say no to things, even when it feels like it’s another demand.

C: Yes, yeah ... I think I can do it, but it doesn’t ... it’s hard. It’s hard for me to do.

T: Okay. Do you want to say a bit about that?

C: Er ... I don’t quite know where to go with that.

T: Okay, that feels a bit uncomfortable or ...

C: I feel a bit stuck there.

T: Okay. So that might be really helpful for us to see that that’s a place where it feels stuck ... that’s

it’s difficult to even imagine saying no to somebody, refusing to do things, in a kind of easy way.

That it would be something quite challenging.

C: Yes, I have to kind of prepare myself for that. It’s far easier for me to say 'Yeah, go on, I’ll do it,

that’s fine, put my name down' or 'I’ll take that on', whereas if I ... I’ll have to get to the point where

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I’m thinking, there’s too much going on for me to actually, I suppose, to myself to the point where I

can turn around to somebody and say 'No, I can’t do that', and so the easier option is to say 'Yes,

yeah, I’ll do that'.

T: Except I guess what you’re telling me is that it’s not necessarily the easiest option in the long

run.

C: No, it’s not.

T: No.

C: Because then I end up in that place where I end up taking too much on and then you can’t really

sort of ... I feel as though then I’ve ... then I feel as though I’d really be letting somebody down. If I

say yes to something ... then I’d be letting somebody down.

T: Yes, sure.

C: It seems as I’m sitting here, as I’m talking about it, logically it seems it would be far easier if I

just, when they first asked me, just to say 'No, I can’t do that'.

T: But it may be almost habitual that you say 'yes'. It sounds like it’s become a real pattern for you.

C: Yes, yeah.

T: Okay ... does that fit in at all with any of your earlier experiences of life? Does anything come to

mind, school, family ... ?

C: What’s come to mind there is that ... er ... my strategy for getting through secondary school. I

remember leaving the standard small primary school and going into secondary school which was a

comprehensive in Liverpool and suddenly I was, I remember the first day of standing there and just

being I suppose overwhelmed by, by the size of the new place I’d got to, and I think as a strategy

for coping fairly early on in that school was a kind of, was to sort of keep your head down, and sort

of just get on with it, and I suppose maybe the connection there might be sort of not be resistant to

stuff and be compliant with stuff ...

T: Right.

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C: ... but I don’t know whether that’s right, but certainly as you were talking about those early

memories that’s a very powerful memory of me, of how I got through secondary school ... if you

keep your head down then, then people won’t target you.

T: Okay.

C: Yeah.

T: Okay. Sounds like it was quite a hard school.

C: It was erm ... I suppose that looking back on it I don’t see it quite like that but I guess at the time,

when I was 11 standing there in my new blazer, then that was a scary place.

T: And I guess that’s the bit that feels really relevant, that that was your experience, your experience

of going to that school on that first day, was that it was big and scary and that somehow or other

you needed to find a method of staying safe, and keeping your head down and being compliant and

saying yes was what happened.

C: Mm.

T: What about in your home, was your home a place where you could say 'no'?

C: Er ... the memories I have of home is that the home was a very safe place, erm ... I think that ... I

don’t think I said no, I don’t think it was, I don’t think I was ... I don’t think there was anything

there that I’m aware of that I would’ve been concerned about ... like I say it felt a very safe place, a

very loving place.

T: Right.

C: ... so I didn’t get hit or shouted at but I don’t know whether that’s because at that point I’d

already developed this sort of, you know, just keep quiet, I never really thought that far back ...

T: Right, okay.

C: ... or made that connection.

T: And there might not be a connection.

C: Yeah.

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T: There may be or there may not be. The connection might be that home did feel safe and it wasn’t

a place where you were avoiding conflict. So maybe going to the secondary school was the stark

contrast to that ...

C: Right.

T: ... a place that really didn’t feel safe.

C: Yeah, that feels more like it.

T: Okay, and somehow or another, that method of coping, of keep your head down, just say 'yes',

has stayed with you.

C: Yes.

T: Even though the danger is probably less there now.

C: Yes, yeah. Yes. I remember a work colleague many years ago say that I have this, how did he

describe it, because he was quite an active person in standing up and shouting, or standing up and

making his point felt, and he described me as having a cloak of invisibility ... that I just found a

level to get on with and drift through I suppose.

T: Okay.

C: Which I kind of took at the time as a sort of compliment I think.

T: Right. How about now?

C: (laughs)

T: Because it looks like you’re questioning that ...

C: Yeah, yeah ... if that’s kind of connected to this not wanting to sort of, not wanting to make

ripples and just to sort of and therefore taking on stuff and not saying 'no' to people, then I don’t

think ... that sounds like it's not a ... I’ve always seen it as a fairly useful strategy but now maybe it’s

not, if that’s ...

T: Well, and maybe it’s both, because I think that you know what you’ve described happening to

you at really quite a young age at school was that you naturally found a method of coping that

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actually did work, it sounds like. You didn’t get picked on at school, you did manage to find a way

through it, and actually that served you very well, most of the time. But perhaps what you’re saying

to me is it’s not serving you so well right now.

C: Right. Yes.

T: Maybe there’s something that’s changed in your life at the moment, or the situation’s changed

whereby that method of coping is becoming a problem.

C: Well yes. Yeah, yeah. I can see how that connects and I can see that what’s going on for me at

the moment is not good in the sense that I’m getting to the point where I’ve been relatively sort of

anxiety free and yet now I actually feeling as though I’m ... that that’s not what’s going on for me at

the moment.

T: Yes. Okay. So shall we go back to that six weeks ago because it feels that that was really

relevant, that something really changed for you at that point. And what you’re saying is that it’s not

really clear what that was in particular. Had you taken on more than normal?

C: I’m really not aware that I’d taken on any more than usual, and when I ... As I say, when I sat

down and tried to work it out I couldn’t ... I couldn’t put my finger on, well I said earlier, I can’t put

my finger on one thing, it just seems like a collection of things really so I’m hard pushed to think is

there something specific happening, erm ...

T: Maybe unconnected, I mean sometimes it can be something like an anniversary or a birthday or a

whole range of things, but it feels like something shifted for you.

C: Yes, um ... I ... all that springs to mind there is that I’ve been working at the same place for 25

years, and that happened around that time that it was, that it was acknowledged that I’d been

working at the same place for 25 years, and so ... I ... I don’t know where that came from, I mean

apart from you saying anniversary, because I really can’t think that that is necessarily connected to

me feeling anxious, but it might be.

T: Sounds like a significant event.

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C: Yes, yeah.

T: That golden handshake or, you know ...

C: Yes, yeah.

T: And you’re saying it was acknowledged.

C: It was, but I think part of me thinks it wasn’t very well acknowledged maybe, and, and I

remember at the time feeling, er ... like as though I had a question over whether I was actually being

valued.

T: Right.

C: And even as I say that now, that kind of ... there’s a ... I feel an emotional connection to that.

That kind of feels ... feels like there’s something going on ... and yet how that connects, or doesn’t,

from you know this whole thing about a significant event, feeling valued by the response I got for

that and me getting anxious ...

T: Well I guess one connection we could make quite quickly I guess is that you do say yes, you do

take on work, that actually from your perspective you give what you’ve got to give and there may

be some connection in that, that actually you’ve given as much as you can, you’ve taken on all these

things and yet somehow it doesn’t feel as though it’s quite valued enough. So maybe it leaves you a

bit invisible.

C: Mm ...

T: Does that resonate?

C: Yes ... I don’t know what I do with it though (laughs).

T: Well I guess maybe you don’t need to do anything with it. Maybe just acknowledging that feels

like a step forward. Because what you’re saying is this event happened ... it almost feels like you

almost felt it and pushed it away, so when I mentioned was there anything significant you know that

came to mind and you said there’s an emotional response to it ... so it is significant and it’s

something that’s really important and it’s fairly recent.

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C: Yeah, yeah.

T: How would you have liked to be recognised? Do you know?

C: ... (pause) ... I have no idea. Isn’t that weird? I don’t know ... I think part of me thinks maybe not

at all. You know, er ... (pause) ... oh, that’s interesting, er, I don’t know where to go with that, I

don’t know. Never thought, never thought about it, and even as I’m sitting here now trying to think

about it ... I’ve gone blank. I just have no idea.

T: Okay, and maybe that going blank just tells us it’s a bit difficult to think about. You know, I

think, certainly my experience is when feelings are kind of powerful it is really hard to think. And

I’m also aware that this isn’t our only session so there’s time for us to come back to that if it’s

relevant.

C: Yeah.

T: Yeah, and some of these things that we’re kind of linking together, you know, maybe you’ll go

away and mull over and it will make more sense.

C: Yeah.

T: Maybe not, but I guess, you know, what feels really helpful is the fact that what you have

allowed to happen is just thoughts to come to your mind.

C: Right.

T: And what you’re saying is why did that thought come in? Why that image? But it feels

important, yeah? Something about being recognised in a positive way, which your cloak of

invisibility perhaps denies you, is the negative part of being not recognised and being able to get

through the difficult bits.

C: Mm, yes.

T: Do you want to say a bit more about, you mentioned the word procrastination earlier?

C: Yes, okay, er ... and that’s linked to all these things that I take on. I think that procrastination

kind of sits in lots of areas of my life really. There’s things I’d like to, or I think I’d like to do ... and

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then find reasons not to do them. And so there’s obvious things when I say to other people that I’ll

do something and then I’ll be in a situation where I have to do it, or will say no, but there’s little

things that I also kind of expect from me, there’s things I want to do for myself, some of which I put

off, and I suppose when I put them off I then ... I don’t think I ever really give myself a hard time

about it, but it’s just something else I’ve put off and I feel as though I’d like to do. An example of

that might be erm, ... years ago I felt as though I was quite creative, I’d sit and draw, I’d play

guitar, I’d write and er, ... I still play guitar and I still sort of promise myself that I’m going to sit

down and draw, but I think that sort of laughingly, I say to myself 'Oh that’s the kind of thing that

I’ll do when I retire'. I’ll take up watercolours when I retire, so I always manage to put something

off, and yet there’s part of me that thinks that’s really important. That it’s really important for me to

do these things for me, and then I don’t do them. And then I feel kind of, I do know, well I’m not

sure what I feel about that really. I feel a bit sort of, the word that springs to mind is, I feel a bit

disconnected.

T: Disconnected to?

C: Disconnected to a part of me I suppose. Erm ... and I don’t know where that’s coming from

either, but that’s what's in my mind at the moment.

T: Can you describe that part of you?

C: I suppose it’s the ... I suppose I’d just describe it as I did earlier on, it’s the creative side, or the

creative part. It’s the part that gives me ... I don’t know, erm ... it’s a part that I feel as though I’ve

neglected I suppose. So maybe a neglected part of me. And, as I say, that feels a bit uncomfortable

as well.

T: Where does that feel uncomfortable?

C: Do you mean in my body?

T: Mm.

C: It feels ... it sort of sits somewhere here (hand to chest), I think. It’s hard to, hard to describe that.

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T: Right.

C: But I just feel as though ... I suppose a bit maybe that bit’s a bit sort of a part of me that I’ve sort

of left behind or lost and that I would like to ...

T: Reclaim.

C: Reconnect to, or yeah, reclaim, just to get back in touch with and I feel as though that’s

important for me because it will make me sort of more ... more whole, more rounded. It’s almost

like I put that on one side to get on with other stuff.

T: Okay, and the other stuff ...

C: ... is probably work, isn’t it ... yeah.

T: Right. Do you enjoy your work?

C: I enjoy parts of my work, yeah, but at a time when I’m feeling quite overwhelmed with bits of it,

then I kind of don’t.

T: So there’s ... I guess if I reflect something that’s going on for me is I keep going back to this

cloak really. You know I think it’s a really interesting image isn’t it? This cloak of invisibility.

C: Right.

T: And the reason it’s there in my mind is because I’m thinking, well what does a cloak do? Yes it

would enable you to not be seen and go through, but also maybe it covers up something.

C: Right.

T: And the things you’re talking about being creative, you know making music, making art, and

those kind of things, you know, they're kind of things that are seen aren’t they, they are a kind of

expression of yourself. That somehow they’ve been covered up. So this other part of you that 'gets

on with it', I think that’s what you said, is able to do that.

C: Yeah.

T: But it feels now split off, you’d like that back.

C: Yes.

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T: Yes, and I guess that having that back partly involves saying 'no'.

C: Well, that’s right, the saying 'no' would free up more time, but then I don’t know whether I

would make use of that time.

T: Right.

C: Or whether I would just sit and procrastinate and find reasons not to do that.

T: Okay, so it feels like your suggesting that actually there’s something within you that both wants

the creative bit but also does things to prevent it from happening.

C: Yeah. Yet there’s no reason why I can’t, there’s no reason why I can’t find time. It’s the, you

know, I can go home quite happily and sit in front of the television when I could actually be doing

something more creative.

T: So what comes up for you if I suggest you dive into that creativity?

C: (pause)

T: What does it feel like?

C: I think it feels a bit risky ... like as though I used to do it so long ago I don’t really know whether

I could do it any more ... and so to actually try it might mean that I realise that I can’t do it I or can’t

do it as well as I like to think I’d be able to do it. I think there’s an element of that.

T: So a fear of not getting it right.

C: Yeah, so it’s easier for me to stick with things that I know I can get right, than to take on

something which is ... that I might get ... well I know that you can’t technically get a creative piece

wrong, but it may not be as good as I would like it to be.

T: Mm. So that’s where the self critic lies. That there’s a sense that you would have an expectation

of yourself, and if you didn’t live up to it ... that would be difficult.

C: Yes.

T: Is that critic alive in your work ... or in other aspects of your life maybe?

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C: It doesn’t really feel as though it’s there in my work. As you say that erm ... in fact part of me

feels as though it’s, not exactly the opposite but part of me feels as though I’m quite happy getting

things wrong. I actually, I’m quite happy believing that that just gives me some, you know, some

opportunity to do something better if I get something wrong, you know, learn from mistakes, that

kind of thing. And yet that doesn’t apply when I’m thinking about maybe wanting to do a, to sit

down and draw or paint.

T: Okay, so a real split there.

C: Really odd, that’s a really odd thing. That doesn’t make sense to me at all.

T: Have you realised that before?

C: No, that’s ... no, no ... and yet I’m really, I’m really ... I’ve always said to my kids, if they do

something wrong, if the first time they do something wrong I never tell them off when they do

something wrong, they probably hate me for it, but my mantra is 'What did you learn from that?'

and then if they do it wrong a second time then they can get shouted at because they haven’t learned

something from it. And so I actually think I’m very open to this idea of get it wrong and you learn

something from it, and yet that is exactly what’s not going on when it comes to sitting down and

being creative. Which I just ... and that’s brand new to me. I’ve never thought about it, never made

that connection. I can say that just doesn’t make, that really genuinely doesn’t make sense to me.

That I’d have to get something absolutely right first time over here, not having done it for 15 years,

and yet over here I’m quite happy to make mistakes, acknowledge them.

T: It feels as though there is something very precious about the creative aspect of you. Whereas it

feels like in your work you’re a bit more robust, you’re able to get it wrong.

C: I suppose I’m more confident in my work, and in other areas of my life. Being creative is, well

while I would only be doing that for me anyway, but I don’t feel confident there.

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T: Is the 'doing it just for me' a factor do you think? Because it sounds like you do a lot of things for

other people ... in the saying 'yes' and taking on things. What you said was that you didn’t want to

let anybody down ... disappoint anybody.

C: I can see that, I hadn’t really thought about that ... no suddenly that’s gone, I just kind of, I just

blanked, that’s ... I don’t know what happened there in that sense but there was, I was following that

train of thought and then I just lost it.

T: Again, I think there is something that you’ve really kind of demonstrated here which is that those

moments when we’ve stopped being able to think are often moments where it actually fells like

something’s really resonating, and I think sometimes you just have to sit with that.

C: Mm.

T: Yeah, we could rush in with all sorts of ideas about it, but that really might not be helpful.

C: Yes.

T: We’re coming towards the end of the session and it feels as though it’s been incredibly full.

C: Yes, yeah.

T: That’s my experience of the session. You know, we’ve been to your school, we’ve been many

places really and I guess what will happen over the week is that some of that will, you know, you’ll

mull it over or it might spark things on your imagination. It might impact on your sleep and your

dreams, you know. And what I would encourage you to do is just let that happen. Bring back what

feels relevant to the next session.

C: Right.

T: And we’ll see if we can make some more sense out of things.

C: Okay.

T: It’s been a real pleasure getting to know you.

C: Is that ... how long have we been talking?

T: We’ve been talking for 50 minutes.

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C: Wow ... right.

T: Does it feel like not as long as that?

C: It doesn’t feel like that at all.

T: It feels like it’d gone quickly?

C: Yeah.

T: Okay.

C: Great.

T: So I’ll see you the same time next week.

C: Thank you.

Analysis of Session

The therapy session can be sectioned as follows.

Introduction

Gentle introduction

Reflection on previous experience with therapy to establish possible expectations and beliefs

about therapy

Addressing any questions about the nature of person-centred therapy

Outlining basic contractual details, especially the limits of confidentiality and the nature of

sessions (length, number, etc.)

Story

Client is invited and encouraged to share his story – this forms the largest part of the therapy

sessions

Focus on feelings and internal experiences, rather than the specific practicalities of the story

Goals

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Establishing goals for therapy is periodically explored throughout the session, rather than

forming a conclusion to the session

Goals are explored in terms of the current and ideal locations for the client

Ending

Warning given prior to the end of the session

Reflection on how the session was experienced by the client

Invitation to return for future sessions

Key questions to consider in relation to this therapy session

How could the nature of this client be understood from the psychodynamic perspective?

Are there any unconscious drives likely to be controlling thoughts and behaviours?

Is it evident that the id, ego and superego are in conflict?

Are any ego defence mechanisms being exhibited?

Does the client appear to be stuck at any psychosexual or psychosocial stage?

What is the nature of the therapeutic relationship in this psychoanalytic therapy session?

Is the therapist a ‘blank screen’?

Is there any evidence of transference or countertransference?

Which psychoanalytic techniques are demonstrated in this therapy session?

Is the therapist using traditional psychoanalysis or modern psychodynamic therapy?

Does the therapist direct or interpret the behaviour, thoughts and feelings of the client?

Does the therapist analyse transference, resistance, defence mechanisms, free association

or dreams?

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Personal experience of the client

My apprehension at being a filmed client was very present for me at the start of the session.

However, this subsided quickly as Tina gave an outline of what she would be hoping to focus on,

and the ‘permission’ for me to free associate, to talk about whatever emerged as the session

progressed. She was clear about being interested in relationships – in my early relationships, current

relationships (including the therapist/client relationship), and my relationship with aspects of self.

As the session progressed, and I felt more comfortable and less anxious, some connections were

made. Firstly how my not wanting to let people down might be something we needed to be aware of

in the therapeutic relationship. I particularly liked the way she commented about things to ‘notice’,

for example my feeling stuck early in the session, and losing my train of thought later. This felt very

freeing, that I could talk about anything without it being pursued in this first session. I wasn’t aware

of being guarded or defensive in the session. The question asking whether I could connect thoughts

and feelings to any earlier experiences was interesting, and again I felt comfortable enough to talk

about my first day at secondary school, something that came to mind (‘free association’).

The session felt as though it had a direction, even though at times I seemed to be moving from one

line of thought to another. I sensed that Tina was tracking content and making sense of my thoughts,

acknowledging them, noticing them, and redirecting me as appropriate. I always felt in control of

the session despite this ‘directing’. For example, about 20 minutes in, after my comments about my

first day at school, she refocused me on what had happened about six weeks ago (the start of my

current anxiety). This brought up a potentially important point about feeling valued.

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I also liked the way Tina used the image that I offered (the cloak of invisibility) and gave me a new

interpretation. From that I came to what I think was the most significant part of the session for me,

the discrepancy between learning from mistakes, but wanting to do anything creative perfectly. This

would be an area for future sessions.

I am aware of the possibility of transference in the session, but overall I felt a close connection to

Tina. The relationship felt comfortable but challenging. I felt supported, listened to and understood.

I really enjoyed Tina being so engaged in the process, in offering possible interpretations, in

‘noticing’, in guiding and gently directing. It gave me much to take away and reflect upon. I know

that I would welcome the opportunity to work with Tina in future.

Phil Thomas

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