PRACTICE SKILLS 2B

PORTFOLIO
2022

KM Marks
1241311

Lecturer
Dr Kerry Thomas-Antilla

Word Count
5225

Video Links 1
Verbatim clip
Full session

1 Interestingly, in supervision a parallel process has been identified where we might laugh watching
videos of M, then feel guilty, before feeling into the more tender feelings M’s humour often clouds.

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 Case Study: M

Nearing 90, visibly frail, with the shaking characteristic of Parkinson’s, M entered flanked on
one side by friend and support person Morag. A repeat participant of AIH’s Creative Future’s
Programme, M engendered a clear fondness from the facilitators. Indeed, his charm and
sardonic wit were soon apparent.

Tasked in this introductory session with relaying the facilitator’s presentation to M’s deaf
ears, M soon became curious about my name, asking somewhat cuttingly why I didn’t more
simply go by ‘Katie’. Unsuccessfully repressing my reflexive wince, I explained my childhood
nickname. M had inadvertently stepped on a sore spot, registering - despite my best efforts -
instantaneously. M’s instinct to repair was immediate, responding in a kindly, grandfatherly
tone something along the lines of ‘names are very special’.

I was both touched and abashed by M’s sensitivity; and warmed immediately to his playful
manner, sharp mind, and dark humour. I returned home that evening with the sense that, in
a manner of speaking, I had ‘fallen in love’ with M.

Presenting Issues

M’s health challenges are manifold; spanning PTSD2, Parkinson’s Disease, Neural
Deafness, Lumbar Spine injury and beyond. However, M was resolute in stating that no
particular presenting issues informed his engagement in psychotherapy.

History
Born the youngest of 6 children, M believes his parents were tired by the time of his arrival in
1933 - the happy glow of the birth of M’s elder brother having long since faded. Born in
Tasmania, during The Great Depression M suffered the early loss of his mother’s return to
work at 6 months old. For the next 6 months he lived with a family friend, who continued to
be a surrogate maternal figure until moving away when M was 9. M describes growing up
confused as to who his ‘real’ mother really was.

This early loss was concretised by the sudden death of his mother when he was 12. M
recalls his father asking whether he wanted to go to the pictures,or to the funeral. Not
understanding, or being companioned in the gravity of the moment, M chose to go to the
pictures. M describes that his family could not grieve together, and with elder siblings leaving

2 (Password for Sharepoint clip access: 2BClip123!)

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home in the aftermath, M was left to deal with his loss alone. In his unheld, unbearable
distress, M attempted suicide twice: trying to shoot himself with a neighbour’s gun, and to
hang himself.

M’s sense of being ‘left out’ and ‘left behind’ pervaded through his schooling, and into
adulthood. Leaving home around 18, M moved to New Zealand and quickly met and married
his wife. Later, aged 30, M joined the army and spent 9 months serving in Vietnam, where
he suffered several traumas later associated with his PTSD diagnosis. Most devastating for
M at this time was the guilt suffered after his inadvertent wounding of another soldier, and
the separation from his wife and home.

Following his stint in the army, M built a somewhat successful career in human resources,
and fathered two sons. M’s professional life came crashing down prematurely, forcing early
retirement in his 50s when his PTSD became unmanageable. The onset of Parkinson’s
Disease followed in time, further compromising M’s ability to pursue his ongoing professional
interests. This exit from the working world, left M with a sense of not having met his
potential, or “self-actualised”.

M’s wife was subsequently diagnosed with leukaemia. Her death around 14 years ago has
left M alone, and living outside a family environment for the first time since his army days.

Dynamic Formulation

Hinshelwood (1991) informs the following psychodynamic formulation of M.

Early Infantile Relations

M was born in a time of scarcity, both in the collective at the time of his 1933 birth, and in the
particular conditions of his family of origin. The early deferral of his care to a family friend
represents his first loss, perhaps experienced by the infant M as an abandonment. However,
this warm, loving caregiver represents a protective factor in M’s development as his parents
were unresourced to meet his needs, or to ‘enjoy’ him (Winnicott, 1967).

M’s recollection of both his surrogate caregiver and lost Mother have tones of idealisation.
His mother, a vibrant woman who was an excellent comedic entertainer; with a fierce temper
from which he was shielded, and who allowed him space to explore on his own. M’s
descriptions give the sense of a yearned-for figure, viewed from afar, perhaps both as a

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child, and now, in old age. M grew up feeling unrecognised by his traumatised, war veteran
father who displayed a more hands-on, physical brand of masculinity with which M is
counter-identified.

M speculates that he was ‘unreceptive’ to his parent’s care, suggesting both omnipotent
phantasy, and a sense of ‘badness’ in the child who concludes: “it is better to be a sinner in
a world ruled by God than to live in a world ruled by the devil” (Fairbairn, 1943, p. 66).

Transference Relationship

In session, I experience M as both highly entertaining and playful, and despondent and
cynical. At times I find myself bored, ‘clock-watching’ and frustrated by M’s intellectualisation.
At others, I feel deeply for the circumstances M describes without emotion. Our connection is
predominantly warm, although subject to the vagaries of M’s idealisation and devaluation
defenses. There can be a fatherly, or grandfatherly feel to M, which I experience as touching
at times, and condescending at others - there are moments where it seems he views me as
a delicate, perhaps foolish ingenue. This devaluing position seems to reinforce M’s
interpersonal distance, suggesting an aversion the closeness he has so often been denied.
After (often humorous) devaluation, M seems to feel guilty and seek repair.3 A mother/lover
transference also emerges, this is where I sometimes experience M’s idealisation, and find a
particularly tender, mirroring part of myself evoked.

The Current Life

M lives in an insular life, in a residential care facility alongside other elderly who for the most-
part no longer have their cognitive faculties intact. M describes himself as playing a role
there halfway between resident and carer; he will often intervene if witnessing another
resident in distress, or displaying a need that isn’t being met. M retains contact with his two
sons and extended family, although my sense is that the relationships are not particularly
intimate. M professes to prefer the company of women, and his one close friend and
support, Morag, endeavours to visit fortnightly.

Diagnosis

3 (Password for Sharepoint clip access: 2BClip123!)

Please note, the session recommences after technological difficulties with sound.

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I hypothesise M’s personality style as narcissistic, at a neurotic level of organisation
(McWilliams, 2020).

M’s personality is organised around “The unresolved polarity of grandiosity and

worthlessness” (Johnson, 1994, p. 41) characteristic of the narcissistic style. M’s defensive
use of idealisation and devaluation speaks to his early wounding, and the many emotional
needs neglected throughout his development. Both ‘left out’ and ‘left behind’ from his earliest
days, my inference is that M was denied the self-object mirroring necessary to develop a
nuclear sense of self (Kohut, 1977). Instead, M appears to have formed a False Self where
aspects of genuine strength - namely, his obvious intelligence and humour - are inflated,
leant on like a crutch in the face of his alienation. Conversely, any sign of M’s ‘personal
fallibility or realistic dependence on others’ (McWilliams, 2020, p. 187) seems disowned,
veiled, and joked away.

Beyond the predominance of idealisation and devaluation defenses that indicate his
narcissistic style, M’s defenses are primarily mature; suggesting a neurotic level of
development. Most striking are M’s use of intellectualisation, humor, rationalisation, and
isolation of affect (McWilliams, 2020).

My sense is that M’s point of maximum pain (Hinshelwood, 1991) centres around the
question of worth; is he worthy of connection, and is connection worth the risk of again being
left behind, disappointed and heartbroken?

Treatment Plan

Overall theoretical approach

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M’s character style informs theoretical grounding in Kohut’s theories of narcissism (1977,
1984), and his early trauma led to Winnicott (1949; 1965/1990; 1967; 1971/2012). M’s
advanced age guides an existential influence that centres ‘philosophical issues’ and the
‘client-clinician relationship’ (Seligman & Reichenberg, 2010, p. 182; Yalom, 1989). Jungian
and post-Jungian theories, and those of Ogden (2016, 2019) are of influence too, guided by
my personal interests and their resonance with M’s use of rich metaphor, verbal imagery and
reverie.

M’s reports that in his current circumstance, that he no longer suffers the effects of PTSD,
therefore this is not a focus of the treatment.

Overall Therapist Stance

My stance with M has been one of warm curiosity, attentiveness, and empathic resonance -
of particular import given M’s narcissistic wounding (Johnson, 1994). I take care to stay alert
to my emotional responses, and M’s unconscious communication through symbolic
language. Questions of ‘what is possible’, and, indeed “what cannot be changed”
(McWilliams, 1999, p.48) inform my stance with M: holding with respect the ways M has
learnt to navigate his life and its many challenges, as expressions of wounds desiring
healing (Hollis, 1996). Keeping in mind M’s stage of life, how meaningful this therapeutic
relationship might therefore be to him (McKenzie-Smith, 1992), I hold hope for how M’s
remaining life might be enriched through an approach that seeks to deepen M’s capacity to
relate.

Goals, Conscious and Unconscious

M shared no conscious goals at the outset, stating he was ‘not expecting anything from the
therapy’ and was willing to ‘see how it plays out’. My sense of M’s unconscious goals
include: a relationship that alleviates some of the loneliness he denies, an ‘affective need’,
as opposed to ‘therapeutic help’ (Rivera, 1992, p. 2); and, contact with the feminine
dimension lost both externally through the deaths of his mother, surrogate caregiver and
wife, and internally through his renouncement of feeling.

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 Narrative of The Therapy

‘I Don’t Do Anger, I Don’t Do Sadness, I Don’t Do Grief’

M’s words, from one of our first encounters in the Creative Futures program, remain
inscribed in my mind.

I was elated to be placed with M, to work alongside him in partnership with a student speech
and language therapist. There seemed to be something special about M. As we transitioned
into one-on-one Psychotherapy via zoom, M paraphrased the biblical saying of ‘casting
pearls before swine’ as he surveyed the potential for connection in his new residential care
environment.

Indeed, apathy, disinterest, and bitter disengagement characterised M’s attitude to his
physical and relational world. This was belied by his weekly attendance of our sessions, and
the obvious delight he took in sharing jokes - sometimes at my expense - and recounting his
many theories on life. I noticed - oftentimes bored and at a loss in the face of his
intellectualisation - that I would hold, too, an immense sadness and sense of loss. M had
forewarned me against this depth of feeling; be it sadness, anger, or grief, he was unwilling
to touch it.

Initial Phase

Present with M and I, from our earliest one-on-one sessions, was the spectre of death; an
existential reality that with M’s advanced age, and in his care home environment, felt ever-
present. I noticed in these early weeks, that if M were late, I would be clutched by fear that
he had died, and yet M’s own attitudes to death, a topic that nonetheless arose frequently,
suggested he was quite simply, unbothered.

As the details of M’s early history of maternal abandonment were shared, and the pervasive
sense of being untended, and unmet throughout his early years, I came to better appreciate
how M’s history shaped his renunciation of vulnerability, need or grieving; “The inability to
mourn … the single most telling symptom of a patient's early trauma” (Kalsched, 1996, p.
27). Despite our warm rapport, M and I felt fundamentally opposed in our ways of being. To
traverse this difference, a shared love of language emerged, of verbal imagery and
metaphor. Indeed, “just as the stars persist even when their light is obscured by the light of

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the sun” (Ogden, 2016, p. 94), dreaming aloud together became a way to bridge the gap
between our respective poles of thinking and feeling; sunlight and moonlight. Here, a space
opened for something of the unconscious to be explored, allowing M’s logic to exist
alongside this more expressive form of communication.

A Flame Flickering Out, an Old Shoe Box, a Toy With a Flat Battery

M dispassionately recounted to me that fellow residents were dying, and were being ‘moved
out in the dark’, I found this disturbing to imagine, and enquired how this was for M. And as
he responded with usual apathy, I noticed the heavenly scene at M’s back; evoking the
nearness of M’s own mortality:4

C: I’m not bothered by people dying.

T: You’re not?
C: Nah. Everyone’s got to do it.
T: Hmmm. I guess I'm looking at you with the curtains blowing behind you and there’s
something… I dunno… like, otherworldly about that?
C: There’s a voice whispering in my ear … walk towards the light (laughs)
T: I hear that and I'm sort of caught between laughing and wondering, is there? For you?
C: No, definitely no. There may be an image of some kind that appears at the end. It’s only
flickering shadows in the back of my mind.

M’s initial response was humour, and as M seemed to parody his own cynicism, I parodied
my own naivety, encouraging his associations. What followed was a description of the
devastating details of his sister’s final days, then a flurry of images:

C: The body is a shoe box, when the shoe’s taken out the box is no use you chuck it away
… like a battery-operated toy or device … The power dies out … the body stops functioning,
you’re just left with a carcass … No more value, no more importance than any other creature
on earth.

Whilst death is undoubtedly a quotidian event in M’s residential care home, I wondered at a
resonance in M’s blase response with the glaring misattunement of his father. Overcome by
his own grief, M’s father had been unable to consider the devastating impact on M. He
announced her passing as a statement: ‘so you know your mother died”. And yet, M’s

4 As M reports he no longers suffers the effects of PTSD, this aspect has not been a formative
element in treatment planning.

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emotional response to his Mother’s sudden death was in stark contrast to this attitude,
emerging as suicidal despair. These verbal images of M’s felt highly communicative,
suggesting his unconscious position, and ‘affective states and motivational dynamics
pictorially’ (Gerard, 1961, p. 5). I wondered at a of sense worthlessness, perhaps shame in
M, and the ‘emptiness, longing, or dissatisfaction with life which leaves many men
wondering, on some level, "what happened?"’ (Cochran & Rabinowitz, p. 594) in our culture
that privileges masculine productivity.

Death and Loss

Waddell (2019) outlines that in old age, a reversal of the container/contained dynamic
emerges, with “the young now struggling to offer states of reverie to the old” (p. 249). Our
immense generational difference formed one of the greatest barriers to my capacity to
mentalise, contain, and enter reverie with M - particularly surrounding his experiences of
death and dying. Entrenched in an experience of ongoing loss, “loss of … objects … loss of
their own lifetime …” (McKenzie-Smith, 1992, p. 363), and surrounded by the indignity of the
infantile feelings evoked in his fellow residents, M’s relentless allegiance to reason and
rationality emerges - beyond his own defensive structure - as more understandable. For M,
perhaps desperately necessary and ‘life-saving’. Indeed, McKenzie-Smith (1992) outlines a
culture of institutional avoidance towards the emotional experiences of elderly in care, an
avoidance that echoes M’s orientation to his own feeling world. How devastating,
overwhelming, and frightening it might be for M, to truly grieve past and present losses? In
coming to appreciate this through my work with M, I found myself better able to respect how
M’s age, gender, and lifetime shapes his relationship to feeling - yet continuing to seek entry
points to explore M’s feelings in ways that are manageable for him. If I were M, and destined
to die tomorrow, would I allow myself to collapse into grief today, and risk spending my last
hours in a deep well of pain? Perhaps sitting with another person, one who cares, would be
enough.

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Elijah and Salomé

Figure #1. Dieric Bouts. (c. 1465). Prophet Elijah in The Desert. [oil on panel]. St. Peter’s
Church, Leuven, Belgium.

In these initial phases, the immense multitude of difference between M and I came into
increasingly sharp focus. Akin to Elijah and Salomé (Figure 1), our pairing symbolically
“represent[s] the most supreme of opposites: female/male … soul/spirit, eros/logos,
young/old” (Mozol, 2019, p. 156). M seemed to enjoy our time together, yet his enjoyment
was often inflected with a note of superiority or condescension; at times he seemed to view
me as overly earnest, perhaps foolishly ‘feeling’, reflecting his own dismissive attitude to the
unformed, rejected anima figure within him. M’s attitude though, was not unfounded. I had
unconsciously resolved to be a ‘very good and very sweet’, a countertransference reflecting
my beginner status, and the paternal and grand-paternal dimension evoked by the 60 year
age gap between M and myself. M’s avoidant, intellectualising style echoed something of my
own abandoning father, and his abandoning father before him; I must be ‘good’, so M would
‘stay’. I was, I came to progressively realise, naive in my initial resolve that in being so very
‘good’, our work would somehow deepen into those human feelings that M denied so
vehemently. Falling into this pitfall of ‘goodness’ that Maroda (2021) describes, in processing
this countertransference I began to make conscious "the need to resist reliving my role as
family caregiver and soother "(Maroda, 2021, p. 178).

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Power

A sense of mutual frustration surrounding our differences would emerge at times, each wed
to our own way of experiencing and being in the world. As ever, The ethical impetus to
attend to “the power imbalance in the psychotherapeutic relationship” (PBANZ, 2022, p. 6),
and a sensitivity to “diversity” (p. 5) merited consideration in working with M. Our shared
status as educated, middle class Pakeha5 in a bicultural Aotearoa formed an ambivalent
meeting point amidst our many differences. Dissociated losses in both our personal histories
were echoed by the ‘unremembered pasts’ that ‘haunt the psyches of all immigrants …
shock, terror and shame’ Dowd (2009, as cited by O’Connor 2020, p. 69). My inherent
position of power as therapist - and the opportunities and freedom afforded by my age - was
complexified by M’s gender, and allegiance to hegemonic patriarchal ideals that I
experienced, at times, as overbearing. Sharing with vulnerability, what it is like as a man to
decrease in virility and efficacy to a young woman, I imagined, would be painfully difficult.

The Middle Phase

‘Jung wrote that analysis begins when the patient becomes a problem for the analyst, and in
some sense that’s true. But before that, to contain the problem that the patient becomes,
one needs to have established some kind of mutual trust and respect’ (Siegelman, 2002, p.
23)

Coming to better appreciate the unlikelihood of a ‘transformative’ psychotherapy in the face

of M’s history, and the socio-cultural factors that supported his defenses against feeling (von
Franz, 2008) our relationship strengthened, able to withstand our many differences. The
particular importance with M, of the notion of a healing relationship (Yalom, 1989) emerged
through supervisory exploration. It became evident that in our difference M and I had
something to teach each other of the masculine and feminine dimensions respectively. as M
and I faced a possible rupture for the first time, our work and relationship began to deepen,
and the development of my potency emerged as necessary.

Getting on Each Other’s ‘Wick’

5 Although, M was born in Australia, moving here aged 18, whereas I was born here.

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The origins of M’s ‘flippancy’ came to light in a session, where he shared more than ever
before surrounding his father who shared this style of relating. M spoke of a tree hut
promised, yet never built, and the raft of disappointments that led him to live by the maxim:
‘don’t expect anything and you won’t be disappointed. Don’t promise anything and you can’t
disappoint’. M explained his father’s ‘macho’ style of masculinity; his father could not relate
to M in his more intellectual style, or shepherd him into mature manhood. I felt privileged by
M’s delicate candour in describing to me, a woman, how he had been uninitiated (Bly, 1990),
and struggled to come into his sexuality. In this, M spoke ruefully of the ways in which he is
like his father, suggesting a conflicted, partial identification with this disappointing figure
(McWilliams, 1999).

I blundered in my response, sharing from my countertransference that it ‘felt sad’ that he had
been so unsupported by his father. In the session’s final minutes, M gave me some
feedback:

M: Stop saying sad, you’re getting on my wick.6

My response seemed to ignite shame, or anger. Perhaps my attempt to attune to the

underlying affect was experienced as belittling. I affirmed I would think about this, and
learning by now to hold my own a little more with M, I affirmed that I would ‘get my thesaurus
out’. I left logged out of zoom feeling indignant, angry, ashamed, and frustrated that such a
vulnerable session had gone off the rails; a cocktail of affective responses perhaps more
appropriate than ‘sad’, and suggesting projective identification.

Sharing this clip in supervision, we explored how at times, pity might enter in working with M,
and how my ‘empathy’ might be experienced as pity, and therefore shame-inducing. I played
with the notion that if M were not a frail old man, I might think he was a ‘fucking asshole’.
Connecting with a previously untouched anger towards M mirrored the untouchedness of
underlying anger towards my own father, emerging at this time in therapy. Perhaps we were
two people who struggled to be angry at our fathers. My supervisor affirmed that our
connection seemed strong enough for me to bring greater potency into our work, and I
braced myself to discuss the matter in our next session.

Getting Off Each Other’s ‘Wicks’

6 I note the phallic imagery of this.

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M appeared recalcitrant surrounding his remarks, “I said something I probably shouldn’t
have”. M, too, sought repair, as he tends to be after speaking sharply, suggesting perhaps
guilt (Klein, 1975), or a capacity for concern (1965/1990). M also expressed doubts as to the
authenticity of my response. I attempted to engage openly, welcoming exploration of how he
had experienced me, before offering an interpretation:

T: I wonder sometimes if I'm feeling into something you might not be feeling, or that’s hard to
feel?
C: I generally consider i’m not influenced a lot by emotion … But I'm aware more recently,
since we’ve been talking about this kind of thing, that feelings are at work anyhow. And I
know from time to time a particular feeling will influence me and I'll have a reaction,
unconscious or unintended response.
…
C: An illustration of what we’ve just been talking about [the comment asking me to stop
saying ‘sad’], an emotion comes up, unintended.
T: I wonder what it was?
C: A part of me gets frustrated.

M seemed to experience my use of ‘sad’ as a generic catch-all, and in reflecting on our

different thinking/feeling styles M shared that he had been noticing he had more feelings
than he let on. For the first time he expressed a feeling towards me, frustration, a new step
in our relationship. We repaired, and I resolved to be more nuanced in sharing from my
countertransference; M’s early lack of mirroring suggested greater care was required here.
His pained early relations with both parents - and this stage in my development - required I
rise to the task of "therapist … called upon to fill both roles, the mother and father, in turn” (p.
112), honing both sensitivity and potency.

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 Figure #2 . Gerhard Richter. (1982). Zwei Kerzen (Two Candles). [oil on linen]. San
Francisco Museum of Modern Art, San Francisco, The United States.

The Dream

This dialogue prompted M’s sharing of a fragment of a dream, for the first time:

M: I dreamt that I’m married to a woman that has a boyfriend on the side.

Details were sparse, beyond M’s description that he felt towards this woman, ‘suspicion and
distrust’, going on to describe circumstances in his fifties, where he sought professional
support, a ‘nurturing alliance’ from a woman, yet did not receive it:

C: I learnt a lesson from that

T: I wonder what lesson you learnt?

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C: People who are sufficient, and have enough stability in their own lives, don’t need
somebody else to support them.

This dream, I think, speaks subjectively (Roesler, 2020) to M’s repudiation of his own
feminine element (Orbach,1986/2005), anima. Objectively it might suggest suspicion and
distrust of me - a likely anima figure - and other women; protecting against his ‘own
repressed feminine identity’ (p. 64). M’s lesson, inferring that to need a woman signals
weakness infers internalisation of social attitudes that encourage independence in boys,
‘without recognising how much of their independence rests on their knowledge that a woman
is there for them, to be relied on emotionally’ (Orbach, 1999, para. 14). The vulnerability
evoked by his mother’s loss is also evoked, a vulnerability M struggles to claim.

Soon thereafter, I had a strikingly parallel dream featuring M, in which we were lying in bed
together at what must have been his care home. There was an erotic intimacy to the dream,
before I became distressed at having somehow become separated from him, lost in the halls
of the care home. .

Mother/Lover

As our work has continued, and beyond M’s understandable expressions of distrust, a
pattern of images and interactions illustrating the likely transference emerged: among them,
‘chink of light’, and ‘songbird’. This time, M reflected, with some reverence on his mother,
having only “seen a snippet” of her, and not having known her “before she was burdened by
6 children”. M moved away from my reflection on the magnitude of this loss to comment, in
light of his concurrent eye troubles:

C: You look like the ghost in the water in the lake… it’ll haunt me for the rest of my days.
Like a water painting it’s a little washed out.
T: Hmmm. That makes me think of how memory can become blurry … it feels poignant
when we’ve just been speaking of memories of your mum.
C: Yeah, well it wasn’t wasn’t connected I was just pulling your leg.

This evoked for me the image of Shakespeare’s Ophelia, (Figure 3), and a sense in the
transference of a simultaneously eroticised, yearned “combination of mother/lover” or
maiden figure. Schaverien (2020) describes the an erotic dimension as speaking to a
‘deepening relatedness’ (p. 61) facilitating internal change. Indeed, that ‘in love’ rush of eros
I felt at our first meeting became increasingly apparent after certain sessions. I noticed M’s

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‘slips’ of eroticised language - for instance, ‘getting on my wick’ - and my own erotic dream. If
feeling particularly frail, M might zoom me from his bed, and I noticed in our silences a
quality similar to that of lying in bed with a lover after sex. There was a tenderness to this,
and yet I felt some discomfort as I tried to make sense of this erotic element, these
mother/lover transference dynamics. The function of the erotic as a ‘sign of life’ (Schaverien,
2003, p. 11) seemed particularly striking given M’s very late stage of life. My discomfort was
largely neutralised in appreciating this, and the notion of sex as “the illusion of having one’s
desires magically known and wordlessly satisfied” (McWilliams, 1999, p. 155), ‘recapturing of
the paradise of early mother infant bliss that was lost long ago’ (Gabbard, 2000, p. 229).

Figure #3 . John Everett Millais. (1851-1852). Ophelia. [oil on canvas]. Tate Britain, London,
Great Britain.
A Brief Note on Hate

It’s tempting to bask in the warmth of this loving, erotic, maternal transference. However, as I
write this, I want to mention the beginning emergence of hate in the countertransference -
made conscious in the last week or so: this sense of infuriation, in despising M’s flippancy,
and refutation of ‘feeling, dreaming, intuition … reason and reasoning is the only way to
make a decision’ emerged in a recent session, and upon reviewing our earliest clips. Given
the maternal dimension present, this feels appropriate, as ‘A mother has to be able to
tolerate hating her baby without doing anything about it.’ (Winnicott, 1949, p. 74)

Reflecting on the Work

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Themes of life and death, love and hate, intimacy and distance; and of course, mother and
father course through the work with M; weaving a tale where M and I - as two quite different
people - have learnt to connect, clash, and experience something of what we’ve missed out
on in the other. In seeking to give M something of the mirroring maternal presence that was
lost to him so young, I have received from him, at times, something of the paternal presence
I myself lack. These transferential dynamics of mother/son, father/daughter emerge
repeatedly throughout our work - as does that of lovers, suggestive of the union Sullivan
(1994), sees as metaphor for the therapeutic process.

Indeed, in some ways, M and I have complementary wounds. The inverse of each other, his
mother dying when he was 12, and mine leaving at this same age, they seem to ‘fit’. In both
cases, these losses only concretised earlier struggles. In this strange symmetry of
woundings, my sense is M and I have both been able to contact the disowned aspects of
ourselves, if only briefly: M’s inner feminine, and my inner masculine, as our alliance
strengthened to withstand observation of M’s defenses, and progressively relational
interventions.

Our most recent session7 speaks to this: with M for the first time drawing connections
between the physical loss of his maternal caregivers, and the internal shutting down of the
feeling, feminine aspect within him. Whilst learning in our work to heed M’s warning of ‘I
don’t do anger, I don’t do sadness, I don’t do grief’ - leaning instead on the relationship as a
vehicle for healing - my sense is that anger, sadness and grief have surreptitiously woven
their way through, after all.

Conclusion: Time to Say Goodbye

As our works draws to close to its close, its death so-to-speak, no grand transformation in
the case of M can be claimed; but on my part at least, it has certainly been a growthful
relationship and process of loving and hating M, and developing as a psychotherapist.

It was heartening, though, to hear M recount of late that ‘over the last year or so’ he has
become ‘less insular’ socially, and more physically mobile as he begins to open more to
connection within his residential care home. I notice his greater capacity for closeness with
me, too. He reports being ‘quietly pleased’, to have enlisted his 19-year old granddaughter to
help him finish his autobiography once she finishes school for the year, ‘The Book of M’; his

7 Shared as verbatim below.

17
legacy. For now, he is working with an AI program, which he likens to ‘therapy, something to
help me along’.

For now though, it’s nearly time to say goodbye:

T: Time to say goodbye, alright …

C: That actually struck a chord with me, ‘Time to Say Goodbye8”,
T: Yeah?
C: Funereal, funeral music. It started out as a beautiful love song now it’s funeral music.

References

8 Follow link if you wish to access the song.

18
Bouts, D. (c. 1465). Prophet Elijah in The Desert. [oil on panel]. St. Peter’s Church, Leuven,
Belgium.
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Bly, R. (2001). Iron John : men and masculinity. Rider.

Douglas, C. (2006). The old woman’s daughter : Transformative wisdom for men and

women. Texas a & M University Press.

Fairbairn, W. R. D. (1943). The repression and return of bad objects (with special

reference to the “war neuroses”). British Journal of Medical Psychology, 19(3-4),

327–341. https://doi.org/10.1111/j.2044-8341.1943.tb00328.x

Gabbard, G. O. (2000). Love and hate in the analytic setting. Jason Aronson,

Incorporated.

Gerard, R. (1961). Symbolic visualization — a method of psychosynthesis. 5th

International Congress for Psychotherapy, Vienna (Austria), August 21st, 1961.

http://synthesiscenter.org/articles/0112.pdf

Hinshelwood, R. D. (1991). Psychodynamic formulation in assessment for

psychotherapy. British Journal of Psychotherapy, 8(2), 166–174.

https://doi.org/10.1111/j.1752-0118.1991.tb01173.x

Hollis, J. (1996). Swamplands of the soul : New life in dismal places. Inner City

Books.

Johnson, R. A. (1986). She : Understanding feminine psychology : An interpretation

based on the myth of amor and psyche and using jungian psychological concepts.

Harper and Row.

Johnson, S. M. (1987). Humanizing the narcissistic style. W.W. Norton.

Johnson, S. M. (1994). Character Styles. Norton.

Kalsched, D. (1996). The inner world of trauma : Archetypal defenses of the personal

spirit. Routledge.

Klein, M. (1975). Love, Guilt, and Reparation & Other Works, 1921-1945. The Free

19
 Press.

Kohut, H. (1977). The restoration of self. University of Chicago Press.

Kohut, H. (1984). How does analysis cure? University of Chicago Press.

Kübler-Ross, E. (2014). On death & dying : What the dying have to teach doctors,

nurses, clergy & their own families. Scribner, a Division of Simon & Schuster, Inc.

Maroda, K. J. (2021). The analyst’s vulnerability : Impact on theory and practice.

Routledge.

Millais, J. (1851-1852). Ophelia. [oil on canvas]. Tate Britain, London, Great Britain.

McKenzie-Smith, S. (1992). A psychoanalytical observational study of the elderly.

Free Associations, 3C(3), 355–390.

McWilliams, N. (2020). Psychonalytic diagnosis: Understanding personality structure

in the clinical process. Guilford.

Mcwilliams, N. (1999). Psychoanalytic case formulation. Guilford Press.

Mozol, A. (2019). A re-visioning of love. Routledge.

O’Connor, J. (2020). Standing at the Waharoa. Ata: Journal of Psychotherapy

Aotearoa New Zealand, 24(1), 67–78.

Ogden, T. (2016). Reclaiming unlived life. Routledge.

Ogden, T. H. (2019). Conversations at the frontier of dreaming. Routledge.

Orbach, S. (1999, June 22). When a man loses his mother. The Guardian.

https://www.theguardian.com/world/1999/jun/22/gender.uk

Orbach, S. (2005). Hunger strike : Starving amidst plenty. Karnac Books. (Original

work published 1986)

PBANZ. (2022). Psychotherapist standards of ethical conduct: Ngā taumata matatika

mā ngā kaihaumanu hinengaro.

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%20Standards%20of%20Ethical%20Conduct.%202022.pdf

20
Richter, G. (1982). Zwei Kerzen (Two Candles). [oil on linen]. San Francisco Museum of
Modern Art, San Francisco, The United States.

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Psychology, 65(1), 44–62. https://doi.org/10.1111/1468-5922.12566

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dreams and individuation. Routledge.

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psychotherapy: Systems, strategies and skills. Prentice Hall.

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and Practice, 3(1), 19–33.

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Publ.

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Psychoanalysis, 30, 69–74.

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environment : Studies in the theory of emotional development. Karnac. (Original work

published 1965)

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1971)

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21
 Books.

Verbatim

Session #: 48
Date: (7/11/22)

Verbatim clip
Full session9

The verbatim is preceded by M raising our impending ending. My tentative broaching: “I

wonder if we might miss each other a bit once we finish up?”, sought to titrate the
intervention, suggesting mutual impact given M’s difficulty accessing feeling.

Challenging for M nonetheless, he resisted this notion, invoking the loss of his late wife to
explain he does not experience missing as ‘longing’. M spontaneously offers reflections on
his unemotionality, describing his father’s experience of grief; and a causal connection with
the loss of both maternal figures, for the first time. This speaks to the mother/wife
transference, and certainly, my countertransference here is maternal. I allude to these
countertransference dynamics in returning to the relational dimension, offering how such
losses might make speaking of our closing difficult.

I notice in this clip my highly expressive face, replete with emotion disowned in M since
childhood. This is resonant, perhaps, with Winnicott’s (1971/2012), description of the
mother’s face as mirror to the baby; yet I wonder also at the gulf between my own face, and
M’s expressionless one.

9 Half-drawn curtains wafting in the breeze, light streaming; reminiscent of heaven’s gates

22
 M shows some resistance to my persistence here, yet as this vignette closes, there is a
sense of intimacy; even as M pulls away, our session coming to an end and his tolerance for
closeness reached.
Therapist Process
I feel very sad hearing this. I
wonder if in speaking of his
father’s grief, M is telling me, by
proxy, of his own.
I nod, continue…
I nod in acknowledgement. This
is a painful illustration of his
father’s anguish.
Beginning to interrupt then
holding back to hear more.
I feel into the enormity of the
traumas his father must have
endured - and that M endured
in wartime - shaking my head in
disbelief and in reverence.
Keep going …
Dialogue Client Process
C1: His eyes red, and sunken, and M’s tone and pace here
- conveys something of his
father’s grief.
T1: Mm
C2: - and weeping even as he M is shaking slightly here,
spoke to me. So I understood his suggesting the emotional
anguish, content might be difficult for him
to recount.
T2: Mm, and -
C3: In that era, everybody had to
toughen up, and my father had
been to two world wars. And seen
men killed all around him, he’d
had the most terrible experiences
alongside all the soldiers of that
day
T3: Mmm
C4: And the conditions that they M looks away as he says this,
had to function in. could he be reflecting on his
own experience as a soldier,
too?
23
M has been vividly recounting
his understanding of, and
perhaps identification with his
father’s distress. I intervene to
validate this capacity in him to
recognise the other’s emotional
experience. I seek to gently
return to M’s own experience of
this time, enquiring as to
whether anybody else could
feel into his distress at this
time. My sense from previous
dialogue is that there wasn’t.
I wonder here at anger or
frustration surrounding this
absence. Or, perhaps some
frustration or anger towards me
in response to my naïve
enquiry, or the repetition of an
earlier theme.
I shake my head in
confirmation, understanding
that there wasn’t.
I widen my eyes, and shake my
head in an expression of
outrage and indignation
towards M’s father failing here.
Go on…
I continue to shake head in
outrage
T4: Mmm-mmm. Mmm. And, it
sounds like he, you were able to
see how deeply he was affected
by your mother’s death, and to
understand it. I guess it makes me
wonder whether there was
anybody there for you at that time
to -
C5: No
T5: - be [with M at this time] .. No.
C6: There was to this extent, my
aunt, my mother’s sister. When
she learned that he had given me
the choice of what I did while the
funeral was on
T6: Mmm
C7: She was outraged that he had
said that I could go to the pictures,
the movies
M shakes slightly, and looks
away. Perhaps there is some
discomfort here surrounding a
return to his experience.
M’s response is brief and
abrupt.
M resumes shaking. Perhaps M
is speaking here of his own
outrage, too, as an adult
looking back on this treatment.
M’s tone lifts as he says
‘pictures’, ‘movies’, suggesting
appreciation of the
24

I feel sad, as I express the
outrage of this, and my voice
strains.
Nodding my agreement with his
mother’s family’s protective
outrage on young M’s behalf. I
too, am on the ‘side’ of this
young part of M.
I feel anger here. I speak firmly,
indignantly, as if speaking from
the perspective of his aunt.
I reflect on how M’s mother also C12: - and her mother -
experiences these losses.
incongruence between the
gravity of the situation, and the
levity of such a suggestion.
T7: Goodness. What an outrage.
C8: She was outraged. There
were very strong feelings in my
mother’s family -
T8: Yeah. Mmm-mmm.
C9: - about life and A hint of understandable
permissiveness and doing the moralisation here, perhaps it is
right thing - easier for M to turn to what is
‘right’, than to ‘feel’ into the
emotional impact
T9: Mmm
C10: - and supporting others.
T10: And you weren’t supported in
that
C11: My aunt had lost her father - Mmm remains measured in his
response, and continues,
perhaps seeking to explain the
strong feeling evoked in his
mother’s family.
T11: Mmm
25

I reflect back what M had said.
The implication here, is that M
is helping me, too, understand
what he had been through.
How lonely to lose Mum, and
be left with a father who
couldn’t understand.
I reflect on how dramatic the
day-to-day impact was, in
contrast, for M. I look down to
gather my thoughts.
T12: Mmm
C13: - before she was 15. And
she knew what it was like to grieve M is perhaps conveying that his
and feel loss.
T13: She knew something maybe
of what you’d be going through
C14: Yeah. My father had lost his
father but not his mother
T14: Mmm-mmm.
C15: And his father died at a time
when my father had to go out to
work anyhow so there was no
difference in what he was going to
do as far as life was concerned
T15: Hmmm. Hmmm.
C16:But that’s a whole other story.
M shakes again a little here.
aunt could understand him, and
what it was like to lose a mother
so young.
M verbally agrees, but looks
away and moves on in the
dialogue. Perhaps with some
discomfort at the return to his
experience. M seems to be
communicating that father could
not understand, what it was like
for M.
M is perhaps speaking to the
dramatic day-to-day impact of
his mother’s loss, one that went
upheld by his father.
M coughs, then strokes chin
and looks down pensively.
Lightness of his tone suggests
26

Seeking to stay with the
implications for M of this
experience. Intervening to
summarise the connections M
has made between his mother’s way you are with feeling, perhaps
death and his shutting off of
feeling. Wanting to validate and
support M’s ownership of this
connection as ‘his’ connection.
Attempting to be non-
pathologising, and to reassure
M that this was understandable
considering his feelings went
unseen and upheld.
I want to convey my respect for
what M went through, and the
ways in which M learnt to
survive this loss and the losses
that followed.
a desire to move away from the
implication of how much his
young life was effected at this
time.
M leans into screen, looking at
it quizzically - is he looking at
the time, suggesting the
interaction is becoming too
much? Or leaning towards me?
T16: I mean Mike i’m just sitting M leans back, strokes chin.
here appreciating what we’re Perhaps this is quite a lot for M
touching on here, we’re touching to take in.
on, you know, the, on your, the
when your mother died, or
certainly when your mother died,
you weren’t companioned in the
deep feelings that would’ve arisen
at that time. And this connection
you’ve just made that perhaps,
from that, you’ve learnt to shut
down your feelings. I’m just sitting
here
C17: Yeah - yeah M affirms conscious agreement,
but after my lengthy
intervention perhaps there is
some resistance present too.
T17: Thinking how profound that
is, and how, yeah
27
Aware I have just said a lot, I sit
back to make space for M to
reflect or respond.
Perhaps M is telling me that
there are feelings here now,
also, but they would be too
difficult to express.
This feels terribly sad,
excruciatingly lonely. Perhaps I
am feeling into what is too
much for him to feel.
I scrunch my face, imagining
how much had to be held in,
then exhale in sadness.
I feel a pang of recognition that
it was not only his mother that
he lost, but his surrogate
caregiver too.
C18: Yeah, from the time my
mother died in 1945 to 1949 -
T18: Mmm
C19: I had to -
T19: Mm
C20: - yes, I had to sit on my
feelings and never let them out -
T20: Mmm
C21: - because I had nowhere to
go with them
T21: Mmm
C22: I was becoming a different
person, from the time I was born
until 1942 I always had a
caregiver, Gardy, and she moved
to Melbourne in 1942 and I was in
Hobart
M begins to make more explicit
this connection, recalling dates,
perhaps to manage the
emotional gravity of this.
There is a slight edge to M’s
voice as he returns to this
connection, perhaps there is
some anger or frustration
present.
He looks away, perhaps
struggling to stay present to this
vulnerability, and perhaps
noticing on my face the strength
of my response to this.
M is telling me it wasn’t always
this way, his feelings had been
received in the past. It is not as
simple as his mother’s death
alone. His hand shakes a little
recounting this.
28
Another, earlier loss of T22: Yeah. Mmm…
caregiver, that followed his
early loss of Mum

C23: Yes so, I think it’s my M shifts from outlining this

unemotional outlook is a
consequence of that period.
additional loss, to returning to
the conceptual link. M itches his
nose, obscuring his face -
perhaps he is holding
something back.

I attempt to speak to my sense T23: Mmm-mm-mm. It seems like

of M’s difficulty expressing maybe, maybe, you’re still sitting
feeling in this interaction, and on those, on your feelings, they’re
validate how this is still shut off -
understandable. I attempt to
draw a ‘here and now’
connection between these
losses, and our impending loss.
More of a pause here would’ve
been appropriate, as opposed
to continuing the flurry of
conceptual links.

C24: Yeah Conscious agreement, but

looks away, and his tone
suggests some resistance

I share what I think M’s been T24: and in a way as we speak

trying to tell me: that these about our ending together, maybe
losses have impacted his ability it’s difficult, maybe there’s
to grieve, and to speak of our something difficult in that
ending now. I am tentative in
proposing this and smile a little
attempting to ‘lighten’ this
suggestion.

To say much more here might C25: Yeah, I think that’s true Expressing agreement, his

29
require opening into the voice warms slightly.
immense disowned grief
surrounding his fractured
relationship with the maternal.

T25: Yeah, mmm

I wonder if M is trying to seize C26: It’s time to go. Said in a mock playful tone. It is
back some ‘control’ of the nearing our time, but M is
goodbye here, given how ‘out perhaps communicating that
of control’ his formative this dialogue has become too
experiences of goodbyes have much.
been. He was never able to say
goodbye to his mother - might
there be something reparative
in this?

I gesture to my heart in T26: It is time to go, yeah, which

conveying how moved I have feels fitting, given what we’ve
been by what he has shared, been talking about, but quite sad
and the sadness his story, and for me too. Yeah.
our ending has evoked in me -
despite the unemotionality in
his way of recounting.

I smile at his M’s playful tone,
recognising his habitual
defenses of humour - revealing
something perhaps of the
flippant introject of his father,
who suggested he attend the
‘pictures’ rather than his
mother’s funeral.
C27: Don’t let it get the better of
you. Contain your feelings, choke
them off, don’t show them to
anybody else, and you’ll be just
like meee!
Said with mock glee, and a
smile. M’s return to his
defensive use of humour
suggests a discomfort with the
intimacy of this exchange.

This is a little frustrating, but

we’ve gone further here than
ever before.

30
I half-smile at M’s humour, and T27: Ooohhh
feel into the painful sting of his
self deprecation as I exhale.

It feels like he is reaching for C28: It’s been a very good talk this M’s tone is inflected with
me, in a small way in the morning warmth.
warmth of this
acknowledgement.

In acknowledgement that this T28: It has been, yep, it has been.

has been a big dialogue, and
uncovery, I reach back to him
with warmth.

Introduction to the Panel

“It is joy to be hidden but disaster not to be found.”

(Winnicott, 1990/1965, p. 187)

My early experiences led me to psychotherapy, first personally, and now, professionally.

Growing up, I served as mirror to my at times frightening mother, I learnt to hide behind this

mirror; remaining unseen, as I had learnt I could not be seen. My father’s emotional, and

later, physical absence left me unmoored in the chaos that was my mother. I protected

myself in order to fulfil my early role of attuning to and supporting my mother’s wellbeing and

the equilibrium of our family.

Entering the course in 2020, part of my unconscious motivation seems to have been to

continue these patterns of caretaking, in the hope that as a psychotherapist I could

31
somehow heal others - and myself - while remaining hidden. This course has challenged me

to begin inching, gradually, out of hiding. It has been terrifying, often, to attempt this, but also

enlivening. I have been touched by the encouragement from my peers, lecturers, therapist,

and supervisor alike to imagine that coming into myself more fully might represent the best

way of being of service to others.

In the privilege of working with clients, I am repeatedly pained and awed by how many of us

have grown up with a deficit of simple listening, witnessing, and curious, warm attentiveness.

My clients, alongside the experiences and theoretical groundings of the course have

supported me in coming into contact with the many familial, societal and cultural factors that

shape us as we grow, and impact how we are with ourselves and others in the world.

In experiencing for myself what it means to receive an empathic, therapeutic presence, I

have also come to appreciate the value of integrated aggression, the important ‘separating’

function of anger; and potency, an edge I continue to develop for the benefit of my clients

and myself.

The realm of creativity; dreaming, writing, making, were among my first methods of

managing early life deficits. I discovered that meaning, beauty, escape and connection with

myself and others could be found here, that something in me could be kept alive. Leading

me to my earlier career in fashion, these long held passions now inform an interest in

psychotherapy’s synergy with the creative; I have discovered my resonance with Jungian

thought, and have recently been captivated by Thomas Ogden’s Conversations as the

Frontier of Dreaming. Opening a space in the therapy room for dreams and dreaming has

reaffirmed my belief that we are all creative beings, in spite - and sometimes in part,

because - of the traumas of life.

32
I expect my ongoing exploration and learning will be guided by the overlap between the two

worlds of creative practice and psychotherapeutic practice.

However this journey of ‘becoming’, and becoming a psychotherapist unfolds, my hope is to

become progressively less ‘hidden’, companioning others too, in whatever their journeys

may hold..

References

Winnicott, D. W. (1990). The maturational processes and the facilitating

environment : Studies in the theory of emotional development. Karnac. (Original work

published 1965)

33
 2022 Clinical Hours

Total AIH Hours: 88 Youthline Placement Hours: 10

Total Youthline Clinical Hours: 92 Youthline Supervision Hours: 40
Total Clinical Hours: 180 AUT Supervision Hours: 30

Client Gender Age Self-identified Presenting Occupation 2022 Session Location

ethnicity Issue Hours

MD Man 89 Australian Parkinson’s Retired 39 AIH (Online)

European Disease, PTSD

JW Woman 32 NZ European/ Grief, anxiety Marketing 15 AIH

White South Professional
African

NA Woman 31 European Disordered Food 17 AIH

(Dutch) Eating Technologist

34
AS Man 25 Indian Sexuality, Student 2 AIH
anxiety

CM Woman 25 Shona - African Relational Student 12 AIH

difficulties Dietician

DG Woman 30 Indian Depression, Psychologist 3 AIH

culture shock

CC Woman 20 Chinese Anxiety, Caring Photographe 26 Youthline

for parent with r/Musician
Alzheimer’s

SC Woman 21 NZ European Anxiety, trauma Nursing 17 Youthline

Student

LP Woman 21 European Social anxiety, Psychology 8 Youthline

(French) sexual trauma student

MP Man 21 European Anxiety, Psychology 23 Youthline

(Macedonian) depression, Student
ADHD

MP Non- 22 NZ European Self-harm, Arts Student 12 Youthline

binary relationship
difficulties

DM Woman 18 NZ Sexual trauma Hospitality 4 Youthline

European/Whit Worker
e South African

JE Trans 22 NZ European Anxiety, Retail 2 Youthline

Woman depression, Worker
navigating
gender
difference

35