In this blog I share my view on how to work with a fictitious client. The “client” James, is a high achieving barrister in his mid-thirties presents with severe anxiety. He has recently started a new relationship and they are thinking of moving in together.
The “client” James, is a high achieving barrister in his mid-thirties presents with severe anxiety. He has recently started a new relationship and they are thinking of moving in together.
He comes from an upper-middle class background where there was a family culture of not talking about feelings and difficulties. He was sent to boarding school ages 6 – 13. He is eldest of 3 children and his parents divorced when he was 13. There’s has been other traumatic childhood incidents that he is yet to disclose.
He presents well dressed, competent, practical and wants quick solutions. He is very busy and wants to know what therapy can do for him and how long it will take
A transactional analysis / psychodynamic approach
I’m interested in James’s past, present and hopes for the future. Also relevant here is James’s attitude towards emotions. What has he learnt from his parents or caregivers about the role of feelings and emotions? Here, clearly there is a culture of not talking about feelings. I would imagine there was little encouragement for James to develop a relationship with his inner-world, given academic achievement was the main focus and what James would have been rewarded for.
In boarding school there is usually a culture of suppression of emotions, including suppressing the distress of leaving home at such an early age. The developmental stage of 6-13 years is also relevant. It is a transitional period for both girls and boys linked with identity development and moving from dependence to independence. Without a ‘secure base’ (parental presence, support and encouragement), this is likely to be compromised.
Starting a new relationship can trigger feelings around early bonding and attachment. Inner conflicts to do with dependence versus independence will likely resurface, causing anxiety about the future of their relationship.
The divorce of his parents at age 13, followed by years in boarding school would have invariably shaken his world. Early separation from parents is traumatic for children, and so is divorce. We don’t know yet about the other traumatic events of his childhood, which will no doubt emerge as the therapy progresses.
I would be led by the person’s telling of their story. The process of telling one’s story and being heard by a present and supportive other can be transformative in itself. This might be an alien concept to James and something that he may find both pleasant and strange.
Wanting quick solutions is part of the driven environment of his family, profession and background. A therapist who is willing to be both understand and challenge his worldview, whilst exploring healthier ways to relate to himself is needed here.
Working relationally in the ‘here-and-now’
I would encourage James to begin paying attention to his experience, rather than on the demands he is likely to impose on himself and others. I imagine that James has never been allowed to experience his feelings and receive comfort and support when distressed, sad, angry, etc.
Unprocessed feelings usually manifest in anxiety and or depression. These will also resurface at key moments in life, such as new relationships, crisis, having children, etc.
The above are just initial thoughts based on a limited amount of information given about a fictitious client. Although the information presented here will be familiar to quite a few readers.
In therapy, client and therapist will work together in defining their therapeutic work. This usually happens in a spirit of collaboration and mutuality which, albeit challenging, can also be an enjoyable and incredibly rewarding experience.
Sam Jahara is a UKCP Registered Psychotherapist and Certified Transactional Analyst with a special interest in cross-cultural and intergenerational influences. She works from our Lewes and Hove practices and sees individuals and couples as well as offering clinical supervision.
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