Nr 18.  2008 sid. 71–83

Session with David
and discussion

Mats Herlin


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Mats Herlin is chartered clinical psychologist, psychotherapist and psychotherapy supervisor. He has more than 30 year’s ex-perience as a clinical psychologist, first within child and youth psychiatric care and then at the “Humlan” Youth Counselling service. As of 2000 he works in private practice together with Anders Wellsmo in central Gothenburg. His main line of work is as a supervisor, a job that takes him all over Sweden, chiefly working with organisations that are involved with the care of youths that are at risk, psychologically speaking.

It is with both pleasure and a feeling of recognition that I read the working notes on the therapy with a young teenager called David. The material is from the 25th session, so David is no longer a newcomer to the therapeutic setting. I am allowing myself the liberty of using the material fairly freely as I ponder the therapeutic dynamics and how they are expressed in the working material.

The first thing we find is that David is severely handicapped by his symptoms. He has been the object of extensive health care interventions for quite some time. It is a long time since his school has given up all hope of helping him, and he has no other form of employment, nor indeed anything else to do. As the notes chiefly cover one therapy session, there are many things about his life we are left in the dark about. Probably, the handicaps he suffers from have left him at an ever greater remove from his peers. He seems to spend a lot of his time in bed, and is described as being exhausted. Exhausted by what? Whatever it is that is troubling David the most, one gets the impression that it is mainly occurring within him, as opposed to in his outer life. Thus he appears to be perennially engrossed with that which is going on in his body and mind, as if a powerful physical drama were being enacted there.

David is reminiscent of defensive boys in their latency period in many ways when it comes to handling conflicts. This makes him come across as hard to work with in the sense that he strives for control and doesn’t give much freely. He categorically evades the therapist’s questions concerning how he feels. Generally speaking, very little of a more adolescent character is expressed. David is a boy that consistently resists adolescence and clings to the world of the latent child, a world full of passivity, reserve and control. In a developmental sense, he shows no signs of independence. Being his parents’ child and being cared for by them as one would for a child are the all-engrossing themes on his mind. It is up to them to make him safe and see to it that his needs are met, regardless of the fact that he is deeply dissatisfied with the way they are doing this. His situation is a difficult one. On the one hand he is suffering greatly, on the other, he is deeply afraid of approaching that which is going on within him.

As we proceed, I will regard the description of the therapy session and continue to speculate about the text.

My point of departure, as should be clear from the previous passage, is that David comes to treatment in a remarkably ambivalent state of mind. He needs help, but is extremely scared of the inner drama being played out within him. To begin with, David came to the therapy sessions with one parent at a time.

David’s parents got divorced when he was young. There is a deep conflict between the parents even to day.

In his early teens David was referred to the clinic for somatic pains like constipation and fear of vomiting. He also had symptoms like sadness, anxiety, difficulties in sleeping and thoughts about committing suicide. At the time of the referral David had not attended his school regularly for a long time. He had been hospitalised due to his chronic constipation. At home he remained in bed due to exhaustion. Treatment started with his parents separately and the family was offered sessions with father/mother and son. David expressed a wish to see someone on an individual basis and he was offered once weekly sessions at the clinic.

Session 25
David is silent for about a minute.

Patient: Last Tuesday, it was Sarah’s (his sister) birthday and Daddy...Have you heard about this?

Therapist: Yes, I’ve heard about it, but I would appreciate you telling about it.

David tells me about what happened last Tuesday. It was Sarah’s birthday. Dad had not called her on the phone nor had any other sign from him appeared during the day. David, Sarah and their mother had tried to reach the father on the phone all day long. But there was no response and by the end of the day they had become more and more concerned about what might have happened to him. When David noticed that even his mother became increasingly worried, he found the situation extremely hard to endure. David and Sarah wanted to go to father’s house and mother accompanied them there.

Patient: It happens that people die accidentally or are run-over by a car or something like that, David says.

They had found the father asleep on the floor, with his trousers round his knees. David realised for the first time in his life, that his father actually was drunk. Earlier on, his father had told him he was allergic to certain things and that was the reason he so often got tired and fell asleep when David stayed with him.

Therapist: How was it for you, seeing your Dad in this condition, I ask.

Patient: When we arrived Dad woke up; he turned away and began to cry. He looked tired and his face was wrinkled. He tried to hide his face.

Therapist: Why do you think he hid his face?

Patient: Well, I guess people often do that when they have a hangover – don’t they? And Dad cried.

Therapist: While you were still waiting to hear from him (when you tried to phone him) it seemed also as if you thought he might be dead and you might have got scared of losing your Dad.

Patient: Yes, and at the point when Mum started to get concerned about what might have happened it got really bad. Mum didn't tell me: Stop that nonsense your Dad isn’t dead, as she usually does. She got scared too and she didn’t want me and Sarah to go on our own to see him. And that really meant that something had happened.

Therapist: You were sure that something had happened and you were really scared that he might be dead.

Patient: Yes, one might get run-over by a car, but he had told me he was so sad about something mother and he had been talking about. I think you knew he was an addict, didn’t you?

Therapist: Who do you mean knew?

Patient: You two, Paul (the therapist at the clinic seeing the father) and you.

Therapist: Who says so?

Patient: Paul knew about it, of that I’m sure. But you haven’t said anything about this. You are not supposed to tell things you learn about – you are not to take it further on.




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