Type Evelyn, a patient:
" Clinical vignette: Evelyn
She was overwhelmed by the relational chaos that she frequently found herself in with
both women and men, which she couldn’t understand. She was fearful, seemed
na¨ıve and much younger than her age. She had tried therapy before but had not
managed to establish a sustained relationship with a therapist. Evelyn would
frequently not turn up for sessions, call to try to cancel or change the date and
time, arrive late and often in a very angry mood, or try to end her therapy.
In spite of this, Evelyn did persevere and after about a year we settled into a
rhythm of three sessions per week. Later, when we were able to think about
this together, it seemed that Evelyn hated the ‘shape’ of what felt to her like a
too rigid and imposed frame. We also came to understand that this to-ing and
fro-ing represented something of her desperate confusion about both longing
for, yet fearing, emotional contact. It was also a reﬂection of her preoccupation
with the question of ‘space’, there was either too much or not enough for her to
feel safe. Throughout the whole analysis the theme of spatial safety and ﬁnding6 Amanda Dowd
a rhythm between us of what felt like ‘just that side of too close’ and ‘just this
side of too far apart’ was a constant preoccupation.
The image that emerged over time was of a woman in constant mental agony
as Evelyn could not understand how relationships or life ‘worked’. This was
hidden beneath a carefully managed and presented exterior of self-conscious
‘softness’. So insistent was her bodily presentation whether in a collapsed or
highly charged affective state that for a long time I failed to appreciate how
un-embodied she actually was. The over-soft presentation also camouﬂaged the
hateful, hard and cruel belief system that she lived within as well as hiding her
agonizing uncertainties about self—her doubts about being a person at all. This
confused her as it did others in her life, and generated intense shame.
Evelyn did eventually manage to make periodic use of me as a present and
thoughtful mother and ﬁrm enough and ordered father in the transference.
During these times the pattern of both the family abuse and chaos and other
traumatic incidents in her life could be recognized to a degree, the pain of
recognition felt, and a more thinkable narrative of herself and her family history
could be constructed in both drawings and language—Evelyn often drew herself
as a very small child in a huge empty space. Evelyn did marry and this marriage
brought a degree of ﬁnancial and emotional stability that was new to her; it
was relieving because she began to feel safe in a way previously not experienced
but at the same time she often felt the marriage to be unbearably constricting.
After a time, acting out within the marriage in terms of dangerous liaisons
and explosions of anger began to mirror the acting out in the transference. At
reasonably regular intervals we entered a period of turbulence characterized
either by Evelyn telling me that she had visited another therapist and they had
told her this or that, or by eruptions of rage because I so obviously ‘didn’t get it’
or by a particular usage of her considerable intelligence to ‘grill’ or interrogate
me when she felt that I had failed her by ‘missing’ something."