Breakdown and development – A clinical case study

Abstract

In this paper I will attempt to describe the treatment of a seriously ill patient in a National Health Service (NHS) clinic who suffered from recurrent depressive disorder with co-morbidity, repeated breakdowns and was at risk of suicide. The purpose of writing a clinical case study is to illustrate the vital importance of a psychoanalytically-informed approach in the treatment of a very ill patient in the public sector. At a time when there is a decrease in the provision of long-term psychoanalytic psychotherapy my aim is to illustrate its value in the understanding and treatment of complex disorders, a perspective that seems to be under constant threat from internal and external pressures and at risk of being sidelined as a non-evidence-based form of treatment.

I will try to describe the different stages in the treatment; from referral through to the beginning of treatment, its interruption, the patient's breakdown and admission, and finally his return to treatment upon discharge. The ending will be discussed with a view to highlighting some of the patient's internal movements enabled by the work undertaken.

Keywords:

• severely disturbed patients
• psychoanalytic psychotherapy
• NHS services
• breakdown

Acknowledgements

I am indebted to my colleagues Cyril Couve and Peter Hobson for their invaluable help and encouragement and for their helpful comments. I am grateful for the willingness of my patient to permit publication of material from our sessions. Personal details have been disguised in order to preserve anonymity.