James came to therapy in his early fifties. His last child had just left home to go to University and he had become aware he wanted to leave his wife. He told his therapist that he had probably been unhappy in his marriage for the last 10 years but had not realised this until now. He thought he might have delayed acknowledging this because the thought of separation from his children was unbearable.

Barbara was in her fifties when she started psychotherapy. During her childhood her mother had been emotionally overwhelmed and angry a lot of the time. Barbara had learnt to hide her angry feelings, because they would trigger maternal violence. Barbara achieved well and became a nurse. In retrospect she thought that she began suffering with depression in her twenties. She did not manage to form any long-term relationships or have children. She put all her energy into work which she said became her ‘family’. When a new manager, an older woman, was appointed Barbara could not get on with her and six months after her arrival a patient died on the ward. The manager implied that Barbara was responsible for the death through poor supervision of a junior nurse. Barbara became depressed and stopped work for the first time in her life. She lost weight, her mood became very low, she became very self-critical, couldn’t sleep and had suicidal thoughts. At this point Barbara started psychotherapy and gradually recovered over the next two years. She told her therapist that one of the most helpful elements in her recovery was the realisation that she was full of anger and hatred for her mother. The new manager reminded Barbara of her mother. She felt angry at what she perceived as unfair treatment and this anger was turned back onto herself. This resulted in depression.

Amina was becoming preoccupied. Every time she was in a session with her patient, Nelly, she found she was thirsty. She tried drinking before each session but that did not help. As soon as Nelly left the room at the end of the session, Amina would rush to the kitchen to have a drink. It gradually emerged in therapy that Nelly had an alcohol dependency earlier in her life and the emotions emerging in therapy were stimulating her ‘need for a drink’. Once this was recognised and discussed in the sessions, Amina’s feeling of thirst subsided. There then was the opportunity to address Nelly’s underlying feeling of deprivation and dependency.

Pardeep’s patient Zeynep had been suffering with chronic pain for five years since her mother’s death from cancer whom she had nursed through the final years of her life. Zeynep had been struggling with increasing pain in her legs, back and head since her loss. Pardeep found that he too started to feel pain in his head during the sessions which would build until Zeynep began crying about her mother’s death. When she started active mourning Pradeep’s headache evaporated. Pradeep realised that Zeynep was projecting her pain at the loss of her mother into her body, so that her psychic pain became physical pain, which Pradeep then identified and resonated with.

Asim’s patient Annabel had been struggling with anorexia. While she was talking an image formed in Asim’s mind of a small girl holding a bunch of balloons. The girl was being lifted up off the ground and drifting off into the sky. Asim linked this to the dissociated state of his patient who was not in contact with the ground, or reality, about the seriousness of her condition. She also talked later of ‘drifting off’ somewhere where she would no longer feel pain.

Andy found that he was starting to feel bored with his patient Desmond. It was hard to concentrate, and he started making a shopping list for his dinner. He felt guilty about this and was concerned that he was not attending to Desmond. When this continued to happen, he wondered if this was a countertransference response. He asked Desmond how he was experiencing the therapy; he said that he dreaded it, feeling exposed and he tried to hide what he was feeling. Andy realised this feeling of boredom was related to the sense of dread that Desmond felt where he hid everything creative from Andy. Once acknowledged, Andy felt more connected to his patient and more alive as a therapist.