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After two assessment sessions he was offered 16 sessions of CAT. He was given the Psychotherapy File (see Appendix 2) and he started to keep a symptom diary. The Psychotherapy File and some of his diary keeping confirmed the initial patterns he had described and also set him thinking that perhaps he was not as bad as he used to be. We identified what he wanted to change (target problems) and how his patterns of relating to others and self‐neglect and self‐comfort fed into these. By Session 4 Bobby felt much improved in morale. He had used the provisional diagram, begun self‐monitoring, and was keeping a diary.

At Session 4, a letter was read to him which is reproduced in part:

Dear Bobby,

Here, in writing, is what we have talked about in recent weeks. I hope it can help us keep on track in the weeks ahead and serve as a reminder to you of what we have been working on.

… One thing you remember of your childhood is either feeling especially loved and treasured, or being a nuisance and ignored and smacked and told to shut up and go to sleep (for example by your brother). You felt you were cared for if ill but otherwise ignored by your older brothers and sisters. You tried to please them and win them over but always felt scared.

This pattern seems to have been echoed in your close relationships with women and with a therapist previously, as well as in the way you either neglect and ignore your own needs or seek comfort through drink or smoking dope … You are usually neglectful of your body and have not seen a doctor or got proper care (for asthma and other ailments) …

We have named a number of patterns of feeling, thinking, and behaving:

1 You long for special care but fear it won’t last, so you tend to cling anxiously and alienate others (as with Elizabeth your partner), leaving you still uncared for.

2 Feeling depressed leads you to drink or smoke dope and ignore problems which then build up making you feel low and even more depressed.

3 You receive care, but only if “special,” so you strive to create special claims but feel you must suffer to deserve it and so neglect yourself and become “agitated” and drink or smoke dope.

These patterns undoubtedly arose from the ways you coped with the limited options of your childhood; they seem to have given you some intimacy and relief but they have been costly …

Already in our relationship we have seen how you push to get me to provide comfort and hold you through this difficult time when you are no longer in a relationship with a woman who will rescue you. By learning to recognize these patterns in therapy you will be better able to explore more satisfactory ways of doing things.

You have said you have been impressed with my help (a bit like the honeymoon phase in one of your relationships), but I suspect it will be hard to imagine how short and limited our relationship is (16 sessions), and how you will cope with tolerating the disappointment when I cannot meet your current pattern of neediness …

Our aims in therapy will include:

 learning to be less clinging and demanding in relationships

 getting help with your health

 focusing on working for your degree and on more concrete “out there” activities and achievements.

With best wishes

He was moved and tearful as the letter was read out. He said he had learnt more in five sessions than in 4 years of previous therapy. He began to see his helplessness within a wider emotional narrative. The state of forlorn “agitation”—which seemed deeply part of him and just swept over him, especially at night‐time—had hitherto seemed beyond his understanding. Now it began to be seen as part of an emotional story. However, he did not like the ending being mentioned in the letter. He asked if he would be better after 16 sessions.