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In session 11, he noted he had five more sessions and asked if I could spread them out to make them last. We talked about his continuing health problems (a recurring theme) and wondered if he might now seek medical help. We looked at it in terms of the diagram and linked this to the old pattern of having to suffer to achieve or get love. We discussed how he could continue to work after therapy on how my “abandonment” might be a helpful experience. He seemed helped by the idea of asking for realistic care from self and others. We wondered what a realistic “okay” relationship with Elizabeth might be like. He talked about me abandoning him and how maybe he could learn from it. He paid detailed attention to his not sleeping pattern and noted that the “agitation” was provoked by thoughts about how forlorn and neglected he was. We wondered what he could do to change his going to bed routines and how to promote self talk whenever he did wake in the night so as to dispute the forlorn feeling.

Figure 2.1a Key formative RR for Bobby.

Figure 2.1b Key RRP enactments.

Figure 2.2 Rating sheet for target problem procedure 1 for Bobby.

Bobby rang 2 days before the final session asking if it had to be the last. I restated that it was tough, but asked how he would learn about managing on his own, using what he had learnt with me, if he did not end the therapy. In the final session, as he read out his goodbye letter, he was in tears and had to stop several times. He wrote:

I can see how I throw myself in and expect too much. I don't know how to hold back. I tried to rope you in to make it impossible for you to reject me, but you were having none of it and I appreciate that. I can't give my whole self to people and expect to be looked after. I have to look after myself. I am beginning to look after myself. The few months we have been seeing each other have seen possibly the biggest changes in me, at least in my way of thinking. I have worked hard at it and will continue to do so because I have seen that it is possible to change. I'm feeling more able to live in the “external reality” and this seems to have come from protecting my “self” a bit more.