Category Archives: Advice

How does Therapy Help — The New

In my last blog, I considered psychoanalytic theorizing and its core understanding of repetition.  Today I’d like to consider the uniqueness of the therapeutic situation itself and the ways that it is different from whatever we presume happened between mother and infant, toddler and parents, etc.

For it may not be, as we largely assume, that parents have not had the ability to contain/digest/understand/empathize with what our client has brought to us to deal with.  Perhaps, they haven’t been given a chance.

For there is a profound difference between infanthood/childhood/teenagerdom and what happens in a therapeutic situation:  the client has chosen to be there, however ambivalently and reluctantly.

Even if our clients arrive expecting magical understanding or advice, they must, after some time, recognize that what we offer is more modest – the chance to think about and re-explore their lives and history, a chance to reinterpret events.  If they persist beyond this initial stage of disillusionment, they are choosing to go on a journey of understanding with us.

When the client continues to come, they are saying, however ambivalently, “bring it on.” And this may well be something that they have never been in a position to say, or think, or do, before.  It makes for an entirely new situation.

I don’t believe we have adequately thought through what this means and how it makes therapy essentially different from that of a child/infant with his/her parents.

A client who persists with therapy says “I choose you to be the person with whom:

  • I will attempt to feel and think things I have always avoided,
  • go to places no right-minded person will go,
  • share experiences that drive me  (and will probably drive you) crazy,
  • and if you prove understanding and trustworthy enough, to whom I will say things I have never said before.

It’s very likely our client has never said/done this before.  It is new, and will have profound consequences in enabling our client to find resources within themselves which they had never previously had cause to discover.

Though this new situation may inevitably involve repetition (for our behaviour/thought and feelings are not starting from scratch), it is profoundly different from what occurs with our parents, who are there, as a given, from the beginning.  If we’re lucky, they’re loving and thoughtful and mean well.  If we’re even luckier, they have some sense of what they have taken on in this most impossible of jobs, and are, in most ways, adequate to it

But I believe what parents sign up for is fundamentally different from that which analysts offer.  And so retrospectively understanding parents as inadequate analysts is a profound mistake.

If this isn’t obvious, there are a number of things that should make it more so:

  • It’s simply out of order for parents to “interpret” their children. I speak from experience here:  my daughter bristles (rightly, I’m afraid) whenever I’m tempted to do so.  She simply has not given me permission to do so, in the way a client gives a therapist.   Interpreting, in the words of Jay Haley, is a “power tactic,” and not one parents should use. I have permission to be her parent, but not her therapist. Thus the fundamental activity of therapists is denied to parents.
  • Of course, much of the “containing” that analysts feel parents haven’t done would be pre-verbal, from the earliest days, months and years of an infant’s life. But even here, I’m not sure we’ve adequately thought the difference between containing/digesting feelings which are formed before significant contact with language (what early mothers have to do) with containing “early” feelings of adults who are swimming in the sea of language, which is what therapists, at their best, do.
  • If being a good parent was simply a question of being an adequate analyst, you wouldn’t find many children of therapists who are messed up. Unfortunately, it is quite easy to do so.

Of course, I am not saying that there aren’t many ways bad or inadequate parents or even good parents in bad moments can’t mess up a child in ways they will still be struggling with years later.  In many of these cases, there will be a clear line of causation which it is possible to make:  for example, if a parent physically/verbally/sexually abuses a child, the scars which the adult bears years later can be traced back to the abuse, and what it meant to the child.

But a great deal of what analysts do, or take themselves to be doing, is dealing with  feelings/thoughts/perceptions/fears that are pre-verbal.   For example, Klein and Bion talk about the primitive fear of dying, which is attributed to the earliest months of a person’s life.   Such feelings may indeed need to be contained/digested/processed in a good analysis.

But here we are in quite different territory as far as causation goes.  We have no way of knowing whether this client’s early mother couldn’t deal with/contain/digest, his early hatred/fear of dying, etc.  This is true even if there is evidence the mother was depressed, preoccupied, grieving – absent in some major way.

All we really know is that there is work to be done, and if we, and the client are fortunate, we will be able to do it together, in a way that has never proved possible before.  But my suspicion is that a big part of why we are able to do that work is because the client has walked into our room under their own steam, sat in our chair (or laid on our couch) day after day, and has continued to do that until what they want/need has been accomplished.

For our clients, in our consulting room, everything they do/say/feel is understood as part of the work they have come to do.  This is an ennobling understanding. What has previously been understood as pathology is seen as attempted communication, as co-operation.  Even when clients seem to be working against us (resisting in its many forms), it is our belief as therapists that this is essentially working with us, presenting us with what we need to grapple with to help them.

All this makes for a unique situation, a proper “job” that clients can find themselves able to do however much previous “jobs” have been beyond them.  Being able to work with someone, in such a difficult situation with such difficult “material,” again, may be new for a client.  The sense of achievement they get from this and the support they get from being party to discovering the “truth” about themselves, may, and I believe is, much more important in their “cure” than the explanations in terms of repetition which we provide for them.

Tough

I’ve noticed lately I’ve started using an expression that isn’t usually in a therapist’s vocabulary – “tough.” As in, “You don’t like that? Tough.”

I don’t use it about my behaviour – anything I do or say I am accountable for, and can be commented on, criticized or complained about.   So I wouldn’t say “tough” if a patient complained about my holidays or an interpretation. That would be cruel and an abuse of my position of power.

But when it comes to things people don’t like about life, other people, their parents, or their partners, I’m much more willing to say this. What I have in the back of my mind is Reinhold Niebuhr’s serenity prayer:

God grant me the serenity to accept the things I cannot change.

The courage to change the things I can.

And wisdom to know the difference.

When I say “tough,” I’m saying “this is something you can’t change. You have to find a way to accept it.”

Our ability to change our thoughts, feelings and the world around us is largely based on our capacity to see things differently. This is the tiny lever with which we can change our world, and that of others.  Everything we know, or think we know, comes from a particular point of view. When that changes, so does our world.

Your pov is infinitely malleable. But reality isn’t. Some things you can’t change. You can’t change your mother’s postnatal depression, that depression that made her dead to your cries, smiles, need for her love, attention, and understanding. (Or your father’s alcoholism, or his preoccupation with work, sports, finances, his navel, etc.)

Some people spend their whole lives trying to do this, in their mothers, fathers, and her/his many subsequent substitutes.   You can be lively, pleasing, attentive, interested in football etc. It simply won’t work. You will always run aground on your mother/father’s deadness, which you will encounter again and again even as you try to escape.

You have to accept the original reality was just “tough.” Or, as my childhood friend Richie would say, “tough titties.” (I have to admit never understanding this as a child, and I am the first to acknowledge that my current, psychoanalytic understanding, was probably not what Richie had in mind…)

This doesn’t mean you are helpless, that you have to throw up your hands in despair. Your potential potency is not in changing her or him (whoever the particular her or him it might be at the moment). It is in altering how you understand her/his deadness to you.

You can appreciate now (in a way that was clearly impossible then) that it wasn’t personal. It wasn’t that she didn’t love you. It’s just that she couldn’t love. Or that she/he was so narcissistic that they could only love what they took to be a likeness of them. Etc. Etc.

This was a disaster for you then, and you have spent many years reeling from that awful truth. Which felt much more awful because of course you did think it was personal. You took it as a judgement on yourself. It is only, now, on reflection, that you can see how you were mistaken. And you can let yourself, and Her/Him, off the hook.

There is always a pleasure in saying “tough.” It puts you in the position of the One Who Knows, the One Who Can Face Reality. And there is a transgressive pleasure too – therapists are not supposed to say this!

So it has to be used sparingly. And in full awareness that you are not the one being called to face this particular painful reality.

But when used in this way, “tough” has its place. In our practice, and in our lives. It’s even become part of my interior dialogue, where a full stop is called for.

“Tough love” is a cliché, often used to justify cruelty and mistreatment. But that doesn’t mean the words “tough” and “love” can’t go together. I hope that’s the way they are used in my practice, and in my self-talk.

What’s Wrong with Me?

This question, and the accompanying statement, “there must be something wrong with me,” are those that I hear most frequently in the course of a working day.

In some ways, perhaps this isn’t surprising. People generally don’t come to therapy when they are thriving and full of joy.   And yet… are unhappiness, depression, feeling alone, etc. best conceptualized as something “wrong” with you?

I would say not, and that this way of thinking about things, and oneself, is pernicious and destructive, and more importantly, a kind of violence to the truth.

Let me try to explain.

Let’s say you hate being in groups of over three people. You feel anxious, bored, foolish, or very alone. Thinking of this in terms like “what’s wrong with me?” may come easily to you – it seems to come awfully easily to most of us.

[Do take a moment now to substitute your own version of this – the kind of situation where you think: “something is wrong with me.”]

It may seem to you that thinking “something is wrong with me” adds something new to the original observation. But what exactly? What do you know now that you didn’t know when you noticed you were bored or anxious?

Nothing, I would say. You don’t know any more, but you have the illusion you do. You “know” that this bored/anxious person is defective – morally/ genetically/spiritually/psychologically, take your pick.

Why does this feel like knowledge? Why do we go to this place so easily?

I tend to locate the answers to these questions in our earliest thinking/feeling. I think the idea “there is something wrong with me” is a transform of one of the earliest proto-thoughts/feelings we have – “I’m not loved.”   In any normal, let alone abnormal, childhood there are literally thousands of moments where we might come to think this: when we’re terrified and crying during the night but no one comes, when we’re starving and there’s no mum/breast/bottle in sight, when we are overwhelmed by any feeling – love/hate/anger/aloneness/fear and there is no one there to hold us and help us digest the feeling. And of course these are just the earliest such moments where we might come to think “No one loves me.”  Later, there’s the arrival of a new sibling, the priority given to another over us at family gatherings and school, the lack of recognition of what we can offer to the world, etc.

I believe that thinking/feeling “I’m not loved” is just too painful, especially to our earliest consciousness. So we replace it with another, slightly less painful thought – “there is something wrong with me.” Initially, I imagine, this is also a hopeful thought – in that if there is something wrong with me I can discover and correct it. And then I Will Be Loved!

But as time goes on, the thought becomes more solid, and the hope fades. The link with its painful origin is forgotten. And, in the fullness of time, it becomes a part of our identity. There Is Something Wrong With Me.

At this point, the thought comes very easily, and gives a kind of comfort – that of “knowing” ourselves.   I believe that for my patients, and indeed all of us, thinking, “there is something wrong with me” stops the pain of feeling anxious/bored/alone and substitutes Bitter But True Self Knowledge. We have come to conceive of ourselves as a malfunctioning machine, rather than a human being in pain.

But of course, there is no self-knowledge here, no truth.   As I’ve shown above, there is nothing added by this strangely reassuring thought to the original perception that we are anxious/bored/alone in a crowd.

Quite the contrary: it helps us avoid the truth. It stops us in our tracks and prevents us from enquiring into what is going on that makes us anxious/bored/alone. It prevents us from seeking our reasons for feeling what we do. In other words, it takes away our power to look at ourselves as rational creatures responding to something in an environment in a way that makes a particular sense to us.

It has become so obvious to me that thinking “there is something wrong with me” is a defence that I’ve become increasingly puzzled about why my clients are so attached to it, to this negative proclamation/conclusion about themselves.

It can take months, years even, to get past this repeated assertion, to get clients to focus on the phenomenology (a fancy word for “what is happening”) of a particular situation that makes them anxious, or bored, whatever.  It’s as if they cling on to this idea “there is something wrong with me” for dear life.

Of course, any identification, even a negative one, is hard to give up. Giving it up means facing the pain that was avoided by it. When people stop telling themselves there is something wrong with themselves they have to face something – a loneliness or self-effacement, for example, that echoes painfully through their lives into their pasts. We are pain-avoiding creatures.

But we are also fed in a powerful way by recognizing the truth. And getting past the empty identification “there is something wrong with me” can put us solidly, if temporarily painfully, on the earth, in our bodies and in our lives. It can give us the future this empty self-knowledge has deprived us of.

A price worth paying?

Confused? You Won’t Be!

Most of us locate confusion in our heads.  But that’s not what language, and our experience, when we look at them closely, tell us.

The word “confuse” comes from the Latin confound.  “Confusus,” a past participle, meant “to pour together, mix, mingle, to join together.” So confused literally means to be fused or joined together with someone else.

The dictionary meaning that comes closest to this is “to fail to distinguish between”” as in “he always confuses the twins.”

Confusion is therefore not something that exists “in your head” but is a result of you being uncertainly located between your head and another’s.

Don’t take my word for it.  Notice the next time you’re confused.  I bet you’ll discover that you’re trying to please/avoid annoying someone else, in a situation in which, if you know your own mind, there will be conflict.  So rather than know your own mind, you become con-fused.  Which, while unpleasant, does have the benefit of letting you avoid speaking and thus incurring the other’s displeasure.

Of course, the habit (or should we call it a strategy?) of being confused starts early.  The first person with whom we’re “fused” in our mother.  For a period, we cannot tell where we begin and they end.  Then gradually (if things go well) and abruptly (if they don’t), we begin to realize we are not self-sufficient, but rather scarily dependent on this person (who we later learn to call “mum”) to keep us alive.

And this is the origin of our later problems with confusion.  Because this kind of dependence, in which we need the other to keep us alive, becomes an unconscious template.  Which is evoked in later confusions.  Thirty/forty/fifty years later, it may be called into being when we’re with someone we “need” in some way — a partner, friend, colleague, boss, etc.

For example, you may become “confused” when your boss tells you that you don’t need a raise, because you’re already well paid.  In the moment of confusion, you’re conflating your boss with your mother, in that you feel you need his/her approval and incurring his displeasure is life-threateningly dangerous.  It doesn’t matter that your mother is dead or thousands of miles away — you’re still responding to an important “other” as if you’re a child and they are the adult crucial to your survival.

Rather than recognize an understandable conflict of interest — your boss may want one thing and you another — you get confused and think he/she knows best. You’re mixing and mingling yourself with him/her so that you don’t know where he/she ends and you begin.  Because if you do recognize that you and he/she are standing in different shoes, there is going to be conflict.  And you imagine, using your unconscious model, that this trouble will be life-threatening, that conflict/trouble will mean we will lose them forever/die/face an unknown but cataclysmic disaster.

Psychically separating from one’s mother is one of the most important elements in becoming your own person.  And naturally,  it’s one of the most complex and difficult to achieve.

Because amongst other things, it means coming to terms with all those feelings/thoughts that were unexpressed (and maybe even unthought) in relation to one’s mother as one grew up — wishing she was dead, hating/loving her with a scary passion, seeing her as the devil/god incarnate alternatively,  envying and being jealous of her, despising her, wanting to gobble her up and keep her forever in your tummy etc. etc.  We unconsciously fear that these thoughts make us bad and unworthy of anyone’s love, that if we allow ourselves to be separate, and voice our thoughts, this terrible truth will come out. And we will forfeit her life-giving love.

Patients often fear even speaking such thoughts in the consulting room — as if their mothers will know, or be stricken down, at a distance.

But avoiding the truth of us being separate beings doesn’t make life easier.  It produces a plague of other ills — anxiety, indecisiveness, confusion, hopelessness, despair.

When we are truly separate, we recognize there are inevitably differences between people, and that these will have consequences.  But we are not tempted to fuse with the other to avoid them.

This makes life simpler.  There’s what you want, your ability to say it, and the consequences you face for speaking your truth.  You don’t get caught up in the anxiety that agreement, or persuading the other that you’re right, is a life or death issue. Which means there is space which can result in understanding, compromise, or simply agreeing to disagree.

(For those of you who vaguely recognize the reference in my title, it’s from Soap, the American tv sitcom in the late 70’s.)

 

Why We Don’t Carry Through Our Resolutions

At this time of year, the newspapers and web are full of advice about how to carry through your New Year’s resolutions.  There are also endless articles about how they don’t work. But there is little written about why we make these resolutions and why they fail.

New Year’s resolutions fall into two broad categories : trying to make yourself into something that you think you ought to be (or want others to think you are)  and trying to behave more lovingly to oneself. Examples of the first are: resolutions to lose weight, to exercise more, to read more, to not drink or eat so much.   Examples of the second : to not push oneself so much, to enjoy yourself more, to give yourself pleasures you usually deny yourself.  Resolutions to learn a new skill or language can fall into either category.

While it’s wrong to underestimate the power of our desire to look and act like we think we should/ought/must (or at least appear to do so), and our desire/belief that we can start anew,  these impulses rarely last the course: witness the sharp fall in new gym attendance between January and June.

Why is this the case?  Simply because the impulse to be what we take others want us to be is not a deep one, however much we wish it were.  I know this because a great deal of work with my clients is about distinguishing what they think they ought to be/do/have from what makes deeper sense to them.  And during the course of this exploration, clients also become aware of the resentment/anger/shame that they’re not what others want just as they are. Because often, these “others” we want to please are basically stand-ins for our parents, who couldn’t help but subject us to their values and judgement.

When we make a resolution to change our shape, appearance or image, however much we are convinced that this is what we want, an unconscious kickback starts almost immediately:  why do I have to do this?  why aren’t I loveable or good enough as I am?  And it is this kickback (more often than not based on our experience with our parents) and the feelings which go with it that undermine our resolutions, not, as we will tell ourselves later,  a lack of willpower.

Okay, so this sort of resolution doesn’t work.  But what about those resolutions based on the impulse to treat ourselves more lovingly?  To take better care of ourselves, to prioritize our own needs.

Often, such resolutions come from a reaction to insight  into how hatefully we behave towards ourselves. The ways we casually treat ourselves worse than someone we loathe: calling ourselves names (you idiot/moron, you pig, you slut), denying ourselves even inexpensive pleasures (the few extra pence we can well afford for a better quality or slightly more substantial treat or even necessity),  or even time off from the grind of daily life.

Sadly, these cruel ways of treating ourselves are not shifted simply by an insight into how hateful they are.  Because often, we unconsciously feel/know this hatefulness is justified and right.  And as long as this is the case, we will return to the hateful behaviours, however much we will ourselves not to.

It is only when we undo this “knowledge,” by understanding its origins and having an experience of what being loved for ourselves truly means that our resolutions to treat ourselves better can be carried through.

Of course, gaining this understanding is hard work.  But shouldn’t it be top of our resolution list?

Is There Such A Thing As An Accident?

No I don’t believe in luck
No I don’t believe in circumstance no more
Accidents never happen in a perfect world

Jimmy Destri, of Blondie

Lately, in connection with another project, I’ve been reading a number of books by ex-residents of Bruno Bettleheim’s Orthogenic School in Chicago.  One thing that each resident takes up in their own way is one of the Bettleheim’s guiding principles:  there is no such thing as an accident.

Bettleheim took this quite far.  If during a hectic dodgeball game, you jumped out of the way of the ball and your elbow encountered another person’s ribs, the game would be stopped and you’d be asked why you had done this.  Saying “it was an accident,” or “I didn’t mean to hit him,” were not allowed as responses.  Rather, you were required to reflect on your unconscious motivation for this aggressive act.

Most people’s response to hearing a story like this is to say it’s absurd. A demonstration of how mad psychoanalysis can be when taken to an extreme.  I can understand this response.  And yet, I think meditating on both the principle and our response to it will pay dividends, illuminating the correct and incorrect use of psychoanalytic ideas, the limits of psychoanalytic explanation.

First of all, is it correct to say that in psychoanalysis that there is no such thing as an accident?  Certainly Freud and many other analysts (including myself) have found that many actions, originally thought to be accidental or inadvertent, can be discovered, through the application of the psychoanalytic method, to have been unconsciously motivated, meant if you like, or at least, meaningful.

But it is important to note here that “explaining” actions in this way is not the point of an analysis.  One doesn’t want a client to come out of an analysis full of lovely explanations for why they do what they do, but behaving exactly the same.

Rather the point of understanding actions differently is the coming to “own” them retrospectively.  So, for example, I’m late by fifteen minutes to meet a friend.  In my mind, it’s an accident, and I tell myself if I’d been luckier with the Underground I would have been on time.

But when I meet him, he says, “Still pissed off about what I said about your story?” I then remember how angry I was about his criticism during our last meeting, how I stewed on it for days, repeating it in my mind and stoking the anger again.  I immediately see — and own — how my being late was in fact, an expression of my anger and reluctance to see him again.  I smile, chagrined.  “I don’t hold a grudge, do I?”

The experience of many such incidents, both in your own life and in the analyses you conduct, does tend to produce some scepticism about the explanation “it’s an accident.”   But does it rule it out of court?  Given “a perfect world,” infinite time to reflect on our lives, and a completely enlightened, unjudgemental mind,  perhaps…

In other words, no.

I’m sceptical about “accidents” because of repeated experience of discovering that what I (and others) once thought was accidental, turned out, not to be.   It may be the case that Bruno Bettleheim had similar experiences to me, and had come to believe a more extreme version of what I do,  that accidents never happen.

No problem so far.

He, and I, can believe what we want.  It’s when Bettleheim attempts to impose his understanding on another that this becomes problematic.  Especially when the others are children in his care/power.

Let’s say, I believe Freud is the bee’s knees.  I may believe a lot of what he says is true. In spite of my wealth of experience justifying these beliefs to myself, I am not entitled to insist that you share them. Even if I believe it would greatly improve your life to know the wonderful truths of Freud, I have no mandate to impose my beliefs on you, any more than I can insist that you agree with me about Barack Obama, David Cameron, or anything else.

If you come to me for help, our work together may result in your sharing my admiration of Freud.   You may have experiences which make you believe that accidents never happen.  (You may not of course.  You may end up thinking Freud, and I, am bonkers!)

I cannot shortcut the process by which you arrive at your own understanding of the truth of whether accidents are possible (and everything else).  If I attempt to do so, and insist you believe something or act as if it is true and I have power over you, you can only identify with me or comply with me — pretend that you agree that what I say is true and give me explanations that might satisfy me.

Since the aim of psychoanalysis is to increase your freedom, identification (technically, identification with the aggressor) as an outcome is unsatisfactory — as it limits your understanding to that of the person you are identifying with.

The latter is largely what seems to have happened at Bettleheim’s school.  Residents learned not to say “it was an accident” and instead to say things like “Yes, I guess I was angry that my mother used to shout at me,” or “I did feel aggressive after my session with my counsellor.”

Having to comply in this way is antithetical to the whole psychoanalytic enterprise, which is founded on telling the truth.   In other words, ideally residents would have been rewarded for saying “I believe it was an accident, Dr. Bettleheim, whatever you think. Maybe I will come to understand differently in the fullness of time, but at the moment I think it is quite wrong for you to insist I produce explanations that relate this to my past.  It completely devalues the currency of explanation, and of this school.  And if you don’t mind, I’d like to go back to my game of dodgeball.”

Of course, the young children at the school were not in a position to say this. Neither are vulnerable and dependent patients. That is why it’s so important that therapists maintain a high degree of awareness of the limits of their explanatory principles, and of the largeness of their power in the therapeutic situation.

The Nightmare Client Who Taught Me To Be A Therapist

When I first started working as a therapist, I had the very good fortune to have a client who was a complete nightmare to work with.   I’ll call her Ellen.

How was Ellen a nightmare?

  • She would reply to my best interpretations by asking “which book did that come from?”
  • She discovered my home phone number and would ring me for hours late at night when she was unhappy with a session or with me.  She couldn’t sleep so she didn’t see why I should.
  • Often, she’d absolutely refuse to leave the room at the end of a session.  I’d have to physically drag her to the door, and out of it.  She’d wail and grab onto anything that would slow her/my progress.

I shared a suite with a number of experienced therapists from my training group. Having a patient leave sessions screaming and protesting as I physically removed her from the room, was completely humiliating for a new therapist. Which, of course, was at least part of the point.

Ellen was humiliated by my lack of understanding.  She was just returning the favour.

When Ellen was unhappy with how I’d responded (or not responded), she would dash from the couch to my desk, jump on on it, open the window and then sit with her legs dangling out.  My room is on the 2nd floor – it was a long way down.  Then she’d threaten to jump if I didn’t give her the answer she wanted.

Sometimes, I’d try to block her on the way to the window.  She’d dodge.  Sometimes I stopped her, sometimes not.

I kept thinking, “this isn’t what doing therapy is supposed to be like.  I’m not meant to be physically stopping a patient from going out of a window! And I’m certainly not supposed to be physically dragging her out of the room!”  (For more on what “should be” the case, https://thetalkingtherapist.wordpress.com/2013/09/11/what-we-shouldnt-be-feeling/.)

I did try to say this to Ellen, in many different ways.  I tried to explain that she was “acting out,” that she should talk about her feelings instead.  To no avail.

I was like a parent telling a child to behave.  Not to help them, but to help me — to stop me feeling useless, humiliated, ashamed, etc.

You’re probably asking yourself:  Why didn’t he just tell Ellen this couldn’t go on and he’d have to “terminate” therapy?

It certainly wasn’t that I didn’t think of this.  I thought of it almost every day.  Many times a day.  Especially during the periods when she was refusing to leave at the end of the session — I’d absolutely dread going to work.

What stopped me?

  • I knew Ellen was putting everything she had into her therapy.  It mattered more to her than anything in her life.  Which was, I recognized even then in my frustration and despair, a tremendous vote of confidence in me or the process.
  • Also, I strongly suspected if her therapy didn’t work, or if I ended it prematurely, she’d commit suicide.
  • And finally, and most importantly, somewhere in me,  I knew she had a point:  I was getting something profoundly wrong.

I sought out different supervisors to give me advice/perspective.  One sympathized with me.   Another told me I should start working towards the end of the session from the very beginning.  Another told me this patient did not feel I was “holding her in my mind.”

Most of this supervisory hand holding mainly served the function of enabling me to keep on keeping on.

I’m not sure now whether I should be embarrassed by, or proud of, how long this went on.  Literally years.

How did it all change?  One day, in frustration and despair at my “not getting it,” she stormed out of a session and sat on the stairs to my office weeping loudly.  I was painfully aware my (incredibly tolerant) colleagues were able to hear this.  And that their next clients, and mine, would be arriving in fifteen minutes.

I went out and sat next to her on the stairs. I was at my wit’s end.  I’d tried everything. Read books on difficult clients.  Sought help and followed it.  And here I was still useless to this client who I knew was in enormous pain and who had put such trust in me.   We sat in silence for a few minutes.  Tears started running down my face.

Ellen looked at me, surprised.  Then she stood up and went back to the consulting room.  I followed her. As the session continued, she seemed unusually open to talking and listening. When our time was up, she got up and left.  Under her own steam.

In the weeks and years that followed, her “acting out” ended. Ellen did the work she needed to do, confronted her demons, formed her first healthy relationship, started to study, and married.

I’m very aware this isn’t your usual case history.  These nightmare stories don’t often make it into print.  For obvious reasons.

All this happened many years ago.  I’ve had plenty of time to reflect on the shift in Ellen’s behaviour, and mine.   (On reflection, this shift had been underway in small ways for some time, as I’d begun to absorb the lessons she was trying to teach me.  The idea of the “one decisive moment” – in therapy or in life, is something I’d want to question.)

Ellen had been adopted and had struggled to get a real response from her dutiful good parents.  Mainly by being a holy terror.  She repeated this struggle with me.  The more I responded to her provocation by interpreting and being a “good” therapist, the farther away the real response she’d needed had seemed.  And the worse she behaved.

She needed my honest and truthful self.  Me.  Not my book-ish attempts to be “good.”  When I reflect on her therapy, I am aware of how acutely attuned she was to the difference.  And how little I was.

It’s not that the interpretations I made were “wrong” or incorrect.  (In fact, after our moment on the stairs, many of them proved very useful indeed.)  The problem was that I was using them defensively, to keep her at a distance, to try to control her.  I was simply not in a “place” to interpret.  And she knew this.

Ellen taught me that interpretation has to be offered freely, with no agenda.   It has to come from a “thinking for” the client.  While I was fighting Ellen, I wasn’t able to do this.  I was too caught up in my concerns/anxieties, in wanting her to be different.

Not all therapists are lucky enough to have a client who teaches them this early in their career.  It takes them years to learn this lesson.  Some never do.

Occasionally, I supervise trainees who have a “nightmare” client.  I always tell them to count their blessings.   That, if they survive (at times, I doubted I would) this person will teach them more than their rest of their training.

It is a therapeutic cliché to say that your clients teach you everything.  In my experience, not all clients need to teach you something.  Some simply need good-enough therapy.  But others really have to make an impression.  Needless to say, I’m enormously grateful to Ellen.  Everyone I’ve seen in the last twenty odd years has benefited from her persistence.