Hoping that you're wrong

While she talks my mind is fizzing. I’m anxious, wanting her to say it once and for all, not wanting her to say it at all. Every week she reels off more of the list of potential adult sequelae of childhood sexual abuse (lack of early memory, self-harm, bulimia, drug and alcohol stuff, depression, post-traumatic stress disorder-like symptoms, and so on endlessly). Partly, I want her to cut to the chase. Partly, I hope I’m on the wrong chase.

Yesterday, she recounted a terrible dream in which she was a child being (remembering being?) attacked in bed. “It was so vivid I woke up not knowing if it was real or not,” she said. And all the time I hear my supervisor’s voice in my head: “We don’t know.” Allowing myself to listen and bear the not knowing, is something I am not good at. I am trying.

She’s always hiding her face, disappearing into her baggy clothes, averting her eyes and never referring to any previous sessions, as though we meet for the first time every week. I say stuff like: “It seems to feel hard to be looked at and thought about.” And then, in the ensuing silence, I feel like an idiot.

Not all psychotherapists follow the “not knowing” guidelines. Everybody wants an easy answer to their problems and many are seduced into providing it. I went to my first therapist back at university when I became overwhelmed with an inexplicable terror as soon as dusk set in (about 2.30pm on a bleak winter afternoon). She announced that I had “existential angst and chronic separation anxiety.” A thing! A name! Almost sounds curable. While I might write that in session notes, my psychoanalytic (Freud/Klein) training wouldn’t brook saying it to the patient.

Obviously, it wouldn’t do that much harm if I did, but it would do a great deal of harm if I were to give voice to my suspicions about the history of my hard to reach patient. After she’d related her dream, I said: “It felt traumatic.” Then I wonder if I’ve said too much. Am I leading?

It might be, as someone in my supervision group suggested, that she is projecting the imperative not to tell into me. She has kept the secret all her life and any hint of it is forbidden. I pick up on that, colluding with her in keeping this secret even in our sessions. Or maybe I’m reaching for an explanation for this woman’s symptoms so that I feel more comfortable, less hopeless in the face of her difficulty (and my own). Wouldn’t it be neat to have an answer? And there is that voice again, the texture of tweed almost tangible: “We don’t know.”

And I think of myself lying on my analyst’s couch, while he thinks things he’s not telling me. While I stare at an erudite bookcase he’s thinking: “Hmm. Unresolved Oedipal issues, clear penis envy [Sigmund Freud], stuck in the paranoid-schizoid position, nowhere near depressive [Melanie Klein], inadequately contained [Wilfred Bion], problems seeing and being seen [John Steiner]…” and so on. When I finally read the theory myself and attempted at least some understanding of the fascinating and complex treatment I’d been through (it really isn’t just sitting there listening), I thought (and said): “WHY DIDN’T YOU JUST TELL ME?”

“Would it have helped?” he asked.

Of course not.