Patients who were hoping for a quick fix from psychotherapy—six sessions of life tips and you’re on your way—often slump after a few weeks of self-consciously talking about themselves to no obvious end. After a few more weeks they might say: “I mean, how does this actually work? I don’t feel better at all. If anything, I feel worse. Where are we headed?”
This is what a patient, Ms S, said to me. She started our sessions talking about her chronic anxiety, sleeplessness, desperate panic about what she knew ought to be minor problems at work. She seemed to want me to tell her to breathe into a paper bag and not sweat the small stuff. I didn’t. She was married, worked from home, barely left her apartment, had no friends and was trying for a baby. She always wore black trousers.
I tried to answer her question. I am optimistic enough to expect improvement from therapy, but absolute transformation? A miracle cure! Well… I told her we were trying to think together about how her mind works and, basically, to make some of her unconscious conscious. “Huh,” she said, looking down. “And will I feel better?” I said that hopefully she would feel less trapped, yes. “When?” she asked. I may actually have laughed.
Amazingly, she stuck with it, always on time, always thoughtful about our conversations (a key sign of progress), often hugely insightful. She talked about growing up in brutal poverty, and about her lonely and violent early life. During the course of our nearly two years of therapy Ms S had a baby, severed relations with her mother and brothers, fell out with her cousin and then rebuilt these relationships from their foundations (as well as literally building houses for her family in her country of origin).
Last week she was late for the third time in a row. “I forgot about you!” she said, smiling, putting her pretty, orange handbag on the floor next to her. “Who would have thought I would ever have orange things!” she laughed, understanding the significance. “You forgot me because you don’t need me any more,” I said. She nodded, solemnly.
Ms S talked about flirting with a man in the office, going out with friends, a book she’s reading and advice she gave to a colleague. She has become, to her…