Sometimes patients are boring. I have a patient who drives the supervision group nuts (trainee therapists like myself, as well as the fully qualified, always need input from others). When I relate a whole 50 minute session I feel their minds drifting away, eyes sliding towards the window, feet shuffling, phones buzzing interestingly in their bags. “Doesn’t he ever do anything interesting?” moaned the medical student in the red jeans. “No, I don’t think so,” I said, honestly.
This patient was describing an altercation at the bank. The cashier insisted on a signature for some transaction or other and the patient thought this was unnecessary, possibly illegal. The manager was called and the patient, eventually, withdrew the last £40 from his account. He then got on a bus and watched a child whine for an ice-cream while the mother talked into her phone. The patient disapproved both of the mother’s indifference and the child’s insistence. Later, he went to the supermarket and was worried he might be mistaken for a shoplifter and thrown out. He carried his receipt ostentatiously so as to avoid being apprehended. He realised on the way home that he had forgotten to buy the jar of pickles he went in for.
The group sighed and fidgeted. I was embarrassed to bore them but also defensive about my patient, whom I actually don’t find boring in the sessions. “It’s not boring, because he’s so oppressive,” I said. “I end up exhausted and confused.”
The supervisor rolled her eyes and struggled to focus. “This is a baby who is not getting what he wants from mother,” she said. “He is getting some negative attention, some groceries but not what he wanted. He feels he is viewed with suspicion and, even if he did get the ice-cream in fantasy, what he really wants is mum.”
Suddenly everyone was interested in my poor patient. We could all imagine being a child too boring and irritating to warrant a mum’s full attention. But my patient feels too much of a nuisance—is, in fact, too much of a nuisance—ever to get anyone’s mind focused on him. In his bid to make me his mother, advisor, consumer rights advocate and moral backbone, he wears me out—a shattered mother after a day (in fact, only 50 minutes) with an irritating child. The last thing I need.
“He is worried he isn’t getting what he wants and needs out of therapy either,” the supervisor said, perked up now. “He knows you’re bored of him and, anyway, you’re going to throw him out at the end of the session.” This is true—he is always reluctant to leave, spending ages with this coat and bag, phone and empty paper cup. “And I’m going to throw him out forever in two months,” I added, his year of therapy on the National Health Service being nearly up. “Ah,” the supervisor nodded sagely, earrings swinging. “The Ending.”
The next week this patient told me about a job interview that he felt had been cut short when it became clear he wasn’t a suitable candidate. This was the perfect moment to say—“And I think you feel our sessions are always cut short, that I’m throwing you out.” He shrugged. “Well, you do, don’t you? It’s your job to get rid of me at the end.”
This seemed like a sad job description. “So, you take it for granted that I’m waiting to get rid of you?” I asked. He thought about this for a while and then laughed. “Is it funny?” I wondered out loud. Then a kind of realisation dawned and he looked terribly sad, his hands clasped in his lap. “No,” he sighed, seeming to confirm my supervisor’s simple interpretation. “It isn’t really, is it?”