Life of the mind: The constant life companion

Some patients, I know, imagine indifference in a therapist just doing the job. The opposite is true"
April 12, 2017

My patient arrived puffy and sleepy from pregnancy. Although she had self-confessed difficulties with being a female mammal (as opposed to a male one), she has surprised both of us by relaxing happily into pregnancy. She looks comfortable in all senses.

“Pete died last night,” she sighed. Her father-in-law had been ill for a year, diagnosed with terminal cancer about six months after the death of her own mother and at the same time as a particularly devastating failed second round of IVF. I feel I got to know Pete pretty well during his illness; his insistence that the extended family (including my reluctant but ultimately obedient patient) gather round his bed to listen to his recitations of TS Eliot, his detailed (though eventually ignored) funeral plans that attempted to control the living even after his death and his effort to cure himself by avoiding conventional treatment in favour of a bizarre egg-only diet of his own invention.

So, farewell, Pete who I knew so well and not at all. He is one of around 10 deaths mourned (or not) by my patients since I started working, and when his granddaughter (I have seen the evidence in scan pictures) is born in a few months time she will be my third therapy baby. The first is now three, speaks three languages, loves squirrels and wants a dog. I have also been deeply involved, and not remotely involved, in two patients’ marriages, one of which was a terrible mistake that rumbles on in our sessions.

Obviously, people tend to come into therapy in times of crisis and these are the big life events that perhaps constitute, accompany or precipitate crisis. Or, possibly, this high incidence of drama is the natural ebb and flow of any life and it’s just that the therapist has the intimate privilege of witnessing a patient’s life at close quarters, getting to know a huge cast of characters from one highly subjective perspective. For all I know, some of these characters could be fictional.

The baby observation part of training, where you find a newborn to observe in a year of hour-long sessions once a week, is an amazing introduction to this extreme intimacy, to this feeling of watching a person develop over time and of knowing minute details of their life. A psychoanalyst once told me that female trainees always get pregnant during baby observations. Men looking for a baby to observe have a harder time and are forced to confront the idea of themselves as a potentially violent threat or seducer of the new mother. One student I knew actually did sleep with the mother on his observation—this was kept secret from the course leaders who would, I imagine, have failed him. Another student in my group was told that her mother (a classic Freudian slip) hated her because she was dressed too attractively. This idea that she was setting herself up as mum’s rival was certainly helped by her getting pregnant six months in.

Some patients, I know, imagine indifference in a therapist just doing the job, or who might be bored by the minutiae of their daily lives. The opposite is true—it is a strange honour to walk through life with a patient and their menagerie of characters. I know this because I see it in my own analyst’s face as I talk about the girlfriends, university choices and struggles of the baby boy he watched me breast-feed in sessions 19 years ago.