Life of the mind: A theoretical defence

Is training and knowledge of the theory a defence against being a “real” patient?
April 23, 2014

If you are training to be a psychotherapist you have to be in therapy yourself, once or twice a week. If you are training to become a psychoanalyst, you need to be in psycho-analysis five times a week, as I was for many years until I ran out of money. At somewhere around £50 a session, and for a required minimum of four years, this is a vast investment.

The idea of therapists in therapy isn’t just that you need to be fairly sane to see patients. If you go into a session as a therapist and your husband has just left you, you might project and feel that the patient is suffused with loss. You need to know what is whose. (If you have had a terrible experience with a rubbish therapist then it could be just that—or it could be that you are unable to bear the process and feel persecuted by the intimacy, or you could be seeing someone who is not, in fact, a trained psychotherapist.)

So there are a lot of people lying on the couch who have read Freud, Klein, Bion, Winnicott and friends and who want to argue about theory instead of thinking. When I started training I was stunned to find things my analyst had said to me right there in the reading. Once you’re entrenched in the literature of psychoanalysis it’s quite difficult not to refer to people as “the object,” to emotion as “affect,” to tiny babies as “envious,” to safety as “containment” and, if you’re really going for the Freud, to attachment as “cathexis.” These words slip out and baffle patients, the worst one being “narcissistic,” which analysts use to refer to a patient’s fantasy of complete self-sufficiency, but which lay people assume means “you think you’re good looking” and always gives offence (my analyst first said it about 20 years ago and I’m only just getting over it now).

I could tell my patient had something up his sleeve last week because he was looking pleased with himself. “So, I’ve been thinking about the Oedipus complex,” he said. Oh God, I thought, adjusting my therapist’s scarf. Ideal patients have never really linked their current problems to their early life: you help them make the connections and—ta da! They’re better! “You know how Freud abandoned seduction theory?” he went on. (Freud at first thought all his female patients had been sexually abused by their fathers). “So, then he comes up with Oedipus. But isn’t that whole myth just a way of excusing child abuse and blaming the child?” This is a common criticism of Freud’s theory, but most people do have Oedipal fantasies, and you can’t assume everyone was abused. (My son, at two: “Daddy can sleep in the shed and I’ll sleep in your bed and be king.”)

So, trying to stay with the affect—the emotion—of what the patient was saying and not get caught up in the content (the main lesson of becoming a psychotherapist, and harder than it sounds), I said something about his wanting to defend himself against my scrutiny by arguing as equals—so much easier to be a student clarifying a point than a patient in need.

And here is the difficulty. Is training and knowledge of the theory a defence against being a “real” patient? I suspect that most of us who go on to train are hoping it might take some of the agony out of being in the position of a patient. However, reading the literature only sharpens our understanding of the problems and makes being a patient all the more essential. You can only grow out of being a patient by fully allowing yourself to be one. I hope…