Life of the mind: My testing first patient

The first hurdle of therapy
April 24, 2013

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"My patient's delivery is breathless and excited; she is jumpy, often leaping out of her chair to act out a scene from her life"

For 18 months I have been seeing my patient for weekly therapy. She has been assigned to me as part of my two-year training to become a psychotherapist. Our first anxious session seems a long time ago. I was extra early, I arranged and rearranged the chairs, read and reread her notes, adjusted the lighting, practised sitting in my chair in a psychotherapeutic manner. Legs crossed? Arms folded? Scarf on or off? Psychotherapists always wear scarves. On. There is an unspoken rule that female therapists should wear skirts. I obeyed it. But this particular Tuesday morning I was not wildly energetic. My own 50 minutes of psychoanalysis—an obligatory part of training—had been gruelling. I am on the couch five times a week, my male and betrousered analyst sitting behind me with his notepad, occasionally venturing a “quite” (he is Kleinian—you probably wouldn’t get even a “quite” out of a Freudian analyst).

When my patient marches in, plonks herself down, grins and begins her usual monologue about how she’ll soon be a famous actress I feel wearier than ever. Her delivery is breathless and excited; she is jumpy, often leaping out of her chair to act out a scene from her life, and, although she meets my eye, she seems not to see me. She talks. And talks. And talks.

I recross my legs, adjust my scarf and think about the coffee I will make myself iiin... I surreptitiously check the clock... only 8 minutes now! I try, as I have been encouraged to do in supervision, to ignore the content, to concentrate on the effect. How is she making me feel? I decide she is making me feel like a cup of coffee. I wonder if I should take this countertransference seriously. Is she projecting her desire for coffee into me? No, that’s ridiculous. She is making me feel…utterly irrelevant to her. She probably feels as though she is utterly irrelevant to me too.

I remember from my own analysis how baffling it was when he kept on about my feelings towards him. “Feelings?” I thought. “I hardly know you. I don’t feel anything.” Of course, this was rubbish. The way we approach our therapist is usually how we approach everyone else, and being able to examine that without the other person’s baggage is key to recovery. I tune back in.

“I just really need to have a relationship. I know men find me attractive all the time, they look at me and stuff, but I think I mess it up because I get anxious and maybe they just feel like it’s intimidating because I’m an actress. Love is important, all you need is love, you know, like the song. I want to love someone and feel for them and think about them and all those things. I just want someone to love.”

“No you don’t,” I suddenly interrupt. Oh, God. I imagine my supervisor’s wrath when I present this session. “There is no room in there for anyone else. I have been sitting here for a year and a half and you don’t credit me with thinking about you now or during the week. I could be painted blue and you wouldn’t notice. I don’t really exist for you. Nobody else really exists for you.” Mental illness is incredibly lonely.

She stops talking and stares at me, mouth hanging open. She seems almost to disintegrate. Her shoulders relax, she stops tapping her feet, the muscles in her face soften and her eyes unglaze. She looks at me and sees me. Stunned at being in the room with a living person for the first time, perhaps, in years, she blushes and smiles shyly. I too feel awkward alone with her, but I’m extremely moved.

“Hello, at last,” I say, smiling. “Hi,” she beams, her eyes filling with tears.

The situation described above is composite and confidentiality has not been breached