Bearing the not knowing. This, apparently, is what the first session with a new patient is really about. Like a first date. There is no way you are going to be able to gabble out all your stories, unload all your baggage, show all your baby pictures, introduce your parents and wrap up your relationship history over half a bottle of wine and some crispy aromatic duck. These things take time. The quirk that may seem irritating over that first pancake might become incredibly endearing. What looked like standoffishness might turn out to have been nerves, or reservation founded on whatever defences we ourselves might have slapped up to detract from our lamentable deficiencies. All this is true for a first session with a patient as much as it is for a first date (except for the lack of bevs and duck, of course).
The therapist really is looking at what you are wearing, how you sit, how you speak, when you speak, how you deal with sitting opposite someone you don’t know, someone (most importantly and perhaps most terrifyingly) who has offered to get to know you. I have a patient who spent the whole first session, running his hands through his hair and saying things like “you should know this about me,” and “the thing you need to understand about me.” None of these things (that he “tells it like it is” and that he “is a generous person”) turned out to have any relevance to the therapy whatsoever, aside from the fact that he felt the need to say them at the outset. His desire to lay his cards so aggressively on the table made me feel that he was hiding a whole other pack of cards somewhere up a sleeve. He was.
In training we were told to go and scout out the institutional and usually grim room we’d be seeing our patient in, ideally the week before our first meeting. We should sit in the chair, feel ourselves into the role. It was suggested that we might take our own lamp or clock (therapists are enthusiastic clock watchers) to make the room more our own.
I saw my first training patient in a windowless conference room in a massive suburban hospital. The ancient brillo pad carpet was pitted with cigarette burns and only one of the huge, cable-hanging fluorescent strip lights actually worked. I say worked—it flickered, sputtered and buzzed like… well, like an anxious therapist. I positioned two chairs facing each other diagonally in the middle of the cavernous room and sat in one of them. Nothing I could have done would have made this seem like a containing environment… or could my weekly presence itself be therapeutic?
Now the setting has perked up a bit (window, etching hanging on the wall) but the first session nerves are the same. My newest patient arrived on time and smiling. He talked about his education, about taking a lot of drugs at university and how he had just started a new relationship with a woman older than himself. I could have made some interpretation about our new relationship, educating ourselves about each other, his worries that the therapy might mess with his mind like drugs. But I heard my old supervisor’s voice in my head whispering over and over again—“We don’t know”; don’t jump to conclusions. He stayed bright, cheery and in control all session in a way that looked exhausting. Eventually he said: “Sometimes I feel I lack energy.” I commented it must be tiring, keeping up the cheery personality. He looked shocked that I’d noticed and seemed to drop the façade, a bit tearful. It was a mixed first date, but we agreed to meet again.
Anna Blundy is a writer in training to be a psychotherapist. The situations described here are composite and patient confidentiality has not been breached
The therapist really is looking at what you are wearing, how you sit, how you speak, when you speak, how you deal with sitting opposite someone you don’t know, someone (most importantly and perhaps most terrifyingly) who has offered to get to know you. I have a patient who spent the whole first session, running his hands through his hair and saying things like “you should know this about me,” and “the thing you need to understand about me.” None of these things (that he “tells it like it is” and that he “is a generous person”) turned out to have any relevance to the therapy whatsoever, aside from the fact that he felt the need to say them at the outset. His desire to lay his cards so aggressively on the table made me feel that he was hiding a whole other pack of cards somewhere up a sleeve. He was.
In training we were told to go and scout out the institutional and usually grim room we’d be seeing our patient in, ideally the week before our first meeting. We should sit in the chair, feel ourselves into the role. It was suggested that we might take our own lamp or clock (therapists are enthusiastic clock watchers) to make the room more our own.
I saw my first training patient in a windowless conference room in a massive suburban hospital. The ancient brillo pad carpet was pitted with cigarette burns and only one of the huge, cable-hanging fluorescent strip lights actually worked. I say worked—it flickered, sputtered and buzzed like… well, like an anxious therapist. I positioned two chairs facing each other diagonally in the middle of the cavernous room and sat in one of them. Nothing I could have done would have made this seem like a containing environment… or could my weekly presence itself be therapeutic?
Now the setting has perked up a bit (window, etching hanging on the wall) but the first session nerves are the same. My newest patient arrived on time and smiling. He talked about his education, about taking a lot of drugs at university and how he had just started a new relationship with a woman older than himself. I could have made some interpretation about our new relationship, educating ourselves about each other, his worries that the therapy might mess with his mind like drugs. But I heard my old supervisor’s voice in my head whispering over and over again—“We don’t know”; don’t jump to conclusions. He stayed bright, cheery and in control all session in a way that looked exhausting. Eventually he said: “Sometimes I feel I lack energy.” I commented it must be tiring, keeping up the cheery personality. He looked shocked that I’d noticed and seemed to drop the façade, a bit tearful. It was a mixed first date, but we agreed to meet again.
Anna Blundy is a writer in training to be a psychotherapist. The situations described here are composite and patient confidentiality has not been breached
