Psychotherapy works. There are studies that show this and there might be (crap) studies that show the opposite. Someone to talk to for the first time? Having a space in which to be seen and heard? The application of Freudian theory itself? Opinions differ. And in terms of “works,” well, it’s all relative.
But, purely anecdotally speaking, there does appear to be a common trajectory.
First, there’s a period of total denial that the problems that bring us to psychotherapy have anything to do with us personally. So someone with tattoos, piercings and a scowl says he can’t understand why people don’t warm to him. He is outraged at the suggestion that fear might make him need to be offputting. Or a woman who hates men believes it’s because they are uniformly awful, rather than wondering if the hatred has its origins in her. This phase goes on for ages.
Next, when we finally acknowledge that we do have a defensive system (mine was a petrifying combination of the above) we are able to start thinking about what this lead sarcophagus of a defensive structure that we’re dragging around might be for. This is the gruelling stage during which a lot of patients leave (I did—but I crawled back). Looking in the mirror, facing the past and present reality instead of pushing the family propaganda and wailing about the side-effects of our defences (usually chronic loneliness/liver failure) is acutely painful.
But then, for those who can plough through all that, there is a moment when a light seems to go on. It is awe-inspiring and it happened with a patient this week.
She’s been very unwell, with a history of early abuse followed by self-harm and addiction. Two years ago she had no memories at all from before about 13 years old (and she’s only 30). She just wanted a cure for her enraged outbursts so she could cling on to her fantastically idealised new husband. A grim year into angry and silent therapy, during which the only interpretation I could offer was “You seem very angry. You seem to think I am quite hostile,” her memories started flooding back. The early misery she had tried to delete from her mind was appalling to face and perhaps only possible in therapy where at least she wasn’t facing it alone. She was sad because it was sad, but her other symptoms (chronic anxiety, paranoid feelings of persecution) slipped away.
Then, this week, she saw me. She looked at me and smiled shyly when she sat down. She told me she’d been laughing about me with her husband, how I always get the name of the computer game they play together wrong. She heard my dogs in the other room and said: “I love dogs. I’d like to have a dog one day.”
I know this all sounds like minor stuff, but, given where we started, it’s huge. It means she thought about me during the week, making a link between myself and her husband as important parts of her life. Also, I’m fallible and get things wrong, so she perceives me as ordinarily human, neither idealised nor denigrated. The dog thing is no less significant—she is looking forward to something in the future (this once seemed impossible) and it has a link to me. She is saying; “You have inspired me to look forwards in a positive but realistic way.”
Early on I would have been prepared to accept that this patient was simply not going to crack, that her early trouble had produced an impenetrable defence system that was too important for her to let go. But she cracked. And it feels like a miracle.
