A Personal Journey Through Psychotherapy : A Case Study Revisited 9781782411567, 9781780491974

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A PERSONAL JOURNEY THROUGH PSYCHOTHERAPY

A PERSONAL JOURNEY THROUGH PSYCHOTHERAPY A Case Study Revisited

Susan M. Fereday

First published in 2014 by Karnac Books Ltd 118 Finchley Road London NW3 5HT Copyright © 2014 Susan Fereday

The right of Susan Fereday to be identified as the author of this work has been asserted in accordance with §§ 77 and 78 of the Copyright Design and Patents Act 1988. All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording, or otherwise, without the prior written permission of the publisher. British Library Cataloguing in Publication Data A C.I.P. for this book is available from the British Library ISBN-13: 978-1-78049-197-4 Typeset by V Publishing Solutions Pvt Ltd., Chennai, India Printed in Great Britain www.karnacbooks.com

For my children without you—no story And for Cassie with admiration and affection

INTRODUCTION

How does it feel to be the subject of a case study? One that has been published and is available to read in the public domain. Is it possible that, in a psychological sense, the tables have been turned and the private space of “the frame”, designed to encourage honest and open reflection, has been exposed to public gaze? The walls fall away, the spotlight is switched on, and now the subject becomes object, unable to hide or run away? In 2002, I was the subject of a published “Kleinian” case study, and years later, after completing my studies in psychotherapy and counselling, I considered writing my own account of this highly personal experience. I thought about using my newly acquired academic expertise to add some theoretical balance to the endeavour, but I realised early on that there was a downside to this approach. Whilst recognising that the case study provides a valuable insight into the theory and practice of psychotherapy, there is something that can elude us in relation to the behaviour and also the psychological processes of the person in distress. It can be difficult as a reader to make tangible some aspects of the terminology that describe complex theoretical concepts. Therefore, my story is not an in-depth analysis of my experience of individual psychotherapy, but is rather an exploration of the 1

procession of causative factors that, for me, acted like signposts, pointing the way towards a therapeutic intervention. I have written from the perspective of an emerging self. That part of me that was left behind while I grew up, had a family of my own, sought work among people who needed care and guidance, and eventually gravitated towards a career in counselling. My true self was not revealed in convenient instalments within the therapeutic process; it was plunged dramatically into a reality that had only previously been glimpsed at from behind a veil of dusty false layers. It has been important to be able to set my experience of psychotherapy within the context of a lifespan, and in doing so it has been possible to integrate what could have been remembered, possibly with a sense of personal regret, as a transient phase of psychological disturbance. It sometimes seems a shame that matters of confidentiality, and the therapeutic tenet of “letting go” of clients in a healthy way, prevent the end of the client’s story from ever being told. The questions lay unanswered on the therapist’s floor. In a sense, the case study subject is set in stone, he or she remains inert year after year, locked in an emotional drama that is hopefully ameliorated by an effective therapeutic intervention. On paper, the subject is prevented from moving on. But of course, in reality, case study people do move on, they have jobs to do, families to support, and the rest of their lives to get on with. I would like to share the experience of how I was myself able to move on, following a remarkable and intuitively adaptive therapeutic intervention. In order to provide a sense of balance and also the opportunity to compare the personal and the professional viewpoint of an individual psychotherapy, I have taken the opportunity to reprint some excerpts from the original published material. This includes a summary of some of the aspects of practice within the realm of Kleinian psychotherapy and also a complete reprint of the original case example. 2

PA RT I THE INEVITABLE ROAD TO THERAPY

TAKING CARE OF MOTHER

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y earliest memory is not a real memory at all, but rather an event that I was told about as an older child. Over time, the memory grew in size and stature, as second-hand memories tend to, and it required some local research in order to base it in reality. I have held on tightly to this memory for all of my life, I think, because it is the only instance I have of being in affectionate physical contact with my father. It is 1948 and my father is standing at our front gate holding me in his arms, and from here we can watch the opening ceremony of the Games of the XIV Olympiad. These are the first summer Olympics since the Berlin Games of 1936. It must have been a spectacular sight. At 2.45pm military bands begin to play for the 85,000 spectators, a little later King George VI, Queen Elizabeth, and other members of the Royal family arrive, and within minutes the competitors enter the stadium in a procession that lasts for fifty minutes. We are back at the gate at 4pm when 2,500 pigeons are released into the North London sky, announcing the opening of the Games. I was told that we watched the last runner of the torch relay as he entered Wembley Stadium to complete a lap

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on the running track that had been created with cinders from domestic coal fires in the North of England. Real memories seem ordinary by comparison; my brother, who was ten years older, pushing me along the pavement on a three-wheeled bicycle, sitting with our parents on striped deckchairs looking out to a grey North Sea and pretending to enjoy cheese and tomato sandwiches that had been liberally sprinkled with sand from a cold east wind. It was a generally accepted fact in our family that my parents were a handsome couple, not unlike 1950s film stars of the silver screen. My father was tall and slim, with a shock of wavy hair the colour of wet sand, which was complemented, I think, by my mother’s shiny black curls, an attractive blonde streak sweeping upwards and away from the centre of her forehead. Her fitted Fifties dresses showed off what used to be described as a well-turned ankle, and her favourite shoes were almost always white with peep toes and a high wedge heel. I don’t think I ever saw her without matching jewellery, and when she laughed, she threw back her head to show off a perfect set of false teeth (her own had been knocked out in a car crash when she was seventeen). By the time I reached the age of five, I had begun to disappear. This was not just from my special position as the youngest child in our family of four, but also in a sense quite literally. It was an indescribable feeling that would come on quite suddenly and only when I was completely on my own. I would be struck suddenly by the notion that I didn’t know who I was, and would feel compelled to repeat the phrase “I don’t know who I am”, over and over again in my head. Usually within seconds, I would feel a tingling sensation high up in my chest, and this would be swiftly followed by the fear that my body was beginning to vanish. Very early on, I discovered that touching something solid, a lamp-post, a wall, a chair, or best of all a living creature, a cat or a dog, would bring me back into the real world. My heart would stop thumping then, and the 6

fear would slowly begin to subside. I often used to wonder if this sort of thing happened to everyone. At around the same time, the dynamics within our family began to change. The focus of attention shifted away from me and onto an enemy that none of us could understand or compete with. On one particular day it became obvious that our lives had changed forever. We are in a noisy train carriage, rattling along on the London Underground. With no free seats available, my mother holds on to an overhead strap, and I try to hold on to her skirt for support, we laugh at each other as we sway back and fore in unison. At Baker Street, we leave the station and file into a packed News Theatre, and there on a huge screen, dozens of stick-thin people are crouching behind a barbed-wire fence, their faces are dirty and they have dark hollow eyes that gaze straight through the camera and out at us sitting here in our comfortable plush velour seats. In one synchronised movement, several men in the row of seats in front of us drop down onto their knees, and placing their palms together, they begin to pray out loud. The Pathe Newsreel runs its course and we leave, walking hand in hand to a large grey building just a few streets away. A tall man in a dark suit smiles and invites my mother into a room, and I am left sitting outside on my own in a long white corridor. I begin to cry, and after a while someone with a white apron opens the door so that I can go inside and stand by my mother’s side. The man smiles down at me and begins to talk about gold, saying that he will give my mother some gold injections and cover her hands and feet with hot wax. He says that I can watch if I want to. The process has begun: experimental treatments, new drugs that will have devastating side-effects; swollen disfigured joints, useless hands and feet, knees that will refuse to bend, hips that grind audibly, bone on bone, and will need replacing; and ultimately, pressure sores, ulcers, and death. 7

On the surface, caring for my sick mother appeared to centre around practical issues like fetching and carrying, running errands to the shops, buying cigarettes for my grandmother who lived with us in a downstairs room, standing on tiptoes to put the money on the counter in the sweet shop. In the home, bottles, jars, and containers would need opening, coal would need to be carried indoors to heat up the water. There was absolutely no mess to be made in the house, no friends to be invited in to giggle and laugh, run from room to room, hiding and seeking, making a noise and, especially, no pets to clean up after. My most treasured possessions as a young child were mud-coloured sticklebacks, carried home from a local pond in a jam jar, and cared for in a green glass fruit bowl outside in the garden. Beneath the surface, a different story. There was to be found lurking a complex and confusing undercurrent of guesswork, predictions, and judgements that needed to be made on a daily basis. On many occasions, I would notice mother struggling to turn on the kitchen tap, and rising to go and do it for her, my father would fix me with his stare and hiss: “Wait, let her try and do it for herself”. Even as a young child, I can remember understanding that he wanted her to feel independent for as long as possible, but it was tricky getting the timing right. Stepping in too soon would invite a re-buff from father; too late and mother would wear a cool look of disapproval. One of my early childhood tasks was to learn how to be independent both inside and outside of the home. Most of the survival skills I acquired had to be self-taught, sometimes the hard way. Walking along on my own to a new primary school, I decided to take a short cut when, unexpectedly, one road branched off into three and I was hopelessly lost. A kind lady, who had found me standing still on the pavement crying, walked me back to the main road and from there it was easy to run all the way back home again. Our family doctor was 8

just a short bus journey away, and one day on an excursion to collect a prescription for mother’s pills, the conductor unzipped his uniform trousers and exposed himself to me as I was getting off the bus. I felt physically sick, but I managed to push the image out of my mind, I felt too ashamed to tell anyone about it. It was always difficult to tell mother about something frightening that had happened to me in the outside world; she would say “Be careful” in a loud urgent voice, fear widening her eyes, and peace only returning when she could be reassured that everything would be fine. But in reality, things were rarely fine, there seemed to be no place outside the home that felt safe, even at a friend’s birthday celebration. The party is going well, there are a lot of children in the garden, laughing and shouting, running and jumping, and playing rough and tumble. Standing alone near the adults, I silently begin to cry and desperately try to wipe away the tears in case someone notices me. One of the mothers bends down to put her arm around my shoulder. “What’s wrong?” she asks. “I have something in my eye” I lie. She dabs at my eye with a lace-edged handkerchief and when she can’t see anything there, she calls to another mother who comes over to have a look. With my head bent back and two smiling faces looking down at me, I begin to sob. In unison, the two mothers give up and decide to send me back home. “You’re just being silly” says mother. I hoped and dreamed, wished and schemed, that someone would come along and take care of me. I was nearly fourteen years old before he put in an appearance.

9

SCHOOL SHOES

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o and buy some shoes for school”, my mother instructed. Folding two grubby one pound notes into a used envelope, she could see that I really didn’t want to go, but arguing with her was not an option. She was ill. Painfully disfigured with crippling rheumatoid arthritis, she was unable to go out shopping with me. Relentlessly over the years her high cheek bones had been lost to steroid drugs, long and graceful piano-playing fingers had acquired knuckles so swollen that her wedding ring had needed to be cut free, and her elegant footwear had now given way to sensible flat shoes made of soft pliable material that failed miserably to hide her badly deformed feet. Nothing for it but to go alone and search for new school shoes. Raucous laughter, shouting, and chanting cascade down from the upper deck of the bus, and reaching the top of the stairs, there is a sea of tartan oscillating before my eyes. England are playing Scotland at the Stadium this afternoon. Beer from brown glass bottles is spilt as the Scottish football fans sing and shout, and prematurely celebrate their team’s victory. They will lose 5-3.

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Wembley high street is crowded with drunken rival football fans, jeering and shouting at each other from opposite sides of the road. Men in coaches on their way to the match hurl abuse through steamy windows from the safety of their seats. It’s hopeless looking for school shoes in this mayhem, and thankfully the top deck of the bus is empty on my journey back home. The bus becomes stationary for a few minutes at a bus stop, probably something to do with the timetable, and gazing out of the window, I have a bird’s-eye view of a tiny shoe shop window. It’s a half shop really, and there, centre stage on a glass stand, is a single high-heeled shoe the colour of ripe tangerines. I’m out of my seat and off the bus in the blink of an eye. “Size five please.” Weary now, and getting off the final bus of the day, clutching a buff-coloured shoe box underneath my arm, I see him. He’s there, leaning against the metal railings next to the bus shelter. My future husband. He’s tall, over six feet. Eyes the self same shade of China blue as his Levi jeans. His battered black leather motorbike jacket smells faintly of two-stroke engine oil, and sparkling in the sunshine is a metal badge, displaying a skull and crossbones, on the breast pocket, “Death or Glory” in biker speak. He tells me his name is Dan and that he wants to take me to the cinema on Sunday afternoon. A shiver runs down my spine as he tells me he will pick me up on his motorbike. Too shy to speak, I simply nod at him in agreement. I am far too excited for words anyway, and already it feels like, at last, I actually belong to someone. Of course, the orange shoes were confiscated and placed under lock and key in a sideboard cupboard, but I didn’t care. I had a boyfriend. A tall dark handsome boyfriend who I met in secret, to ride around the streets with, on the back of his motorbike. No crash helmet, just a warm summer breeze to tie knots in my long straight hair.

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Teenage years rolled on, and for the briefest of times I enjoyed my new hedonistic lifestyle. But all too soon, my father began to crack under the strain of working full time and taking on the role of main carer for my mother. He would get lumbago, and spend days at a time in bed, often lying on the sofa in the lounge with agonised vertebrae locking him into a foetal position. Occasionally, on a Friday, he would not come home from work until well after midnight, the worse for drink, and having spent or lost all of his wages, which left my mother crying pitifully long into the night. The house felt like a pressure cooker, and one evening I was confronted in an exasperated tone. “You need to stay in tonight or your mother will be left on her own.” “OK.” “You know you’re making your mother ill, keep going out all of the time, don’t you?” “OK, I’ll stay at home more.” “And throw away that glittery eye shadow, you look like a freak.” “OK.” * * * Dan rolls up his shirt sleeve and raises his forearm to show me the artwork. I’m shocked to see a red heart with an arrow shot through it, my name printed in dark blue ink across the centre. He must be serious, this new boyfriend of mine. We ride around London during the day when I am supposed to be in school, usually enjoying a cigarette and a cup of coffee for lunch, but in the evening we have to leave the cinema half way through the film, so that I can be back at home for 9pm. Father is nearly always waiting at the front gate with his arms folded, and checking his wristwatch. At the age of sixteen, I took on a dull office job, working as a copy typist for the marketing manager of a paper bag factory. During the lunch hour, I would rush home to help mother 12

finish washing and dressing, and if there was time, make us a quick sandwich. At seventeen, I persuaded Dan that we should get engaged, and for my seventeenth birthday I had a pretty diamond ring on my finger. Both my parents disliked Dan, saying that he wasn’t good enough for me, but not why. I found their attitude strangely satisfying. I loved Dan very much, and I felt safe whenever we were together. I loved his family as well, they were loud and funny, they would laugh, argue, shout, and sometimes even fight with each other. I was determined to get married to Dan when I reached eighteen and live happily ever after.

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UNHAPPY PILLS

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t’s a girl”, says the nurse. “She’s beautiful.” And sure enough, she is. Dark hair, a pretty little rosebud mouth, and weighing just six pounds. I am elated, she will join her brother who is just two and a half years old, we will be a perfect family. I want everyone to be told that I have had a baby girl, especially my mother, but unfortunately, she has been very ill in hospital for several months now. Two months before my daughter was born, I had set off as usual on my weekly visit to see mother, it was a three-mile walk with my two-year-old in his pushchair. I had found her alone, swaying precariously on the top stair, her speech unintelligible. She was repeating words of one syllable over and over again, her eyes and hands were pitifully imploring me to understand her meaning. Holding her around the waist, I managed to slowly get her down the stairs and into the living room, and then I called for her doctor. When he arrived, he set down his black medical bag and gave mother a pen and a pad of paper, asking her to write down her name and address for him. Smiling up at him sweetly, she drew a small circle in the centre of the page, and then realising that this wasn’t enough, she struck a line straight through the centre.

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Over the next two days, mother became bedridden on the lounge sofa, she was unable to speak and needed help to stand up and sit down. Walking there every day to wash and feed her, empty the commode, shop, and manage her medication, I became totally exhausted. Only then was she admitted into hospital, where it was discovered that a reduction in her steroid medication had caused such a profound effect. It took several months to stabilise her both mentally and physically, but there remained serious doubts about her ability to cope any longer in her own home. Sadness settled around me. We were both in hospital, mother and I, just a few miles apart across London, and I so desperately wanted her to see her first grand-daughter. The prospect of going back to my freezing cold flat with a tiny new baby filled me with horror. On the short journey home, I could see the February snow was banked up at the sides of the road, remnants from a recent blizzard, and watching the traffic struggling along icy roads had an eerie, unreal quality about it. In the ten days that I had been in hospital, it was as if I had forgotten what a busy street looked like, and stepping inside my own front door felt like entering the home of a complete stranger. I was hardly able to recognise the pattern on the carpet or the wallpaper, the colours seemed more intense, and as hard as I tried, I couldn’t remember what it used to feel like to live there. I felt lost in my own home. Where had that feeling of elation gone? Taking care of my tiny new baby daughter now seemed like an impossible task, ridiculous really, when I had done it all before with apparent ease. Back then, I had been able to stir a pot with one hand and cradle a contented baby son at the same time. But now, this poor helpless little mite was making me feel like I didn’t have a useful bone in my body. I clung on by my fingertips for the first few days, but it was fruitless, inch by inch I lost my ability to function in any useful way. Silently, I slipped down 15

into a cold grey place that was steeped in a bleak hopelessness. Clinical depression had made an ugly arrival, and things got much worse. I am standing in the centre of our tiny kitchen, paralysed, frozen with fear and unable to make a decision. Should I try to cook a meal or should I make up a feed for the baby? I realise I can’t remember how to go about cooking a meal, what to do, where to start. Worse still, I can feel panic rising: should I have sterilised the jug I use to mix up the baby’s milk, and should I have also sterilised the spoon? I can’t remember what to do. When, at long last, I managed to venture out to do some shopping, I bumped into a neighbour and she peeped curiously into the pram. “You’ve had your baby, a boy or a girl?” “A girl.” “How lovely, what did you call her?” Endless silence. Panic. My mind has gone blank. Poor baby. I can’t even remember her name. One evening, Dan decided to take me to see our doctor, and I sat silently in front of him, unable to open my mouth or utter a sound. After a while, he patiently told me how I felt. “You’re feeling depressed, can’t see any joy in life. Crying all the time?” He prescribed anti-depressants, which slowed me down to a complete standstill. Some days I would spend hours just trying to remember what day it was. Watching the people around me who were smiling at each other, fascinated, I would try desperately hard to emulate them, but it was impossible, my face had frozen into an unhappy mask. With no visible improvement in my condition, my husband grew impatient and organised a second visit to the doctor, which in turn resulted in a referral to the psychiatric outpatients’ department of our local hospital. One visit per month, a different psychiatrist each time, increased medication, new brands, lots of different colours. When I could remember, I took 16

about nine tablets a day, but each day remained relentlessly the same. Cold, grey, and lacking in any kind of hope. On a long weekend visit to my brother, I forgot to take any of my pills with me, and three days later I realised that I didn’t feel any worse. When I returned home, I made a decision to stop taking them altogether, but fearful that I would be admonished for making my own decisions, I didn’t go to my hospital appointments for several months either. Under pressure from my family, I did eventually return, and as expected the doctor was very cross with me, and he insisted that I start taking medication again, giving me a new prescription which I didn’t actually need. Like a difficult child, I was bribed with the promise that if I complied with my treatment, the medication could be gradually reduced over a longer period of time. Dutifully, I went home and took several tablets, and laying down on the sofa, I fell into a deep sleep that lasted for several hours. I woke up to the pitiful sound of crying children, alarmed that they had not been able to wake up their comatose mother. Furious and angry, I got up to put all of the new pills into the rubbish bin; next, I emptied the bathroom cabinet and flushed all of its contents down the toilet. No more pills, no more hospital, I would try doing things my way for a change. Several weeks went by, and then one day I opened my front door and could see that the sun was shining, the grass looked lush and green, and I realised that I was really glad to be alive. The depression had lifted. Within a single week, I could smile, and laugh, name the day, name my children, cook meals, and plant flowers in the garden. Two and a half years had been lost, but at last it was over. I had two lovely children who suddenly looked like two new little people to me. They laughed and jumped about, we went to the park every day, we joined a playgroup, we made a mess, had fun, and grew happy with each other. While I wasn’t looking, my parents had sold their house and bought a small bungalow near to the coast. My father made a 17

special trip to visit me, explaining that he realised the strain of mother’s illness had become too much for me, and they were moving to be near my mother’s relatives who would be able to help him care for her. He thought I would be happy. I was bereft. He said it was for the best. I was redundant. Although they had moved many miles away, mother’s frequent hospital admissions were always to the same London hospital, and when she was there I visited her every day. Rushing home from work, hurrying the children off to a babysitter, practically running all the way to the Tube station, three changes of overcrowded trains, then out into the freezing cold London streets. Quick, run, visiting hour will be over before I even get there. Mother greets me with bemusement. “Oh, is it cold outside?”

18

ABANDONED

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he phone call came from left field. It was my father speaking in his usual authoritative tone: “Your mother and I have decided to take you and the children away on holiday for a week, it’s a small holiday camp in Great Yarmouth, we’ve booked two chalets.” I was speechless. I knew that my mother was in no fit state to go away on holiday for a whole week. She was wheelchairbound and heavily bandaged, an urgent hospital admission had been requested to treat her badly ulcerated legs, and she would need skin grafts because her tissue-thin skin refused to heal. But they were both determined, and on a warm sunny day in June we set off for the cool east coast. It was heart-breaking to watch my mother trying to enter into the holiday spirit and appreciate her surroundings. The deterioration at the top of her spine had caused her head to bow forward, her chin now almost coming to rest on her chest. Unable to lift up her face, it was only her eyes that could move easily. Swallowing food, drink, and pills had become almost impossible, and with tears in her eyes, she confided that her specialist wanted to put two screws into her head, one on each side, and she would then be spending three months on her back in traction, it would be an attempt to straighten her spine, even if 19

only to allow for the passage of an anaesthetic, should the need for further operations arise. It all sounded horrific, unimaginable, like the last straw in a long line of painful procedures, and I wondered how much more her ravaged body could endure. Despite these dark clouds on our horizon, we did manage to enjoy each other’s company for a whole week. I was happy pushing mother around the grounds in her wheelchair, we had afternoon tea out in the sunshine, and watched the children splash around in the small swimming pool next to our chalets. On the return journey home, we stopped off in London and left mother safely tucked up in her usual hospital ward. It was a huge relief to leave her in someone else’s care. We all slept soundly for two nights, and then on the third day came the phone call. “Hello, there’s a bit of a problem with your mother, can you get here as soon as you can?” My father had received a similar call. We arrived at the same time and sat one each side of her bed. Watching her semiconscious face, we both could see that no-one comes back from that place where she was, and reluctantly we made our way back home, only to receive a call to let us know that she had died without regaining consciousness. My first thoughts were: thank God, no more pain, no more suffering, there was a massive sense of relief. We had all been set free from the tyranny that was her disease. The funeral was a well-attended occasion, and it had a somewhat inappropriate atmosphere of a family celebration, a wedding or christening even. There was laughter and the joyous coming together of old friends, small children ran about, weaving in and out of tables, where adults tried to catch a hold of their arms and make them stay still. Surrounded by so many members of my mother’s family, a small seed of an idea took root in my mind and slowly began to grow. My mother was free now, perhaps I could be too. Dan had been my escape from an unbearable home situation, but in truth I had never liked being married to him. 20

He had turned out to be a very poor father, openly admitting that he wished that he had never had children. He had made no attempt to be supportive either financially or in person, happy for me to bring up the children entirely alone while he worked abroad for long periods. He was moody, sulking for days or sometimes weeks if he couldn’t get his own way. No doubt about it, I would be better off without him, no more arguments, no more unhappy children, sent off to bed early for making a mess, or a worse crime, not putting their toys away correctly. Three months after my mother’s funeral, I told Dan that our marriage was over. His swift response was to leave home immediately, there and then, no discussion, no arrangements made to see the children; he simply vanished into the night. I didn’t tell my father, worrying that he would disapprove of my actions, and a few days later the impact of what I had done suddenly hit home. It’s late November and the light has disappeared hours ago. I am driving the children to their swimming lessons at the leisure centre. The freezing temperature is not helped by the heavy rain, and the car coughs and splutters to a halt at the roundabout. A crippling pain hits me in the chest, like I have been punched hard, stabbed even, I can barely breathe. I’m alone. Completely and utterly alone. What if something happens, if the car breaks down or I get ill? There will be no-one to help me, no-one who cares about me. It made no sense at all, I didn’t even like Dan, and I had asked him to leave, my life ran much more smoothly when he wasn’t around, why on earth did I feel so totally abandoned? Our divorce was acrimonious, verging on violence and abuse, and at one point I went to live with a relative for six months. But eventually, I was free to live my own life, albeit in a tiny house on a shabby council estate. We were extremely poor, but we grew close and were sometimes happy. One year after my mother’s death, my father decided to spend the coldest months of the English winter in Spain. 21

He was lost and lonely now and thought that a few months in the Spanish sunshine would lift his spirits. I wished him well; at the age of sixty-seven, he had never travelled abroad before. Ill health had prevented him joining the army and travelling to other parts of the world during the war years. Several weeks later, an airmail letter fell onto the doormat, it must be from him. Just like the Spanish climate, his conversation was warm and sunny. The Mediterranean Sea was just a few yards from his apartment door, he loved the red and pink geraniums that seemed to be everywhere, in pots on steps and stairs, and cascading down from painted wooden balconies. He liked the shops, the people, the wine, and the food. His words became almost coy, he had met a Spanish lady and they were spending a lot of time together. My father had enclosed a photograph of himself with the letter, in a formal pose, he was standing upright in the yellow sunshine, smart, in a black jacket and a white shirt, casually open at the neck. He had a warm smile, he looked happy. I didn’t know it then, but I was looking into the eyes of a dead man. The day after he posted the letter to me, he had died unexpectedly in his sleep, of a heart attack. He lay undiscovered for more than forty-eight hours, and in accordance with Spanish law, he was required to be buried immediately. By the time I was informed of his death, his coffin had already been placed in a white marble wall in an ancient cemetery, perched high on the hillside of a pretty fishing village, the Mediterranean Sea shimmering blue below. It would be twenty-five years before I could bring myself to visit his grave. Back at home, with no funeral or grave to go and visit, it felt as if my father had simply vanished. I fully expected him to turn up at any moment and demand to know why I had cleared out his flat and given away all of his furniture. Now I was well and truly free. And alone.

22

HE’S ON THE ROOF

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y children grew into adult-sized teenagers, and I needed to find work that would pay more than the faculty assistant salary I earned at a local college. Trawling through the local authority vacancy list, I spotted an advertisement for a residential social worker in a crisis intervention unit for teenagers. Surprisingly, no formal qualifications were required, but it was clearly stated that a background in childcare was essential, as was a good sense of humour apparently. Intrigued, I completed an application form. I had teenagers who could at times be difficult, how hard could it be? The interview was held at the children’s home, a long nondescript building set back from the main road and partly hidden by fir trees. The manager opened the front door and asked me to wait in an L-shaped living room. Making myself comfortable on a well-worn sofa, I looked around. The room was dominated by a full-size pool table where two male staff members were focused on finishing a game. An enormous dining-room table, large enough to seat about sixteen people, occupied the rest of the space. Next to the living room was a gleaming kitchen area, and I could see a middleaged woman in a white housecoat preparing lunch. No sign of 23

any children. Perhaps they were all at school. From the sofa, I could hear a phone ringing, and after a short muffled conversation, a secretary came out into the hallway, shouting at the top of her voice. “Can someone go and collect Adam from school. He’s on the roof.” The interview was a relaxed affair, with most of the questions relating to the basic needs of children, and I answered them all comfortably. I was offered the position, and together we agreed a starting date for the following month. It was exciting. I hoped that I would like the children and that they would like me. I thought that perhaps it would be like being part of a big happy family.

24

MOTHER’S DAY

S

itting here on the same sofa in the living room, I feel the heavy atmosphere in the house. It’s too quiet. Where is everyone? An elderly labrador wanders past and on into the kitchen. It feels odd just sitting here and doing nothing. Perhaps I’ve made a mistake. Maybe this job isn’t for me, after all. I can sense that I am being watched from behind and a cold tingle starts to creep up my spine. Turning a little, I take a look over my right shoulder and there she is. She has to be at least six foot tall. She’s leaning against the kitchen door-frame and staring down at me. I smile and say “Hello”. There is no response. Now I’m really scared. At that moment, Bill, the manager, called me into his office to give me some details of the six children who were currently living at the children’s home. In theory, they had been placed at the unit on a short-term basis, but in reality they could be waiting for a decision on their future for anything up to eighteen months. Bill went on to explain that the staff team consisted of thirteen residential social workers, two senior social workers, two cooks, four domestic cleaners, three night waking staff, one secretary, a maintenance man, and a visiting psychologist who helped to assess the children’s needs for ongoing care and 25

protection. Some of the options for the children were: boarding school, an unpopular choice; secure accommodation, an even more unpopular choice; foster parents; or on some rare occasions, they were able to return to their own homes. Before I had a chance to fully absorb all this new information, Bill went through some of the reasons that the children had been taken into local authority care. Michelle, the girl who had been watching me in the lounge, was remanded on a charge of attempted murder. A girl in her class at school had decided to end their friendship, and carefully concealing a kitchen knife up her sleeve, Michelle had gone into their youth club and plunged the knife into the other girl’s chest, causing a near-fatal injury. Michelle needed to be under strict supervision at all times, and I was informed by Bill that one of my first tasks would be to take her out shopping for some new clothes. A large and heavy stone sank slowly towards the pit of my stomach. The stories continued. Donna had recently been discharged from hospital, having had her step-father’s baby aborted. She was thirteen years old. Terry was fourteen, and following a series of failed car thefts, he had mugged an elderly woman, stealing her purse and leaving her severely injured in a pool of blood outside the post office. Terry’s mother had refused to have anything to do with him after his arrest, and like Michelle, he was awaiting court proceedings. Adam and David were young brothers, just one year between them. Their one-way journey to the children’s home had begun on the evening their mother left them at home alone, while she went out to the pub. During the course of the evening, the boys had decided to make several bonfires in the garden and also one in the house, and even though they had managed to extinguish the fire, there had been extensive damage to the kitchen and hallway. It was well after midnight and the boys were fast asleep in their beds when their mother ran

26

into their room and attacked them with a hammer, fracturing bones and their future relationship beyond repair. Bill’s voice lowered to a barely audible whisper when he saw that Katy had come downstairs, he went on to explain that she had been repeatedly beaten about the head by her mother’s boyfriend. Several brain scans had revealed that there was no lasting damage to her brain, and she had been removed from her home when her mother had refused to evict her violent partner. “Let’s go and have lunch now”, said Bill. My thoughts were in a state of turmoil. I thought: I can’t do this job, I can’t not do this job. How on earth can people be so cruel? I had never heard anything like it. How can their lives ever be OK again? Surely, it’s not possible. Over the weeks and months, I settled into the work but it was emotionally draining. The morning would begin at 7am with getting the children up and driving them to school, hardly any of them stayed there, and very often they would get back before I did. One day, Christopher explained the problem: “When I’m in class, all I can think about is that I’m different from everyone else.” Having been excluded from school, Josie stayed in bed until mid-morning. Often, her sheets needed to be soaked off her arms because she had cut herself during the night. Her delicate white skin was livid from shoulder to wrist on both arms with row upon row of scar tissue. Sometimes the only thing that stopped me from crying was laughing; the children were endlessly entertaining. “Sharron, you can’t wear those roller blades to the doctor’s surgery.” “Yes, I fucking well can.” “OK then, let’s see how we get on.” Of course, we get thrown out, much to Sharron’s delight. She makes a rude gesture at the receptionist as we are ushered out of the waiting room and back onto the street.

27

One evening, I arrived for a night shift and expected the children would all be tucked up in bed. Not a chance. They were all up in the trees that surrounded the home, something or someone had sparked off a mini protest. A major protest would have involved calling out the police, the fire brigade, and probably a local firm to temporarily board up the large shattered plate-glass windows that fronted the building. Three years of working with such emotionally damaged children was enough, and one Mothering Sunday in particular served to highlight the fact that it was time to move on. Three of the children are up early. Washed, dressed in clean clothes, smiling, and chatty. They have each spent all of their weekly allowance on flowers and chocolates for their mothers. Nic asks if he can use the telephone. “Hello Mum. I’ve got you some flowers. Can I come over for a visit?” He throws the phone receiver down hard on the desk, as if it has burnt him. “She said no.” Hurling the flowers at the wall, he runs back up to his bedroom before we can see his tears. Sarah and Leon stop smiling and walk silently out to the car. They lay their flowers down on the front passenger seat as if they were precious babies, and get into the back of the car. Parking outside a small block of maisonettes, I notice Sarah’s mother is standing outside on her doorstep, she’s smiling over at her daughter and looks pleased to see her. As I open the car door for Sarah to get out, a large man in a food-stained vest pushes past her mother and stands just inside the front gate, he folds his arms tightly across his chest. I walk over to where he is standing. “Sarah has come to give her …” He interrupts me before I can finish. “Well, she’ll just have to walk past me then, won’t she?” 28

Looking back at the car, I can see Sarah is crying, she can’t get out of the car, she’s terrified and begs me to drive away quickly. I go on now to where Leon used to live with his mother. Beyond her control, she had sent him to live with his father, who had only managed to look after him for one week before sending him back again. We all get out of the car and immediately see his mother is leaning out of an upstairs window. She shouts down at her son: “I’m not going to open the door for you, go away.” Leon’s shoulders drop several inches, but then they rise up again in a shrug, as if to say, “That’s exactly what I was expecting”. It’s now 3pm and my early shift has ended, the office is littered with flowers, the chocolates have been eaten. Three broken bouquets. Three broken hearts. Time to go home to my own teenagers and cook them a Sunday dinner, appreciate their Mother’s Day gifts, and maybe write a letter of resignation. I have spotted an advertisement for a vacancy in adult social services.

29

I’M LISTENING

P

icking up the telephone on my desk, the receptionist tells me it’s Mrs McGee on the line. “Hello Mrs McGee, how are you?” Straight away, I expect to hear the worst. Her husband Jack has terminal cancer and he has already exceeded his original prognosis by more than six months. Jack’s family have decided that he should not be told how seriously ill he is. Consequently, he carries on as normal, a real force to be reckoned with, terrorising the local community on his mobility scooter as he speeds along the pavement, not a care in the world. A long silence and I can hear Mrs McGee sobbing quietly. And then. “It’s Jack”, she says in a faltering voice. “I’m so sorry, is there anything I can do for you?” Another silence, but the sobbing begins to subside. “Yes there is. Jack’s been arrested for shoplifting, can you speak to the police for me please?” This was the kind of scenario that could crop up at any time in the adult social services team. The nature of the work was to visit people in their own homes and assess their need for services that would help them to live more independent lives. I loved this work. It never ceased to amaze me how readily people were prepared to share their vulnerabilities, their worst 30

fears for the future, and I admired the way they would fight on when their lives had been all but destroyed by illness, accident, or injury. Just like at the children’s home, there was laughter and tears. Visiting a young mother who had just been diagnosed with multiple sclerosis could easily be counter-balanced by a comic situation like Joey’s. Joey, just nineteen years old, was trying to cope with the debilitating symptoms of the most serious form of muscular dystrophy. Sometimes he would fall over in the street and, assuming that he was a drunk, people passing would look the other way as he pleaded with them for help to stand back up again. Living alone in a dingy council flat, Joey’s only companion was a six-foot Burmese python called “Bubbles”. In a rare moment of insight, Joey decided to donate Bubbles to a pet shop in London, because she had become too difficult for him to handle. But Bubbles had other ideas. In the back of a London taxi cab, she had shed her flimsy cardboard box, just like one of her flaky old skins, and managed to create mayhem somewhere along the Edgware Road. Providing services that helped people always felt like a very satisfying way to spend a working day, but there was something missing. In a lot of home visits I noticed that very often people just wanted to talk, and if given the chance to do so, they very often didn’t want any other service. Somehow listening was counter-productive to the work I was supposed to be doing. After one such visit, I became convinced that listening skills would be an essential asset in this line of work. I was visiting David for the first time. Pressing the doorbell for one last time, I have all but given up hope that anyone is at home. As I turn to leave, the front door opens a few inches. I can just make out the shape of a male figure balancing precariously on a pair of elbow crutches. A bit more shuffling and he manages to open the door wide enough for me to go through. We walk slowly towards the 31

back room of the property. He says he was discharged from hospital yesterday and hasn’t had time to get his bearings. It’s a large house, bigger than the average semi, and I can see several areas that will need attention, stair rails, grab-rails here and there, and probably he will need changes to his bathroom. The interview begins as normal, a question: “How are you feeling?” “I have a lot of pain, here, even though I know it’s not really there, it’s bad.” “How did it happen, David?” I can see that this is going to be difficult for him. He explains that he had got up for work really late, and with an important meeting going on that morning he just couldn’t afford to miss his train. Arriving at the station, he could see that his train was already waiting at the platform, and as he hurried down the steps he could see that the doors had already begun to close. It was raining, quite heavy, and as he ran along the platform, he slipped and fell down. He says it was as if everything then went into slow motion, and he slid slowly towards the train, which by now had begun to pull away from the platform. David shuts his eyes tight, as if he doesn’t want to visualise what happened to him next. How his right leg slipped under the wheels of the train. “They had to amputate my right leg, here at the hip.” He points to an empty trouser leg. “What do you think we could do to help you, shall I look around the house and see?” “I’m just so scared.” Silence. Then tears start to roll down his cheeks. He makes no attempt to stop them. Putting away my notebook and pen, I give up all thoughts of assessing the house. Listening is clearly what’s called for here. David talks about the fears that he can’t somehow bring himself to share with his wife. Will he ever be able to take care of his family again? Will his wife still love him now that he has 32

only one leg? What about work, how is he going cope? I don’t offer him any solutions. I haven’t got any. As I get up to leave, he says he feels more able to see things in perspective now, and no, he doesn’t want another appointment, thank you, he will try a prosthetic leg and go back to work part time. Goodbye and, again, thank you for your help. Back at work, I asked my manager why listening wasn’t one of the options that people could choose for a home visit. She was sympathetic to the idea but pointed out that listening could not be measured in the same way as other services. We had targets to meet, budgets to balance, boxes to tick. Our work had to be accounted for in terms of figures, all of which had an impact on staffing levels and funding. And so on and so on. But she did agree that if I could find a suitable course, one that would fit in around my work schedule, she would be glad to support me. I found a course in counselling skills at a local college, one day a week for two years. Experiential and psychodynamic in orientation, the course aimed to teach listening and communication skills to professionals working in health and social care. A focus on personal growth, working with silence, and group work were all part of the package, and I couldn’t wait to get started. An essential requirement of the course was for students to have weekly personal therapy with an accredited therapist. I was somewhat taken aback by this, unable to fully take on board why it would be necessary. My feeling at the time was that I had accrued a lot of experience in a helping profession, not to mention a wealth of in-house training. I had read almost every self-help book on the market, so why on earth would I need my own therapy? Feeling a bit like a fraud, I contacted a local hypnotherapist and asked her if she would offer personal therapy in relation to my training course, she agreed immediately. Her house was enormous, I imagined that she must be very wealthy, and 33

immediately equated this with professional acumen. A small understated brass plaque at her front gate, showing her name followed by several letters, surely was enough to confirm that she would be registered. A few weeks into the course, I wrote in my learning log, “I have started a relationship with a man who lives near me, he is in a wheelchair”, and possibly showing the early stages of a degree of personal insight, I had added “I really like him, I wonder why?”

34

PART II BREAKTHROUGH

“Pam had started a relationship with Tom. This was unlike any other previous affair.”1

1

Cooper, C. (2002). Psychodynamic therapy: The Kleinian approach (p. 78). W. Dryden (Ed.), Handbook of Individual Therapy (4th edn.). London: Sage.

Author’s note From this point on, I refer to myself as “Pam”. This is in order to keep continuity with the original case example.

TOM’S STORY

T

hursday: Who can that be, knocking at this time. It sounds urgent. Opening the door is a surreal experience. I am looking down at the top of a man’s head. It’s Tom, my new neighbour, he lives a few houses away, down the hill. Somehow he has managed to propel his wheelchair up a steep incline and now he has positioned it sideways so as not to roll back down again. “Hi. Pam, I was wondering if you would like to come out for a meal one evening?” A warm smile reveals perfect white teeth, and a split second before he finishes speaking, I blurt out: “Yes, thank you, that would be lovely.” Surprised, we both laugh. “OK then, how about tomorrow evening. I’ll pick you up at seven thirty.” Watching Tom, as he chose the less steep, longer pathway home, I felt sad about his loss of mobility. But at the same time, I did find him very attractive. Confident. Arrogant even, as he free-wheeled his chair back down the slope, head held high, slightly back. With a stab of excitement, I realised that I was hooked. 37

I had heard about Tom from one of my other neighbours. One sunny Sunday morning, Tom had been test-riding a new motorbike. 1000 cc. He had no memory of the crash, only a few blurred flashbacks of the air ambulance helicopter blades whirring noisily above his head. Despite his many broken bones, Tom felt no pain. Not surprising, his spinal cord had been snapped in several places. Friday: it feels strange. Being taken out on a date by someone in a wheelchair. Should I help him to get out of the car? Should I hold the door open for him when we get to the restaurant? On our arrival, the manager holds back the heavy glass door and a waiter discreetly removes one of the chairs from a table for two. We sit opposite each other and we “click”. Our conversation is seamless. On our way home, Tom offers to cook me a meal tomorrow evening. Saturday: I can hear the music as I approach the front door, and through the frosted glass panel I can see a fuzzy dark image of Tom gliding towards me. Flinging open the door effortlessly, he asks me to join him in the kitchen where he is adding the finishing touches to a coq-au-vin. Next, he shows me into the lounge, where candles glow on a small round dining table that he has set beautifully for our meal. I settle into the sofa with a glass of Bordeaux, shimmering scarlet in the candlelight, I can’t remember ever feeling this special. Pouring himself a drink, Tom sits facing me, very close, the toe of his shoe gently brushing against my leg. I have to remind myself that it is only me who can feel it. “Pam, I was thinking I should tell you a bit about my past.” Tom’s story begins when he is eight years old. He and his two sisters are waving goodbye to their mother, just like they always did when they left the house to go to school. When they rushed back in again to tell her about their day, she was not there. Tom’s ashen-faced father explained. “Your mother has left us, and she won’t be coming back home again.” 38

Tom says that he refused to believe that his mother would not come home because he always knew that he was her favourite. For several weeks, Tom would ride his bike around the streets searching for her until the sky grew dark. By then, she was in New Zealand. Her companion, a father of four who had left his family suddenly, without any warning, on the same day. Tom recalls getting upset one day at a friend’s house, the boy’s mother put her arms around him and wiped away his tears. For Tom, it was too much, he remembered how it made him feel. “I felt such a strong sense of shame. I hate it now if people feel sorry for me.” As I listen to Tom telling me about his childhood, something doesn’t feel quite right. It’s the way he’s speaking, it’s almost as if he’s talking about someone he knows and not himself. He continues. His story has only just begun. Tom soon acquired a step-mother, a well-upholstered woman who had eyes only for his father. Tom’s sisters liked her. She was an accomplished needlewoman and would make them pretty dresses out of leftover pieces of fabric. She taught them how to sew and cook. Now it was the girls who were favoured. At sixteen, Tom left home. He lived rough for a few months and then managed to get a job at a hotel in Wales, where, a year later, he met a free-spirited girl with flowers and beads in her hair. After a brief holiday romance, she announced: “Tom, I’m going to have a baby.” His reply: “I suppose we should get married then.” I am eager to hear about the baby. Was it a girl or a boy? What name did they choose? “Two months after we were married, she left me. No warning. She just left.” Big red alarm bells are starting to ring somewhere in the distance. I silence them. “Go on”, I say, leaning forward. 39

The following year, Tom’s young wife returned to their tiny flat and on her hip a beautiful plump baby girl. Tom adored her immediately. “I was so besotted with her, I suppose I didn’t notice the faraway look in her mother’s eye.” Three weeks later, she left him again, this time for good. She didn’t take the baby with her. Tom struggled to bring up his daughter alone for several years. Trying to earn enough money to raise his child and keep a home together, eventually it all took its toll, and he reluctantly came to a heartbreaking decision. His decision was to let foster parents care for his daughter. They were a nice couple who had two daughters of their own, and Tom’s girl grew tall and happy, she liked school, loved animals, pretty clothes, and spending weekends out and about with her dad. Without pausing for breath, Tom begins to tell me about wife number two, this was a spur of the moment thing, and it only lasted for a year. He looks quite proud of himself as he recalls how this time, it was he who had done the leaving. She had made a cutting remark about her new step-daughter on the evening of their wedding, and Tom decided immediately that one day he would leave her. I can’t help wondering about his daughter, and I ask him where she is now. Tom’s voice is barely more than a whisper. “I was visiting a relative when I got the phone call, telling me she was dead.” It was an horrific car crash in freezing fog on a motorway. Tom’s daughter and her foster mother were killed instantly, the rest of the family taking months to recover from their multiple injuries. Months, then years turn into a blur for Tom. A third marriage lasts for a number of years before history repeats itself yet again. The house is in darkness. A hand-written note on the mantlepiece. She’s gone. One year later, Tom goes out on a sunny Sunday morning for a motorbike ride … . 40

YOU’RE TALKING ABOUT AN ADDICTION

M

y studies on the counselling course took on a new dimension once I had met Tom. Not only could I learn how to be a better social worker, perhaps I could also help him come to terms with his traumatic past. Better still, I could help him to have a long-term relationship with a partner who really cared about him, something he seemed to have been consistently denied. On the course, we were at that time covering Freud’s theory of the defences and the general history of the British object relations school. When we watched James and Joyce Robertson’s film about a young boy who went to stay in a residential nursery,1 I thought about my years working at the children’s home. I wished that I could have been more help to them while I was there. Unlike most of the other students on the course, I was unwilling, or perhaps more accurately, unable, to relate any of these new concepts to my own experiences of childhood. I thought I was very lucky, my parents had stayed together until they died, I didn’t have a

1

Robertson, J. & J. (1969). Young children in brief separation, No. 3: John aged 17 months, for nine days in a residential nursery. [Further information can be found at robertsonfilms.info.]

41

divorce or step-parents to contend with, I considered my own childhood to be both secure and reasonably happy. On a superficial level, I did understand the connection between Tom and my mother from the outset. I had indeed been in this situation before. Assembling and dismantling a wheelchair, organising and collecting medication; in fact, I had always involved myself in these kind of tasks that were either impossible or extremely difficult for someone with a major disability to do. It felt normal, familiar, and rewarding, it was what I was used to doing. Unfortunately, what I hadn’t been prepared for was the emotional rollercoaster ride that I was so eagerly trying to find a seat on. When I spoke to my training therapist Anita about Tom, she said that she was really pleased for me, how nice it was that Tom and I had met each other, how good it was for him, that he now had someone to go out and about with. But there were other times when she didn’t appear to be so clear-headed and articulate; on those days, she muddled her words and easily became distracted. I am perched on the edge of Anita’s sofa, describing my relationship with Tom; how we seem to have the same interests, what an amazing cook he is, so independent, how well he drives his car and takes me out to lots of interesting places. Anita thinks it all sounds lovely. She asks me if I feel hot. She feels hot. Shall we go out into the garden where it is cooler, and we can have home-made lemonade and biscuits? It’s a beautiful garden with a large manicured lawn which has been edged with colourful flowers and shrubs. The birds are singing, the sky is clear blue, a perfect summer day. I feel horribly exposed. Out here we are overlooked from the houses on both sides, her family are in and out of the kitchen, and her husband acknowledges my presence with a nod and a brief smile. I wish the session would hurry up and come to an end. 42

Soon after I met Tom, I joined the other students on the counselling course for an emotionally laden residential weekend, we stayed in an out-of-town conference centre. During one of the group sessions, I was shocked to find tears rolling down my cheeks. There had been no warning, just a sudden desire to weep. When I wasn’t able to stop, the tutor gently asked if there was something that I wanted to talk about. I shook my head, “no thank you”. I could think of no reason why I would be crying. Arriving back at home on the Sunday evening, I couldn’t wait to see Tom, and when I arrived at his house, he opened the door straight away. He told me that he had really missed me and asked if I would like to go away on holiday with him to the Cotswolds. Pleasantly surprised, I said yes. Tom’s lack of physical movement was wildly at odds with his spontaneity. At a moment’s notice, he would whisk me off to a smart restaurant in town, or perhaps the theatre, sometimes he would get tickets for a music concert for that same evening. Cosy nights at home were spent huddled up together on the sofa where, skin to skin, I would frequently lose the point of where I ended and Tom began. It was a little frightening, but mostly it felt like a magical experience, a sensation I had not known before, the two of us merging completely into one single being. It was like being lost and found all at the same time. It could also happen when we kissed. There was no doubt about it, I loved Tom more than life itself. I would sacrifice anything for him, his happiness and wellbeing were all I could think about in the coming days and weeks. Our holiday was a perfect delight, it had the idyllic quality of a romantic honeymoon. Not that I really knew much about honeymoons, Dan and I had spent ours in a cold grey rented flat, painting and cleaning until our hands were red raw. No, this was surely how honeymoons were supposed to feel. Driving around the undulating Cotswold scenery, looking for 43

a quaint restaurant to have lunch, Tom and I would sing out loud to Sixties songs on the car radio, laughing and singing at the same time, word perfect. It was like being in another world. Picnics every day, relaxing on a four-poster bed in the afternoons, and champagne every day, before and with our candlelit meals. In close proximity for twenty-four hours a day, Tom and I became psychic about each other’s private thoughts. Tom often used to laugh as he protested, “Get out of my head”, as I voiced something that he had already been thinking about. Our little rented holiday cottage had a stereo, and when either of us chose a piece of music to play, the other would more often than not accurately guess the title. On the journey back home, we tentatively discussed the possibility of us living together, perhaps at some stage in the future. My first day back at work was spent day-dreaming about the practicalities of living with Tom. Maybe he could do the cooking, while I dug the garden. He could operate the washing machine, and I could peg out the clothes and do all of the ironing. I had it all planned out in my head. I could see it so clearly. There would be no problems, it would all run along like clockwork. As soon as I got home from work, I hurried along to Tom’s front door to tell him about my day. But, after ringing the bell several times, it became clear that he wasn’t going to answer. It was odd. His car was parked in the driveway. I walked away confused and upset. Once back at home, I phoned him, and again several times during the evening, but nothing, no response. I was cast adrift, unconnected, I lost track of who I was, and felt unable to make any sense of what was happening. My night was long and sleepless, and after a miserable time at work the following day, I returned to Tom’s house and anxiously pressed my finger on his doorbell. This time, he slowly opened the door and spoke in a flat voice that held no sign of recognition, “Hi”. We drank tea in an uncomfortable silence, 44

and then suddenly: “Look Pam, I don’t want you to rely on me. I’ve never been very reliable.” Like a zombie, I retraced my steps back home and struggled through the next few lonely weeks. Devastated and confused, I tried to find some enthusiasm for my work and a reason to carry on living. Sitting at home on my own each evening, I felt as if I had been crushed, and I was certain that I could never ever be happy again. Tom was the only man who had ever made me feel really special, and I desperately wanted it to go on and on for eternity. Out of the blue one evening, a phone call, it’s Tom, would I like to come over for a meal? I showered and dressed in minutes, put on make-up and perfume, was out of the door and on my way to Tom’s house, heart racing, happy once more. Music is playing, chicken with lemon and rosemary sizzles in the oven, and the table is set. Tom is apologetic for being so distant with me. He pours the wine. Briefly touches my arm. It’s OK. We carry on as before, music concerts, museums, we visit my family, his family, we are a couple, we fit. We can get through this. We will be happy now. A pattern evolved. We would be close and happy for a couple of months, and then, slam, the shutters would come down again. No contact. Silence. No explanation. Just an empty nothingness that went on for weeks. I began to keep a watch on the movements at Tom’s house. If I came home from work and his car wasn’t parked in the driveway, I would be distraught, and anxiously keep a lookout for his return until well after midnight. I felt abandoned and confused, extremely upset that he was with friends and I was alone, it was as if I was being punished for doing something very bad, but I had no idea what it was. I held Tom in my thoughts all of the time. I began to toy with the idea that a different kind of therapy might help me to understand him more, and one day on my course I shared with the group how unhappy I was with my training 45

therapist. One of the other students suggested that I try a local psychotherapist with whom she was very happy, and during our lunch break I looked out the slip of paper and dialled the telephone number of Cassie Cooper. We booked an assessment visit and I began to take personal therapy a lot more seriously. Cassie had trained at the Tavistock Clinic and had been supervised there by John Bowlby. I felt sure she would be able to help me. Following a routine assessment visit, we agreed to meet weekly for the duration of my course. A few weeks into therapy, I spoke to Cassie about my relationship with Tom, describing to her his mood swings, the long silences and withdrawals, about how much I loved him and wanted to take care of him. I seriously believed that she would have the answer to the question that had seared itself into my mind: How will I get Tom to understand that he can trust me? Cassie leaned forward a little and spoke in a slow, gentle voice. “You know you’re talking about an addiction, don’t you?” No, I didn’t. That wasn’t how I saw things at all. I was a grown woman with a very demanding job. Some of my clients were addicts, drink, drugs, glue, it seemed ridiculous that she would think of me as suffering from an addiction. I grew hot. The pressure increased. Cassie asked me about sex. How did we manage? I tried to reassure her that everything was just fine on that front, and that my love for Tom was on a different plane altogether. I told her ours was a meeting of minds, rather than bodies, that was just the nature of things between us. She looked unconvinced, and I saw this as a failing on my part for not being clear enough, that I should be more precise. I berated myself for having such difficulty in being able to explain what I meant. I resolved to try harder. Months passed, a year or more, and my course came to an end. At last, I was able to offer clients at work a one-to-one listening service, where they could explore issues that were important to them. Clients like Angela, who had jumped 46

out of a first-floor window the moment that she heard her husband had died of a heart attack. Her broken feet and ankles had healed, leaving her with limited mobility, but her spirit was broken, she could see no future for herself, having been left behind in a bleak land of the living. Or Matt, terminally ill with AIDS. Matt had no family or friends, and watching his own body gradually wasting away terrified him. He wanted to talk to someone about his unrelenting fear of dying alone and in pain. Providing a service to people in their own homes was by no means ideal, but it was better than nothing. My own therapy with Cassie continued for a while, but after a long break in my volatile relationship with Tom, I decided to stop. I gave up on therapy and on Tom at the same time. My own physical health had deteriorated, and a hospital admission had been arranged. Psychologically, storm clouds were also beginning to gather on the horizon.

47

DISINTEGRATION

“To every session she brings written material …”1

O

n 26 April 1999, I was admitted to hospital for an operation. The other patients on the ward were talking about the television presenter Jill Dando, who had been shot dead on her doorstep that very morning. Distracting us from our own fears, the discussion served to unite us as a group, we shared family details, compared symptoms, and generally enjoyed each other’s company. Five days later, it was time to be discharged back home. Alone. There were several months of recuperation stretching ahead, and despite my best efforts to stay positive, I sank under the weight of loneliness, depression, and eventually despair. My birthday passed unnoticed. No cards or flowers, not a word from Tom. I phoned Cassie and asked her for an appointment the following week, hopeful that she would be able to help me feel more positive. That familiar front door, the silver intercom button next to her name. The anxious wait out on the street. Will she answer?

1

Cooper, C. (2002). Psychodynamic therapy: The Kleinian approach (p. 76). W. Dryden (Ed.), Handbook of Individual Therapy (4th edn.). London: Sage.

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Is she really there? Perhaps she is busy with another patient. Ah, there it is, the reassuring metallic voice spilling out from the microphone: “Hi Pam, come on up”. Her smile is different, it looks warmer and more welcoming than I remember. As if, for the first time, she is really pleased to see me. Taking the usual route down the hallway, passing a tall glass vase of fresh flowers, I push open the door of the small therapy room at the end and stop, unable to move any further forward. Cassie smiles and encourages me to keep going. “I’ve swapped the chair for a couch Pam. Go on in and try it.” Reluctantly, I manage to get both feet off the ground, but it takes a while to feel settled. Then suddenly, without any warning, the truth comes tumbling out, it’s frightening, it’s as if I haven’t been able to speak the truth before. I begin to talk about my disappointment in not making good use of my personal therapy. How I have wasted so much time and money trying to fix Tom, all to no avail. Pointless. I don’t have the energy now to start all over again. I’ve lost out. I’m lost. Towards the end of our session, Cassie speaks in a gentle voice. “You’ve had major surgery, you’re not working, and you’re not seeing Tom. You’re depressed.” She raises an eyebrow as if to say “What else would you expect?”. As I am leaving, I thank her for seeing me so quickly and for listening to me. “I just like hearing people’s stories”, she says with a kind smile. I travelled the short distance back home on auto-pilot, and with a feeling of dread. I unlocked my front door and then closed it behind me. It was like shutting myself in a box. A vacuum. A coffin. Something important was coming to an end, but I didn’t know what it was. With a mug of tea, I sat down on my sofa and stared at the wall. Nothing to do, no-one to see, nowhere to go. .

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Watching the wall, but not really seeing it, goes on for what seems like an age, and then from nowhere it’s there, a barely noticeable flutter, just below my ribcage. A few seconds more and it grows in intensity and becomes a ball, a rotating burning ball, and now I know what it is. It’s fear. Looking around the room, I can see no reason to be this scared. It doesn’t make any sense. The fear increases and rises up to grasp at the back of my throat, and holding my breath doesn’t help. Focusing on the front door, I think it could be out there. I think it could be coming in here to get me. I think it could be the Devil, and then, “Crash”. Like a fragile piece of glass, my mind has shattered. I can see fragments of it rising upwards and away. An overwhelming sense of panic forces me to jump up and pace round and round the living room in small circles, trying to work out what I can do next. I have to be quick. Got it. I’ll write it down. Before it’s gone. I’ll write it down and then my mind will still be here, with me. On paper. Opening the writing bureau, I reach for a pad of writing paper and a pen, and I begin to write. Words appear as if from nowhere, line after line, as fast as I can commit them to paper. When the page is full, I read it back, and in a hurried scrawl, a childlike fairytale is revealed. It begins in a traditional style, “Once upon a time, there were two selves”. As I read on, I am surprised to see that the story is indeed my own. The following is a shortened version. The two selves go their own separate ways, one self is strong, the other weak. One day the strong self looks back and feels sorry for the weaker one, who is struggling to bring up her children alone. The strong self, overwhelmed with guilt, goes back to rescue the weaker one. At the end of the story, the two selves are re-united but, like Hansel and Gretel, lost in the forest, they don’t know where to turn for help. “I know”, says the strong self, “we can take 50

our story to Cassie, I know she will help us because I saw her eyebrows move.” I felt a strong affinity towards the story, but the way it had come about frightened me. I wrote “END OF STORY” at the bottom of the page in capital letters, and shut it away in the bureau. Wandering from room to room for the rest of the day, I felt extremely anxious, I didn’t know what I should do next. Every now and again, I would rush to the bureau to add a few more lines to the story, sometimes it was just one or two words, and after each entry I wrote “End of Story”, underlining the words now, several times. As the story grew, I resorted to locking the bureau, frightened that someone may come in and steal my mind. In the early evening, I dialled Tom’s phone number.

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TWO REALITIES

“

H

ello Tom, how are you?” “Oh, hi Pam” (He’s lost interest in me.) “My friend Sasha is staying with me.” (He’s in love with her.) “She’s having to sleep on the sofa in the lounge.” (She’s sleeping with him.) I could hear two conversations going on at the same time, and regardless of what Tom said to me, I knew what he really meant. I felt as though I could read his mind. Despite having lost my own mind, I looked upon this extra-sensory perception as a bonus, and my anxiety and fear were temporarily replaced by a notion of power and influence over others. The following day, I phoned Cassie to ask her for another appointment, soon, and without question she agreed to see me. Shortly before the appointment, my daughter phoned to say that she was feeling depressed. As a single mother of a new baby boy, she was struggling to cope. Unable to go outside without having a panic attack, she was now having a recurring dream about rabbits, she had hundreds of them, in cages, and she wasn’t able to feed them. “It’s OK, I can help you, I know what’s going on here”, I said with confidence. 52

Intrigued, she agreed to come for a visit at the weekend, but as soon as I put down the phone, I was overcome with a feeling of panic. Was I too crazy to help to her? She could be harmed. But I knew the truth, surely I should be able to share it with her. Going to see Cassie is a double-edged sword, I desperately need her to help me understand what has been going on, but at the same time I think she may pronounce me mentally ill and refuse to see me again. But it’s OK, she lets me in with a welcoming smile. She is curious to know what brings me back with such urgency, and with a sense of trepidation I give her my story about the two selves. She handles it very carefully and takes her time to read it. When she has finished, she carefully hands it back to me. “It’s free association”, she says confidently. “Something I’m very used to dealing with.” “Is it OK for me to help my daughter?” I ask, terrified she may say no. “Yes, of course it’s OK for you to help your daughter.” I am in safe hands. We arrange to meet regularly, and Cassie says I should bring my writing with me. Even so, I watch her like a hawk, just in case she is saying one thing and meaning another. I don’t mention my problem with the television. In the relative safety of my own home it was proving impossible to watch television. The moment I switched it on, messages came to me from all directions. It could be something insignificant like seeing a number three on the screen and in a split second I would link together all kinds of unrelated events in sets of three. It wasn’t the same as thinking. At the speed of light, dozens of images spontaneously appeared, seemingly from nowhere. At other times, it could be a name, a colour, or even a particular hairstyle, the process was exactly the same, a startling array of links would group themselves together without me having to make any mental effort at all. I was constantly surprised by the process. It felt clever, no, more than 53

clever, it felt as though I had suddenly become a genius, an all-seeing, all-knowing special being. I was able to produce and link together events from my past that had long, long ago been forgotten. In between therapy sessions, I continued to write profusely. Sometimes it was long lists of single words, seemingly unrelated, but at the time they made a pattern that reassured me that my mind was still functioning. On one list, I wrote down all of my academic achievements since childhood, it was vitally important to write only single words, one underneath the other. One of my most important lists was written hastily on the back of a supermarket receipt, and I recited the words to myself over and over again, it was remarkably reassuring on a physiological level, temporarily holding the fear in check. Religion became very important over the next few weeks. Out walking my dog in the park, I would look up at the sky and feel an overwhelming sense of euphoria, as if there was a balloon in my chest that just carried on expanding. I was at one with an all-powerful God. We were superior beings because only we knew the whole truth. We could see into people’s minds and we knew what they were thinking. A most striking phenomenon at the time was my ability to enter into a magical, mysterious world of superior truths, on the one hand, and then be able to have a mundane conversation with the milkman on the other. This ability to switch realities seemed like a superpower in itself. My daughter comes to visit, and she explains how having a baby on her own is beginning to feel like a disaster. I can see that she is struggling. I smile. Tell her that this baby is a gift from God, and we must be very proud to have him here with us. I make an announcement to her, it’s something that I have earlier written down on one of my lists: “He is our prize.” She is amazed, my daughter. Tears spill down from her eyes. The hood of the pram goes down and the baby is carefully lifted 54

out. We pass him back and forth, taking turns to hug him and kiss the top of his downy head. * * * Almost fourteen years later, I asked my daughter if she could remember that day and what had happened between us. I asked her to write it down as if she were there, and as if it were only yesterday, this is what she recalled: I arrive at mum’s house exhausted by the effort to get here in one piece, and contrary to all the visions that followed me here, of dying, crashing the car and being found out, I am here in one piece. Unusually there is no reassuring wave from the kitchen window, I am disappointed because I need it today, just to get out of the car and arrange the pram, the baby, the bags, and all my other newly acquired accessories. He has a name but I don’t like to use it in public, it doesn’t seem real, he doesn’t seem real, or at least as if he doesn’t belong to me. I am at my mum’s because she will make it all okay. I knock on the door and there is no answer, and another fear takes over that she might not be there, why would she not be in on this day when she wanted to see me. I go round the back of the house and I see her sitting at her dining-room table scribbling furiously on a notepad. I can feel there is something wrong, but I need her to be okay so that I can be. “Shall I put the kettle on?” I ask her. She doesn’t move from the table, so I go and stand behind her and look over her shoulder. The writing is just scribbles, reams of paper with random thoughts in big angry letters or little tiny ones, as if she didn’t want anyone to see what they said. I can see she is not writing a letter. This is something far more serious and very out of character. I put my hand on my mum’s shoulder, and she looks around for the first time and gives me a familiar look, a look that my

55

mum would usually give me, and I show her the baby with no name and no presence. She takes him off me and studies his perfect form, holds him up like an award, and his legs dangle. Immediately, he is real. I start to tell my mum how I can’t breathe and how I don’t know how to be with this third baby. Can I call him what I want and take him everywhere with me? What if someone wants to take him, or tells me that I can’t keep him, or that he’s just a bastard and no one cares about him? Listening for a while, she says in a calm voice: “He is our prize.” We start to say his name over and over again, and it starts to fit him. I feel less breathless, and he feels bigger in the room. She takes him round the garden to show him all the flowers, one by one. I watch them through the window, and I know I will be okay. We never really spoke about that day again. It was just an important day that I feel stuck us back together again in our roles of mother, daughter, and family.

* * * Some days, I would wake up early in the morning, and clutching at the fragments of a fading dream, write pages of painful recollections from my childhood. One particular dream produced a memory of being left at a neighbour’s house when I was a very small child. I sobbed as I remembered watching her children playing together happily, and feeling heartbroken that I could never be in a family like this one. Something new had happened. Not only could I reproduce the memory on paper, but along with it I could feel the emotion that had been too painful to acknowledge at the time. These were the kind of stories I took to therapy. Cassie insisted that I read out my own writing to her. It was extremely tough, sometimes taking me the whole fifty minutes to get through a single page, choking on the words, 56

sobbing uncontrollably. Very often, I would drive to my therapy sessions an hour early, and sit outside in my car, leafing through my lists and stories, deciding which one to read out loud. It felt safe to be near Cassie. Back at home, strange experiences continued. It’s early evening. I’m sitting at my dining-room table and in the chair next to me sits the Devil. I can see him. Not in a flesh and blood sense, but I do have a clear vision of him sitting there, and he’s smiling at me with a kind expression on his face. I like him, the Devil. He has soft pale grey hair all over his face and body, piercing red eyes, no horns. He doesn’t speak. But no matter, I know what he is trying to tell to me. My telephone starts to ring. I’m not sure if I should get up to answer it, but I do, and it’s good to hear the cheerful, chatty voice of a colleague from work. We talk for half an hour. Normal talk about work, my operation, her holiday, and so on and so on. When we finally finish, I go back to the dining table and he’s still there, the Devil, waiting patiently for me to return. We sit together for a long time. No words are spoken. At the end of the evening, I have discovered a universal truth, and I know that I am the only living person to know it. The truth is: “The Devil is good and the Church is bad.” The rationale is very clear. People go to church to confess their sins and pray for forgiveness. They expect God to make things better for them, and consequently they don’t actually take any responsibility for themselves. The difference with the Devil is, if you don’t face up to your own truth, it’s simple, the Devil gets bigger and bigger until in the end he is sitting right there with you in your living room. When this happens, you are forced to face your own truth. I find it difficult to believe that I am the only person to know this truth. It seems so obvious. Unsurprisingly, Tom featured heavily in my writing. I wrote an apologetic note to Cassie about taking so long to let her know that I had visualised him as a devil, one with horns and a swishing forked tail. Not at all like the devil I had met with. 57

Once I had “come clean” about this, Tom took the full force of my fury, and eventually my pen revealed how he had replicated for me my childhood pain, in terms of never being sure of whether or not my parents loved me. Dealing with Tom on paper felt enormously powerful, my sense of strength seemed to come from my ability to contain this hatred, without having to act it out like I used to do. At the beginning of August 1999, my period of recuperation had expired, and it was time to return to work. Physically, there was no reason for me to still be at home, but I was filled with doubt about how I was going to cope. My early morning appointment on that first day back was to carry out an annual review of a care plan that I had previously arranged for a young disabled man. I was terrified to be going back into the real world when I didn’t feel ready. I had no idea how the visit would go.

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BABY STEPS

D

riving the car on my way to work was unusual, hard to describe, but the car seemed to be heavier, more solid. Suddenly I had become a better driver, making positive moves, and quick decisions in the early-morning rush hour. I felt safe. Unfortunately, this new feeling of confidence began to disappear as soon as I parked the car, a short distance from my first client of the day. Standing on the pavement, I realise that I have forgotten how to walk. Rooted to the spot, I look around, wondering what is going on. Looking upwards, I can see an ultra-blue sky, the bright sunshine has created rays of white light that are bouncing off the leaves on the trees that line the pavement. It looks like the leaves are made from pale green glass, and they sparkle like Christmas tree lights. I’ve never experienced anything like this before. Looking down at my feet, I can see that one foot is starting to move forwards. It rests on the pavement, and then the other foot slowly begins to take a step. Smiling, I’m thinking that this must be how a baby learns to walk, watching themselves as they try it, and then seeing that it works, they repeat the movement and take another step. It is as if I have never walked

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before, these are my very first steps, and slowly, slowly, I make it to the front door and press on the doorbell. Much to my amazement, the visit is a success. I can hear myself talking like a professional person. It’s easy. I can do it. After the visit, I sit in my car and write down my strange experience of learning how to walk again. Gradually the routine nature of being at work each day replaced the mystical world that I had inhabited while I was at home. Also, my colleagues didn’t appear to notice that I had changed. Working with clients took on a different quality, there was a calmness within me, an easy direct honesty that I had not known before. To myself I sounded like somebody else. Cassie had told me that it would take time to adjust, and she was right. One evening, after a long day at work, the telephone rang. Nobody there. No message. I knew who it was immediately. Tom. I could sense his presence down the silent line. The following evening, at exactly the same time, he phoned again and invited me round for a drink. I thought, “I’m different now. I will be able to handle him this time.” It’s 18 August, and I make a note of my visit to Tom in my work diary. Walking to his house I have a confident step, which begins to slow down the nearer I get to his door. Questions bounce around in my head. “Why am I doing this?”, “Is it just to see if I can?”, and “How hard would it have been to say no?”. No time to find answers, Tom opens the door. I haven’t seen him for five months, he’s looking sun-tanned, happy, and healthy. As if there has been no gap in our relationship, Tom pours the wine, he’s friendly, charming, a little seductive. I’ve missed him. A lot. After a couple of hours, I notice that something has dramatically changed. It is as if I have left a significant part of myself at home, and it’s interesting that it is a part that I

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am looking forward to going back to later. It feels like there is someone at home waiting for me. We spent every evening together until the end of August, it was a lovely hot Indian summer. On most evenings, we ate al fresco under a warm red sky, citronella candlelight making the champagne glasses sparkle. I knew it couldn’t last, but it no longer mattered, I could enjoy each moment for what it was, without desperately wishing that it could last forever. Therapy continued, albeit less frequently, and Cassie asked me if she could use my story as a case example, in a book that was to be edited by Windy Dryden. I happily agreed, curious to see how I would look “in print”.

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MELANIE’S EXAMPLE

C

assie hands me a weighty book; no need for us to speak, I know immediately what it is. Peeping inside the front cover, I can see her generous words waiting to greet me: “To Pam, with admiration and affection, Love Cassie.” It feels a little like a literary analogy of our relationship. I gave her my story and now, after I have done the work, digested the affects, walked through the fire, met with the Devil, cried thousands of tears, she gives it back to me in a form I can accept. A priceless gift from a remarkable therapist. As I thank her for the book, and start to leave, I am taken back to that day two years ago, when I had stood in this same spot thanking Cassie for listening to my story, and now here I was thanking her for writing it. For a few seconds, I allow myself to feel like her favourite child, the only one worthy of her special attention. Briskly I leave her and find my car, placing the book on the front passenger seat, like it was a very important passenger. Back indoors to the same sofa, another mug of tea, I search for Cassie’s contribution on the contents page and settle down to read. Like an actress scouring the early morning papers for a favourable review, I am eager to read what has been written about me. 62

Starting at the beginning, I am surprised to see that Cassie has written from the Kleinian perspective, and even though I have seen a draft of the personal details that will be included in the example, I wasn’t expecting this. My knowledge of Melanie Klein comes from my counselling course, and my memory is that she worked as an analyst at the “deep end” of early childhood disturbance. As a group, we had found her terminology harsh and difficult to connect with, and we had not chosen to dwell on the good breast and the bad breast, or her concepts of early childhood sexual aggressive tendencies. Reading about Melanie Klein the person is very illuminating, she had been an unexpected baby, as I was to be, and she also had an older brother to whom she looked for validation and affection. Serious health issues had affected the family dynamics, and most strikingly, she had been disappointed and disillusioned with her marriage, which, like my own, had been besieged with financial problems, ending acrimoniously with bitter arguments about custody of the children. Reading on through the theoretical assumptions of the approach, I quickly become overwhelmed with a barrage of half-understood terms and descriptions about the early roots of psychological distress in adult life. Associating myself with “schizoid mechanisms” and “projective identification” is impossible on this first reading, but some of the smaller phrases jump out at me, “fragmentation of the self”, and how early disturbance affects the child’s ability to develop normal relationships with other objects, toys and animals, for instance. This puts me in mind of my treasured childhood teddy bear. The teddy bear had been a present from my maternal grandmother on my first birthday. We are in a railway carriage, me and my brother, mother and father, travelling to a seaside bed and breakfast hotel for a short holiday. I am clutching my teddy close, but noticing an open window in our carriage I am overwhelmed with a desire to throw him out onto the railway line, so he will be crushed under a train coming the other way. I hold 63

on to him very tight, but continue to imagine him in pieces on the track. Teddy somehow manages to get left behind when we get off at our stop, but on the return journey my father takes me to the lost property office at Waterloo Station and we spot him, he has a ticket pinned to his chest, it says “one shilling to pay”. I still have him. I skip to the case example, and quickly read through the section where I am presented as “the patient”, and the first thing that strikes me is how accurate and coherent my life appears on the page, I read about it with interest, almost as if I wasn’t there myself. After all my jumbled words, silences, accusations, recollections, memories, and regrets, it all makes sense. My mother’s illness is described with a depth of insight that takes my breath away. Gratitude sweeps over me as I appreciate how Cassie has presented things from my mother’s point of view. She had been unable, in her lifetime, to acknowledge how her illness had affected her ability to mother me, although I think that maybe she did try once. I’m at home and not long recovered from a lengthy depression, mother has moved miles away from me, and I am really missing her. The phone rings, and as I pick up the receiver, I can hear a woman crying, and soon I realise that it is my mother. “What’s wrong?” I ask her, frightened that she may be hurt. “I’m sorry” comes the reply. “So sorry”, she continues to cry uncontrollably. “It’s OK. Don’t worry. Everything’s fine.” I reassure her. We never mention this incident again. She takes her apologies with her to the grave. Cassie describes my parents with respect, no blame is heaped upon their shoulders, they look like two people caught up in a situation beyond their control, victims of circumstance. As I am reading the section where I begin a relationship with Tom, a thought occurs to me, “Tom and I will be linked together forever, just like in a real love story”. It is reassuring 64

to think that whatever happens to us in the future, we will always be together side by side in this book. I feel a sense of omnipotence creeping in, I’m covertly famous. For years to come, this book could find itself laying around on coffee tables, standing upright on serious students’ bookshelves, in libraries, and if I have understood correctly, available for purchase on the internet. I want to shout out loud “Look, this woman here is me!”. But is she, though? So many of my personal details have been changed, it’s quite difficult to recognise myself. It’s me, but not me. I like the sound of my imaginary career, but at the same time I would prefer my work with social services to have been acknowledged. Conversely, I wish my children and grandchildren did not have to appear in the presentation, but they are integral to my story, so they have to be present. It’s quite bizarre. In some ways, the case example could have replicated my childhood experience of being “the silent child”, spoken about, but not able to answer back. “Seen and not heard” had been a common expression when I was young. But in fact, the reverse is so, verbatim excerpts from my own writing have been used extensively in the case example; Cassie has held on to them for me, as I still find them unnerving. My sense of pride in seeing my own words on the page is oddly counterbalanced by a strong wish to clarify what I meant to say. I feel anxious that perhaps I just sound mad; will anyone really understand what I was trying describe? In summing up, Cassie describes my frightening experience of losing my mind as a “catharsis”. An “outlet to emotion afforded by drama”, or by “abreaction”, so says the Oxford English Dictionary. Both terms sound like a very accurate description of my experience, abreaction being further explained as “free expression and release of a previously repressed emotion”. Closing the book, I sit and reflect for a while on my reactions to reading the case example. I feel guilty that I am still with Tom, here I am on paper, describing him as the Devil 65

incarnate, when in fact he had clearly been nothing of the sort. I feel I should try and make it up to him, but at the same time I also feel that I should have moved on somehow, and no longer needing to be in a relationship where I could be viewed as a carer. No more time to ponder, Tom is cooking a meal, if I don’t hurry up and get ready, I will be late. We sit eating supper, the case study sits between us like an uninvited guest, I can’t share it with him, and it has already started to feel like a wedge. I am worried about our long-term relationship, will it be able to withstand this secret intrusion?

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PART III INTEGRATION

BACK TO SCHOOL

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very once in a while, I would revisit my story in the Handbook of Individual Therapy. At one year post-therapy, I had been left with a burning question: “What had really happened when I lost my mind?”. It was tempting to dwell on the word “catharsis”, a word Cassie had used when she spoke about my compulsion to write. The definition of catharsis was pretty accurate in terms of my experience, but nevertheless, the definition did not quite capture the essence of my experience, there was something missing, something tantalisingly elusive, and for my own peace of mind I needed to find out what it was. Along with catharsis, there were some other words that had been used in the explanation of Kleinian concepts that I struggled with. The “paranoid-schizoid position” and “projective identification” sounded like symptoms of mental illness to me. I had heard about psychosis and psychotic episodes from my work with mental health patients at social services. It was all getting a bit too close for comfort. There were some Kleinian concepts that did resonate, both in terms of my childhood experiences and actions that I had taken later on as an adult. “Greed” and “envy” were two such terms. If anything, the guilt I felt about my previous behaviour 69

was what kept me still attached to Tom. Not for one moment had I considered that he may have been depressed or struggling to cope with his physical difficulties. If Tom was unavailable, for any reason, I quickly became consumed with panic and rage. From my point of view, it felt as though he was withholding something essential from me, a deliberate attempt on his part to make me suffer. There were many memories that I now felt ashamed of. It is 7.15pm and Tom should have been here fifteen minutes ago. A delicious meal is waiting for him. It has taken all day to finalise the perfect menu. An unusual starter, one he hasn’t tried before, a roast for the main course, something he doesn’t bother to cook for himself, several cheeses, and the most expensive bottle of wine I can afford. He’ll be here any minute now. He’ll be so impressed with my efforts. At 7.40pm, I knock on his door. Slowly he opens it, and uses a flat voice. “Oh, hello Pam.” “I’ve been waiting for you to come and have dinner.” “Oh, sorry. I don’t feel up to it this evening.” Without further discussion, I turn to walk back home. Panic and then fear turn to anger before I can get back indoors. I must take action immediately, before I am overwhelmed. I forget to breathe, I am flaming hot, my reflection in the mirror is scarlet with rage. Find something quick, quick. Post-therapy, it was possible to look back and see how out of control my behaviour had been, and consequently a new way of reacting became a possibility. The new me would remind Tom that he should phone me if he changed his mind about a dinner-date. In a more generous and understanding mood, I would probably offer to bring the meal down to him. Either way, I would no longer rush home and search for an article, a gift from Tom, anything, a box of chocolates, a piece of jewellery or an ornament, and smash it into a thousand pieces.

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Grinding, pounding, gouging, sometimes cutting, until the article had all but been annihilated. Only then could I breathe. “Envy” was a different kettle of fish, and had been a lot more difficult to recognise in my own personality. It had been, for me, a consistently frightening emotion, heavily impregnated with a sense of loss that was so deep, it actually caused physical pain. An unbelievably destructive force, that had had the devastating side-effect of spoiling all of my relationships from early childhood. It’s the beginning of the school holidays, a lovely hot summer day, and Uncle Jim is coming to collect me on his motorbike and side-car. Mother is too ill to take care of me, so I will spend three weeks with my cousins, Jenny and Josie, who live in the country. What fun we will have. Horse riding, making perfume in the garden from sweet-smelling old English rose petals. There will be lots of outings to places of interest, all three of us girls crammed into the side-car. Uncle Jim arrives alone, and we set off on the route out of London, the wind blowing through my hair, the smell of old leather as I hold on tightly to the belt on his jacket. No backward glances. I’m free. We sit at the kitchen table on a warm evening, tired after an active day. Uncle Jim and Auntie Elizabeth are passing food around, who wants potatoes? Peas? They laugh with their girls, a family joke that I don’t understand. In unison, they turn and smile at me, they want to let me in on the joke. I begin to cry. I’m upset because they are so happy. It’s something I can’t ever have, and I want to go home. Home, where this sort of thing doesn’t happen. By adulthood, envy had become second nature, more often than not creating confusion rather than pain. Looking around at my female relatives and friends, I would wonder why it was that they could attract nice, loving partners, men who really cared for them. I couldn’t have what they had. I was certain of it. It was in my blood. My bones. My DNA. Just like I couldn’t

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have black skin, or blue eyes, it was a given. I couldn’t have someone who really loved me, and I didn’t understand why. There was no doubt about it, I was a much better person after therapy. I was on an even keel. I felt genuine, real, no more highs and no more lows. Perhaps it was enough, I thought, why bother to delve deeper? Why not just get on with things? Enjoy life. But the question remained. It didn’t take long to find a post-graduate course in psychotherapy and counselling. I loved learning. In my younger days, it had taken me six years, on a part-time evening course, to complete a BA degree in art and design. Having received the starting date and term times, I browsed through the rest of the paperwork and was surprised to see that The Handbook of Individual Therapy was considered to be recommended reading. I was inside a book on my own book-list. How strange. On that first day of term, I entered the college feeling both anxious and excited. I walked up the old stone steps, down the corridor, around the corner, and there was the book, sitting on the top shelf in the bookshop. Looking around the tiny bookshop shelves, I struggled with the feeling that I couldn’t be in two places at once, up there as a case study, and also down here as a student, learning how to be a therapist. It seemed like a very big gap to bridge. Term one focused on psychoanalysis, and each week we looked at one of Freud’s famous cases. Students were asked to volunteer to present a paper each week, and it was impossible not to wonder if people were sitting around in classrooms, somewhere, at this very moment, talking about me. Feeling uncomfortable and set apart from the other students, I pushed these thoughts to the back of my mind. The tutor’s voice rose above the noisy chatter at the end of the lecture: “I need a volunteer to present a paper on Kleinian therapy next week?” My heart began to race. It was usual, if nobody volunteered to make a presentation, the tutor would choose someone who hadn’t taken a turn yet. Keeping my eyes focused firmly on 72

the floor, I heard one of my fellow students speak up: “OK. I’ll do it.” Temporarily relieved, I spent an anxious week wondering what I would do if my story was chosen for a class discussion. Would I “confess”? Should I? Would they believe me? Did it really matter? Yes, it did, it mattered very much, so much so that I suddenly felt as though I shouldn’t be there. I didn’t have the right. My newly discovered confidence began to ebb away. Resisting the urge to stay at home the following week, it was an anxious moment waiting for the presentation to begin. The student had decided to copy some information from the internet, and rather than an actual case, he presented a rather critical view of Melanie Klein’s theoretical concepts on early childhood disturbance. There was an air of negativity around during the discussion, nobody wanted to dwell on Kleinian theory for very long, and there was no debate at the end of the presentation, we simply moved on to another topic. I felt strangely let down, and suddenly protective of Kleinian therapy.

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MY SELF

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ne week into the second term and a class discussion, the lecturer poses a question: “Is there such a thing as a self?”. The discussion gets underway, we consider “yes”, we do have a self, but we have different opinions about where it can be found. We laugh. It’s funny. The very word “itself” is set in our language: himself, herself, myself, but we were unsure of where to locate it and how to describe it. I think fondly of my little story about the two selves, and realise with a jolt that I didn’t used to have a self, myself, but now I do. All of a sudden, it’s perfectly clear. Once I had nothing but space inside, an emptiness that was quite unrelated to loneliness. Events in the outside world went straight to my head, no stopping along the way to be looked at, considered, weighed up, or rejected. Now, it was as if I had a whole other person inside of me, someone who listened, advised, was always kind, and, most importantly, always “there”. Our discussion continued, some continental philosophers are introduced, Søren Kierkegaard, Friedrich Nietzsche, Edmund Husserl, and Martin Heidegger. I was enthralled, a whole new area of study had just opened up, and I was certain now that this was the right place to be. Our lecturer was describing how Heidegger had used the term “angst” to 74

describe a dread of something that could not be named, “an encounter with nothingness”. I grew cold, thinking about the fear that had engulfed me moments before my mind had shattered, I remembered it as an insurmountable fear that had no focus. Towards the end of the lecture, another moment of epiphany. My childhood experience of disappearing was something much worse than I had originally thought. I now realised that it had been a sense of never having existed at all. A terrifying encounter with nothingness. It also occurred to me that I couldn’t summon up this feeling now, even if I wanted to. It wasn’t long before I came across other explanations of a similar nature. Despite having been a follower of popular culture in the 1960s, I had never heard of R. D. Laing, but I sat up and listened to him now. Interested in the man himself, I read John Clay’s biography A Divided Self,1 and found that Laing had described his own experience of “going to pieces” on a daily basis during his first year of life. In his own work The Divided Self,2 Laing had written about “existential birth”, a secondary process where, in an ideal world, the infant gains a sense of being real, of living in time and space, and becoming a “whole” individual with a basic core of “ontological security”. Initially, I didn’t understand this term, but I instinctively knew that like Laing, I had acquired the other kind. Ontological insecurity. From Laing’s point of view, ontological insecurity was a legacy passed down by inadequate parenting. My parents were long since gone, and it was only possible now to speculate on their own particular style of parenting. Several years in personal therapy had given me the means to

1 2

Clay, J. (1996). R. D. Laing: A Divided Self. London: Hodder & Stoughton. Laing, R. D. (1960). The Divided Self. London: Penguin.

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thoroughly examine my childhood experience of having had a very sick mother, and a father who focused all of his attention on her wellbeing. It was time to revisit John Bowlby’s theory of attachment,3 with a question: how had my early sense of self been affected by the care I received from my parents? Bowlby’s concept of a secure base felt like an old friend. The idea of two parents providing a safe haven from which their offspring could go out and explore the world had appealed to us all on the counselling course a few years back. At that time, I thought how lucky I was that, although my mother’s illness had been difficult to deal with as a child, at least she was always there, waiting for me when I got home from school. This belief had enabled me to focus all of my attention on the secure bases of other people. Tom, for instance, whose secure base had been turned upside down by an abandoning mother, and some of the children I had worked with, their secure base had shut them out, locked the door, and forbidden them ever to darken its doorstep again. Post-therapy, my own childhood base had begun to resemble a very shaky structure indeed. I am about ten years old, and arriving home from school I am hoping that mother has had a good day. Opening the back door, I see her immediately, standing in the centre of our tiny kitchen. Her face is red and blotchy from crying, and as soon as she sees me, she holds out her arms. Taking hold of her hands, I look down and I can see the cause of her distress. She has tried to remove some bandaging from her leg and, in doing so, a large area of tissue-paper-thin skin has come away. There is a gaping wound on her shin and she is in agony. She doesn’t know what to do, and neither do I. I was always anxious about what I may find when I arrived home. Sometimes the house would be empty. No note, no clue 3

Bowlby, J. (1988). A Secure Base: Clinical Applications of Attachment Theory. London: Tavistock/Routledge.

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as to where mother may be. On the rare days that she was feeling well and mobile, she would go out shopping, and I would sit in the kitchen waiting for her to return, watching the clock until the room grew dark, terrified she may never come back again. I could by now recognise myself in Bowlby’s description of the anxious avoidant child,4 unsure of being responded to when seeking care. The very idea of seeking care felt strange to me, when in reality, from an early age, I had been the care provider. I felt familiar with some of the features of the anxious avoidant child; an attempt to develop emotional self-sufficiency, and later on in life, showing an ability to live without love and support from others. I knew these characteristics well, they fitted “like a glove”. Bowlby’s theory of attachment5 speculates that when severe, the anxious avoidant person may be diagnosed as narcissistic or as having a “false self”. Although the term “false self” was fairly new to me, I had always been aware of having “two layers”. A friendly and compliant exterior, coupled with an inner core, or column as I used to visualise it, of steel. I was always very proud of this ability to appear friendly and charming on the outside, while at the same time having access to a hard centre that protected me from getting hurt. I thought of this as my inner strength. Now I could see that something or someone very small had been hiding deep inside all along, isolated, lonely, and sad. Melanie Klein’s concept of the schizoid position had been easy to grasp when she spoke of very young infants. But I had found it much more difficult to recognise in my own behaviour

4

Bowlby, J. (1988). A Secure Base: Clinical Applications of Attachment Theory. London: Tavistock/Routledge. 5 Bowlby, J. (1988). A Secure Base: Clinical Applications of Attachment Theory. London: Tavistock/Routledge. 6 Laing, R. D. (1960). The Divided Self. London: Penguin.

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as an adult. But now, looking at Laing’s theories of the inner self and the false self system,6 I couldn’t fail to connect his descriptions with my own hidden self. Laing spoke of a compliant component of the false self system which protected the real self from extinction. In forthright language and terminology, he goes on to describe some of the major characteristics of both selves. The false self system also protects the real self’s sense of omnipotence and freedom. Everyday life feels futile and meaningless to the false self system, bodily experiences and actions can be dreamlike and unreal, and all the while the real self is hyper-alert, watching out for threats of destruction. I knew this one. The party is noisy, everyone is either laughing or talking to someone else, while I sit here alone on a chair by the patio door. I can’t just keep sitting here, people will pity me, I must move. Where can I go? I know, I’ll go to the bathroom. I need to mentally talk myself through this, right, here goes. “The creature gets up and walks to the living room door.” “The creature is now opening the door.” “The creature is walking up the stairs.” I had found this kind of self-talk incredibly reassuring. The most important thing about referring to myself as a creature was how anonymous it made me feel, no name, no description, just a creature. It was as if my mind was telling my body what to do, how to move, where to go, and this helped to make my actions feel real. I could then move around with a sense of purpose. If I didn’t do this in times of stress, I would feel as light as a feather, dizzy, and in danger of falling down. Similar to my experience at the birthday party when I was a small child, as an adult I would be, as Laing would describe, hyper-sensitive to the fear of being an object in the eyes of others.7 It was so true, I could feel pierced to the centre if I suddenly became

7

Laing, R. D. (1960). The Divided Self. London: Penguin.

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the centre of someone’s attention. I felt as if they could see right inside of me, and I would burn scarlet with shame and embarrassment. A year into my training, and I was constantly surprised by my new sense of self. I was a real person, living in a real world, with real feelings and responses. I could now make balanced decisions about what was best for me, which was fortunate, because Tom had proposed. During one of our intimate evenings, he had suddenly turned to me and asked, in a gentle voice: “Pam, will you marry me?”

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THE DREAM CATCHER

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t had taken a long time to get to this point. Seven years, in fact, since Tom had first knocked on my door introducing himself, and I still didn’t know what to do about him. I had been besotted, bedazzled, and bedevilled. Adoring, idealising, and addicted. Then came disintegration, followed by serious therapy, and now change. Cassie’s case example, telling our story, still stood in the space between us, creating a rift, it was as if I knew a secret that I was not able to share with him. A further difficulty was that I could now feel real empathy, it was no longer just a theoretical concept that I had picked up from books. Tom had recently opened a cupboard door and saw that what he wanted was on the top shelf. Momentarily, forgetting that his spine was broken, he tried to lean forward to stand up, losing his already precarious sense of balance, he fell out of his wheelchair onto the kitchen floor. I felt sad to my soul for Tom, it was heartbreaking to watch his determined efforts to live his life as normally as possible. I loved him very much, and agreed to marry him. There seemed to be no other choice. I couldn’t bring myself to let him down. We searched for somewhere to live, visiting properties for sale on most weekends. They all turned out to be unsuitable, 80

some had too many steps, others had an inaccessible garden or garage, and soon it began to feel like an impossible task. At the same time, my college course continued. A new term begins and analytical psychology is on the timetable today. An image is projected onto a white screen, in fact it’s ten small square pictures, erotic and medieval in appearance. I am spellbound. It looks as if there could be a powerful message contained here in these mystical little woodcut prints. Our lecturer carefully explains the significance of the symbolism in each of the frames. It’s incredible. It sounds like he’s describing my own experience of psychotherapy with Cassie. It is the same process of transformation that was unfolding here right before my eyes. I am surprised to hear that the author of this work is Carl Gustav Jung. Jung had produced an essay in 1946 entitled “The Psychology of the Transference”, in which he reproduced these images from a sixteenth-century alchemical text called the Rosarium Philosophorum.1 The images show how a king and queen undergo a sequence of changes in their relationship and emerge anew. After a decade of studying alchemy, Jung believed that he had stumbled upon the historical counterpart to his own particular theories on the psychology of the unconscious.2 The images tell a story. The king and queen represent the chemical transformation of matter, and they are first seen fully clothed with their left hands touching, symbolising the awkwardness of their union. They discard their clothes and, now naked, confront each other without illusion. Immersed in an alchemical bath, they are engulfed in a psycho-sexual union from which a newly formed androgynous being is formed, the new being is not viable, and following its death, it undergoes decomposition. By not abandoning the transformational

1 2

Jung, C. G. (1946). The Psychology of the Transference. London: Ark Paperbacks. Jung, C. G. (1995). Memories, Dreams, Reflections. London: Fontana Press.

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process, the soul of the androgyne ascends to heaven, but it soon returns to its body on earth, and is reborn, standing upright in its divine glory for all to see. From my own memory of therapy, It had been awkward meeting Cassie on that day when our “real” relationship began. The nakedness of the royal couple symbolised for Jung the opportunity to move towards wholeness, and for me it described how I had stopped being defensive and allowed myself to be vulnerable to the process of psychotherapy. The next step of the story translates in psychological terms to the emergence of the self, and for me, this is exactly what happened. Cassie and I had entered into a new kind of relationship, one that we were able to immerse ourselves in, and this led to the emergence of my own self. The excitement I felt about this new insight was tempered by the realisation that I could not go through this process of transformation with Tom, our relationship was doomed to remain the same, and unable to be born anew. I was constantly being reminded of this. I am holding the heavy restaurant door back so that Tom can negotiate his way through the opening. Once inside, the manager comes over to tell us that all of the tables are taken, but soon some people will be leaving, and would we like a complimentary drink while we wait? Tom immediately spins his wheelchair around to leave, but I persuade him to stay. He huffs and puffs, swears a little, and then we sit in silence. I take hold of his hand and tentatively speak. “Tom, why is it that you don’t like waiting?” Angry eyes fix me with a stare that chills. It feels like an age before he answers. “I don’t know why. I just don’t.” His response sounds like an accusation. A table is now empty, and we are served with our meal, but the evening is ruined. Silence surrounds us, and I can see that beneath a forced smile, Tom is incandescent with rage. 82

At college, I looked forward to learning more about Jung, and during a class discussion a remark about Jung’s “creative illness” caught my attention. I rushed down to the college bookshop, glanced briefly at the Handbook, and came out with Memories, Dreams, Reflections.3 I read with amazement about Jung’s life during 1913 to 1917, following his break with Freud. In his own memoir, Jung described how he became disorientated during this time, and following dreams of his childhood self, he returned to playing games with building blocks. These games released in Jung a string of fantasies and visions, he began to write them down, not only that, he felt compelled to write them down in the style selected for him by his unconscious. Jung also spoke of his determination to endure this experience and how he had managed to keep one foot in the real world, by maintaining ordinary relationships with his family. Just like the Rosarium’s tale of transformation, Jung’s mystical experiences sounded like familiar territory to me. Jung held that the visions and fantasies that materialised from his unconscious placed a great responsibility on him. The choice was clear, work towards greater understanding, or face a painful fragmentation, like others he had known. In 1946, both Jung and Melanie Klein were writing about the experience of fragmentation: The various ways of splitting the ego and internal objects results in the feeling that the ego is in bits. This feeling amounts to a state of disintegration.4 Consciousness is depotentiated and the patient is at a loss to know where his personality begins or ends.5

3

Jung, C. G. (1995). Memories, Dreams, Reflections. London: Fontana Press. Klein, M. (1946). Notes on some schizoid mechanisms. In: The Writings of Melanie Klein, 1975. [Reprinted Virago, 1988.] 5 Jung, C. G. (1946). The Psychology of the Transference. London: Ark Paperbacks. 4

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My own personal experience of disintegration was starting to become separated from my current studies in psychotherapy and counselling. Lectures, class discussions, and assignments about narcissism, schizoid personality types, and borderline patients had become about “them”. To be able to look for these traits in others, it felt as though I needed to forget about them within myself. In training therapy, I could now be more honest about what was going on in my mind, but in college time, out of necessity, I always felt one step removed from the subject. Learning about Jung’s “illness” and how he had been determined to integrate his experience with his life and work, brought me up short, and made me realise that I still had work to do. A quote from Petruska Clarkson pointed me in a direction that I was certain deserved further investigation. Jung in particular gave birth to a psychology which was not based on the mechanical but on an appreciation of spiritual or transpersonal dimensions …6

Keeping in mind Jung’s vision of a lifetime journey towards wholeness, I searched for a new therapist, and I was lucky enough to find someone nearby who practised from a transpersonal orientation. My therapy took a path that looked eastward, and I discovered an enormous sense of joy and illumination in the journey. Isla adeptly joined me in my dreams, and there we found all kinds of interesting creatures. I begin to tell Isla about a dream I had last night. “Stop”, she says. “Close your eyes, if it helps. Speak slowly, be there, tell me now what do you see.” “I am standing outside the gates of a zoo, they are open and an animal runs out into the street, he stops, looks around and

6

Clarkson, P. (1995). The Therapeutic Relationship. London: Whurr.

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then runs off. I follow him. There is something about him that I find very attractive.” We spend the rest of the session discussing what it is about this animal that fascinates me. At first, I don’t know, but then slowly, slowly we capture his essence. He is confident, strong, in an “up-front” kind of way, but he’s not intimidating. He is black, as black as night. His muscles are well defined but his movement is graceful, fast, he knows exactly where he is going. Isla suggests that I draw a picture of him and bring it along to the following session. I pin him down on paper, my creature of the night, and by the end of the week, he was perfect. Isla laughed when I told her that I just couldn’t get him black enough, and in the end I had to tip out a whole container of mascara to achieve the required finish. We talked on until I recognised and owned his qualities: grace, strength, and confidence in my own body. We practised breathing, we looked at chakras, and eventually I became, in Laing’s terminology, embodied. I took another course of action that I hoped would be a step in the right direction: I moved fifty miles away from Tom.

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THERAPY REVISITED

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y childhood experience of not knowing who I was continued on into adult life, and only stopped when I started therapy with Cassie. The experience itself had grown over the years, and began to arrive at any time. It grew more frightening. More intense. No longer satisfied with holding on to something solid, I would challenge the sensation, look in a mirror or shop window, hoping each time that I would recognise my own reflection. But it was fruitless. I could see a person, but couldn’t feel any connection with them. Over time in therapy, I came to feel like an actual person, recognisable to myself, physically real and existing in the world. In therapy, it was the little things that mattered. “Cassie, I’m so pleased, the bank has agreed to give me a mortgage.” “Well yes, you’re a professional woman.” A slightly raised eyebrow underlines the point. Her words were important, they confirmed to me that she had taken account of who I was. I could never have referred to myself as a professional woman, I always felt like a fake in whatever role I was trying to assume. But more significantly, the slightest movement in Cassie’s eyebrows was hugely important to me, sometimes it was barely noticeable, 86

but I would pick up on it straight away. To me, it was a sign, a powerful sign that my words had made an impact on her. It confirmed that she was being genuine in her response, and not just pretending to be interested in what I had to say. This barely noticeable glimpse of body language was what compelled me to take her my little story about the two selves. I instinctively knew that she would understand what my story meant. My first therapist, Anita, had engendered a different kind of relationship. I realised early on that she provided very few boundaries to speak of, and strangely, because of this I felt more oppressed, trapped in an uncomfortable situation that I was unable to get out of. Her house was huge, the sofa enormous, and I felt like a small ornament in an ocean of Anita’s personal artefacts. One day I went to a therapy session with Anita immediately after a particularly humiliating experience at work. Returning to my office base, following a home visit, I ponder the possibility of getting an increase in funding for Mr Johnson. His health has deteriorated and he doesn’t want to go into a care home. One extra visit a day will probably keep him in his own home, but unfortunately he has reached the ceiling in terms of funding. Writing a short report, I manage to make a good case for supporting him, and a quick phone call secures a meeting with the head of care services, only she can make the final decision. She looks particularly stern today, steel-grey hair cut short in a severe bob, a look on her face suggests that she really doesn’t have time for this today. I grow hot. It’s like someone has opened a furnace door. I can feel my skin, scarlet with blotches that creep up my neck and face. I muddle my words, desperately try to remember what it was I wanted to say. Questions are fired at me like bullets. I can’t answer them. She makes an effort to be polite, and speaks in a quiet voice which for some reason is worse than shouting. 87

“Why don’t you come back, when you can be more specific about what it is you want?” Anita thinks this is no problem. She suggests that I sit back, relax, and close my eyes. She says she is going to talk to my unconscious. And so she does. But my unconscious refuses to listen to her, and as I leave I pay her my fee, with a mixed feeling of disappointment and resentment. Although I felt seen and heard by Cassie, I remained confused by the way she didn’t seem to understand some of my actions. During our first year, I constantly tried to impress her with the various efforts I made to free myself from my obsession with Tom. On one occasion, I mentioned that I had changed my telephone number, so that Tom could no longer contact me. She was cool and measured in her response, whereas I had predicted that she would be pleased with me. I wondered why she couldn’t appreciate that I had taken a positive step by not having to sit next to the phone for hours on end, waiting, hoping, and praying for Tom to call. Her lack of enthusiasm was very disappointing. These were the kind of interactions that I had found difficult to understand when they were described in her case example, within the description of “projective identification”. My earlier understanding of this process was of how we become aware of our own unwanted characteristics in others. When I discovered that some theorists had described the concept as an interactional activity that was designed to make the other experience the projection,1 bells started to ring. I remembered a conversation from the early days of my relationship with Tom. We are sitting in Tom’s kitchen, having tea and biscuits. His dark eyes twinkle as he speaks in an intimate tone. “Pam, I’ve never felt like this about anyone before.” Even though I desperately want to, I don’t believe him. Tom has had many 1

Bion, W. R. (1959). Attacks on linking. In: Second Thoughts. London: Heinemann.

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lovers before meeting me. How could this be so? But, as if he has seen the doubt in my face, he goes on to qualify what he has just said. “I can’t explain it properly, but it feels like caring for a child”. I think it’s a really sweet thing for him to say, but somehow it doesn’t sit right. I’m not a child. What can he possibly mean? There was another phenomenon, even more baffling than the notion of Tom caring for me as if I were a child. He often appeared to copy my body language. If I made a sudden movement, like running my hand through my hair, within a split second Tom would do the same. A sudden laugh, clearing my throat, leaning to one side, all seemed to have the same effect on him. Sometimes I had the unnerving sensation that I was looking in a mirror that had a very slight time delay. When I learned about the concept of “mirroring”, within the mother/ child relationship, I became convinced that Tom was doing it deliberately. There seemed to be no other explanation. I needed help to unravel all these tangled threads. … patients in psychotherapy or analysis are often unconsciously seeking a needed development-enhancing response from the therapist.2

Therapy didn’t need to be perfect, but it did need to be long term, patient, and adaptable, to be able to provide the right channel for the only way that I could find to communicate my dilemma. Despite my early resistance to the therapeutic process, I believe that I unconsciously recognised in Cassie someone who could help me to understand who I was. Eventually I grew tired of the power struggle, of trying to surprise and impress her. My operation, depression, and a sense of despair must 2

Mollon, P. (1993). The Fragile Self: The Structure of Narcissistic Disturbance (back cover). London: Whurr.

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have removed the last strands of resistance, and her words “I just like hearing people’s stories” must have provided a catalyst for a sudden and cathartic expulsion of anger, aggression, grief, and loss. When my false sense of self disintegrated, she managed to contain the fragments that were left behind. She held onto an expanding collection of my stories, lists, and letters, as if they were of national importance. The most valuable gift of all must have been Cassie’s encouragement for me to develop my own psychic skills, so that I could rely on them in the future. For me, this was the epitome of freedom. And then there was Tom. Post-therapy was a very exciting time, as if someone had presented me with a brand-new personality to play with. Like a sculptor with a new block of marble, or an artist with a blank canvas, I recognised my own personal responsibility in deciding which direction I should choose. Just as Cassie had been a vital linchpin in my psychological development, in a parallel process, so had Tom. I slowly began to accept that marriage to Tom would seem like a backward step to all the hard work that had been done. Painful work that Tom had no intention of taking any part in. I could not bring myself to blame him for his resistance, he had already suffered enough. My relationship with Tom continued at a distance, a gap that widened both physically and psychologically over time, until eventually, I took to the sea.

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F REE TO CHOOSE

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break from studies at Easter was much needed. Getting around on the London transport system had been miserable for years, terrorist attacks had made everyone suspicious of their fellow travellers. It was not uncommon for a simple journey to take twice as long as it should, and would often result in a scenario that involved a shrill voice over the intercom, announcing that an unattended parcel had been left at the next station, the train standing still for an age in a dark airless tunnel, and people beginning to sweat and stick together in unlikely poses. An invite to a partially habitable farmhouse in southern France sounded irresistible, and a small orange and white aeroplane delivered me into the welcoming arms of a childhood friend and her husband. Once we had caught up on too many years of neglected friendship, it seemed only polite to offer to earn my keep by weeding her vegetable patch. Horticultural skills are unnecessary, it’s all weeds. Digging and pulling, poking and hoeing, is hard work, a white Sussex chicken comes over and cocks her head to one side, a beady eye scanning the earth for worms. A distant call breaks the silence, it’s lunchtime.

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Red wine, a large baguette, and several cheeses adorn the garden table, crimson red grapes and pale green apples complete the picture. A neighbour calls in, and he is invited to join us for lunch. His name is Marcus. The men talk about work, cars, computers, and I pay little attention, but then one word stands out above all the rest, “Laverda”, an Italian motorbike, I look up and our eyes meet for the briefest of moments. Lunch is over, time to return to the vegetable patch, but before Marcus leaves he asks for my address, would it be OK to write to me? Yes, it would. I like writing too. A few days after returning home, an airmail letter arrives, and slowly, slowly, a love affair begins. At first by letter, and then with each of us crossing the Channel in turns, days of discussion, holding hands, long nights of passion. Exhausting, exhilarating, unexpected, and a great deal of fun. In time, on a hot Sunday afternoon, a text message appears. “Would you like to come and live with me in France?” “Yes”, was my simple reply. I didn’t doubt for a moment the long-term potential of a relationship with Marcus. A reciprocal relationship, something I had only read about in books and watched from a distance, wondering why I had been excluded from such a pleasure. I took time now to watch what was happening between us, let things unfold at their own pace. I had found that real relationships were more about what you don’t do than what you do do. We had taken turns to write letters, neither one of us trying to excel, enthral, entertain, or seduce the other into entering into a competitive race against time. Dozens of letters passed each other on their journey from one country to another. Words that described our everyday life, the weather, friends, children, pets, places of interest. I asked myself again and again, am I being tedious here? Will he be bored with me? Old habits died very hard indeed. I no longer needed to be manipulative or controlling, but I hadn’t

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forgotten how. But I managed to stick with what felt slightly uncomfortable, and seeing that it worked, a deep friendship materialised, a friendship with a future. Visits were also of a reciprocal nature; we alternated, neither one needing to prove they were more keen than the other. Each making sure the other was warm, comfortable, well fed, and safe. It was the strangest sensation, having these most basic of needs provided for me. I stifled the urge to resist, again taking time to notice the little things that come together to make up a genuine relationship. Marcus bought comfortable slippers for me, a hair-dryer, a pretty flannel, and soap that smelled of lavender. My needs were taken into account in a way that I had not experienced before in an adult relationship. I didn’t need to make anything happen, I was able to be patient and wait for something wonderful to occur. Having always been predisposed to fantasy, I allowed myself a visual interpretation of my feelings for Marcus. I have been in a long, long queue, waiting patiently for what feels like an eternity for a Marcus of my very own. When I reach the head of the queue, I am told “Sorry, we don’t have one for you”. I walk away, my head bowed, ashamed, a pit of emptiness in my centre so deep it threatens to engulf me. I stop, look up, someone has called out my name. I turn and go back to the head of the queue, and I am told “Look, we have found one, there was one here for you after all”. This is how I felt about Marcus, an inner sense of joy so complete it was enough, if I didn’t live to see another day, I knew I would die happy, satisfied that in the end there really had been someone waiting in the wings to love and take care of me. I would go to France, but before starting a new life, I needed to draw a line under the old one. “Tom, I’ve met someone and it’s serious.” “Oh.”

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We spend the evening not talking about our parting, or of the years we have spent in our on and off relationship. Ten in all. We part with a kiss, a smile, and a self-conscious wave that I think will be our last. I feel like the abandoning females from Tom’s past, his smile looks false, his eyes dark with …, I don’t know, perhaps it’s fear, sorrow, or maybe it’s anger.

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JOURNEY’S END

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f course, there is no real end to the journey, while there is life there is story. When Cassie was finalising her case material, I remember her saying that the editor had reminded her of the temptation of providing a happy ending. I only realise now how right he was. Today, twelve years post-therapy, I am sitting here in France, in my fourhundred-year-old farmhouse, where I am able to cherish the ponies, walk the dogs, chase the chickens from the garden, and wait for glorious grandchildren to come and visit. At the end of our therapy, Cassie intimated that she thought I would meet someone who would adore me, I recall how certain she was of this at the time, as if it were a real possibility. How right she was. “Marcus, I would really like a garden pond.” “OK, I’ll hire a digger.” “No, no, just a little one, a bit bigger than my upturned dustbin lid pond back in the UK.” “You can have anything you want.” If I were asked to encapsulate the essence of my encounter with psychotherapy, I would not use the written word, instead I would use a photograph.

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The photograph has been around for as long as I can remember, and every now and again it would come to the fore, as certain photos do, as if they have an important message to tell us. I must have looked at it a hundred times pre-therapy. I would see a picture of a small girl smiling at the camera. I knew on one level that the girl in the photograph was me, but at the same time I could feel no connection at all, no recognition for who she was. She looked just like a stranger. Recently I was searching for a newspaper cutting in an old suitcase, and I came across her once again. This time I was stunned. It was as if I had stumbled upon a most valuable piece of treasure, and I studied the picture in every detail. It’s a professional photograph that shows a beautiful girl sitting on a stool. She looks about three years old. Her dark eyes twinkle in the studio lights, and she is wearing a smile that seems to come from somewhere deep within, it reveals an even row of perfect little white teeth. Her shiny hair is caught up in a ribbon and her dress has been exquisitely knitted with a yarn as fine as silk. Clutched in her arms is a dolly with plaited hair and a costume of Dutch national dress. I can see a powerful aura of confidence that appears to radiate from around her, she holds her head high, she is her own little person. For me, this reclaimed image is the epitome of the potential of psychotherapy. Along with the photograph, I also noticed an old fragment of paper. It was a section of my father’s indenture papers, a contractual agreement for a seven-year apprenticeship into the bookbinding trade. As with the photograph, I had ignored this small piece of evidence left over from a long-forgotten past. In the section of the indenture that asked for a home address, two words stood out from the page: “boy’s home”. After some internet research, a large brown envelope arrives, it is full of pleading letters, and their responses. From beyond the grave, my grandmother reveals her flair in producing the most beautiful copper-plate handwriting. On 9 April 1925, an 96

official reply to one of her requests shows an authoritative tone: Your application on behalf of your two boys, Richard and Ernest, has been considered by my Committee. We have decided to accept them on your terms of ten shillings a week. Vacancies will be sought as soon as is possible.

On 25 April 1925, grandmother writes another anxious plea. Dear Reverend Father, I am getting concerned regarding the boys going away. I thought you would be able to get them away by last week. I am now feeling very anxious. I need to get this parting over with as soon as possible, it is getting too much for me, and the quicker I can find something to occupy my time, the better it will be for me …

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APPENDIX I

Psychodynamic therapy: the Kleinian approach* Cassie Cooper Selection criteria Only uncommonly aware and brave people seek to know about themselves and to face up to what psychotherapy can reveal. There are many patterns to therapy and many different approaches to the relief of psychic pain. Patients have a choice in the kind of treatment they would prefer, and can and do move from individual to group therapy, from group therapy to family therapy, if they so wish, and in whatever sequence seems beneficial to them at a particular time. In selecting patients for individual therapy, there are criteria that the Kleinian psychotherapist would seek to fulfil: • that the patient has problems that can be clearly defined in psychodynamic terms; • that the patient appears motivated enough for change and insight into their previous behaviour;

* Reproduced by permission of SAGE Publications, London, Los Angeles, New Delhi and Singapore, from Dryden, W. (Ed.). Dryden’s Handbook of Individual Therapy: Fourth Edition © Cassie Cooper, 2002.

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• that the patient has sufficient internal strength to cope with the demands and tensions that are to be created by the process of interpretation and confrontation; • that the patient produces evidence that they are able to accept and sustain a long-standing relationship with significant others in their immediate surroundings. Patients may arrive with little knowledge of how Kleinian therapy differs from other forms of treatment, how the procedure works, and even less knowledge about the outcome of psychotherapy. Initially the therapist will indicate that therapy involves a detailed process of examining and discussing problems. Patients are told that it could be distressing and painful, that there are no guaranteed “cures”, but that they can be enabled to help themselves to identify the origin of their symptoms, the reaction to these symptoms, and the ways in which these symptoms constrict their life. The therapist has the right to decide if he or she is prepared to work with a specific patient. Personal feelings will obviously affect the outcome of an initial diagnostic interview. Conversely, the patient may decide that he or she will be unable to work with the therapist. It is essential to respect the rights of both parties in such a delicate transaction. What is important is that the relationship between therapist and patient can be one in which there is mutual respect, the respect of one human being for another and hope for the potentialities of this other person. This is termed the “therapeutic alliance”. It is hoped that each patient has the capacity to come out of the therapy with the opportunity to love well, to play well, and to have some optimism for the future. A Kleinian psychotherapist finds it most suitable to work with patients whose underlying conflicts are towards the narcissistic side, whose egos have undergone considerable deformation or weakening. Patients may come into therapy

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expressing inability to love or be loved by others, with conflicts about dealing with people in a social, sexual, or work setting, general intellectual and academic under-functioning, symptomatic phobias, anxiety states, or minor perversions.

Therapeutic relationship and style To understand the difference between the Kleinian relationship in therapy with the patient and other methodologies, one must look at the nature of the interpretations given to the patient. Klein changed the emphasis in the analytic process from formal Freudian theories to aspects of material not seen before. She was impressed by the prevalence and power of the mechanisms of projection and introjection, and highlighted the fact that these introjections led to the building of the inner complex being, with its projections that colour the world and our perceptions of reality. Once verbalised and “seen”, as it were, these revelations of our primitive levels of experience can be understood and detected in the material provided by our adult patients. Kleinian therapists are aware that if a patient gains control in psychotherapy, their difficulties will be perpetuated in later life. The patient will continue to live a life constricted by the paranoid-schizoid symptoms which caused them to seek therapy in the first place. It follows that however neutral and laid-back the therapist contrives to be, in successful therapy the therapist maintains control of the kind of relationship that will operate. In all forms of psychoanalytic psychotherapy, therapist and patient are confronted with a basic problem, the problem of object need. Every patient regards the psychotherapist as real, regards all the manifestations of the treatment situation as real and strives to regard the therapist as a

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real object. The therapist too wants to regard the patient as real and to respond to the patient as a real object.1

The primary urge in this relationship is the temptation to turn back the clock, to regress, to restore the symbiotic parental relationship that initially occurred with the mother: to lose the boundaries and fuse, to re-create the past as it was, and return to the time of ultimate dependency, replete, at one, inside the mother. In no way should the therapist confuse the therapeutic function with the parental function. The therapist may give over part of their mind to this experience, since they come so close to the patient’s life experience, but in essence the therapist must also remain detached from it, holding on to professional anonymity. The therapist will be aware of the seductive danger of imagining him/herself (even for the briefest time) as the ideal parent figure for the patient. The therapist uses these skills of awareness and identification to assess and understand the complexities of the interaction of the patient with the parent parts of the therapist.

The change process in therapy During treatment, the patient comes to understand that feelings of aggression and love can be valuable, and so it is possible to value them. Early responses to interpretation which were felt by the patient to be prohibitive, unkind, or unduly harsh, and which tended either to frustrate desire or to punish, permitting, even commanding, the patient to enter in fear and trepidation the forbidden areas of primitive and passionate feelings, these regressive infantile expectations are overcome and

1

Tarachow, S. (1970). Introduction to Psychotherapy (pp. 498–499). New York: International Universities Press.

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replaced by a rationality that can be accepted and understood. Melanie Klein opened the door to insights which enable us at least to attempt to contend with human behaviour. We are confronted in life with a view of ourselves in a succession of social relationships which are disrupted by hatred, jealousy, rivalry, greed, and other destructive feelings. The process of change in therapy enables us at least to establish more constructive relationships. It is said that as Freud discovered the child in the adult, so Klein discovered the infant in the child. Patients change as they become more open and free to acknowledge their constant struggle between love and hate. Facilitated by their therapy, knowledge of the destructive elements that are present in the psyche can lead to clearer judgement, increased tolerance of themselves and others, with the ability to remain in control and to be less fearful. Change can be identified as a desire for reconciliation and reparation. The patient can begin to identify with other people in a caring and sensitive way. The patient can let go of the negative aspect of the painful frustrations and suffering of the past and believe once again in their own capacity to love and to expect to be loved in return. In making this reparation for the past, the patient makes good the imagined injuries both given and received in infancy and moves on to relinquish their guilt.

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APPENDIX II

Case example* Cassie Cooper

The patient Whilst many psychotherapy patients present with a sense of urgency, even of panic, initially I had no sense of this pressure from Pam. A feeling of resolve emanated from her. She knew that she had a problem. “A deep-rooted problem” which she was determined to confront. Pam had been in therapy before, but only for one year. “It didn’t help then.” We are three years into our therapeutic relationship. Pam has agreed that her story can be told. Our initial therapeutic contact was for two sessions per week. After one year, this was reduced to once weekly. Two years on, we mutually agreed to conclude. Six months later, in deep distress, Pam asked to resume therapy. We are still in weekly contact. Of enormous help in the therapeutic process has been Pam’s talent and enthusiasm for writing. To every session she brings written material, recollections from the past and insights into

* Reproduced by permission of SAGE Publications, London, Los Angeles, New Delhi and Singapore, from Dryden, W. (Ed.). Dryden’s Handbook of Individual Therapy: Fourth Edition © Cassie Cooper, 2002.

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her present difficulties. Excerpts from this verbatim material are quoted in this case presentation: they relate significantly to a current relationship which is important and is causing much anguish. A tall, attractive woman, naturally blonde, with dark-brown eyes, trim figure, wide warm smile, and air of gentle firmness. Pam at fifty-two has successfully completed her studies for a diploma in personnel management. Pam was born in 1948, the younger of two children. Her brother Brian was eleven years old at the time of her birth. “I grew up feeling like an only child. We were a mixed-up family. My mother was Welsh, father Scottish, and later I married my boyfriend from Ireland.” The family led a comfortable life. Pam’s father, a skilled craftsman, worked as a typesetter for a national newspaper. Membership of a printers’ union ensured that he had regular well-paid employment. Pam’s mother worked briefly, but serious health problems prevented her from continuing employment. Following the birth of a son, Pam’s mother was told that she would be unable to conceive other children. Therefore, the arrival of a daughter eleven years later shocked both parents. They behaved awkwardly, not knowing how to respond to a new baby when their elder child was already in senior school. Pam’s father occasionally took her on outings, but her mother’s interest was limited to her little girl’s outward appearance. I was dressed, doll-like, my hair in ringlets, wearing pretty dresses, but I was not allowed to compete with my mother, who always claimed the centre of attention. Mother was sociable and charming. She spent much of her time cultivating friends whilst my father, devoted to her, remained private and unobtrusive, always working long hours.

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My brother used to to take me to school, always in a hurry, other people used to take me home again. One day, it was half-day finish and nobody came to collect me. I was terrified. At primary school, I was very good, always smiling. I didn’t learn very much, I was too scared of getting it wrong. School was near home and I walked there and back on my own, I was about seven. At senior school, I had a friend to go with, her name was Sandra, she was big, strong, and confident, we laughed so much. I looked around at senior school and envied the clever girls who got high marks. I couldn’t do that. So I became bad. I had lots of fun, making people laugh, doing things they wouldn’t dare do. When you misbehaved at senior school, you had to stand outside the headmistress’ office and read the Highway Code, for one playtime. She would ask you questions on it afterwards. I spend three months outside the head’s office reading the Highway Code. When I was twenty-one, I passed my driving test in record time, after only a few lessons! My mother’s rheumatoid arthritis continued to deteriorate, and became a serious problem when I was fifteen and it was time to leave school. I was going to be a hairdresser. The teachers must have been pleased to see the back of me. But—I had made a decision—I really wanted to be one of the clever girls. I went, on my own, to see the headmistress, to tell her I wanted to stay at school an extra year and pass some exams. I can still remember the look on her face. Neither of my parents had ever been to the school, I can’t remember them taking an interest in what I did there. A lot of the time I wasn’t even there, I was off on the back of Dan’s (my boyfriend’s) motorbike with the wind blowing through my hair. I was very disruptive. The headmistress consulted other teachers, who looked at me in disbelief. They listed all the reasons why

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I should leave, but they did let me stay, and so I started a pattern collecting so many pieces of paper qualifications to wear as a suit of armour, to prove that I was one of the clever girls. My parents disapproved of Dan. “He’s not good enough for you”, they said, but I was in love with him. While her mother grew increasingly disabled, Pam led a lonely life. Her boyfriend provided a sense of security which contrasted with the solitariness of her existence. Going to doctors, dentists, shopping on my own— I needed to find someone to keep me safe. My parents were never able to go to an open evening at school even though I got good exam results. When Dan came to call for me, I would be straight back on his motorbike, and what’s more, I wouldn’t wear a crash helmet.

Four years on, with Pam eighteen and already pregnant, they were married. Dan was not a reliable husband. After their son arrived, he took work as a long-distance lorry driver and was away for many weeks. Left alone with her baby and facing the rapid deterioration in her mother’s condition, depression took over. For Pam, life became a succession of hospital visits watching her mother endure painful and often demeaning forms of treatment. Pregnant once again, with little help from Dan, and with her mother desperately ill, her depression deepened—life became a nightmare. Heavily pregnant, she would push her child to and from the hospital where her mother was dying. Twenty years of life had been constricted by her mother’s disfiguring illness. Tending to her, fetching, carrying, cooking, endeavouring to behave as an adult while still a child, Pam would collude in her mother’s despairing attempt to remain attractive and charming whilst enduring unimaginable discomfort, bedridden, plagued by open sores. Pam’s father, at sixty-five, retired, devoting himself to the care of his wife. After she died, he sold their home and went 108

to live in Majorca. Still abroad, one year later, he died, leaving Pam abandoned, isolated, despondent, and bleak. With two children, a boy and a girl, two years apart, an intransigent husband who was away for months and sending intermittent and insufficient funds to provide for the family, Pam took a succession of menial jobs, but with a biology A level, she eventually found work with a bio-tech company. She is still employed. Pam has attracted lovers and has had both short- and longterm relationships. She divorced her husband in 1979, but resisted offers of marriage, preferring to devote herself to the well-being of the children. Pam’s depression remained; she did little for herself in order to be “there” for them as they needed her. Later, the children as adults went their separate ways. Her son married, had two children, then divorced. He has another partner. Pam’s daughter has recurrent bouts of depression following the birth of a premature baby (weighing only 1 lb) and remains unmarried with two children. Pam is a supportive mother and grandmother. Before therapy, Pam had started a relationship with Tom. This was unlike any previous affair. Tom appeared seductive, difficult, challenging, intriguing, and unusual—unique, in that he had been seriously injured in a car crash and was partially paralysed, but still mobile with the use of crutches and leg irons. He had been married and divorced before his crash. Women had always found him attractive, even in his immobilised state. For Pam, Tom’s immobility resonated with her mother’s illness, producing feelings of passion and compassion. His very inaccessibility made him important in her life. He was dependent. She could be there to help this attractive man, and in the throes of sexual desire, make love to him as often as possible. But he was unpredictable, moody, demanding, accepting all that Pam could give him but reticent and withdrawn at times. He would offer wine, music, and food when he was affable, but could be erratically morose and 109

non-committal at other times. Pam was distraught. She would vow never to see him again, never to phone him (especially when there were long silences and breaks in contact). Railing against him, his inconsistencies, his coolness, his hardness, Pam would implore me to take a strong line with her, forbid her to see this man again. He was dangerous, destructive, but her addiction escalated, each day she watched to see who was calling at his home. Pam wrote: Went to see my therapist with a lot of sadness. I had realised from the start that my mother and Tom were linked in my mind, that I had taken Tom to my therapy because I couldn’t handle him. How typical that I had put his needs before mine … Felt incredibly depressed also I felt angry. I kept taking an evil demon to Cassie and somehow she diluted him and sent me home with him again. I feel like begging her to take him from me, he is going to kill me, seeing that I have resisted the urge to kill him.

Twelve sessions later, Pam’s ambivalence towards Tom took on a new meaning, and she became calmer and more analytical about his behaviour, his obvious loss of affect. She could admit that this badly damaged man, physically and psychologically, was self-obsessed, unable to give her or anyone else his full attention. He could never reciprocate her “devotion to care”. Pam assumed an introspective view, professing to care more for herself, but who was she? A woman who loves her children too much to see their personalities destroyed by a “crazymaker”. With faith in her kind of love, she could refuse to be bullied, holding on to the power to take care of herself and her children. Why had she taken so long to recognise this power? She had stumbled on the right path in life by coincidence or luck.

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I am no longer ashamed of this lady—she is fantastic, I love her, she is coming with me forever to be thanked and appreciated. Together, she and I will grow together and break this cycle of destruction. I am now concentrating on my needs. The point of this relationship has been to heal my past deprivations, to truly understand the very nature of psychotherapy, I consider this relationship a blessing, I still fear for Tom, but I can’t help him and I shouldn’t. End of story.

Pam left therapy at this time to concentrate on her studies, changing her telephone number, and determined to change her feelings about Tom. Her son developed symptoms of rheumatoid arthritis (her mother’s illness) and her daughter was again depressed, needing her support. She intended to help them, but I was convinced that this intense preoccupation with her children’s welfare resembled a “flight into health”. However, I supported her new-found confidence and optimism in her ability to survive. Obviously, her need for Tom would return. This potent mixture of past longings for a mother’s attention and Tom’s seductiveness was a heady combination which could not be resisted. A year elapsed before Pam requested a further appointment. After a hysterectomy, she was off work and recuperating at home. The relationship with Tom had resumed after a short break, but Tom was again avoiding contact. No flowers, cards, or phone calls during and after her hospitalisation. A spate of frenetic writing was triggered in Pam on her return from hospital in the face of Tom’s subsequent silence. Pam was terrified, experiencing violent feelings of hate and revenge towards him and destructive feelings towards herself. Was she on the edge of madness? She was out of control, unable to sleep, conducting feverish recriminations against Tom,

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having conversations in her mind with Tom, the Devil, fearing his power over her and her family. The flow of written material from Pam increased, containing insights that were remarkable. The flow of self-interpretation was impressive. Tom, the Devil incarnate, was the focus, looming large in all her thoughts: his behaviour, intentions, the malevolent influence he had on her and her family; actions ad inactions which filled Pam with fear of annihilation. Pam produced more pages, writing both night and day. Hanna Segal, in a past case presentation, once advised her audience to resist seduction and over-involvement with written material, which would deflect from analysis of events in the here and now as the primary focus of therapeutic sessions. But each piece, as submitted by Pam, was confronted and contained in an individual session. The process was free-associative, Pam had not edited her writings before sharing them. I was asked to keep the papers, and I still have them. Reading aloud excerpts from the papers, Pam could own and confront her words and challenge their meaning if she wished. She wrote: Tom lures little girls into the pit. He offers them food/ wine (sweets) tells them he will care for them and always be there for them (safety). In comfortable surroundings he lies to them with his eyes, admiring you, desiring you, accepts your good and bad and then … he uses your addiction to control you into giving unrealistic amounts of the above back to him. But it’s never enough. How? By giving the opposite of above. Abandonment, rejection, with-holding, judgemental. Then little girls crawl away and want to die. They continue to look for the “good parent” who can make them feel better. They find him from time to time but they know the “bad parent” is waiting to pounce … .

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Cassie please take him away. I thought I could handle him, I sat with his father while he died, I didn’t mind because I couldn’t be with my father when he died, what’s more I didn’t even go to my father’s funeral. But, Mr Psychopathic man now won’t talk to me. I feel so sad, why wouldn’t he understand that I need some comfort now? Never mind, I hate him, he must be a Devil. Sorry Cassie I forgot to tell you that I have grown an image of him sitting on a chair with horns and a tail swishing to and fro with anger.

The therapy The experience of counter-transference appears to me to have quite a distinct quality that should enable the analyst/psychotherapist to differentiate the occasion when he is the object of a projective identification from the occasion when he is not. The therapist feels he is being manipulated so as to be playing a part, no matter how difficult to recognise, in somebody else’s fantasy.1

All of Klein’s work was initiated by the study and treatment of children. It is the basis of her emphasis on introjection and projection. Clinical material from her work with children gave her rich material to explain and develop new theories. However, theory building was never a priority for Klein or her followers. It was used only as a means to an end, that of making better sense of the facts as they are uncovered in work with adult patients as well as children. It is true to say that Klein’s most important concepts have rarely been changed or challenged even though these concepts are in everyday use.

1

Bion, W. R. (1952). Group dynamics—a review. International Journal of Psychoanalysis, 33: 235–247.

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Klein argued that the introjection of a good object (i.e., the mother’s breast) was a precondition for the development of a normal child. It was a sound recipe. A form of introjective identification, coupled with a normal amount of projective identification, would combine to form the foundation stones of early childhood development. In Pam’s recollections of her early childhood, her mother’s ill health both before and after Pam’s birth deprived her of this close connection to a mother’s breast. Pam’s mother had dutifully and carefully responded to her baby’s material needs, but the dutiful responses to her daughter contained elements of both puzzlement and exasperation. Preoccupied as she was with the early symptoms of her impending illness and increasing disability, Pam’s mother failed to understand that her baby’s tears were more than just a demand for attention. An attuned mother is able to be sensitive to the anxieties with which every baby strives to cope; the anxieties that are projected into the mother with the expectation that the mother can sensitively internalise them in a balanced and empathetic way. Feelings of relief and gratitude towards myself as therapist, a person whose close attention to detail facilitated exposure of these unmet needs in Pam, fluctuated with periods of negativity and hostility when the therapeutic process replicated for her the denial and avoidance experienced at the maternal scene. I was not Pam’s mother and was experienced as resistant to the internalisation of her powerful projections, feelings and frustrations that resonated with previous failures of communication in early childhood. Colluding with the powerful projective identification emanating from Pam could only result in a deterioration of her own personal development. Pam was overwhelmed with hatred and envy at her mother’s inability to shrug off her own desperate neediness for tenderness and love. Pam grew up with a mother who, preoccupied with her own battle for survival, could not tolerate 114

her needs, and a father who successfully avoided them. Both parents, unprepared for late parenthood, reacted by denial, concentrating instead on their child’s external appearance. A perfect doll-like baby with golden curls and pretty clothes. Beginning therapy, Pam’s bitter recollections of early childhood were of primary importance, affording her an opportunity to express feelings of depression, loss, and loneliness which had previously been withheld from her parents and her own children. The poignancy of these stressful childhood years, the pain, anger, and resentment she had felt and the consciousness of the early deprivation were quickly aroused. Pam would try to dislodge my seeming equanimity (described as her mother’s detachment). Detachment was experienced as hostile indifference, and I was accused of being hostile, indifferent, and unresponsive when Pam appealed to me to “forbid” her tortuous relationship with Tom. Pam’s problems were twofold. She had an inborn disposition to excessive self-destructiveness and envy. These were substitutes for the mechanisms of splitting and projective identification which her mother’s illness had denied her. How can you love a mother who appears to be engrossed in her own survival and hate a mother who is in constant pain and physically deteriorating before your very eyes? She grew up preoccupied with functions, disturbances every day of a life-threatening nature, bandages, medications, bedsores, hospital visits, the pervading smell of illness and death. Could she have investigated these feelings with a parent (either her mother or father)? Would they have had the capacity to contain them? If so, all would have been well, but it was denial of these mechanisms for understanding that characterised her early years, destroying the link between infant and breast and the ability to control emotion. Difficult enough for everyone, but intolerable for Pam. 115

Pam would quiver with hatred for her mother and Tom, as representing the past denials she had experienced. She shook with rage at their seeming indifference to her pain and distress, unable to separate one projection from the other. So many patients in the course of therapy ask themselves “why me?”, but Pam gradually came to understand causation. Her current painful state of mind was exacerbated by the persistent course of action taken (in relation to Tom) which could be predicted to cause her pain. In her later written material, Pam acknowledged her complicity in this process. Pam’s mother was a beautiful woman. Even during her illness, she retained her attractiveness. She remained seductive, beguiling, managing to surround herself with admiring and sympathetic helpers. Her husband, when at home, made her support his priority. Pam was often ignored. She was the healthy one, part of a support system. She had chosen to replicate this system with her lover, Tom. He was partially disabled, handsome, needy, attractive to women, basking in the help and affirmation of willing others. The transference relationship was obvious. It was her expectation that this time she would get the love and attention she craved as a reward for being helpful. Pam could see that Tom and her mother were inextricably mixed. She wanted to pull back from the frustration of replicating this relationship. Pam always came to her therapy carrying a large plastic bag which she placed on the floor next to the couch. I asked her to tell me what the bag contained. She laughed and said “I am a bag lady. My world is in this bag. Diary, work papers, lists of things to do to be helpful to other people. My ‘buying love’ bag. In it are all the things I feel are necessary for me to be seen as a good mother, grandmother and friend.” I added “And patient”. A medical condition that required surgery led to a break of several months before Pam returned to therapy. In this

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period, she had been writing compulsively—whilst again feeling mentally unstable and again distraught over her nonrelationship with Tom. They had not been in contact during this period. She was “be-devilled and obsessed” with him and by him. Her prolific writings and the disappointments in her life railed against him and her mother. I knew they represented a catharsis—in them, she had expunged so much bitterness and regret. I highlighted their value and significance. I hold Pam’s writings in trust for her until she is ready to take them home. We revisit them from time to time in the months of therapy that remain. Inevitably, Pam has returned to visit Tom regularly, but equally has given time and effort to re-organising and re-decorating her own home. Her son stays with her when he is at college, and her daughter has a new partner. Pam continues to see me, albeit on a monthly basis. It is experienced as a review and support session to prepare Pam for our eventual ending.

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ABOUT TH E AUTHOR

Susan Fereday was born in London in 1947. She was educated at a London secondary modern school and went on to achieve a BA in art and design, a diploma in counselling, and an advanced diploma in psychotherapy and counselling. Initially working as a laboratory technician, she changed to a career in social work, and for eighteen years worked with children, young people with physical disabilities, and people with mental health issues and learning difficulties. She now lives in France with her second husband and a variety of animals. She has two children and seven grandchildren.

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