From The Therapist's Couch

'My patient was frightened of her mother's coldness and strictness'

Most people who come to therapy start the ball rolling with what I would call outward blaming. Their distress is causally linked to significant others in their lives: if parents, siblings, husbands, wives had been different and better, then all would now be well. Yet there are also those who begin their therapeutic journey from the other extreme. Harshly blaming themselves for their own suffering, they insist that It Is All Their Fault. Neither pattern of blame, outward or inward, serves any constructive purpose. And often, they are two sides of the same coin.

Most people who come to therapy start the ball rolling with what I would call outward blaming. Their distress is causally linked to significant others in their lives: if parents, siblings, husbands, wives had been different and better, then all would now be well. Yet there are also those who begin their therapeutic journey from the other extreme. Harshly blaming themselves for their own suffering, they insist that It Is All Their Fault. Neither pattern of blame, outward or inward, serves any constructive purpose. And often, they are two sides of the same coin.

A woman in her mid thirties came to see me because of a dream she'd had which unleashed torrents of grief. In it, an 18-year-old girl walks towards her. She is lost and crying.

My patient awoke from the dream with tears streaming down her face. Almost exactly 18 years before the dream she had had an abortion. The further twist to this tale was that she had been 18 at the time. So what was the dream about? Bereavement for the child she had never known? Or for the young woman she had been who had become so lost?

My patient was, she says, always a difficult child. Her father died when she was five, and she remembers the terrible change that came over her mother. She became frightened of her coldness and strictness.

In her early teens my patient discovered the power of her sexuality. She was extraordinarily pretty, and was soon using her capacity to make heads turn for her own comfort. From an early age she had many sexual relationships. It never crossed her mind that sex was about trying to find the intimacy she had never had from her mother.

One day she discovered she was pregnant, and decided to have an abortion. "I remember thinking: I must get rid of it because mum will kill me if she finds out."

Shortly after the abortion, her manically promiscuous defence broke down and she went utterly to pieces. Like the girl in the dream she was 18 years old, lost and crying. Broken with distress and shame, she returned home to ask for her mother's forgiveness. Gradually it came, but at a cost. And the cost was compliance. In return for maternal acceptance she became an echo of her mother's way of seeing. Frigidity replaced promiscuity, and self-blame crushed the libidinous acting out.

Now 18 years on, how does this woman make peace with herself, her dream, and her mother? As we work to ease the load of self-blame by understanding the emotional roots of her promiscuity, she becomes wounded by a new recognition of maternal harshness and neglect. Gradually released from her identification with her mother's way of seeing things, she stumbles into anger, and some of the blame she had heaped upon herself becomes directed outwards towards her mother's lack of nurture.

And yet neither inward nor outward blame achieves very much.If therapy is to help, blame has to be sifted through, sorted and shelved. Then the harder but richer task of accepting our unique responsibility for who we are now can begin.

Elizabeth Meakins is a psychoanalytic psychotherapist in private practice. None of the above material refers to specific individuals

e.meakins@independent.co.uk