From The Therapist's Couch

'A photo of his dead mother seemed to nourish some long-parched need'

Arms folded defensively, the man sitting in the room with me looks irritable and fed up. Eight months down the road of weekly therapy sessions, he has had enough of looking back in anger. To be honest, so have I. The grievances that hang upon his life story are still as loud and clear as they were in our initial session, and the weekly stuck-record of discontent is beginning to feel more than a little repetitious. I am the third therapist he has worked with in his almost four decades of life, and the events that scuppered his ability to enjoy life have become familiar and well-vented furies.

Arms folded defensively, the man sitting in the room with me looks irritable and fed up. Eight months down the road of weekly therapy sessions, he has had enough of looking back in anger. To be honest, so have I. The grievances that hang upon his life story are still as loud and clear as they were in our initial session, and the weekly stuck-record of discontent is beginning to feel more than a little repetitious. I am the third therapist he has worked with in his almost four decades of life, and the events that scuppered his ability to enjoy life have become familiar and well-vented furies.

When he was 10 years old, his mother died in a road traffic accident. His father first took to alcohol, then to a series of different women, and finally to his stepmother. It was a stormy second marriage, fuelled with grief and drink, and my patient suffered badly.

His history began to haunt him in the form of symptoms as well as memories, and he found himself prone to black pits of despair and insecurity. Reaching, like his father, for alcohol as a comforter, he soon fell into a pattern of addictive behaviour.

He first sought out some therapeutic help in his mid-twenties. Ten years on, he has managed pretty much to get in control of the binge drinking, but the feeling that his world is flat and unprofitable because of his tragic early history still haunts him with a sense of terrible injustice. He is fed up of looking back in anger, but doesn't know how to let go of the need to do so. He knows he is living life reactively, in the shadow of what was, or what failed to be, but he doesn't know how to live with a sense of intentionality.

During our sessions, I have increasingly adopted a cognitive as well as an analytic approach. I find myself focussing upon the here and now. His everyday habits and habitat are coated with what Freud termed the "repetition compulsion": inertia yet despair about the mess in his life spills onto the clutter of unwashed dishes, the piles of unsorted paperwork, the unanswered phone messages. I encourage him to take action against this sea of practical troubles as a way of loosening the grip of the past, but any suggestion is met with derision and despair.

Therapeutic change is a very difficult beast to name and an impossible one to control. It can't be ushered in with sense or logic, but it can be invited in. The room can be made ready, the door opened, and left a little ajar. Then all one can do, is trust and wait. Which can feel at times like an unbearable lot.

Then one day you realise that something has happened. For the man above, this "something" occurred (as it so often does) during a therapeutic break. He had decided to spring-clean his flat. While doing so he unearthed a photo of his mother. Taken shortly before she died, she gazed out with incredible love and beauty.

This seemed to nourish some long-parched need. It also appeared to move him on. It was as if he could now see what could be, instead of what hadn't been. The paralysis began to be released.

What had enabled the shift? A spring-clean? A dead mother's loving gaze? Months of raking over the soil, preparing the ground for new shoots? I would put my money on all three.

e.meakins@independent.co.uk

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