Tales from the Therapist's Couch

'Remembering the cold fury of parental rejection, my patient puts his head in his hands. The memory is unbearable'

A psychoanalytic training often incorporates a wide range of theory, and when listening to different people's stories, or the same person's history at different times, it is fascinating to see which ideas come to mind. Surprisingly often, the seemingly insurmountable differences between the "big names" in psychoanalysis seem to dissolve in the clinical light of day. Take Freud and Jung, for example. Often it feels as if their insights are about essentially different stages of development, so that, rather than their ideas vying for the same piece of psychological ground, one theoretical model naturally takes off where the other peters out.

Let me give an example. A middle-aged man has been coming to weekly sessions for a few years. He suffered a minor breakdown in his early twenties, and is frightened that he is about to have another. In our initial interview he describes himself as being "too buttoned-up". My initial impression confirms this. There is a tautness about him that rarely gives any slack.

I ask about his earlier breakdown. He tells me he was at university when he "went to pieces" sharing a house with students who were concentrating hard on having a good time, while he struggled hard to concentrate on his work. His sobriety was teased a little, and, eager to be liked, he developed the art of seeming to join in with their world. But the cost of the inner conflict this gave rise to was heavy, and soon even coping with everyday life felt like an insurmountable hurdle.

Over time and sessions he talks about earlier memories. While his was not a childhood full of any huge unhappiness, it was nevertheless very constrained. Both parents were ambitious for their children, and with discipline and hard work he and his sister won musical scholarships. During one session, he recalls with discomfort an event that had ripped into this picture of sobriety. One summer, a cousin of his age had come to stay for a couple of weeks. They were both about 15, chalk and cheese. Full of anarchic energy, and with Pied Piper charisma, this cousin had lured my patient from his usual sense and persuaded him to explore the local pub. Remembering the cold fury of parental rejection that greeted them when they finally staggered home, my patient instinctively puts his face in his hands. The memory of the conflict is still unbearable.

At about this time he has a dream. In it, he is in his family home with this same cousin and a childhood music teacher (whom he describes as severe and demanding). There is a conflict going on between the teacher and cousin, and my patient feels uncomfortably stuck in the middle. The dream seems to offer such a neat example of Freud's map of the psyche - the conflict between the id, ego and superego - that I decide to interpret it along these lines. The id (the cousin's anarchic energy) the superego (the teacher's/parents stressfully high expectations) and the ego (my patient's tension at being sandwiched between two such opposing inner forces) are here personified in a three-way drama that seems to encapsulate the agony of the conflict he has lived with for so long.

Both his dream and the description of Freud's "map" of the psyche have a huge impact on this man. It is as if he can stand back for the first time and really see how he has been in a three-way battle. Living for so long under the shadow of superego demands, it is clear that whenever id forces lure him away from a controlled upright stance, the backlash from both his outer and inner worlds is ferocious. And so, as in the dream, his ego has become broken down by the battle.

Over the weeks and months that follow, my patient strives to shift his ingrained attitude towards both himself and the world. Freshly aware of how rejecting he has become of everything outside of his "buttoned-up" control, and terrified of another breakdown, he is determined to shift ground. Challenging a deeply ingrained fear of the turbulent and unknown, within and without, isn't easy, but over time it is certainly rewarding. "I used to think," he tells me, "that I knew all that life had to offer. And that was that. But now I feel both appalled at who I had become, and often unexpectedly moved by this life. It's as if there is something within me now that I can trust, which is nudging me in the right direction."

In terms of theory, my patient's words marked for me a shift to a different analytic model. Freud is brilliant on the need for integration. But it is Jung's notion of the Self, the idea of an inner wholeness that guides us towards our own life's meaning, that takes off at this point, and takes us further.

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

elizabeth.meakins@blueyonder.co.uk