Tales from the Therapist's Couch

'As so often happens, this woman chose the year's end to finish therapy and embrace a new beginning'

"I shall miss you. I shall miss this space. And I'm still afraid that the 'me' that dared slowly to come out of hiding here with you will find it difficult to stay strong in the world. But I know I have to try. And yes, I do think I'm ready."

"I shall miss you. I shall miss this space. And I'm still afraid that the 'me' that dared slowly to come out of hiding here with you will find it difficult to stay strong in the world. But I know I have to try. And yes, I do think I'm ready."

The annual calendar leap from the old to the new year often leaves a few empty spaces in my work diary - gaps that were previously filled by the names of people I have grown immensely fond of over months and years of working together. Mostly, the decision to finish analytic work comes from a mutual recognition that whatever it was that made someone seek therapy out (and that question in itself can undergo many sea changes) has been sorted - or sorted enough. And that, rather like a fledgling needing to trust its own wings for flight, it is time to end a certain dependency, and embrace a new beginning.

Jung once said that the first dreams brought to therapy often chart the course and meaning of analytic work. In that sense, the beginning anticipates the ending. This was certainly true of my work with the woman above. Early on in therapy she told me about a dream image that had dogged her for many years. It took different forms, but the central motif was the same. In this dream, she was always unable to speak. Sometimes she was on stage, sometimes with friends; often she was in front of a class (in her working life she was a teacher). In some dreams, she was a child, in others, an adult. Always there was a paralysing feeling of being unable to make her voice heard.

Over the next five years our work together was in a way all about making sense of this muted image, and challenging it. It spilled into her daily life in the form of inhibition, social anxiety and being far too much the echo of others' demands and opinions. At its root was a deep fear of rejection if she showed forth any different self to another. My patient's father, often the worse for wear because of drink, had often been experienced by his daughter as frighteningly dominating and unable to tolerate any differences of opinion. Her mother had chosen acquiescence as the safest way to negotiate his bullishness, and my patient had unthinkingly followed suit. Only now, in her early twenties, was she painfully discovering that being muted in order to feel safe didn't really work.

This fear of becoming her own separate person in the presence of another was transferred onto our relationship. For the first year or so, she was always the responding echo. But when she saw the connection between this self-effacement and her lack of voice in the dreams she was appalled. She began to scrutinise habits of a lifetime with greater consciousness. As the jigsaw pieces of her story were assembled and explored, she saw more clearly why she was so mute in her world. The prospect of a lifetime of compliant anxiety made her determined to shift this pattern, and something in her kick-started a desire to fight back

For several months she took tremendously courageous risks to do just this. It didn't come easily, but she fought hook, line and sinker to resist the automatic response of an echoing compliance. She was soon rewarded with a new batch of dream images. In them, she was voluble and engaged with her world. This internal shift was mirrored in the outer world, where she was becoming far more present to herself, and so to others.

Soon after her dream images had changed course I broached the notion of her outgrowing a need for therapy. As her essential struggle was with feeling securely alive as a separate person rather than just an echo, I thought it important to acknowledge that, whether months or years ahead, there would come a time when she wouldn't need me to enable her to be who she was. And that what she was discovering in a safe and hidden space needed, increasingly, to be lived more openly in the everyday world.

Initially, my patient balked at the idea of managing on her own two feet. So I let the idea lie fallow. Then, several months later, she herself mooted the idea of finishing our sessions. As so often happens in therapy, she chose the year's end as her own point of therapeutic departure. As she approached our final session together, I was moved by how much the fear of being her own separate self had been replaced by an eager hunger for life. It was a shift that was enabling a confident separation from the old and familiar in order to embrace the unknown new. "In my end," as TS Eliot wrote, "is my beginning."

elizabeth.meakins@blueyonder.co.uk

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