Tales from the Therapist's Couch

'My patient had developed a successful "false self". The part of him that felt authentic and true went into hiding'

"Last night, I watched these terrible images about what we are doing to one another and our world: wars, poverty, pollution. I felt overwhelmed by the pity of it all. And totally pathetic because I do nothing to change it. I come here and talk about how I feel disconnected from everything. But how is that going to help the world?"

"Last night, I watched these terrible images about what we are doing to one another and our world: wars, poverty, pollution. I felt overwhelmed by the pity of it all. And totally pathetic because I do nothing to change it. I come here and talk about how I feel disconnected from everything. But how is that going to help the world?"

At the time this was spoken, my patient, a man in his mid-forties, had been coming to therapy for about four months. During our initial meeting he described himself as someone who has spent his life feeling like an impotent outsider, and, as we gathered together his life story, the aptness of this became poignantly clear. As a child, he was intimidated by his bullying father, whose sarcasm frequently reduced him to tears. When he was six, his father left home and my patient found that an unkind father was replaced by a needy mother, who increasingly depended upon him for emotional support. "I suppose I always had to hide from or fit in with other people's worlds. As the eldest I had the top bunk bed, and it may sound mad but that was the one place where I could be with me. I escaped there as often as possible, just to daydream."

In the language of the psychoanalyst Winnicott, my patient developed a successful "false self" in order to fit in with what others needed him to be. The part of him that felt authentic and "true" went into hiding, only emerging in fantasy or solitude. As he grew older, this difficulty in being who he was in the presence of others developed into an air of detachment. What was inside felt real, but he found it increasingly difficult to show this to the world around him. A voracious reader, he spent many hours at his local library, and worked as a porter at a local hospital.

What struck me from early on in our work together was the paradox between his feeling of being cut off from the world and his intense empathy for suffering around him. As his opening remarks indicate, this often gave rise to anguish and frustration at his own feeling of impotence in the world. His words above also pose a challenging question to the whole therapeutic process: do the private conversations that take place behind consulting room doors have any connection with the wider world? Or is therapy as cut off as this man felt himself to be from anything beyond the personal?

For me, this important question has a boomerang-shaped response. As this man's story went on to show, our social and political worlds inevitably enter the consulting room alongside the personal story, because psychotherapy is invariably about the fall-out that results from cultural patterns of prejudice, violence and inequality. So, as a therapist, analysis of someone's story doesn't stop at the level of the personal. Understanding the suffering someone is going through means having to throw the net out beyond the family make-up, to encompass factors such as gender, race and socio-economic status.

The man above, for example, was the child of a mixed-race marriage. He was also brought up on a tough council estate. Throughout his school years, both these facts played an important part because, as a bright boy, he succeeded in getting a place at the local grammar school. His experience of racism and snobbery contributed to his feeling of being a powerless outsider as much as his immediate family baggage.

During his months of therapy, this man struggled hard to understand why he felt so cut off from life, and what compelled him to stay emotionally hidden. Analysis was simply and essentially about becoming conscious of all that had shaped him. With this knowledge came a new responsibility to actively change his script. As Jung said, insight is not enough. It has to lead to endurance and action. Hopefully, it is at this point that the boomerang finds its way back into the wider world, as with insight into why we have become the person we are, we can begin the task of sloughing off old skins.

For the man above, accepting that being defensively hidden from the world had become more destructive than protective dovetailed beautifully with a gesture from that world inviting him in. Arriving for a session in a mood of animation one day, he told me that he had been invited to organise the book club at his local library. What for many might have been a small step was for him a seven-league stride. Which he courageously took.

And, at long last, what had been too isolated and hidden found a fitting way of connecting to the wider social fabric.

elizabeth.meakins@blueyonder.co.uk

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