Tales from the therapist's couch: 'She projected on to others all that she imagined she lacked'

The woman sitting opposite me is riddled with self-doubt. Her background is full of the right ingredients for nurturing this feeling of inadequacy. She was sent at an early age to a very punitive religious school whose message was starkly clear: you are a sinner. At home, as the only child of a deeply unhappy marriage, she inevitably bore the brunt of her parents' emotional shortfall. Their mutual frustration invariably found its way to her in the form of criticism.

The woman sitting opposite me is riddled with self-doubt. Her background is full of the right ingredients for nurturing this feeling of inadequacy. She was sent at an early age to a very punitive religious school whose message was starkly clear: you are a sinner. At home, as the only child of a deeply unhappy marriage, she inevitably bore the brunt of her parents' emotional shortfall. Their mutual frustration invariably found its way to her in the form of criticism.

When I met her, I was struck by two things. Firstly, the discrepancy between the person she believed herself to be (ugly and stupid) and the person that I felt was sitting in the room with me (attractive and bright). Secondly, I was struck by her poignant but also infuriating habit not just of deflating herself but of inflating others in her life: projecting on to them all that she imagined she lacked. I soon became one of those others. My every word was accepted unconditionally.

To be under the onslaught of such a positive projection is worryingly enjoyable. Although this is a danger inherent in many professions, it is particularly so in the analytic relationship. Patients bring their hidden selves, often fragile and insecure, to share with someone they barely know, but towards whom they need to feel a great deal of trust if constructive change is to occur. A powerful and deep intimacy often develops, and yet it is not a relationship on an equal footing. Therapists may be dripping with problems, but they cannot burden their patients with the flux and uncertainties of their own lives. And so, without the kind of warts-and-all personal disclosures that happen in ordinary social intercourse, the illusion that the analyst is sussed and sorted develops apace.

Apart from the therapist's need to resist this idealisation, there is another layer to the problem. Far too often, idealising the analyst can lead to a feeling of passivity on the part of the patient. This was pretty much what unfolded with the woman above. I felt that a lifelong experience of being told that she should listen to others' authority rather than her own self-knowledge was being transferred into the relationship between us. She remained infantilised, I became idealised, and nothing I said could shift this unhelpful pattern.

Then one day, utterly without intending to, I let her down. We had recently changed the times we met, and I forgot our agreed alterations and double-booked her. The following session, I was expecting her to be quite rightly irritated, yet she appeared almost relieved. It was as if my failure had enabled her see that it wasn't always wise to assume that the other person knows better. From this time on, there was far more of a sense of her own authority in our relationship.

I'm aware that analysts are often accused of reading too much into minutiae, and the changes that followed were obviously not wholly determined by my forgetfulness. However, I do think that this instance highlights the importance of therapeutic failure. As the Chinese saying goes: "Only the wounded physician heals."

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