“The Portable Analyst” Part 1

The Portable Analyst is one of a series of personal clinical memoirs in which I am trying to make accessible to a general audience, as well as to the psychotherapeutically trained, and to myself, what it feels like to sit with another person as we turn a story from something toxic, to something healing. The memoir is presented in 4 parts. We begin with the basic element of the work, two people in a room, a psychotherapist and an individual seeking help. See below for a link to an earlier memoir.

Part 1 of 4; The foundations of psychodynamic work, a room and the people in it

“A story is not like a road to follow … it's more like a house. You go inside and stay there for a while, wandering back and forth and settling where you like and discovering how the room and corridors relate to each other, how the world outside is altered by being viewed from these windows.” (Munro, 1996)

Let us take our seats and begin the work.

A young man in his late 20s, very tall, is trying to look comfortable in the patient’s seat opposite me when he says something revealing about a childhood memory, and then asks how I might have felt in similar circumstances. He withdraws slightly. “Oh,but I forgot. You are not you. You are ‘the therapist’.” It is my final year of training, and he has brought me up short. After a perceptible pause, out of some internal depth I choose not the neutral words of analytic inquiry, but the forceful words “On the contrary”. For in that moment, I know that in that room and with the patient I am my most essential self. The patient looks at me. “Ah, I'll think about that.”

I think about that, often. Why did I feel compelled to speak those words, and not the tried and tested neutral words designed to elicit a response from the patient addressing a person he does not know, who is not yet real, “the therapist”? It seems important that I acknowledge my own authenticity.

Each essay that I begin is haunted by the echo of voices from my training foundation, especially when I feel that in order to do my work, I’m defying shibboleths. It can be painful to silence those voices in order to hear only my own and those of my patient. And the shibboleth in the vignette above, was the choice of words that belonged to me rather than the accepted phrases of an analytical session. The work proved to be therapeutic.

The young man and I worked together for a further six months after I qualified and when I asked how he was experiencing the ending he said, “sad but grateful.” And the room we went to had windows.

1. The Room

Here, step into this room. It is big enough for two to sit at a comfortable distance from one another. Light falls through a six- paned window, with two small casements that fill the top half of a wall, facing south-east. A patient sitting on the red sofa here could see, by late summer, tossing leaves of beech, oak, quince, apple and rosa rugosa, and the red tile roofs of the house at the end of the garden.

This room is a container, it has a door to enter, and perhaps as importantly, a door by which to leave. The room has windows and light. That is my choice. Not all consulting rooms have windows. For many that can represent womb-like safety. I learned in my training days in rooms below ground with no windows that my mind and other minds became shadowed. Perhaps the shadows were the thoughts of the patient, as they wandered in the unfamiliar space. Since I am inviting you into this room, for a moment it may seem as if it is my voice that is first heard. But of course, if someone has come here, they have spoken first when they asked to do so. And often for the people who come here, the experience of someone listening to their voice is a new one. The purpose of this safe room is to make it possible for each of us to listen. For one of us to speak. There is a story to be told.

This consulting room is a room in my house. The walls are the dividing space between our internal worlds and the world outside. But, as I write this I am in another house in another room on the shores of the Atlantic. As Alice Munro says, the world can be altered by looking at it from the windows. The morning after my arrival I stepped into the cool day, sunny and glittering with drops of the previous night’s rain on the ravaged old apple trees.

The air was full of the salt tang, as fresh in my nose as when I smelt it as a child on visits to the warmth and protection of my grandmother, who would wrap me in a hug full of the deep rose scent of Madame Rochas. For two months every summer she gave me a safe place to be; a quiet room, time to read, no punishment for errors for which I could never make reparation. And, just as my patient’s words had distilled for me the essence of my work, looking out the window distilled a memory of safety that has unconsciously informed my belief that such places can exist, and that I can share them with others who need them. The memory creates a boundary around the fear that there is no safe place.

People find themselves in pain when all the familiar fabric of life seems to be failing them; moth holes of pain letting in the chill. At that point some ask for help, and somehow, they must find some sheltered place to speak; to find again a thread that helps to make life coherent. Patient and therapist use this space to build insight into the experience and its sources. They explore fears and loss; memories and hope. Some even see the analyst’s mind as “a house that the patient slowly inhabits…a place where the patient can find shelter and be hosted” (Resnik, 2007).

2. The People

2.1 The analyst

No wonder, then, that when I qualified in 2009, I left with such a clear sense that containing was central to the work, and that it was up to me to use discipline and a framework to hold the patient (and myself) in safety. The frame, seemed to me at the time to be very material, consisting of time and space. Time, in its material sense represented the day and the hour at which a therapeutic session began and ended. Space meant the room in which the session took place; the arrangement of chairs, the table, the tissues, the lighting. And the way in and the way out. What was left with me as I moved on from my training was that the physical space was sacrosanct; objects could not move, lights must be tuned to the same level, chairs must be aligned in the same way. Only now do I recognise the irony that this was my belief when the inevitable consequence of moving on was to take myself, and those patients who chose to come with me into a new space.

Firmly seated in my imaginary armchairs of theory, were Wilfrid Bion and Donald Winnicott. Both men reflected deeply on contained clinical space. Both, inheritors of Melanie Klein, understood the powerful fabric of understanding between two minds, specifically the maternal mind and the infant. Winnicott speaks of “maternal preoccupation”, that time when the mother absorbs herself intently in the infant, and the infant brain takes in all it knows of the world (Rayner, 2015). Having practiced first as a paediatrician, Winnicott was acutely aware of the emotional needs and growth of the child, whose traces he found in his adult psychotherapeutic patients. Bion described a “metabolism” of thinking in which a “container”, the mother takes in all the infant’s emotions, and quandaries; metabolises them in the “maternal reverie” of her own mind and returns them in some useful way to the infant; for example, understanding the meaning of a wordless cry as a call for food or dry nappies, and then delivering them (Caper, 1999) . Research of the human mind from the late 1940s through until today, has sought to observe, to describe and to understand the at once robust and delicate capacity of human minds to relate to one another. The therapeutic relationship between analyst and patient seeks to recreate the sense, when all is going well, of safety and profound understanding between two minds. Paralleling the maternal reverie, is the “analyst’s reverie”, a capacity to pay attention to as yet unspoken thoughts or feelings, and to interpret them. (Akhtar, 2009)

In the containing room I have invited you to enter there is a wooden bowl, silky smooth and curving to a wide lip. Many colours of inlaid tiles made from 12 different woods flow around the bowl. I bought it from the M’ikimaw artist who made it in Nova Scotia, because in addition to its being a lovely object, I could think of it as being able to hold the thoughts of many sessions. While some of my training supervisors were a bit censorious about personal objects in the room, I’ve always taken comfort in objects that hold light or are smooth to the touch. Cosimo Schinaia observes that objects create a kind of intimacy in the consulting space, a subtle self-disclosure, which can “become part of the analysand’s fantasies.” (Schinaia C., 2016).

2.2 The Analysand (Patient)

“Has anyone else ever said you remind them of Tony Soprano’s analyst?” The patient was an English actor, starting six sessions of time-limited therapy. So we both had to work quickly. And he got in first, with that question. Hard not to feel a little frisson of pleasure in being compared to Jennifer Melfi, husky-voiced empathic listener, perhaps the first to listen to the painful truths of the sociopathic Tony.

And here is a signal point for the analyst; one’s own foibles need to be heard and reflected upon, as much as the patient’s are. What might that frisson of pleasure mean? It is nicer than being attacked, certainly. But, reluctantly I must step away a little, and wonder if I am perhaps hearing a self-protective act on the part of the patient – keeping the unknown person at bay. And then I need to remember that in the beginning I am not myself to thepatient. I am who they imagine me to be. Although I feel fully authentic in the work, that authentic person is not yet known to the other person in the room. On my part I need to be aware, not only that it’s a pleasure to be imagined as such a charismatic person, but that it is not useful for the work for me to be seduced by the idea. There is every possibility that hate and anger may now or soon form part of the communication. And all of this reflecting happens simultaneously with listening as intently as I can to what the patient is saying.

Click here for Part Two

Note:

“The portable analyst” - I borrowed the title from Mignon Nixon, describing a sculpture by Louise Bourgeois. (Nixon, 2012)This is the second in a series of Clinical Memoirs. The first, Therapists and Patients at the Epicentre of a Pandemic of Not knowing can be found here www.therapyroute.com/article/therapists-and-patients-at-the-epicentre-of-a-pandemic--of-not-knowing-by-a-foster

Anne Foster, MA, FPC (Fellow), UKCP is a psychodynamic psychotherapist in private practice in Buckinghamshire, UK, although one of the strange gifts of the pandemic is the ability to be present for people through technology that makes borders truly liminal. She is a writer and presenter. anne@annefosterpractice.com

Works Cited – This bibliography refers to works consulted and cited in all four parts, and will be repeated in each part

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Akhtar, S. (2009). Comprehensive Dictionary of Psychoanalysis. London: Karnac.

Arquitectura-G. (2021). Leopold Banchini: Not Nomadic. apartamento(27), pp. 193-216.

Bourgeois, L. (2019). The Spider and the Tapestries. Berlin: Hatje Cantz Verlag.

Bronfen, E. (2012). Contending with the Father: Louise Bourgeois and her Aesthetics of Reparation. In P. Larratt-Smith (Ed.), Return of the Repressed (Vol. 1, pp. 101-114). London: Violette Ltd.

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Schinaia, C. (2016, 05 22). Psychoanalysis and Architecture: The Inside and the Ouside, by Cosimo Schinaia. Retrieved 05 29, 2018, from https://karanacology.com: karnacology.com/2016/05/22/psychonalysis-and-architecture

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