Wilfred Bion [for those of you not familiar with him, he’s one of the most important, British, post-Freudian psychoanalysts] asks us to approach every session with a patient “without memory or desire.”

When I first went into psychoanalysis [and I did the full on the couch five times a week – full Freudian immersion], I told my analyst that I hadn’t slept for 24 years…

I was 24.

And I told him that I lived in an almost constant panic attack. I told him I wanted peace. He, being a Freudian/Kleinian psychoanalyst, said;

‘Mmm.’

In fact, that’s pretty much all he said for the first year.

At the time, that first session when I lay down on the couch in a little attic in Willesdon [for those of you not familiar with Willesdon it is a particularly shitty area of West London], my father, a war correspondent, had recently been killed in El Salvador and I was drinking a lot of vodka. I studied Russian and had spent loads of time in Moscow where the locals were impressed by my capacity for drinking vodka. If Russians are impressed…well, you get the picture.

I realize now, that I was an incredibly difficult patient and I feel almost apologetic when I occasionally still check in with my analyst [who has doggedly not moved house in twenty-five years] for what hard work I must have been – brittle. Defensive. Aggressive. Constantly trying to attack the work we were doing, to attack my analyst himself [not physically, I should stress] and the very idea of psychoanalysis, which I said was like being in Woody Allen film or a New Yorker cartoon, was navel gazing, self-indulgent crap.

‘But you are here,’ he would gently point out.

And there I was. Pushing for a quick fix, marriage advice, haranguing him for not providing the peace I was after.

BUT if he had offered me life tips he would not have been doing his job. Without memory or desire. ‘All we can really do,’ one eminent psychoanalyst once said to me, ‘is try to understand our patient session by session.’ Without memory.

And then there’s the desire. This, I think is the hard bit. We are supposed to come to patients without a desire somehow to cure them, tweak them, solve things, without thinking we know the answer to their problems.

I had a supervisor once whose only comment on our long patient summaries and sessions notes was; ‘Well, we don’t know.’ Of course, this was totally maddening, and he always had a mouthful of salmon and cream cheese bagel when he said it, but his point was serious. He meant we mustn’t rush to know. Psychotherapy doesn’t offer life tips or quick fixes. If that stuff worked everyone would be fine, wouldn’t they? [I always think quick easy therapy solution offers are like the diet industry]. We are offering our mind, and a new kind of relationship in which deep thinking is possible.

Having an agenda and wanting to reach a goal stops us listening, hearing and feeling all the unconscious and unspoken communications in and behind the words patients say or gestures they make.

I feel that patients who come for therapy tend to have two things in common – a feeling of profound loneliness and a feeling of never having been properly heard and understood.

Actually, that’s probably one thing, isn’t it?

So, easy. Sit down, listen, don’t rush to understand or interpret, only hear what the patient is saying now, never mind what they said last week. Simple? Right?

Well, we all know it isn’t simple at all. And that’s at least partly because patients are constantly nudging us for answers, quick fixes, goals to achieve.

And we don’t help much either. We often ask patients what they want out of psychotherapy and they’ll say things like ‘to be happy’. In asking the question we are immediately suggesting we might have the answer. And we haven’t. We’ve got understanding, thinking together, facing reality, making the unconscious conscious.

So, just to finish, I’m going to give you a vignette from the couch.

This patient I want to tell you about lives in northern Europe and is a survivor of childhood sexual abuse and subsequent violent relationships.

In the transference she evokes huge sorrow in me, a desperation to help her, invite her to come and stay with me here in Italy, and I find myself sometimes asking her if there isn’t a nearby spa she could check into, how about a cottage in Normandy instead a fortnight in Las Vegas? How about a yoga retreat?
Last week she lay in bed for her session and hardly spoke. She is exhausted and defeated. I watched as, as the session ticked by, her tremulously high anxiety receded and her middle-distance gaze softened.

I thought to myself that I would try just to sit with her and bear my own impotence, my own inability to make her better. And I began to realize, watching her, helplessly, that her life is unbearably stressful and that illness is her only refuge, that she wants people to stop pressuring her to be better and to allow her to be ill. This interpretation, when I made it, got a smile and a nod from her and, counterintuitively, it seemed that understanding her, instead of racing to fix her, seemed to bring her some peace.

I don’t want to make out that I’m some psychotherapeutic genius. And, honestly, I find the extremely abundant literature where psychoanalysts catalogue their triumphs over complex cases hugely irritating.

‘Look how marvelously insightful I was!’

Obviously, we fail. Patients walk away. Patients stay but never really free themselves from situations we know are hurting them. We are clumsy, boring, pompous, patronizing and all sorts of other terrible things. But when we are good, when we are able to help patients effect that real, tectonic inner change, it’s when we’re simply listening and trying to understand.

Er…that’s it…so, if we were at some university dinner in England I would now toast the queen and we would move onto the port. So, er…Her Majesty The Queen!

Anna Mortimer, Therapist, Journalist and Co-founder of the Mind Field