Onward and upward
The strangest thing happened the other day during a session with a patient who I have been seeing for many years now. Typically she is quiet, mousy and eager to please—even to the extent of never challenging any of my interpretations. She speaks so quietly that, from time to time, I have to lean in over the couch to hear her. During the last session she was especially quiet. I duly leaned over (from behind the couch, if you can picture it) in order to hear her. Well, the reason I couldn’t hear her was that she had fallen sound asleep and was snoring like a contented little piglet. I knew that I should have remained present and alongside her until she woke up or have woken her myself when the session was up. Instead I found myself creeping slowly away to my desk to finish off my tax returns. Some minutes before the end of the session she stirred and woke up. I just managed to dash to my chair, cross my legs and place my pad casually on my knees and say: "We will continue with this next week." She then muttered: "Thank you Doctor, that was very useful", straightened her skirt and left the session as usual without fuss.
How do I understand this, Frau? And how can I, in all conscience, charge her for this session. And if I do not charge her for this session, how will I explain it? What will happen if she falls asleep during all of her sessions? What if it’s catchy and I begin falling asleep as well? Oy.
Oh deary, deary me,
Sometimes we do not want to see what is directly in front of us. The clue lies in your last sentence. She wants you to fall asleep with her. Yes, I am sure of it. In so doing she will get you to enact an erotic fantasy that she has, in all likelihood, been harbouring for years Your sloping off to do your tax is clearly a refusal on your part to enter into this vital part of the therapeutic process. And isn’t it interesting that you unconsciously choose to do your tax, symbolic no doubt of the very defenses that your patient engages in. I suspect that she is an accountant by profession and dresses in a grey skirt with variations on the twin set cardigan theme. We might also find that she has small eyes, a collapsed chest and a receding chin. Yes? In the early days when Zigmund and I were expounding on the psychoneuroses we considered this type as a separate diagnostic entity from the hysterias and the neurasthenias. Here the body itself (and the chin along with it) has imploded due to continual pressure of sexual desires and the strain of its denial. In severe cases an accompanying curvature of the spine from obsessive adding and subtracting becomes a clear diagnostic indicator. However, we did not include these intriguing creatures since the profession of accountancy was still in its infancy and none of us were yet paying tax or keeping books.
Anyway, I digress. I urge you to seize this therapeutic moment. If you do not therapy will surely stall. Next time she falls asleep, take your clothes off and make sure that when she wakes you are standing naked in front of her. In this way she will be confronted with the reality of her sexual desire for you in effigy of her father who was probably also an accountant. At this point one of two things will happen. She will either run screaming from the room but arrive at the next session in a push up bra and skimpy skirt ready to deal with the mess of sexuality or she will report you to the authorities. If the latter happens, just pass her complaints off as fantasy. We have all done that from time to time...
Onward and upward my friend.