Presumption and veridicality: Chronicling the therapeutic encounter

by John Kearns

Passing through a security gate on leaving a shop in Dublin I accidentally set off the alarm. An avuncular security guard checks my bag, pinpointing the problem to my library copy of Susie Orbach’s book, The Impossibility of Sex. The book’s library security tag has interfered with the machine’s sensors. On reading the book’s title, he looks at me:

“Y’know you can get tablets for that now, bro’?”

The poor guard’s presumptuousness was an ill-fit with his indiscretion. Yet while the avowedly fictional nature of the therapeutic relationships described by Orbach in her book might let her off the hook as far as indiscretion is concerned, in another sense she is no less presumptuous than the guard. Paving their respective paths with good intentions, both are informed by a knowledge of the intimate – Orbach with the training of the professional psychotherapist honed by a long career of working with therapeutic relationships, the guard with his perception of shared brotherhood with an only-slightly younger male in an only-slightly lesser state of physical (and, he presumed, sexual) decrepitude. Orbach is boundaried, the guard should be more so, but both set store in the currency of presumption, as indeed do most of the rest of us to greater or lesser degrees.

There is an episode of The IT Crowd where, following a recent break-up, the heartbroken Roy photoshops his ex out of all the photos from their relationship – we get Roy happily sitting on a park bench with his arm around the shoulders of nothing; Roy kissing the nothingness of air by a fountain; Roy riding a two-seater bicycle alone. “It’s like someone broke up with Stalin”, comments erstwhile buddy Moss. As therapists, we keep notes of our sessions with clients, notes that take a stab at objectivity in the knowledge not only that no two people will ever recount the same session in the same way, but that the whole course of the session will be determined by a twosome, one of whom will consciously try to absent herself or himself from the case notes subsequently. We photoshop ourselves out and, viewed with honesty, the effect is no less weird than Roy’s sorry photos.

Maybe this is the less obvious side to writing about our clients. The more obvious – should we wish to make our accounts public – is that of respecting clients’ confidentiality, a condition integral to respecting them as human beings. In his seminal On Learning from the Patient, Patrick Casement uses disguised examples from his supervisees’ clinical work, hoping “that no student therapist will feel a sense of injury from this sharing of their struggles to become better therapists” (Casement, 1985/2014:194). I don’t know – I might. It would depend on the disguise, but would my sense of injury be assuaged by my fondness for his book? Orbach is not alone in trying to capture representative therapeutic encounters through fiction – it is a strategy Philippa Perry foregrounds in the title of Couch Fiction (Perry & Graat, 2010). Yet the fictionality of Orbach’s account seems of a different order to Perry’s and perhaps to focus on it may seem pedantic but, as Muriel Dimen (2001: 405) notes, the relationship between truth and fiction may be crucial to the success or failure of Orbach’s enterprise:

Are clinical accounts fact, or are they fiction? Are they veridical? How does the reader know? Clinical psychoanalysis, in its particularity, unverifiability and uniqueness, can never meet the modern Western guarantor of truth: the scientific method.

Indeed, how does the reader know? Notwithstanding her concern, I would say Dimen underplays the compositional influence exerted by the reader-as-stakeholder. If I read Orbach solely for the admittedly beguiling cadences of her prose or the intrigue of her narratives, I read her as literature. Yes these are stories, though they are also promissory notes in the insights Orbach invests in them and I, as a trainee therapist, am willing to reap this investment. To do so involves a hermeneutic disentangling of truth from fiction, in turn requiring an acknowledgement of the author’s subjectivity and her motivation for writing, as much as it does of my own subjective engagement.

Here I part ways with Dimen, who sees the stumbling block as that of Orbach’s (lack of) objectivity – a desideratum that, as noted above, is more fictive than anything Orbach writes. What of the therapist’s subjectivity? Orbach (1999: 2) notes “We are accustomed to thinking of the therapist’s neutrality, of her imperviousness and her attentiveness, but we may not be aware of how this equanimity comes about”. And yet the equanimity is there, and while Orbach’s stated aim in these essays is to examine the ways in which the therapist is “affected and stirred up by her patients” (2-3), the boundaries are set – the affect may be great but in the professional therapist it may never challenge the equanimity that enables the holding crucial to the therapeutic relationship. This is okay if we regard the notion of equanimity exclusively in the sense of this holding, a professional phlegmatism. Put baldly, this is why the therapist is a therapist and not a client. Subjectivity is obviously greater than this, and it is the remainder – the overflow – that Orbach wishes to examine. But can the one be skimmed from the other like cream from milk, as smoothly as this?

Of course not. Indeed, it could further be argued that the intermingling is potent if managed with dexterity, and this intermingling itself will contribute to that characteristically therapeutic intertwining of transference and countertransference comprising the therapeutic relationship. So, we may well raise an eyebrow when Orbach tells us how she allowed one of her clients, Belle, to maintain telephone contact with her out of hours because Belle “felt psychologically homeless. In taking her on for therapy, I had to allow her to almost seep in to me” (53). A fine line is being trod here between challenging ‘professional’ boundaries in order to draw attention to their therapeutic cumbersomeness, and abandoning them altogether.

But in the safety of words on the page Orbach can do this risk free – fiction isn’t real life, after all, and given the importance of transference in the relationship, one feels at times that she is adapting this unusual writerly form to flaunt an emotional gush more typical of Hollywood melodramas. The case preceding Belle’s in the book – that of Adam – opens “I felt twitches in my vagina, pleasurable contractions” (7) and recounts a tale of erotic transference in terms that do their best to remove the narrative as far as possible, not just from scientific case history, but from literary fiction too, leaning instead towards Mills & Boon. She describes taking a shower in the morning: “all at once the image of an enormous shower-head in a Claridge’s bathroom I had glimpsed years before melded into an image of Adam and me making love […] I saw and felt that I wanted to love him” (17). Of course she doesn’t, but this isn’t the point – this is about her conceptualisation of the therapeutic relationship, and if the movement of transference and counter-transference can – and has – been likened to a dance, Orbach is ostentatiously limboing solo under a flaming pole, showing us what she can do, perhaps, but more importantly showing us who she could be, outside the confines of the therapeutic alliance in a process of her own self-discovery: “Just where was this singing inside me coming from? Was I letting the counter-transference … get a bit heady? I chuckled to myself. I was not prepared to give up the good feelings so hurriedly” (16-17).

More power to her! Power, not just for savouring the moment, but for daring to be open about it. Again, hers is neither the remit of case notes, nor academic enquiry, nor indeed literary fiction. It succeeds as none of these individually and yet, in a writing that is most appropriately about herself, I would agree with Anna Vaux (2000) that it works in its attempt to articulate what Clarkson (2003) identifies as the multivocality of the relationships obtaining in therapy – relationships which can only be heard in their different voices through her own experience.

Who is Belle for Orbach? And, indeed, why ‘Belle’? Literary Belles we have known include most obviously Belle de Jour – the 1967 Luis Buñuel movie, based on the 1928 novel of the same name by Joseph Kessel. In the film Belle, played by Catherine Deneuve, certainly parallels the adventurous sexual life of Orbach’s Belle, while also similarly betraying a vulnerability – in fact there are numerous points of comparison between the two characters. Another day’s work.

The trap here is one I mentioned earlier – that of reading these narratives as literature, focusing on what Jakobson (1960) would have called their ‘poetic function’. Regarding the latter, in Belle’s case there is no satisfactory resolution to the intrigue, though one feels this may have bothered Orbach more than it does us. Orbach-the-writer, one presumes (that word again!), felt compelled to wrap up an unwrap-up-able story with the coda of seeing a photo of Belle in Harpers & Queen with a glitzy new husband several years after she had exited Orbach’s therapy – is this the trace of Orbach-the-therapist’s need for denouement in art, if not in life? What kind of artist or writer abandons denouement? Here Buñuel returns – in the beautiful scorn for bourgeois artistic convention that marked his Dalí collaboration Un Chien Andalou, or indeed – at a more subtle level – four decades later, when this scorn has transmogrified from the artistic to the social in Le Charme Discret de la Bourgeoisie. And in Belle de Jour. Yet here is the bind Orbach finds herself in from the beginning, when she announces how she must tone down reality to make plausible fiction – the fiction itself must be unobtrusive if it is to serve the purpose of parable. If the analysand’s narrative is constructed as a meeting between the happenstance of individual experience and the situation of the therapeutic encounter, then the analogous meeting in Orbach’s fictional narratives is between her own experience as therapist and the expectations of the reader – and her expectations of the expectations of the reader. These expectations serve to move her writing towards the literary without literature ever fully becoming its occasion.

This last point is a conundrum lost on Dimen (“I wish I could understand her argument”: 2001: 409) but it’s a point on which I would defend Orbach: yes we have all probably met, at some stage, liars as pathological as Belle, but this is not a story about Belle. Moreover, to regard Belle as a figment of Orbach’s imagination or as a composite of Orbach’s clients is also to miss the point. Belle is Orbach, in the same way that anyone who has gone through here-and-now process group work begins to see other participants in the group as reflections of themselves.

This kind of reasoning is counterintuitive in precisely the way presumption is not. Moving in the opposite direction to the royal road Freud claimed for dreams and the unconscious, presumption is the red carpet of common sense leading to the champagne sycophancy of the movie premier of your own life – reality kicks in with the morning-after hangover, when you read your mauling in the press. Returning to where we began, my critique of Orbach is not dissimilar to my critique of the security guard: both presume. And the therapist in me is more than happy to overlook this.

For we must presume. In an interesting twist, my security guard’s presumption regarding Orbach’s title was more insightful than that of Vaux (2000) who commented on its intrigue: “What can she mean by ‘impossible’? Impossible for whom? Impossible how? […] Ooh! Which of us doesn’t want to look inside to see if we, too, suffer from the impossibility of sex, whatever it is?” (32). Perhaps the impossibility of sex is a reality more understandable for a security guard in his late 50s than for Vaux, a consultant editor of the London Review of Books. But there I go again – presuming! (Perhaps Vaux is married to the security guard? Perhaps his tablets work? Who knows?)

The crux of the story of Belle comes when, after a prolonged break occasioned by a bereavement in Orbach’s family, Belle rings Orbach to cancel a session, telling her she has had to travel to Berlin; Orbach’s curiosity leads her to dial 1471, only to discover Belle is lying and is still in London. It is what comes afterwards that reveals how problematic the narrative is as anything related to a case history. To Orbach, for Belle to end her therapy in this way is a betrayal. What is it that raises it to this level from white lie? Perhaps the failure on Belle’s part to recognise her own resistance? And yet the fact that this is Belle’s failure appears as lost on Orbach as any other possible interpretation, given the neatness of the reading (a reading, remember, in a writing) which she does come up with:

The symmetry was too neat: her mother’s two-week disappearance, my unforeseen two-week break. I had not taken it seriously. More striking even was her mother’s need to get away from the deadness of New Zealand and my awareness that I was preoccupied with the death of an important person in my life. Belle had not entered my awareness. I had not taken her with me. (59)

She’s right – the symmetry is too neat. To overlook it would be poor narrative tact. But to say that narrative tact is a matter of fiction, not fact, is not the same as saying that chaos rules – merely that adherence to one interpretation alone risks being reductive and essentialist. This is a common theme in much psychoanalytic criticism and is material for a separate discussion, but the fact that it leads her to think that Belle “had not entered her awareness” when everything else in the chapter suggests otherwise, demonstrates how prone we are to being entranced by presumption.

What are we faulting her on here? Her seduction by narrative conceit? This is somewhat rich of us when we’ve already praised her for her use of melodrama to confound stylistic expectations. Shapiro (2004) draws an enlightened comparison between what Orbach does with narrative and Denis Diderot’s enterprise in Jacques le Fataliste et son Maître, the 17th century novel where narrative coherence itself is questioned. To focus on plot conceit when the larger narrative challenge to style (or, perhaps, genre expectations, if one can talk of such in this context) is so much more conspicuous, is again to regard what Orbach is doing in literary – rather than psychotherapeutic – terms.

And what about my own reaction – not as universal reader (the burden shouldered by Dimen, Vaux and Shapiro), but in the less taxing role as trainee-therapist reader? Yes, I’ve had the experience of clients ending on me unexpectedly. Certainly there is a risk of seeing it in terms of betrayal similar to that experienced by Orbach. But how would I compare conceptualising my relationship with my clients in relation to the admittedly fraught deployment of fiction that she uses with hers? To characterise this conceptualisation, rather than thinking of it in terms of conventional narrative, or of Jacques le Fataliste, one could opt instead for the model of narrative employed by the British experimental writer B.S. Johnson in his novel The Unfortunates: a book presented in a box, made up of 27 unbound sections, with the first and last chapter specified and the 25 chapters in between ranging from a single paragraph to 12 pages in length, designed to be read in any order. Such a novel deconstructs the notion of a master narrative, with the story being the product of the engagement with the reader in what the author (or client) has offered. Yet it is ultimately the client who calls the shots and, while the final section may well be designated an ending, there is no guarantee it will be to the reader’s satisfaction. And we return to presumption: I can think of no other format where narrative presumption is so minimised. This is as it should be.

John Kearns is completing an MA in Psychotherapy at Dublin Business School. He previously worked as a translator, editor and university lecturer.

References:

Casement, P. (1985/2014). On learning from the patient (Routledge Mental Health – Classic Edition.) London & New York: Routledge.

Clarkson, P. (2003). The therapeutic relationship (2nd ed.). London & Philadelphia: Wiley.

Dimen, M. (2001). Review of The impossibility of sex. International Journal of Psycho-Analysis, 82(2), 405-410.

Jakobson, R. (1960). Closing statement: Linguistics and poetics. In T. Sebeok (Ed.), Style in language (pp.350-377). New York: M.I.T. Press.

Johnson, B.S. (1969). The unfortunates. London: Panther Books.

Orbach, S. (1999). The impossibility of sex: Stories of the intimate relationship between therapist and patient. London: Penguin.

Perry, P., & Graat, J. (2010). Couch fiction: A graphic tale of psychotherapy. Houndmills, Basingstoke: Palgrave Macmillan.

Shapiro, S. (2004). The impossibility of case histories. Contemporary Psychoanalysis, 40(4), 669-675.

Vaux, A. (2000). Cooking the books. London Review of Books, 22(9), 32-33.