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The Other Side Of The Couch


Hilary Tupling


This is a personal account of the journey from one side of the couch to the other 
and back again. It has nothing other than its face validity. I make no claims for its 
universality. It is not easy to be a therapist in therapy. It is not easy to be the
 therapist of the therapist in therapy.

It had not been part of my plan for last year to find myself needing to seek therapy; 
the event, which precipitated the search, was both banal and brutal. My body
 wasn’t hurt, but my mind was.

Much as I tried to find ways to reset my internal sense of safety and well being, I 
rapidly became exhausted and so did my friends. The telling and re-telling of the 
story, particularly when it has no resolution in sight, wears thin the tolerance of
 even loved-ones and intimates. They wanted the old self back, not this one whose
 focus and pre-occupations with hurt and anger takes away from enjoyment, and
 true living. They had moved on, while I hadn’t. Professional friends urged me to
 seek help, appealing to the remaining vestige of my own professionalism; if this
 were my client what would I suggest?

Beginning the search confronted me with difficulty; to whom could I go who came
 recommended, but was not known to me? In a smallish community of 
(psychologist/psychotherapy) professionals, most of those who have acquired a
 good reputation will bump into each other at some point, at seminars or training
 workshops. Going further afield meant moving into the medical model; a 
psychiatrist whose orientation was psychotherapy was suggested to me. I felt it was
 unlikely that I would be sitting next to a client, colleague or ex-client in his waiting 
room, so I booked in. Looking back, I now find myself questioning the fear I had 
to be seen as a client, whilst feeling that it deepens the compassion and respect I
 have for my clients.

Even the act of booking an appointment can be a confirming or disconcerting 
experience. On the one hand, a relief that the problem will be shared, my emotional
 burden shouldered by another as well as myself, presumably in an atmosphere of
  trust and acceptance. On the other, a reluctant admitting to myself that I could not,
 at this time find my way out of the distressing maze into which I had, it seemed, 
fallen. It has been my experience that people, who highly value their independence 
and autonomy, find, in the seeking of help a sense of personal failure. Despite the
 reassurance that I would give a client in this situation, I found it hard to convince
 myself that it was indeed OK to ask for help. 
It seemed that all my previous ability to self-validate had been swept away by the
 drama I had gone through, leaving me desperately needy, and simultaneously angry that I was so. To return, to regress, to a phenomenological position of requiring
 another’s validation was galling, to need the validation of a professional stranger,
 even more so. Yet, that was reality. I was therefore not an easy client.

I was critical, emotional, at times a fly on the wall, at times a demanding child. I 
swung wildly between equal and inferior, sometimes superior. I required him to
 have an ability to be flexible; the same ability that I demand of myself. And
 inevitably, he didn’t have it. Perhaps it is vital that ultimately, we disappoint our 
clients. This was a voyage of discovery, undertaken, not for the purpose of
 training, or curiosity, as had been most of my previous excursions into therapy. 
This was a necessity; part of me felt broken. I felt a vulnerability I had not often 
had before, with an intensity that was at times overwhelming and crippling.

I became aware, as I anticipated that first session, of the enormity of trust a client
 places in the therapist, and what courage it takes to make that leap of faith. To place 
yourself, your mind, in the care of an unknown, whose attitudes and beliefs may be
at odds with your own, whose experience may be significantly different to yours.
 To trust that this strange person is competent and caring in their treatment of you
 and to ask for and accept their assistance, when you have no idea what kind of
 assistance they might offer. This is not like knee reconstruction surgery. There is
 no textbook theory into which this condition fits. The situation that created it had
 lurched into the abyss of litigation, and there were few reality bites. What I needed
 for certainty could only be obtained through the lengthy and tortuous process of
 subpoenas and until then I had to find my own sense, and try to discover what 
particular meaning the event, which had obviously been traumatic, had in my life.
 I wanted this therapist to help me find the story that allowed me to understand and 
move past my present injury, but I didn’t want it to be his story, I wanted it to be
 mine. I didn’t know if this therapist would be willing to walk beside me in this
 process, or whether he would insist on my taking his path.

Would I, having waited several weeks for this appointment, have the courage to
 walk out of it, should this psychiatrist turn out not to be the empathic professional
 he was reputed to be? Or would I just accept him, regardless of whether his 
approach and methodology suited my needs? Would I rationalise that I was in no 
position to assess the ‘fit’ between what I wanted and what I needed; or between 
my conscious neediness and his degree of skill? Simply, would I stick with him 
rather than ‘therapist shop’? I found myself in a state of confusion, in his waiting 
room; partly wishing I wasn’t there, partly feeling the kind of nervousness 
associated with serious exams, wondering if the feeling would go away if I
 consulted one of pile of last year’s women’s magazines, discovering it didn’t and
 wanting to throw up.

He was a kind, slightly portly, serious looking, typical doctor. He ushered me into 
his office and gestured to one of two comfortable chairs. There was also a couch
 on one side of the room, and a desk. For one moment I thought he was going to sit in the other chair; instead he took up residence on the other side of the desk, and 
proceeded to open a folder. Our sessions were conducted with him barricaded in
 this fashion, behind the desk, his notepad and his frequent note taking. It is a
 challenge to rapport development to take notes. It is impossible for the client to be 
unaware of the fervent scribbling, and I found myself attempting to alter the speed 
of speaking to accommodate the writer. I found myself trying to read what he had
 written, upside down. I wondered about why ‘this’ had been written down, whereas 
’that’ hadn’t. I wished he would stop, and attempt to really listen. I didn’t ask him 
to stop, however, this was clearly his territory, and if I had entered it, then I had to
 accept his rules. The very vulnerability, which had led me here, interfered with my 
being assertive, or requesting a change in the process.

I was struck by how much work I did to get into rapport with him, and how little 
he seemed to do to get into rapport with me. Every time my natural shift into 
rapport occurred, I wondered if this was simply my attempt to please. I found 
myself with a dual description of the process; the view from his side of the desk,
 and the view from mine. Then there was the third position, from which both sides 
of the dance were seen. I wanted him to appreciate my expertise, yet my 
vulnerability got in the way. I wanted him to lead; yet where he went seemed stilted 
and orthodox. I wanted someone who empathised with the new territory in which
 I found myself. I did not want someone who thought they had standard answers. I 
found myself dreading the sessions, and then questioning if this was somehow an 
indication or confirmation of their value. There were times when I needed the 
session, and times when it happened because it was booked. There was 
ambivalence between us. I could not accept that I was his patient. Rather, I was an 
impatient. He blew it when it appeared on one occasion that he could not 
remember what he had said the previous time, and on another, when my tears and
 distress were answered by the suggestion of anti-depressants. It was then that I 
realised his mission was to prevent intense feelings, rather than have me learn to 
be with them, or find my own meaning in them.

I have no doubt he acted professionally or with caring. I have equally no doubt that 
analysis and interpretation are of very limited value for those who seek to re-write
 their own history or find meaning for themselves. After trauma, which by 
definition involves disempowerment, healing requires the finding again of personal 
power. What I found in my psychiatrist was his power, not mine. When I left the
 therapy, I felt as though I had ingested something that did not entirely belong to
 me. I had had enough of analytic, cognitive explanations. I could talk my way out 
of this, and explain it better than anyone else. Whilst I have no doubt that my hip 
bone’s connected to my thighbone, and that like everyone else’s, my emotional
 vulnerability is as raw as the day it happened, I knew that down this path lay only
 more of the same dogma. Belief systems are very powerful. Undoubtedly they 
underlie our actions, our thoughts, and our interactions. In his belief system, my
 on-going sense of vulnerability was not to do with what I believed, but rather to do 
with his theoretical assumptions about my personality. He knew better than I did, and was anxious that I should accept this. And yet still I had no real relief from the 
underlying feelings of vulnerability, the periodic panic and the sense of 
disorientation.

Six months later, I sought help from one of my own kind. This time I saw another 
psychologist. One whose orientation was Milton Erikson style hypnosis. It was an 
interesting contrast. This time I had a person who declared himself at the outset an 
equal, and acknowledged the difficulty of working with a peer. Perhaps
 psychiatrists have no peers. In my experience, there was a fundamental difference.
 In one the presupposition was of conscious attention and analysis, in the other an
 assumption that the unconscious process was the work. In the one there was
 attention to the words, the meaning and the narrative. In the other, I could be
 blissfully unaware. Shock, horror. How could a therapist be blissfully unaware? 
Surely we should always know what was going on?

In the quest to find this ‘other’ kind of therapist, I had made a pact with myself that
 I would not try to out-therapist him, that I would reserve my observations for later.
 It seemed senseless to be both client and critic at the same time. I decided to allow
 the process, with no critique or comment until after the sessions were over. He too 
had a standard approach. His therapy was time limited; after the initial session, he
 would see me four times. Whilst accepting that I might need another session if the 
litigation proceeded to court, our contract was clear. His aim was to assist me to
 gain a separation from the traumatic state, by re-accessing resource states as well
 as building new specific ones. Theoretically he was presuming that in the absence 
of the actual trauma in the present, I was collapsing into a regressed state, based 
upon previous experiences of infantile powerlessness. In this framework, perhaps 
not so different from the psychiatric model, the work of therapy was to re-form the 
earlier experience and place it in a safe context that was unavailable at the time. 
His assumption was that had I been able to do this consciously, I would have 
already done so. Hence the need for trance work. I could comment; I could note 
that his use of personal stories was at times inappropriate, that he missed
 opportunities for a powerful suggestion, or that his technique relied heavily on my
 willingness to ‘go with it’. Yet I looked forward to those sessions. I knew that even
 if my tears flowed in the depths of a memory, which I couldn’t quite recall once 
out of the Trance State, I would nonetheless feel good as I walked down the street
 out of his office.

It is now, another six months later. Time enough for both healing and reflection. I 
am left with an overwhelming sense of the power relationship in therapy, and that t
he ecological use of that power is both subtle and difficult. At every turn, the 
therapist must make decisions about how to use that power. To be without direction
 may create or magnify the client’s anxiety about being adrift in the chaos of their emotions, to be directive may remove from him or her the growth that comes from
 confronting or acknowledging fear. This use of therapeutic power exists outside of
 normal requirements for successful therapy, such as caring or empathy. Both
 my therapists would be seen as caring, sensitive and empathic; both were as
 anxious to be of help, as I was to receive it. It was my perception that the 
psychiatrist believed he knew what would make me feel whole again, the 
psychologist believed he didn’t and assumed that I alone had that power. In a 
curious psychological paradox, I believe that I could not allow the former to have 
that power without reinforcing the powerlessness that had undone me in the first
 place.

As always, there are therapeutic ingredients which are almost missed in their 
simplicity. So it was for me. I cannot allow the above account to stand without
 acknowledgement of the on-going dialogue created between myself and two
 special people via e-mail during this time, both offering different, loving,
 immediate and genuine responses to my distress, my pain and my rage. Within the
 whirlpool, I felt I was not alone. Perhaps we created e-mail therapy.

IAHIP 1999 - INSIDE OUT 38- Autumn 1999