Medium 9781782204435

Scenes from a Clinical Life

Views: 236
Ratings: (0)

How does psychotherapy work?What is the role of a therapist?And what do therapists do when their wish for professional advancement is blocked?This ground-breaking novel looks at these questions in a frank and engaging way, following the progress of David Treuherz, a clinician, as he attempts to juggle his working life with the turbulence of his personal life.In this vivid picture of a therapist at work, the intimacy of the clinical encounter is movingly delineated. Central to the story is David's struggle to secure further training, and his own experience as a patient, as well as a therapist.Can David be successful in getting the advancement he seeks? And can he build a relationship with the attractive Clara?This is a book for anyone who wants to explore what it means to be a therapist - or a patient.

List price: $13.99

Your Price: $11.19

You Save: 20%

Remix
Remove
 

19 Slices

Format Buy Remix

One

ePub

It was a day at the end of summer. The light seemed to shimmer with a piercing clarity. The elderberries were turning from green to gleaming black, and the sloes were beginning to look like dusty blue globes in the hedgerows. David Treuherz was partly aware of the incandescent light but was more concerned with getting his car started, and himself to the interview. The car was a make that he had imagined would not only convey his person but would also project an image of him as rather alternative and unusual. He was relieved when it started; it was a cheap car, with an idiosyncratic tendency to inexplicable inertness, and he knew that sooner or later he would have to get it attended to.

Successfully on his way, he headed out to the suburb where he was being interviewed for a job as a clinical psychologist in a child and adolescent mental health consultation service. It would be his first job since qualifying as a child psychologist, though he worked privately with adults as a psychodynamic counsellor. He glanced anxiously at himself in the mirror as he drove, checking his tie. His hazel-coloured eyes looked back at him nervously, and he had to make an effort to be calm, smoothing back the black tuft of hair that flopped on to his forehead. He ran through the answers to questions he might be asked, half his attention on the driving and the increasing greenery as he approached the suburb. A jay flew across the road almost under his wheels and he delighted at seeing so clearly the warmth of its colouring in the brilliant light, feeling that it was a good omen.

 

Two

ePub

It was two weeks later that David was able to induce Clara to meet him for supper at the same café where he had met Jack. He could not ascertain from her manner and the relative freedom with which she had arranged to meet him whether she was in fact already in a relationship with someone else. He felt nervous as he waited for her, and she was clearly nervous too. She let the two sides of her hair hang down in front of her face, obscuring his view of her, until she began to relax and flicked one side up behind her ear. By the time they were on their dessert (chocolate and chestnut torte this time for him, with associated memories of his Swiss childhood; fruit salad for her) some of their mutual nervousness had declined. Each had discovered that the other was single. And David had discovered more about her book than his competitiveness would allow him easily to know. It was about childhood autism and psychological approaches to it.

His competitiveness was piqued, too, by her professional aspirations. Not content with her psychology doctorate, she was starting the application process to the Radcliffe and was clearly in a state of rather dazzled idealisation in relation to the issue, and the possibility that she might train as a psychotherapist. He bore with her patiently while she gave a lengthy account of her first interview. Through this account he did find out more about her. Her parents (lived in Kent), her degree, her cat. With this last he winced for a moment. Oh God! Not more cats! But she convinced him that this cat was modest in habit, affectionate, and prone to greeting her with warmth on her return from work, alleviating, she said, the pain of the end of a recent long-term relationship. He resisted the temptation to see her description of the cat as representing something of her character, and was openly sympathetic to her recent loss whilst secretly pleased that there might be a future in their relationship. He told himself that he needed to play his cards carefully, liking Clara more the more he saw of her. She was dressed stylishly this evening with earrings whose little purple glass drops were arranged like bunches of grapes, and her green eyes were set off by the minute leaves that twined in a necklace that matched the grape earrings. She was alert, intelligent, and lively, but not intrusively so, and listened to him with attention and warmth when he talked.

 

Three

ePub

Meeting the new therapist was exciting on the face of it. He had asked around among his acquaintances about her reputation. The general view was that Sonya Merryn was well regarded, a kind woman. Only one person, a colleague who was a psychotherapist, sounded a note of warning. She asked him if he realised that the new psychotherapist's professional allegiance was to a particular group of therapists who did not deal with part objects. He asked her what she meant, and she explained that these therapists did not, like his Dr Smythe, think in terms of different parts of the internal world in relation to one another. In Merryn's view, and that of her colleagues, the internal world was more unitary. This set of therapists did not, like Dr Smythe and the set of therapists he belonged to, hold with the importance of very early experience in shaping the internal world. David felt uncertain, but perhaps he should give this therapist the benefit of the doubt. His experience of having approached training therapists fruitlessly made him feel he was unlikely to find one akin to Dr Smythe…psychotherapists of his set were all popular, sought after—and tended to have no vacancies.

 

Four

ePub

At the weekend David went for a run with Jack. Jack was in an excited state of mind, eyes gleaming as they ran past the café, which was full of families and couples on such a fine sunny morning. His golden hair was lit up almost into a halo by the sun behind, as he confided, beside himself with excitement, that he had been accepted to train at the Radcliffe as a psychotherapist. David was not surprised.

“I'm pleased for you, Jack,” he said breathlessly—they were running at a speed to match Jack's elevated mood.

“Yes, great, isn't it? You should apply too, you know. They would be very enthusiastic about someone like you applying.”

“I'm really not sure about that. I went and had an introductory chat and the response was less than enthusiastic…in fact I had the distinct impression that the person I saw was trying to dissuade me…What were your interviews like?”

“The interviews weren't too bad, really. I was expecting something much more searching. I kind of got the impression that I wasn't quite waved through but there was rather that feeling…I think being a medic helps.” By unspoken mutual consent they stopped at a spot where they could look from the hill over the city. Puffy white clouds cast shadows on the grass and the sun had a welcome brightness. In the blue distance David could see the hills beyond the clusters of tall buildings that gleamed white and geometric in the clear air.

 

Five

ePub

The next day there was the second interview for the Radcliffe training to address. He arrived promptly at the small terraced house where his next interviewer had her consulting room. He rang the bell and the psychotherapist came to the door and opened it. He said hello and she greeted this with a blank face and stiff nod. A young woman with blonde hair, she was slim—and, to his discomfort, determinedly silent. He looked around her consulting room for a moment as he wondered how to deal with the fact that she wasn't going to say anything. He noticed the plants, again, the neutral setting, the couch, the rather graceful antique furniture with which the room was furnished. He decided he would volunteer first of all why he wanted to train at the Radcliffe, and discussed his wish to enhance his clinical capacity and the fact that it was the obvious place to approach to do so. She greeted this with another stiff nod, and said nothing. Saffra Downy had a good reputation—but she didn't seem to speak.

 

Six

ePub

As though the disappointment with the Radcliffe and with Clara was not enough to struggle with, David suddenly had much more with which to contend.

Like his father, David's mother liked to swim, generally in the sea. She and Evan were in the habit of spending their holidays in Cornwall, where they would walk, swim, and deal with some of the reading and writing of papers they didn't have time to attend to during term time. During the academic year she took little exercise apart from a weekend country walk, and would admit that she was envious of David's running and of the fact that Evan was also a runner and a cyclist, riding his bicycle to work routinely. So her heart attack was something that perhaps should have been expected; she had seemed more tired in the months preceding the summer and had talked with enthusiasm of her retirement planned for the following year. The workload she undertook had been heavy.

That summer, temporarily (he hoped) single, David had joined his mother and stepfather for a week and joined in their walks and swims, enjoying the break in his routine and glad of the chance to get away. He planned to join friends in a cottage in Brittany after he had returned to London, spending a week back at work and then going on leave again. However, one evening during that week in London, as he was cooking himself a meal, Evan rang, speaking calmly despite being clearly distraught. There had been no warning, nothing. David's mother had a heart attack as they were climbing a steep coastal path near the beach. The lifeguards had been magnificent. The air ambulance had been called and took her to hospital but it was such a massive heart attack there was nothing they could do.

 

Seven

ePub

Back in London, David considered his position. He started work again with his patients and the families he saw at the clinic. The choir rehearsals were more enjoyable now that he had Rachel to compare notes with. Perhaps it was time to move forward, to reapply to the Radcliffe. He knew that it was possible to carry on applying. Nothing against that. This would be his second application, but when he wrote requesting a new application form he was disconcerted to receive a curt note back telling him he could not reapply. Puzzled, he wrote back and received another dismissive note telling him that, on the basis of his previous set of interviews, it was not felt appropriate to offer him another chance to apply.

He described this situation to Sonya, and was disconcerted when her response was to say, “Well, maybe they have picked up something about you. Maybe there's some anxiety about you? After all, you told me you felt down when your mother died, and you have actually been feeling quite depressed.” She didn't link this loss with his infant experience of losing a warm maternal presence as a result of his overwhelming prematurity; the mark this had left. David knew that she didn't privilege infant experience in her thinking. He was stung into remarking that he felt that if most people didn't find themselves being depressed, and being very low, mourning, in the face of losing a parent, there might be something wrong with them…after all, Melanie Klein had famously written a paper about a similar bereavement reaction to the loss of her son, although ostensibly about someone else—and even Freud talked about the possible severity of mourning. Of course it was pointless to argue, and Sonya simply remarked that he seemed to want to minimise the seriousness of his psychological state. David left the session nettled, feeling once again that he was not in the presence of someone who had a compassionate understanding, based on her own struggles, of psychological issues, but someone who had a tick-box reaction to certain matters—even, said David to himself, a wilfully blind approach to the difficulties of her patient, someone who seemed to want to lodge her difficulties in the patient and criticise them there…and then he sighed and told himself that this was simply a parody of something Sonya had said to him earlier in the therapy about lodging his difficulties in his patients and looking after them there…for the first time, though, David began to think about ending this therapy, and finding another therapist who could think about his interior reality in a more cogent, understanding, and benign way. He wouldn't want to be the sort of psychotherapist Sonya was. No doubt she was helpful to patients who had not suffered early infantile trauma. He knew she had a good reputation, presumably because she helped patients whose internal reality didn't have its foundation in insecure and profoundly difficult early experience. Those patients did not need the sort of approach favoured by therapists who focused more actively on the way that early experience permeated emotional life. The more superficial stance of someone like Sonya would be appropriate for patients whose emotional reality had been forged in a secure early attachment.

 

Eight

ePub

David got a letter from the Radcliffe in January. He had been turned down again. He was disappointed, even though he had come to expect this sort of response. That evening they were going out with Jack and his partner Marie; they had tea together at a concert hall where they were going to hear a celebrated tenor give a recital of Schubert Lieder with a distinguished pianist as accompanist. Jack was startled to hear the news that David had been turned down.

“They don't know what's good for them,” he said gruffly and then added: “If you were someone foreign—if you had a Russian accent—or better still a Lithuanian one—or if you were from Latin America—you would've been accepted…” Rachel looked at him, puzzled.

“Why's that?” she asked. “Are they more in favour of you if you're foreign?”

“He's just joking,” said David uncomfortably. But as the concert began he did begin to find himself wondering if there was perhaps some truth in what Jack had said. Would he have been more in favour if he were not so clearly and identifiably an ordinary person from the UK? Albeit with a Swiss father?

 

Nine

ePub

A few days later David started work in the new child and adolescent consultation service. He was welcomed by all the staff at a team meeting—when asked about his orientation there were nods of satisfaction when he said that his theoretical interests clinically encompassed both systemic and psychoanalytic approaches. He was surprised and gratified at the number of child psychotherapists, and took a keen interest in the clinical presentation that formed part of the meeting. He noticed that the child psychiatrist, Thea, was quite active, and dominant in the discussion. She was a large woman, with light brown hair and a pleasant manner, and a voice that was quiet but nonetheless cut through the vagaries of the discussion like a knife through butter. He thought her comments apposite and interesting. The principal child psychotherapist was also a woman, but a different type altogether, slightly vague, withdrawn, and with an anxious look. Frieda's contribution to the discussion was careful and limited to one comment. His impression of her as rather withdrawn was underlined when he noticed that she made no real attempt to engage with him over the next few weeks. He found his other child psychotherapy colleagues and the other clinical psychologist more willing to get to know him and he was grateful for the time they gave to welcoming him, despite the endemic NHS work overload.

 

Ten

ePub

It was June. The new job had become more routine. All seemed much as usual; Jack and Marie's baby arrived, just a few days late. David visited them with Rachel, on a hot sunny day. The new baby was a boy, christened for Jack's grandfather, Peter. Their front room was festooned with cards and flowers and the new parents were beaming but shocked by the sudden change to their lives. The tiny baby dozed fitfully with occasional dreams and whimpers. As David had feared, the sight of the happy new family provoked Rachel into a fresh assault on his determination not to go down the path of having a baby themselves.

“But why not, David?” Rachel said to him as they arrived back in their flat.

“I just feel I'm not ready to be a parent, Rachel,” he said, nettled by the pressure from her.

“Well I can't carry on like this, hoping you'll change your mind,” Rachel said, clearly hurt, yet again, and downcast. “What future do we have as a couple, if you won't really commit yourself to the future?”

 

Eleven

ePub

It wasn't long after he and Rachel had split up that he found himself at a meeting at the Limes clinic about a new research project that was being proposed. He noticed that Clara was sitting in the front row and at a suitable moment he found his way towards her. She was obviously pleased to see him. David told her that he had moved on from his relationship with Rachel, whom Clara had encountered a few times at social events to which they had all been invited.

“I hope it's not too difficult for you, David,” she said with a warmth and sincerity that surprised him, looking at him with her clear green eyes, which he felt were quite unique. Nobody else could have eyes of that colour. He realised that he was staring at her wordlessly while he entertained the thought about her eyes, and, embarrassed, he was stilted and awkward in his response.

“It is a major a change. Difficult too being turned down again by the Radcliffe.”

“What, again?” she said indignantly. “Why don't they know what's good for them?”

 

Twelve

ePub

Not long after this David decided to put in another application to the Radcliffe. His first interview was with an elderly man, a tall stooped figure with wisps of grey hair creating a halo effect around his head. His consulting room in a leafy street was extremely dark, and slightly dank, even allowing for the fact that it was November and the weather was gloomy. David had the impression that he was entering a cellar. It was a dark room anyway, overshadowed by lime trees growing close to the house, and the two dim table lamps on polished antique side tables did little to lessen the dimness. The interview started in a way that took David aback. Andrew Coulterden had a sheaf of papers in his hand, which he waved at David as they sat down.

“I've read your application form and the reports of your previous interviews,” he said. “Quite frankly, I have to tell you that some psychotherapists would regard you as hardly treatable, let alone suitable to train as a therapist.”

David's jaw tightened. “What makes you say that?” he asked, as coolly as he could.

 

Thirteen

ePub

It was when David was thinking of his next interview that he realised—or thought he did—the full implications of not being accepted this time. He had decided that it would be the end of his contact with the Radcliffe. He could carry on in the two settings he worked in. He could struggle to get a relationship going with Clara—but it would be undermined by the fact that she was a psychotherapist at a prestigious organisation while he wasn't. Similarly with Jack. Jack and Clara were in; he would be out. He supposed he could apply to a less prestigious organisation, but the Radcliffe was unique and in a leading position. There were other trainings across the world, several in cities in the States. He toyed momentarily with the idea of moving; perhaps he could pursue a career as a therapist there. But this was a big step to take…it would mean leaving everything behind—his relationships with friends, his family, his network of work colleagues built up over the years. And of course it would mean leaving Clara. He shrugged off this thought and, as it was the weekend, hurriedly organised himself to go for a run. It was spring again; the cold of the winter months, the dark days, were being left behind and it was bright but blowy, with clouds scudding across the sky. As he ran, David thought that the pigeons he could see being tossed and thrown about by the wind perhaps enjoyed it, and he felt his state of mind improving. His interview was the next day and he slept well, eager to get it over with and determined to make a good impression.

 

Fourteen

ePub

David hoped the new therapy would provide a setting in which he could encounter the thinking of the Spaltung set of therapists at the Radcliffe, as well as a place where he could recover from the shock of the interviews and his failure to be accepted. As spring progressed, he certainly felt a new liveliness; warmth was not only all around him but seemed to affect his state of mind, so that he noticed with pleasure the thickening buds on the trees and the sunlit white clouds, which seemed to bloom against the freshly blue sky. He didn't travel in the Easter break, contenting himself with being at home or doing some sailing with Jack and enjoying playing with the baby. For the summer holiday, however, he found himself planning a trip to visit a friend who had settled in Norway. With a pleasurable sense of anticipation he worked out a cheap route from Newcastle to Bergen by sea, and from there by steamer up the coast. His friend Roald would meet him at the small harbour and drive him to the family farm.

 

Fifteen

ePub

David did send in a complaint. To his chagrin, he was passed from pillar to post, with lengthy delays. He wrote first to the group that dealt with applications, on the basis that he had been told at his last set of interviews that his academic qualifications were not sufficient and that he should have been told this before he had put in a long series of applications lasting years. A long delay ensued, after which he received a letter suggesting that he had no cause for complaint and that he should let the matter drop. He then wrote to the group responsible for the education of psychotherapists. After the passage of several months, he was brushed off in the same way. He wrote to the director, and was invited to a meeting with him. The meeting at least gave him a chance to air his concerns, but once again he was brushed aside, with the thought offered that perhaps he was harbouring a grievance. He protested at this pathologising of what seemed to him a legitimate matter of concern, but to no avail.

 

Sixteen

ePub

It was a relief to David that he was with a therapist who was clearly appalled at the way he had been treated. He could hold on to a sense of the competence of some therapists, even though the institution itself was, as he put it to himself, in trouble. He could clearly differentiate between what belonged to the dynamics of the Radcliffe and how his own internal world might be linked with those dynamics and throw up a mesh to ensnare him, potentially, into misery. Gradually recovering a degree of objectivity about what he had been through—in his attempts to be accepted by what he could now think of as an impressive organisation but one in some difficulty—he could get on with his life. He could attend to his own patients, his work with the families—and his pursuit of Clara. It was a significant problem that Clara had come to the end of her training at the Radcliffe and was becoming involved there…but she was none the less desirable for that. If only Georg wasn't there…and, he could see, Georg was increasingly not there. He and Clara often talked on the phone in the evenings now, and she was the first to learn of his thought that he would visit Alaska in the summer, that it would do him good to travel, to get away from his routine and the Radcliffe. He would have a trip; he would visit his friend Gemma Stadtler in Alaska; he would return in September invigorated. He could see that Clara was rather regretful that she could not accompany him. Her projected trip in summer with Georg to his family, followed by walking in the Alps, clearly didn't seem so attractive to her, and he sensed that the relationship was in difficulties. But it was still a relationship, and there was no point in trying to hasten the decline of it in too obvious a way. He told Clara about Gemma, and she was politely interested, trying, he felt, to push away jealous feelings about this other woman.

 

Seventeen

ePub

As the little plane dipped down towards the inlet, David was entranced by the view. They seemed to be flying over a rainbow, which had its foot in dappled grey water, half lit by bright westering sun and half swathed in a veil of grey rain falling from a heavy black cloud. In another minute they were into the cloud and visibility was lost. He looked at Gemma. She was a tall woman, blond hair swept back behind her ears and green eyes lighting up a tanned face. She grinned at him and said, confidently, that the pilot of the plane had done this run hundreds of times before. The plane bounced slightly on landing, but it was smoothly done, and as David climbed from the plane and set about the business of helping unload their baggage he was relieved that the serious travelling was over. He felt jet-lagged and rather unlike himself after the long journey from London.

To be in Alaska and about to set out with Gemma on a camping trip was an excitement, and he looked about him eagerly. The little landing strip was adjacent to a small group of timber houses arranged in a strip on both sides of a rutted road, and he found it difficult to believe that the place was important enough to warrant it, but Gemma assured him that it was common, during the light summer months, for planes to fly in equipment, hikers, and photographers to this isolated spot. He was stunned by the tall mountains that ran down to the sea, their bases swathed in heavy forest, and snow still on their peaks. In the waters of the inlet were half a dozen boats, some of them clearly for fishing, others looking as though they were ready for taking trips up the coast.

 

Eighteen

ePub

Back in the UK and at work, David felt that it had been something of a dream. After a week of seeing his patients and the families in the child and adolescent service, he felt that he had never been away, getting over the customary return-to-work difficulty far more speedily than usual. He was impatient to see Clara again, but she seemed still to be away, her phone unanswered. His flat seemed small and cluttered when he looked around it after his trip, and he spent some time clearing it and doing some decorating, painting the hall a pale shade of grey, as suggested by Marie. Over the dinner he had with her and Jack, they listened to his traveller's tales, enthralled. They were clearly feeling somewhat tied down by the demands of parenthood. He was glad to see them again, and glad to see his colleagues at work and his patients. He felt that the trip away had been a transformative one; he could see the value of the work he was doing with the families. He was less inclined to regard the work as of lesser status than private work as a psychotherapist, and therefore as less worthwhile. Looking at himself in the mirror one morning in September he saw an older, more sober face looking back at him, definitely with some grey hairs now.

 

Load more


Details

Print Book
E-Books
Slices

Format name
ePub
Encrypted
No
Sku
BPE0000117142
Isbn
9781781817025
File size
757 KB
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Format name
ePub
Encrypted
No
Printing
Allowed
Copying
Allowed
Read aloud
Allowed
Sku
In metadata
Isbn
In metadata
File size
In metadata