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Page 1: CouCh FiCtion - Macmillan International Higher Education · The drawings are perfectly ... CouCh FiCtion story philippA perry ... A catalog record for this book is available from

CouCh FiCtion

Page 2: CouCh FiCtion - Macmillan International Higher Education · The drawings are perfectly ... CouCh FiCtion story philippA perry ... A catalog record for this book is available from

‘Funtastic! How therapy works with all the fun of a cartoon.’

— Oliver James

Clinical Psychologist, Writer and Broadcaster

‘The charming pictures show psychotherapy working; the witty and brilliant notes explain how and why.’

— Dr stella tillyarD

author

‘A fresh, transparent look at the process of psychotherapy from the perspective of both the psychotherapist and the client. For the reader who is looking for a psychological understanding, the book provides theoretical reflections on the process.’

— PrOfessOr maria GilBert

Clinical Psychologist, Psychotherapist and founding Director of

metanoia institute, london

‘I loved it. I smiled and laughed. And nodded. One to read for sure.’

— PrOfessOr susie OrBaCh

Psychotherapist and Writer

‘Deceptively clever. It is easy to read and yet communicates some complex theoretical ideas. It is a rare thing to find such an informative and accessible book.’

— PrOfessOr Diana shmukler

visiting Professor of Psychotherapy, middlesex university, uk, and

formerly associate Professor of applied Psychology, university of

Witwatersrand, south africa

‘Philippa Perry has succeeded brilliantly in demystifying the complexities of the psychotherapeutic encounter.’

— PrOfessOr Brett kahr

senior Clinical research fellow in Psychotherapy and mental health

at the Centre for Child mental health, london, and honorary

visiting Professor at roehampton university, uk

‘An enchanting book. For something so playful and light-hearted, it packs quite a punch. The drawings are perfectly wedded to the content.’

— DOris BrOthers PhD

Co-founder and training and supervising analyst at the training

and research institute for self Psychology (trisP), new york

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A G r A p h i c TA l e o f p s y c h o T h e r A p y

CouCh FiCtion

story phil ippA perry art Junko GrAAT

Afterword Andrew sAmuels

Page 4: CouCh FiCtion - Macmillan International Higher Education · The drawings are perfectly ... CouCh FiCtion story philippA perry ... A catalog record for this book is available from

Text and story © Philippa Perry 2010Illustrations © Junko Graat 2010

All rights reserved. No reproduction, copy or transmission of this publication may be made without written permission.

No paragraph of this publication may be reproduced, copied or transmitted save with written permission or in accordance with the provisions of the Copyright, Designs and Patents Act 1988, or under the terms of any licence permitting limited copying issued by the Copyright Licensing Agency, 90 Tottenham Court Road, London W1T 4LP.

Any person who does any unauthorized act in relation to this publication may be liable to criminal prosecution and civil claims for damages.

The authors have asserted their right to be identified as the author of this work in accordance with the Copyright, Designs and Patents Act 1988.

First published 2010 byPALGRAVE MACMILLANHoundmills, Basingstoke, Hampshire RG21 6XS and175 Fifth Avenue, New York, N.Y. 10010Companies and representatives throughout the world

PALGRAVE MACMILLAN is the global academic imprint of the Palgrave Macmillan division of St. Martin’s Press, LLC and of Palgrave Macmillan Ltd. Macmillan® is a registered trademark in the United States, United Kingdom and other countries. Palgrave is a registered trademark in the European Union and other countries.

ISBN: 978-0-230-25203-5

This book is printed on paper suitable for recycling and made from fully managed and sustained forest sources. Logging, pulping and manufacturing processes are expected to conform to the environmental regulations of the country of origin.

A catalogue record for this book is available from the British Library.A catalog record for this book is available from the Library of Congress.

10 9 8 7 6 5 4 3 2 118 17 16 15 14 13 12 11 10

Project editor Charlotte Troy Produced for Palgrave Macmillan by CT Bureau. www.ctbureau.co.ukPrinted and bound in Italy by Graphicom on recyclable paper

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for Grayson

and flo

Philippa

for chris

Junko

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N o t e t o t h e r e a d e r

I wanted to call this book Interruptions of Contact but the pub-lisher quite rightly pointed out that it sounded obscure, negative and could be mistaken for coitus interruptus, so we went for Couch Fiction instead.

However, what I was trying to imply with the title, ‘Interruptions of Contact’ was a nod to the phrase used in psychotherapy, ‘inter-ruptions to contact’ which refers to how we avoid having full contact with others, with ourselves and with the environment, resulting in avoidance of those feelings that full contact would have given. A neurosis can develop and grow if we are not aware of how we interrupt our contact with the world. Sometimes we think we are having a relationship with another, when actually we are mostly having that relationship in our heads as we largely have avoided contact with the other person or thing. If we continue to follow such a pattern, we will develop a neurosis and diminish our experience of being alive.

The habit of avoiding contact and avoiding feelings is usually a creative adaptation to the environment we experienced as

children, enabling us to survive and thrive despite less than per-fect conditions. However, when the conditions change, we are usually stuck with the old habits even though it may not be in our or the world’s best interests to continue with them. This is the underlying theme to the following tale.

With their permission, I have taken content from real people’s actual dreams, but apart from that, this story is entirely from my imagination. Although none of the characters have ever existed, nor have any of the events described actually happened, it is typical of psychotherapy case studies. I wrote the book because I wanted to describe what life can be like as a therapist and as a client.

With most of the pictures there are some notes. You can disregard these and still follow the story. Or, if you want to find out more, try the notes.

—Philippa Perry

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Uh huh, Who’s Next? Ahh... A new Client.

A G r A p h i c TA l e o f p s y c h o T h e r A p y

CouCh FiCtion

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8

C o u C h F i C t i o n

Some schools of psychotherapy suggest that prior to a session, a therapist should empty themselves of preconceptions in order to maintain the openness of mind necessary to be aware of the nuances of the encounter. The psychoanalyst Wilfred Bion said that the therapist must prioritise perception and attention over memory and knowledge as the practitioner’s most basic working orientation.

This position is almost always adhered to by the most experienced therapists (occasionally due to dementia rather than a rigid adherence to theory). The therapist in this story is not rigidly adhering to this theory. She is not a perfect therapist and there is no such thing.

JAMES CLARKSON SMITH?

I REMEMBER – SOUNDED POSH AND CONFIDENT ON THE PHONE.

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9

C o u C h F i C t i o n

I wonder how much research has been done on the impact of recycling bins and their contents on the doorsteps of therapists’ premises? I would be especially interested to know of their impact on the first-time client.

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C o u C h F i C t i o n

Many psychotherapists do not worry about the impression that their appearance makes on their clients*; some have a habit of wearing open-toed orthopaedic sandals whatever the weather. Footwear can give an idea of whether a therapist is working from home or renting a room – slippers or open-toed sandals in winter are a sure sign they are home based.

*This is either because they have worked through their own narcissism issues or they are inherently unstylish, or both.

James,Come In.

Patricia?

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C o u C h F i C t i o n

We can never assume that the absolute truth in and of another person can ever be completely known. It is, however, important in psychotherapy to strive for that truth. Whether Pat clocking that she finds James attractive can be seen as striving for absolute truth is debatable.

PLEASE TAKE A SEAT.

THANK YOU.

ABOUT 35,

GOOD LOOKING,

QUITE FANCIABLE

IN FACT...

MESSY PAPERS ON DESK, BIT OF BREAKFAST ON

CARDIGAN.ABOUT 50...

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12

C o u C h F i C t i o n

WHAT CAN I DO FOR YOU?

ER ... UM ... ER ...

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C o u C h F i C t i o n

In the past, unlike Pat, many therapists didn’t ask questions in order to be a blank screen onto which the client then projects. Projection is when instead of having pure contact with another, we project a part of ourselves onto the other person and relate to our own projected part, rather than, or as well as, to the person before us. It is now recognised that a practitioner who says nothing is anything but blank and, however talkative or silent she is, the client will still react to her as she is in the present (with her funny sandals and her recycling).

Nor will failing to remain silent prevent projection or transference. Transference is when we make subconcious assumptions about the person before us in the present, based on our experience of people we have known in the past. For the record, countertransference is what therapists call the feelings that the client causes to emerge in the therapist. It is desirable that therapists recognise their countertransference so as not to complicate an already complicated matter.

... OR MAYBE YOU’D LIKE TO ASK ME

SOMETHINg?

UNDERNEATH THE SAVILE ROW

STRIPES, HE’S PRETTY SCARED.

COME ON! PULL YOURSELF TOGETHER!

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C o u C h F i C t i o n

By talking about Simon, James is avoiding the subject it would better serve him to talk about – himself. Pat appears to be experiencing a countertransferential parallel process to James, as she too is finding it hard staying with the business in hand. Possibly, due her distraction, Pat has missed the clue that James ‘heard’ Simon talking about her, rather than James reporting having a conversation he

had with Simon. It is as though he has taken the information from Simon by stealth. She missed this. It does not matter. If it is important that a behavioural pattern is addressed, the client will invariably either demonstrate it again, or bring it up later on.

I HEARD SOMEONE CALLED SIMON

TALKING ABOUT YOU.

HE WAS SAYING THAT HE HAD BEEN HAVING ANXIETY ATTACKS.

Much Better,

Thank you.

He saw you

six times.

DYING FOR A CUP OF TEA ... ... I’M DISTRACTED ...

... HOPE I’VE GOT MILK ...

BY TALKING TO

YOU, HE FELT

BETTER AND THEY

STOPPED. BUT I

DON’T SEE HOW

THAT WOULD

WORK FOR ME.

WISH SHE’D TALK ABOUT SIMON.

DON’T WANT TO TALK ABOUT ME.

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C o u C h F i C t i o n

Research has shown that clients are most likely to make positive changes in therapy when the therapist uses the client’s own theory of change, or when the therapist’s own ideas about change coincide with the client’s previously held psychic beliefs. This is why Pat asks James what would work for him.

WHAT DO YOU THINK WOULD WORK FOR YOU?

Er ...I Don’t Know.

Pity.

Uh Huh ...

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C o u C h F i C t i o n

The highest indicator for a successful outcome for therapy is the client’s expecta-tions, motivation and hope. The second is the relationship between the client and the therapist. Neither area seems to be thriving for Pat and James at this stage in the therapy.

I’M NOT FEELING MUCH OF A

CONNECTION WITH JAMES.

THIS IS SURPRISINGLY HARD.

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17

C o u C h F i C t i o n

WHEN HE FIRST ARRIVED WE HAD GOOD

EYE CONTACT. THAT HAS GONE NOW...

THERE IS NO WAY OF PUTTING THIS. I’LL HAVE TO JUST SAY IT.

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18

C o u C h F i C t i o n

Many clients report that naming the issue that brings them to therapy out loud for the first time can be a powerful experience, even overwhelming.

I’M A THIEF.

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C o u C h F i C t i o n

Psychotherapists are often asked whether it is boring listening to people talk about themselves all day long. The answer is no, not when they are really talking about themselves. If the therapist does feel bored, she will be interested in that feeling because it will be telling her what needs to be addressed in the session is probably not being attended to.

Therapy can break down if client and therapist have not agreed goals. By asking James what he wants, Pat is beginning to negotiate a potential contract for their work together. She is also checking out whether she would be willing to work with James. Not many therapists want to act just as a confessor.

AHA! NOW WE’RE COOKING

WITH GAS.

AH, OKAY AND WHAT D’YOU WANT

TO GET FROM COMING TO SEE ME?

HE MAY JUST WANT TO CONFESS

AND CARRY ON.

THERE! I’VE TOLD HER NOW. SHE’LL PROBABLY SAY SHE DOESN’T DO THIS SORT OF THING AND RING UP HERFRIENDS AND HAVE A LAUGH – MAYBE

SHE’LL EVEN TELL SIMON. AHH ... WHY DID I COME?

I WANT TO STOP.

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C o u C h F i C t i o n

Many people consider undergoing therapy only as a last resort. They have usually tried various strategies to change or to feel better before getting help. Pat would not want to suggest something James has already tried, hence her line of enquiry.

I’VE TRIED TO STOP BUT ... I DON’T KNOW...

APPARENTLY I AM UNABLE TO.

WHAT HAPPENS WHEN YOU TRY?

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21

C o u C h F i C t i o n

Although kleptomania isn’t a particularly common compulsion amongst people in a position to afford private psychotherapy, it is not unusual in that most of us continue with a habit we would rather we didn’t. For example: procrastination, smoking, eating too much, being over critical, over-reacting, acting shy, getting drunk… the list goes on.

HERE’S YOUR

ESPRESSO SIR. THANKS.AND I’LL HELP MYSELF

TO CHOCOLATE WHILE I HOLD YOUR EYE CONTACT,

HA HA HA.

I JUST FORGET NOT TO DO IT. I GO FOR

OVER A WEEK WITHOUT STEALING AND THEN I

DO IT AGAIN.

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22

C o u C h F i C t i o n

Inevitably when a therapist looks back over a session, there is always something she could have done more sensitively or intelligently. Here, Pat is going too fast for James in looking for triggers for his behaviour. It would serve him better at this stage if she empathised with him more. The idea, though, is not to be perfect. The idea is to remain authentic while striving for the unknowable truth.

I’M A BARRISTER –

I COULD LOSE MY CAREER.

I’M JEOPArDISING EVERYTHING

AND I DON’T WANT THAT.

HMM... PERHAPS HIS LOGICAL

SIDE KNOWS THIS BEHAVIOUR IS

NOT IN HIS BEST INTERESTS,

but UNCONSCIOUSLY HE

BELIEVES STEALING

IS ESSENTIAL.

... ER ... UM ...

UH HUH ... WHAT ARE YOUR TRIGGERS? WHAT HAPPENED BEFORE YOU

LAST STOLE?

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23

C o u C h F i C t i o n

I WAS IN A SPANISH SHOP. I WANTED SOME OLIVES AND THE ONES I ASKED FOR WERE IN THE BACK. OF COURSE, SHE WOULDN’T

THINK ABOUT NOT TRUSTING ME. I DON’T EXACTLY LOOK LIKE A CRIMINAL.

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C o u C h F i C t i o n

If this was an ordinary conversation and not a therapy session, Pat would prob-ably go into raptures about the combination of pitted black olives in chilli oil with pickled garlic available at the nearby Spanish deli. But this isn’t an ordinary

conversation and so she does not share her passion about olives with James. Although James is relating a story about buying olives, olives are obviously not the subject here.

I SAW THIS OLIVE OIL.

I DIDN’T THINK ABOUT IT.

I CERTAINLY DIDN’T NEED IT.

I JUST TOOK IT and...

...PUT IT IN MY

BRIEFCASE AND

CLOSED IT.

SHE CAME BACK WITH

THE OLIVES, I PAID FOR

THEM AND LEFT.

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C o u C h F i C t i o n

The process of telling the story and the relationship of the teller to the story is of more interest to a therapist than the content of the story itself. The content is the icing but the process is the cake itself. This is why therapists will often ask a client how they feel about the story they’ve just told. It is another of the differences between a normal conversation and a therapy session.

HOW D’YOU FEEL NOW,

TELLING ME THIS?

WHEN I

WALKED OUT OF THE

SHOP I FELT EUPHORIC,

BUT NOW I FEEL

ABSOLUTELY

AWFUL.

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26

C o u C h F i C t i o n

Pat is formulating theories about James’ behaviour that she is choosing not to share. Therapists commonly refer to this process as ‘bracketing’. Pat does not know James very well yet, so she is unsure about what he can and cannot tolerate hearing at this stage. Possibly it would serve James better if she also bracketed her line of enquiry about triggers, as her inability to let go of the trigger theme is in danger of rupturing their relationship.

Bracketing is more complex than just withholding information. It actually means suspending judgment. To understand this thoroughly one has to study the philosophy of Husserl. He talked a lot about how seeing a horse qualifies as a horsiness experience irrespective of whether the horse appears in reality, in a dream or hallucination. He also talked about the very essence of how you experience the phenomenon of horse essence, but I’ll bracket that.

I SUPPOSE IT WOULD BE EASY ENOUGH TO RETURN THE STOLEN

GOODS AND I DON’T REALLY UNDERSTAND WHY I HAVEN’T DONE THAT.

UH HUH.

HE HASN’T TAKEN THEM BACK, SO A

PART OF HIM MUST BE SATISFIED WITH WHAT HAPPENED.

THERE IS ALSO THE EUPHORIC REINFORCE-

MENT HE GETS AT THE ACTUAL TIME HE STEALS, WHICH PROBABLY MEANS HE’S ADDICTED TO

THIS BEHAVIOUR.

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C o u C h F i C t i o n

WHAT HAPPENED BEFORE YOU STOLE?

I TOLD YOU. SHE WENT INTO

THE BACK.

WHAT HAPPENED IN THE DAYS LEADING UP TO THAT

ACT OF STEALING?

I’VE LOST THE CONNECTION – HE FEELS FURTHER AND

FURTHER AWAY...

BLANK

NOTHING.

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28

C o u C h F i C t i o n

Pat continues to pursue her trigger theory. Her speed here means that she doesn’t stay in contact with James. In her enthusiasm, she appears to have for-gotten her early counselling training on closely tracking the client and going at the client’s pace. James is being pushed not only to where he does not want to go, but where his body is unwilling to go, and so he goes blank. Going blank, or dissociating, is not an act of will but an automatic response to certain stimuli.

Some people are more prone to this response than others, especially if they started to do it at a very young age. You might assume – and perhaps this is Pat’s mistake – that James being a highly educated professional person would be able to follow Pat’s simple questioning. But all of us have the potential to be highly functioning in some areas and relatively immature in others.

MAYBE HE’S UNNERVED BY

SILENCE – FEED HIM A QUESTION...

WHAT WAS HAPPENING AT

WORK?

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29

C o u C h F i C t i o n

In most people’s lives, there are three main areas: what we do, where we live and who we live with. Pat has tried the first area, what we do – work, in other words – and did not come up with anything. She’s moved on to the people in his life to see if anything untoward is happening there.

I HAVE PLENTY OF WORK, SO THAT IS GOOD. I WAS WORKING WITH AN INTERESTING QC. THERE

IS NOTHING TO TELL...

I DON’T KNOW WHAT YOU

WANT...

WHAT ABOUT YOUR SIGNIFICANT

RELATIONSHIPS OUTSIDE WORK?

DON’T KNOW.NOT SURE.

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C o u C h F i C t i o n

Therapy is not like a normal conversation in that there can be long silences in order to give things time to emerge from the unconscious mind into awareness. Although unless this has been previously negotiated between the parties, what is likely to come up is,‘Why isn’t she saying anything?’ or ‘What am I supposed to do now?’

DON’T PANIC PAT. SOMETHING MUST HAVE

TRIGGERED THAT STEALING EPISODE.

GIVE HIM SOME SPACE.

WHY ISN’T SHE SAYING ANYTHING?

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C o u C h F i C t i o n

As either a client or a therapist, if something pops into your mind, it may be worth sharing. Even if, on your own, you cannot see its relevance.

OH, I DON’T KNOW. I HAD MENTIONED TO MY GIRLFRIEND, JUANITA, THAT SHE COULD MOVE IN WITH ME. BUT SHE DIDN’T SEEM THAT INTERESTED.

HOW DID HER REACTION MAKE YOU FEEL?

WE COULD BE ONTO

SOMETHING HERE.

I’M CLUTCHING AT STRAWS. THIS

HAS NOTHING TO DO WITH ANYTHING.