Tuesday, 15 February 2011


Having posted previously on the In-betweens of a therapy session, I thought it might be interesting to focus on the very first session between therapist and therapee (‘patient’, ‘client’, ‘service user’, ‘analysand’ all sit very uncomfortably with me, so I have invented my own word that means ‘s/he who has come to seek insight and emotional healing’).

Before the beginning of each and every therapy session I always experienced a degree of anxiety – but when I walked into the therapy room with someone for the first time I would sense a whole rabble of butterflies taking off inside my innards. In the early days, this used to worry me, until I came across these words written by Wilfred Bion:

In every consulting room there ought to be two rather frightened people: the patient and the psycho-analyst. If they are not, one wonders why they are bothering to find out what everyone knows.

Assessment sessions are very different than subsequent sessions, in that there are certain questions that need to be asked in order to compile a history and gather information about the person’s difficulties.  Nevertheless, these sessions still provide opportunities to develop a rapport and, in the interludes between questions, engage with the other at the deepest level.

What follows is an imaginary, first assessment session between Riadne, my imaginary therapee, and myself:

if strangers meet, life begins - e e cummings

I stand as I first encounter the other – I smile. I feel privileged and eager to be with her, yet my smile is a dictionary definition: a facial expression characterised by an upturning of the corners of the mouth, portraying friendliness. I assume a smile.

The other – Riadne – does not smile. Her gaze is anywhere and everywhere.

We sit. I say ‘we’ … I mean Riadne and I. We have not yet become ‘us’. She reminds me of a frightened schoolgirl who is in trouble, expecting to be scolded. I tuck that feeling in my pocket – I do not want to lose it. I acknowledge her fear. I try to respond in a balanced manner: I do not want to rescue her – yet I want her to know that my heart is open and I am there for her.

Riadne is a woman in some pain. We exchange words. I have an agenda. I need to learn. Riadne is my teacher (though I have no expectations of her – she owes me nothing). I hope to discover her.

I gaze at Riadne with my agenda’d eyes. Minutes pass … I look, I listen.

A shaft of sunlight sneaks through the window blinds; fragments of dust rise and fall in a thin corridor of ghostly light. And then they are gone – switched off, swallowed by glowering clouds.

Suddenly as sleep, I waken – unaware of passing moments, magnolia walls, clichéd paintings. My eyes have closed and now I can see.


The therapeutic hour ends – sixty minutes of words but mostly non-words in a temporal container. I have learned. I have it in black ink that Riadne’s mother is 20 years dead, that her father is 55 years alive, that her partner is ‘understanding’ … and I know, now, that Riadne feels hopeless, worthless and unlovable.

I have most of that information written in big, colourless teardrops, too … and in the grey-white bubble of snot that slid down her right nostril as those heavy tears tumbled out of her eyes.

‘How should I be?’ I asked myself. ‘Should I speak my discomfort (oh! You have snot on your face)? Should I deny/avoid it?’ And then I realised: it was merely the glaireous liquid of her distress. She was a child who needed her nose gently wiping. I handed her the box of tissues. And I knew I was not rescuing her. I was being as any good-enough parent would be.

But what of Riadne during this hour? I shall never ‘know’. I can merely write what I thought I believed. I think I was just good-enough. It was an hour when we began to learn how to be with each other. Riadne never took her jacket off. I held onto my pen like an infant’s comforter. It was our very first together and we spent a lot of it necessarily and unavoidably apart. There were very few in-betweens.

As Riadne left I felt her absence – yet the heft of her stayed, resonating like a cathedral tune.

Sometimes with
the bones of the black
sticks left when the fire
has gone out
someone has written
something new
in the ashes
of your life

David Whyte


  1. An amazing look into a slice of your world.

  2. I know very little about mental health or the treatments of. But I do know when I had post natal depression, that therapy was me crying for an hour and telling regails of my childhood wrongs like a confessional. I also know that it helped...a lot. Every "patient" with a different story, you must see so much of the world in them, and learn. Very insightful and nice to get the "other" side of the chair perspective...if that made any sense whatsoever!

  3. Thank you Peter, for sharing this. I'd never really considered it from a therapist's point of view before. From reading this I can clearly look back to my first appointment; to when I was a bundle of coiled nerves with no idea of what I was going to say.It took time and patience on my 'therapists' part and a willingness just to 'be' with me and ask the right questions. Like you say, no 'in-between' then; but a time to gain some trust. I think you must be a sad loss to the profession since you retired.

  4. Hi Diana - thank you for your lovely comment.

  5. Hi repressedsoul. Yes, your comments made complete sense to me. Quite often, 'therapy' is about being with a person & travelling with them as they tell their story. And yes, I have learned so much about people &, also, myself. I am indebted to each & every person I have sat with in a therapy setting over many years for teaching me so much.

  6. Hi Louise - thank you so much for your lovely response. I think you are absolutely right about the importance of 'trust' within the relationship. And those early sessions are all about developing trust, which includes being there & 'holding' the person in an emotional sense whilst she finds her way around. Very few in-betweens at that stage as you say, but some golden opportunities for the therapist to support the other by being there & allowing her to travel along at her own pace.

  7. Thanks for sharing your thoughts, Peter. I can understand well. I work as a voluntary in telephone counselling and I experience the same thing although in a rather compressed time setting. The first minutes are essential for buildung up trust and a relationship. And at the end - if you are lucky - together with the caller you have "written someting new in the ashes" of his/her life. I love the poem.
    Greetings from Germany, Uta