Assessment

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