Sometimes a cigar is just a cigar

                                                       (Sigmund Freud)


This week I will take a break from my medium of the short story during the summer months, both because the return to work and the intense beginning of the academic year are always at the forefront of my mind in late August, but also, because this has been a week where several difficult themes emerged for me, which tempts me to employ a more direct voice.

            What do we do when people behave badly and in ways that are difficult to process or understand? As therapists, we are called upon to process bad behaviour through understanding its deepest motives, and when we do, the possibility of empathy and even forgiveness is one of the transformative experiences of the therapy process. Yet, inevitably such deep exploration can only take place once a therapeutic relationship of trust has been established. What does that mean practically? In many ways, therapists open themselves up to potential substantial harm, if the premise of trust is broken from the side of the patient. Like most therapists I know, I do not get patients to sign a contract or disclaimer of sorts, and even the minority of therapists who do, I very much doubt that this is legally binding within the confines of confidentiality. So, in reality, if patients choose not to pay us or to vanish with no warning in the middle of a long term therapy process while we have got to care about them and feel implicated in their wellbeing or if they choose to lie about significant facts in their life, there is very little a therapist can do to soothe the toxicity they have been left with. It has been said before that being a therapist is like being a psychic bin for others’ toxic material, and yet, few of us would be masochistic enough to continue practising, unless most people behaved with respect and proved more than worthy of the trust that is required in taking a new patient on. I have noticed a trend in more newly qualified therapists of attempting to safeguard clinical work through writing detailed contracts or taking payment in advance. And yet, I still believe that being a therapist is a premise where one accepts their utter helplessness in relation to their patients. So, when we encounter bad behaviour, which in my experience is a rather rare occurrence, it inflicts a wound that can take a long time to heal.

            Linked to the above is the question of judgment; how do we judge that somebody would be able to make good use of therapy and the therapeutic relationship and also that we can work with them? This is what is called a ‘clinical assessment’ which implies a position of expertise. Yet, in my view, it is a rather more intuitive process. Therapists work in different ways of course and choose different styles and theoretical frameworks to describe their work. Consistent with my training, but also with the relational school of therapy, which claims that the essence of any therapy lies in the therapy relationship, my style is rather anti-theory. So, in simple words, I would say that for me, what is called ‘clinical assessment’ comes down to a few key questions. What is being repeated in this person’s life and how is it likely to play out in the course of the therapy? Am I up for accompanying this person in their particular journey? And lastly and most importantly, do I feel moved by them? If the answer is yes to both the above questions (i.e., I am up for working with this person and I feel moved by them), then, an offer is made. And yet, one can never quite know whether their judgment in these initial sessions was right.

   I have to admit that I find it really hard to forgive myself, when my judgment proves wrong. It is not so much that I suffer from some kind of perfectionism, as I fully accept that I am bound to make mistakes and as long as these can be acknowledged and worked through, it is fine. But when it comes to bad behaviour of the kind listed above, when people choose deliberately to mislead, hurt us or violate our trust, a therapist cannot simply feel like they are the victim of someone’s undecent actions, they have to question their judgment as well as the course of the therapy work. Yet, judgment is inevitably bound with expertise, as how can we claim our judgment was ‘wrong’ , without implying that an expert knows best what is ‘right’?

During the last six months of what has become ‘the vaccine wars’, polarisation and witch hunting are not even questioned anymore by most. Experts know best and we are just supposed to follow them. We are also strictly required to adhere to one of the two camps. Where is the space for uncertainty and self-questioning in what is by all accounts a complex and very difficult situation for all such as a pandemic? When patients behave badly, I mostly feel hurt for the inevitable failure of the premise of trust and sad about the loss of the therapy relationship and the hope that the therapy would make a difference. This is normal. What I would like to resist in future though it not forgiving myself for ‘bad judgment’. Freud infamously said that sometimes a cigar is just a cigar. Also, sometimes undecent behaviour is just that.

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