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 What it’s really like to be in therapy with Susie Orbach

If you've ever wondered what it would be like to sit in on someone else's therapy session, here's your chance 

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By Susie Orbach on

Welcome to the consulting room. What follows is a play script – the verbatim notes of therapy sessions, initially made for the radio, with the addition of my commentary about what I was thinking and feeling during the making of them. I also include some general observations about psychological and social phenomena.

Writing about clinical work and what actually occurs in the therapy is hampered by the con dentiality of the therapy relationship. It makes transcripts of actual sessions all nigh impossible. I have tried to solve the problem of how to invite the reader into the feel of what occurs by using actors to give a sense of the taste and avour of an encounter. The therapy encounter defies conventional back and forth conversation as it searches to meet the hurts and burdens of the one who is seeking help. 

This is Richard and Louise’s fourth session. Louise is from the Hull and Richard is first-generation London-born whose mother came from the Caribbean. He’s a compact man, 5 foot 7 inches, with striking dreadlocks, leather jacket and trainers. Louise is the same height. She wears combat boots and a long skirt. Her hair is flowy and lush. They are in their early thirties. Louise is about to have a baby and things have become frayed during the pregnancy. 

We can hear the tension in their relationship as they climb the stairs. He’s coming as Richard; she reminds him he is coming as part of a couple – Richard AND Louise. The session usually starts with a skirmish. 

Louise Hi.

Richard Hi Susie

Susie Hi, come on in. Right. 

Louise Nice to see ya. Um, see, yeah, well we’ve got to make sure that we leave on time because we are parked in a really dodgy spot. 

Richard It will be alright, it will be alright. 

Louise It probably won’t be alright but as long as we leave on time, then we have got more chance. 

Louise is trying to draw me into a conversation about Richard and what she experiences as a certain kind of casualness or neglect, in this instance, about risking a parking fine. He, for his part, is trying to shush her up. This is the pattern they’ve shown in the previous sessions. 

Susie OK. 

Richard Relax. 

Louise Laugh 

Susie I’m sorry, I’m not quite getting what’s going on between you, or maybe I am! 

Richard No, I just keep telling her to relax, you know, she is just always on at me – things like the car, I just feel like, you know, she’s on my case. I am constantly under attack. 

Susie Do you think that you might default to feeling under attack and that in this instance it might be more that Louise is nervous? 

Louise I am nervous. I am nervous about money, about time. I think these are the essential problems. I am really aware of the fact that I am eight months pregnant and about to have a baby. In one week’s time I will be full term, so the baby could be born then, and yet you haven’t been to a nursery shop with me, you haven’t bought anything for the baby with me, all your plans are about time out of the house, and it is making me really nervous. 

Susie I think it might help if you, Louise, said ‘I feel’ instead of ‘you do’. That way Richard might be able to hear what’s troubling you a little more easily. 

Louise I feel like you are leaving everything to me, I feel quite lonely when I am walking around picking things for our baby. 

Richard Well, you never walk so I don’t know what you are talking about, you never walk do you. 

Louise Laugh. I never walk!

Richard You never walk anywhere, you just sit at home all the time. 

Louise That is a ridiculous thing to say. When I go shopping – I don’t do it online, I go to a shop and I walk around the shop, that is what I am talking about. 

Listening to them zigzagging it is hard for Louise’s point – at least so far – to be heard by Richard. He gets busy pushing her off course by criticising her

Richard Yeah, because Mum helps her pick up all the stuff doesn’t she, Mum’s always there to help you out. 

Louise I am not having a baby with your mother, I am having a baby with you, Rich. 

And actually, I don’t know which is the better prospect. Laugh

Richard Why are you making comments like that? Wh... wh... what is it, what is the thing with my mum? All she wants to do is help out, make sure that you are not lonely while I am out there working hard trying to make sure that we keep the wolf away from the door, and you are ridiculing my mum, what is all that about? 

Louise I am not ridiculing your mum. I’m just saying that I want to make these decisions with you, I am having a baby with you, not your mum, she is not your substitute and you shouldn’t see her that way. 

Richard Alright, alright. 

When you are with a couple they demonstrate how their relationship is and the ways they interact. It can be quite delicate to work out how long to let a dispute run. It might be that their style is to fight and come to a resolution. It might be that fighting creates distance from one another. It might be that fighting heightens their passion. Or it might be that being criticised and feeling beleaguered is a pattern they’ve imbibed from their parent’s relationship or how they were treated. There are so many possibilities when a couple is in the room together that I need to watch it for long enough to know the emotional spaces that each one of them occupies and what they psychologically carry for each other. 

Listening to them zigzagging it is hard for Louise’s point – at least so far – to be heard by Richard. He gets busy pushing her off course by criticising her. In one way it is simple: you’re nagging and hassling me so I’m going to get back at you. Inevitably, the more she pushes, the further he backs away or appears obtuse. 

Richard appears very laid-back and Louise rather systematic about what’s not right and what needs attending to. She’s sitting forward intently and he’s put himself in the far corner of the sofa, legs spread, quasi-relaxed, quasi-dismissive. Their embodiment mirrors character traits which have psychological significance for them as a couple and each other as individuals. Richard relies on Louise’s lists and scolding. He’s been responsible from a very early age and very conscientious about earning. He wants to be free of responsibilities that aren’t to do with money. Her remonstrations keep him aware of the other things he needs to be doing. She carries his list in her head like an outsourced memory stick. 

Louise has always loved Richard’s more laid-back attitude. Until the middle of her pregnancy, she bathed in it and was able to relax with him. The change has been hard for her as she can’t use the laid-back part now for herself. It feels too irresponsible. 

Observing how they divide up their psychological ways of being leads to the question of how the therapist can intervene to reshape those places which they once valued in each other but which aren’t working now. My job is to help them walk along- side each other, to amplify their voices to each other so that they can hear one another, rather than be alternately bounced on a seesaw of: you’re the baddy, no you’re the baddy. 

Susie We talked last week about how hard it is for you to imagine being a dad. You are giving Louise your mum rather than giving her yourself. Maybe it will be very different when the baby arrives, but I sense that up to now it feels like it is just a scary proposition. 

Richard Yeah, I guess I have been thinking about my dad. 

Susie Uh-huh. 

Richard I mean yeah, but I am not going to be like him, I mean I’m not going to disappear like he disappeared. 

Louise Richard, you already are. You’re not around. You haven’t been around. 

Like, I find it difficult, I find things difficult, I can’t even reach my boots to zip them up at the moment cos my stomach’s in the way. God knows how fat people cope. But you don’t help me do these little things. 

Susie So in other words, Louise, the caring that you used to experience and must have been part of the reason you wanted to have a family together, has disappeared. And Richard, you may not be aware that you would spontaneously go towards looking after and looking out for Louise. 

Louise That’s exactly it. 

Richard Yeah, maybe.

Louise It’s like …

Susie Sshhh, let him think. 

I have the sense that Louise’s understandable grievances are crowding Richard. She sees it as him running away but for him to reflect on what she is upset about, Louise needs to back off. Otherwise we are in a psychological cha-cha routine where he retreats, she chases or criticises, and he retreats further. This maintains the same distance between them rather than the beginning of a coming together. 

Richard Yeah, I mean the dynamic’s changed, it feels like some of the fun, some of the fun’s gone, you know, it’s – I thought having a kid was meant to be fun you know, and we’re meant to be, you know, celebrating this journey, but the vibes I am picking up all the time just feel passive-aggressive. 

I feel rejected before it has even begun, I feel it is pushing us apart. The more my belly grows it is like a wall pushing in the way

Susie What about your own vibe inside, Richard? Do you think it’s possible that you might be quite a bit more scared than you know, than you acknowledge to yourself? 

When working with a couple you can see the projections they foist on each other. He’s making the problems all about her and she’s making them all about him. By asking him to listen to his own vibe I’m hoping to move him from a defensive attacking and rather dismissive position to see what feelings and fears he is dismissing inside of himself. 

Richard Oh yeah.

Susie What are you scared of?

Richard I guess how I’ll mess it up.

Louise Laugh 

And as she laughs she herself becomes dismissive of his fears. She doesn’t want to know about them any more than he does.  

Richard Well ... 

Louise Yeah but you haven’t even started yet, you haven’t even ... 

Richard Yeah but you know it’s like you kinda – you know ... 

Maybe I am more like my dad than I realise maybe. Maybe the feelings I am having right now are the feelings that he was having. Maybe. 

Susie Uh-huh. 

Richard You know, these feelings of destruction that I have, you know sometimes I just want to tear the place down. 

Louise Oh my God. Laugh

Richard I do, I just feel like smashing the place up. 

Susie Louise, if Richard’s telling you what he is feeling, this is so the two of you can connect rather than for you to jump on him. 

Richard is showing his fear. This terrifies him. It terrifies Louise but if both of them can bear it, she will know him better, he will know himself (at this moment) better and it will bring them closer. It will redraw and deepen the emotional field between them. 

It sounds like a simple thing to do but it is a psychological shift for both of them to hear and bear. The fear is a fear he is anxious about. It is not inevitable that he is or will be like his disappearing father. It is not a reality. It is a worry. 

Encountering fear doesn’t make it bigger or more real. Curiously, it can make it more manageable. Its shape can change and become porous and less monolithic. It’s worth engaging with because it will move them into a different and deeper relationship to each other. 

Louise for her part will have to expand her view of Richard. She will have to see his vulnerability. If Louise can hear his fears rather than rubbish them, she will add to his capacity to examine and know them. If he can acknowledge his vulnerability, which he is starting to do by expressing himself, he can begin the process of accepting it in himself, aided by her understanding. 

Louise Yeah but it is pretty frightening to hear that you would want to tear the place down. 

Richard Well that’s how I feel. 

Susie What interests me is that when Richard showed you a bit of his vulnerability, Louise, you kind of pooh-poohed it, pushed it away or it wasn’t good enough. 

You are wanting more closeness, Louise, and part of getting there may be accepting where he is at and where you are at. 

Louise I just feel really far away from him, from, from you. 

Richard Alright, alright, but you know, I’m here, you know I’m looking out for us, I am not going to run away am I? The closer we get, I’ll get the lads, I’ll get the Poles to take over the workload and I will be with you, and mum will be there as well. 

Louise I don’t want your mum there, I’m sorry. 

Richard Why don’t you want my mum there? 

Louise Because she is not my mum. I don’t want your mum at my birth, I don’t. 

Richard Why don’t you want her at the birth? 

Louise I don’t want your mum looking at my vagina quite frankly. 

Richard What’s all that about? 

Louise It’s weird. 

Richard Why are you saying things like that, what do you mean, like... 

Louise Well that’s what would be happening. 

Richard She’s a woman, you’re a woman. 

Louise I don’t want to look back and say there were three of us there. 

I mean I just feel it is such a personal thing and it is something that is potentially so intimate between me and you. 

Susie Right ... 

Richard, is this you again feeling that your mum is sort of a proxy for something you don’t know how to do, whereas actually what Louise wants is for you to be there with her? 

I can understand you are not sure you can do it, but I don’t think your mum can do it for her – or for you.

Richard I’ll be there, I’ll be there. I’ll hold her hand, you know I’ll like – you know, I’ll say the things that I need to say. 

Louise Yep but see you get – look at your body language, you’re funny about it. 

Richard What is this? 

Louise Well you can’t even look at me, you’ve leant forward, you are looking at me like over your shoulder, like I’m an imposter. 

I am your partner, we made a baby. 

Richard Yeah, yeah, alright, alright. 

Louise I want you to stop putting things in the way between me and you. Not your mum, not your business, not your time away, not your cheque book. I just want it to be me and you. 

Where have you gone? That’s what I want to know. 

Richard Yeah, alright, alright, you’re right. 

I was wishing that I could shush Louise again so that Richard’s words could be heard by both of them and they could clear some ground but now it is Louise’s turn to go zigzagging off ... her statement is strong but timing is all and I wished I could slow it. 

Louise Well we’ve come here for therapy and that’s really good, 

Richard I’m just not, I’m just…

Louise He’s paying for the therapy and that’s really good. 

You talk about money because you know it is always going to be there in some way because I am always going to be providing it

Richard You know... 

Louise I see the effort but where are you? 

Richard That’s why we’re here right, that’s why we’re here, because I’ve made the effort and put the, you know, the things in place that we can come here, so that we can share what’s going on. 

Louise But paying for them is not a substitute for intimacy, it’s not. 

Richard You talk about money because you know it is always going to be there in some way because I am always going to be providing it, so that is why you have got such a whimsical view on money. 

And we are off again ... This time it’s Richard who can’t hear what Louise has said about money being a poor substitute for intimacy. 

Louise Don’t talk to me about being whimsical about money. 

Susie OK, so here’s what I think, when you get to the thing that needs to be said, one of you goes off. So you were saying something, Louise, about how you want Richard to be there, or pointing out he wasn’t. He was saying yes, OK. And maybe that yes, OK – his acknowledgement – is the thing that you need to hear, rather than the two of you escalating it. 

I think it is a scary moment for both of you, and a precious moment for both of you, or a precious time, and I think a little bit more tenderness rather than leaping on each other with how you are disappointing each other is required, because I sense you are both very disappointed in each other. 

Richard Yeah ... look I am going to be more engaged, I am going to be more present, I just need you to be able to see that sometimes I’m blocked. 

Susie Uh-huh.

Louise Do you want this baby? 

I’m not surprised she says this rather aggressively because Richard has gone into a yes-mode, which is actually dismissive, rather than a being-there mode. He’s leaned back again into the corner of the sofa. His words seem pro-forma. I sense he is not purposefully dismissive but rather feels out of his depth. 

Richard Yeah, yeah, of course I want the baby. 

Susie What was that actually? Were you trying to say, Louise, I have missed you or I am insecure, or ... 

Louise I do feel disappointed and I just feel really upset all the time ... and I feel rejected before it has even begun, I feel it is pushing us apart. The more my belly grows it is like a wall pushing in the way. 

I think there is something about her saying a wall pushing in the way that allows Richard to go into a reverie and share what’s been troubling him. 

Richard You know, I don’t know, it’s funny, like the other day I was looking through my, you know, just some papers, and I don’t know, I come across my birth certificate and it was weird moment because you know, it had my mum’s name on it but it didn’t have my dad’s name on it. Where it said Dad it was just two dashes, you know, and I just thought that was weird, it was kind of, I don’t know, it felt like it was a sign. 

Louise A sign of what? 

Richard I don’t know, I don’t know what, I just felt like it was saying something to me, do you know what I mean? 

Susie That there is a void? 

Richard Yeah.

Susie Where your dad was? 

Richard Yeah. 

Susie And so you are not sure what you have got to bring to your baby and to Louise, and so you go and work like a madman? 

Richard Yeah.

Susie As a way to do something? 

I’m thinking now of how Richard’s concerns – albeit largely unconscious up until now – about how present and adequate he can be, have turned into being a provider and working for the soon-to-arrive family. He feels himself to be active in response to the forthcoming arrival so he feels rather put upon by Louise and her definition that she is doing everything.  

Richard Yeah, I guess. Um, um. 

Louise Baby, you’re going to be an amazing dad, you are just going to be amazing, you are. You are nothing like that thing, that void, that man, you’re not. 

You don’t have to be anyway. 

Like that’s why we were always going to have kids, it was always going to happen, and you were always going to be brilliant. 

So Louise now has turned her panic and accusation into idealisation, and it is true that Richard is in a different place because he has had a chance to say why he is so frightened. We are ending the session with a sense of two different emotional states going on, two different emotional journeys, extreme intensity and preoccupation on both their parts and the possibility that they might understand what the other is feeling. 

What’s important for the therapist to convey is that being on the same page with the baby doesn’t mean having the same emotional response to this event. Louise isn’t going to feel as Richard does. Richard isn’t going to feel as Louise does. Being on the same page means having an ear out for how the other is feeling and respecting where each other is coming from. In the best of all possible worlds we might be gently suggesting to each member of the couple to become curious about the why of their partners’ feelings. 

Susie Alright so…

Louise Yeah.

Susie See you next week. 

Louise OK.

Richard Yeah, thank you. 

Su​sie Unless of course ... 

Louise The baby comes. 

Richard Unless of course. 

Louise Laughing. Yeah. 

Susie OK.

Richard Thank you. 

Susie Alright. 

Louise It’s got to wait anyway, we’ve got to finish decorating the bedroom. 

Richard Yeah I’ll get onto that, don’t worry about that. 

Louise Thanks Susie, see you next week. 

Richard See you next week, yeah, thank you. 

Becoming a parent is momentous. Moving from being a couple to being a parenting couple is challenging. In this session we have been seeing Richard’s concerns expressed as flight. Louise’s ways of coping are focused on getting everything ready for the baby and in trying to get Richard to behave more like part of a couple. Her anxiety is an equally potent force as is her initial incomprehension about his concerns, but in this session the focus has been on helping Richard to recognise his fear. 

Both Richard and Louise bring the imprint of their relation- ships with their own parents to the pregnancy. Richard’s mother has been a very available lone parent who has done everything in the household and looked to Richard to be financially responsible at a young age and to help support her. He has managed that since he left school at seventeen. Louise has become the next woman he is looking after financially. 

Louise’s mother was quite controlling of her, her sibling and the rest of the family. Her dad was around but disengaged and Louise’s mother would mutter about how neglectful or useless he was. Louise hated her mum’s way of being and was drawn to Richard because he was much more laid-back and gave her a lot of space, but as she moves into being a mother, the family constellation is stimulated in her. She sees Richard acting like her father and she has become controlling and full of complaints. She doesn’t like it – and we’ve discussed it – but as her isolation grows, it has become almost a default. 

In a couple, one sees the trace of the family stories each member emerged from. Often, of course, these are supportive and nourishing. Even so, there may be aspects of their upbringing that they have disliked and have consciously chosen not to reproduce, but when the going gets tough, the difficult bits of the relationships that made them can come to the fore. There is no formula in working with a couple. The endeavour is to give each member the extra beat to hear what the other is saying and wanting while becoming clear enough to express what’s on their own mind. That process can illuminate the unconscious entwinements and longings which need addressing. Each couple’s story is different and surprises and touches me in unexpected ways. It is the details that I always find enchanting and affecting. Richard’s discovery of the two dashes and Louise’s bluntness about not wanting his mum in the delivery room. Such details create an empathic curl and warmth in me as I get to know them better. 

In Therapy by Susie Orbach is published by Profile Books and the Wellcome Collection.



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