Who do you turn to in a crisis? In her latest book – In Therapy: The Unfolding Story – psychoanalyst Susie Orbach shows us how therapy really works. Through a series of dramatised case studies, originally broadcast on BBC Radio 4, Susie reveals the thinking behind what she does (and doesn't) say. In the first of two extracts, we meet Douglas during a personal emergency.
Douglas rang me, breathless. He had asked around about who he should see as he was in an emergency, and he found his way to my consulting room. He is 64 and portly, a grammar-school boy who grew up in the Midlands.
Douglas: Hello, Susie.
Douglas: I’m Douglas. Sorry I am late, traffic was terrible and it’s quite a way. So I am a bit pressured time wise.
He claps to indicate that we should get started.
Susie: So, tell me.
Douglas: Well, I mean, I don’t know how this process works, I really don’t. I have never done this before. As you know from my email, I heard about you from a friend and I thought I would try this route because I am having some problems really, and I wanted to see if you could offer me anything or help me with this problem.
It is a problem really with anger, which is affecting me in my work, in my life and, well I need some advice really, some help, because I am worried that I am going to damage myself professionally. Really that’s the issue I am worried about, the way I am in my job, and I need … I need some help with this anger issue. I am angry all the time, I am angry in my work, I am angry with the world and I really need to know what I do with the issues that flood into my brain.
Susie: Are you angry right now?
Douglas: Ah, well, I’m – yes, I am rather, yes, because I don’t know how this works, I don’t know what to say, I don’t know how to proceed.
Susie: Can I just slow you?
Douglas: Yeah, sure, sorry.
Susie: I am intrigued that you said you are angry now because you don’t know how it works.
Susie: Could you bear to not know how it works?
Douglas: I mean this is all new to me, I have never really talked about this before to anybody, let alone a therapy person, so I am rather nervous actually.
Susie: So you are nervous right now?
Douglas says he’s angry because he doesn’t know how this works. I find this useful in getting a sense of how wide the scope of his anger is. To the ‘logical’ mind not knowing doesn’t necessarily engender anger, so Douglas helpfully gives me another dimension to his anger.
Susie: Well, I would like to help you, I would like to hear a little bit more about you.
Douglas: About me.
Douglas: Well, I am 64. My name is Douglas Stapley. I am a judge. I am currently sitting on a case at Southwark Crown Court, and really that’s the issue that has brought me here, because it is beginning to affect the way I do my work and it is worrying me.
Susie: What is the case?
Douglas: It is a case of a chap accused of GBH (grievous bodily harm) and sex trafficking. He is involved in a criminal gang that imports girls, usually from Eastern Europe, and puts them in massage parlours, some in London, some in Leeds, and he has been arrested for GBH against one of these women. He is a very nasty man and he is – well, I can’t really say more about the case but I am worried about my reaction to him.
Susie: What is your reaction?
Douglas: I want to kill him. Of course, I shouldn’t say that, but um …
Susie: Well, it’s privileged in here.
Therapists and clients have privileged status unless there is a real danger, in which case reporting may be required. If we learn of an intent to commit a serious criminal offence, to harm oneself or others, we may break confidentiality. See, for example, the British Psychoanalytic Council's Statement on Confidentiality.
Douglas: Yes, good. Um, I am furious with him, I am furious with his counsel, I am furious with what he represents, the people who stand behind him who will never be arrested or extradited. I am furious with the way the world is going, and I just don’t know what to do with this angst and this anger about things I see on the news and things I see in my courtroom.
It is beginning to overwhelm me, and of course I am meant to be objective.
I am meant to dispense justice in a calm and rational way, and I am feeling I am losing my ability to do that.
He comes to a full stop. He looks like he has drifted off somewhere.
Susie: Please go on.
Douglas: Sorry, I beg your pardon.
He pauses again and starts speaking slowly.
Douglas: Something happened to me last week in the course of this trial that had never happened before. I had to call a recess that went on for more than an hour while I tried to recover myself in my chambers and in the gentlemen’s toilet, and I couldn’t conduct the trial because it was just beginning to overwhelm me, my rage, and I am worried I am going to lose my judgeship actually.
Susie: Do you know what – can you remember what exactly happened before you called the recess? Douglas Yes. Susie What was going on in the trial?
Douglas: This man’s counsel has called what I laughingly call a character witness, and he was cross-examining him on the stand. I found the machinations of the defence counsel completely intolerable, the excuses, the mitigations, the excuses for this low-level, violent bully and this character witness who, as it turned out, hadn’t actually met or seen the man whose character he was testifying for, for a matter of twelve, thirteen, fourteen years, um, and I stopped the – I actually lost my temper in court and shouted at the defence counsel. I abused the witness verbally and I, as it were, saw a red mist descending and I just had to leave, because the thing is, this defence counsel, he is a very clever, very sly man. He knows me from other cases and he will, if he can, call for a retrial if I lose myself in that way again, and I am fearful that I will. He has told his client that he might get away with a suspended sentence.
Well, he is going to find that he might end up with a life sentence and I am just worried that if it is appealed, which it will be, I might…
Susie: Because of your anger.
Douglas: Because of my anger and because of certain other instances in the courtroom where the defence counsel could make a case that the judge is unbalanced.
Susie: Douglas, could you tell me what the defence’s argument is briefly?
Douglas: About his client?
Susie: Yes, about their client.
Douglas: He is saying that he is not really violent, that the instance of violence for which he is on trial was an aberration, that he had a difficult upbringing, that he is a family man with children who would be deprived of their father if he was in prison, that he actually – and this is the one that really got to me – he actually put him forward as caring for the girls that he is trafficking and being a protector father figure if you will. And I mean, the thing is, I really want to kill this man.
Susie: So beyond the ethics or the politics, which I can empathise with, is there anything else that might be leading you to want to kill him? Is there something in his story that resonates at another level?
This is an open question. It could be he has a niece who is shielding a trafficked young woman, or a brother who married a Thai bride. Therapists are often thought to have X-ray eyes. We don’t. We have questions that can turn a mirror on the self.
Douglas: Um … yes … he reminds me of something in myself, I think. Um, it is as though his violence and his, in a way, his rage, which came out in this attack on this woman, it just mirrors my own, and I think that disturbs me. Um, he … I think he, um … There is a type of man that I hate and I always have hated, I find myself not listening to the evidence but looking at him in the dock and having fantasies of violence against him as though I know him personally, as though he has personally hurt me.
Susie: Uh-huh. Well, he has hurt you personally in the sense that you experience his behaviour as an affront, but I think you are saying something else about that.
Douglas: I have a friend who is a vicar, who I mentioned this to in passing, and I am not really a believer, but I was so desperate I would do anything, talk to anybody, and he said look at Luke, Chapter 6, which I did, and I had heard of the words before, of course – ‘judge not that ye be not judged’, and ‘do unto others as you would have them do unto you’ – it is all that stuff which is meant to be the credo by which I practise my profession and I find that I can’t do that any more. I can’t do it in the face of what is happening in the world.
I suppose what I want to ask you is what do I do with all this rage and angst in my courtroom against this man, but also against leaders of the world and violent people in the world who create wars, who create suffering? It is beginning to overwhelm me and I fear, not exactly for my sanity, but I certainly fear for my ability to do my job because how can I judge him when I feel guilty too, as it were?
Even in the few moments of our speaking together, Douglas has become very thoughtful. He’s afraid, yes, but he is also questioning how to handle himself, how to make sense of the emotional discomfort he’s beset by. I’m a small woman, but I almost feel my physicality expand to meet him so that his confusions will have enough space inside of me too without belittling him.
Douglas: Yes. I wonder. Sorry, my driver is outside and I need to go.
Susie: That’s fine, but I need to know in order to be able to be of any use to you Douglas.
Douglas: Umm. Well I suppose we all have secrets, and mine is, as it were, surfacing in this trial because this man, much as I despise him, is only providing a market, if you will, for men who wish to buy sexual favours from these girls, and that is something that I have done, yes.
Susie: And for that you hate yourself?
Douglas: I hate my anger at this man.
Susie: Yeah, I know, but could we just parse it a little better, or a little more fully?
Douglas: What does that word mean, parse?
Susie: Well, you know, we did it in grammar in school, break down what you are actually saying, into its parts of speech.
Douglas: Break down. Um.
Susie: You said you hate yourself for having taken …
Douglas: I hate myself for having given this man a reason to do what he does, and so how can I judge him?
Douglas: I have to judge him because I am a judge.
Susie: So as you are telling me this, I am sensing there is another feeling coming across that isn’t quite anger. A sense of shame and hurt. Does that mean anything to you?
Douglas: Yes, I am deeply ashamed.
Susie: You are ashamed of the act and you are ashamed of yourself, and so you can’t find any compassion towards yourself. Would that be right?
Douglas: I am ashamed of the act, yes. I am ashamed of the hypocrisy that I find myself demonstrating. I am ashamed of – I am very – I find sexual matters very shaming and, um, this case coming before me has brought that to the surface, I think, so I feel ashamed and I find that my shame is becoming anger at him and I am losing the ability to distinguish between the two emotions in the court. In a way I should acquit him, [clap] I should give him a suspended sentence.
There is no time for me to unpick with Douglas the shame he experiences towards sexual matters. His shame is driving his aggression as though to keep the whole thing as far away from him as possible. At the same time his identification inclines him to put himself in the same category as the trafficker. His thinking is glued up because we are just beginning to explore these difficult issues.
Susie: How much longer is the case going on for?
Douglas: About another week. The jury will retire at the beginning of next week, and then I expect – he will be found guilty, [clap] and then I have to sum up to the jury of course before that, and then I have to pass sentence, which will be two days later, after the end of the trial.
Susie: Well, can I suggest this, can I suggest that we meet again, very soon?
Susie: Before your summing up?
Susie: I think it is important that you have been able to make the link and if we can loosen it a little bit, you might feel safer in the courtroom. So if you could come next Monday.
Susie: Before court.
Susie: Yes, come at 8.30.
Douglas: I know you are a feminist. I have looked at your book titles, although I haven’t had time to read them, and I, I, I am ashamed as well. I hope you won’t be angry with me in the way that I am angry with him.
Susie: See you next week.
Douglas, understandably, is seeking reassurance that I won’t judge him. Perhaps the reader is wondering why I couldn’t have responded with a soothing word. I felt that this latter remark about my being a feminist was diverting us into the issue of judgement and taking away from what Douglas had been able to talk about just before. I had no wish to add to his discomfort, but I felt that I would be softening the links he had just made for himself. I had offered another session right after that weekend and hoped that would be sufficiently containing. As for the issue of judgement, him as the judge, me as the judge, these fascinating questions are in my mind and I anticipate will be part of what we talk about in the future.
Douglas is coming in an emergency. It is often like this. There is no space for history. Only the immediate present. Urgency is what drives him, and the question is how the therapist responds to that emergency while knowing that emergencies come and go.
I know I can’t provide a solution. I can hope, however, even in his first session, to slow things down enough to make some pockets of air in his head so he is less overwhelmed by rage and the fear that he will act inappropriately. Obviously in therapy we don’t do this by suggesting the individual could take a specific course of action as a colleague might. We do it by trying to expand his thinking, his feelings and his stance towards his dilemma.
I also want to slow him down enough so that I have a way of entering into his world: how his mind, his thinking, his body, his feelings work. If a therapist is to work in any sustained way with someone, then they have to get as close to the experience of the person as possible. They have to ‘walk in their shoes’ sufficiently to understand. But we have to do this while thinking through the manner in which the individual makes the links they do which lead them to full stops.
This extract is taken from In Therapy: The Unfolding Story by Susie Orbach, published by Wellcome Collection.
Want to know what happens next? Susie's second session with Douglas will be published tomorrow.