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Sigmund Freud's Persian rug used to cover his psychoanalytic couch as it appeared in Wellcome Collection's Madness & Modernity exhibition

Freud was jeered at in his day. I don’t use his famous couch – or share his background in hypnosis or his fascination with antiquities – but in social settings I’m often greeted with a reminiscent scepticism.

I don’t get the chance to go to a lot of cocktail parties. When people in other professions are beginning to gather for wine and hors d’oeuvres, my workday is just gearing up. As a psychoanalyst in private practice, I have to be available to work when other people aren’t working. That means solidly from 5 to 9, rather than 9 to 5, as well as during normal people’s lunch hours, and the other times my patients can snatch from their famously busy New York City schedules. 

When I do manage to make it to a soirée, I’m sunk. I’ve been a psychotherapist for 20 years, and a psychoanalyst – more specifically – for the past five. Telling others what I do for a living means being confronted, almost always, with disgust or distrust – embodied in sceptical questions about my work which I wish I were then given time to answer fully. 

Don’t you get bored sitting there all day listening to people complain?

What may sound like a complaint to you is likely to hold deeper meanings for me. 

When my patient Ruth tells me it’s infuriating that my elevator is still broken, I accept her comment at face value. But, especially as I work on the second floor and Ruth’s in good physical shape, I then ask myself: “What could this statement also mean? Is Ruth telling me she’s been experiencing her daily life/job/family as a climb she’s been doing alone when she had expected some help?” 

Then I’d look for messages she might be sending about the two of us. My guess on this one: she’s letting me know she feels like recently she’s been having to do all the work in therapy by herself – to make ‘upward’ progress. (Alternately, she could be implying that she’s exhausted by her attempts to ‘elevate’ her mood. Or that she’s worried I’m not going to manage to ‘fix’ her.) 

These are only guesses, gleaned from hints, and I make sure to regard them as such. But let’s say I toss a hunch to her – “Ruth, do you feel like you’ve been having to do all the work around here recently?” – and her reply is, “I hate to say it, or even think it, but I feel like you haven’t been focusing much on me for the last few weeks, Maggie,” I’ll believe I’ve listened between the lines successfully. 

My broken elevator is real, but it’s also functioning for Ruth and me as a symbol. (As a symbol, it’s functioning fine.) After we discussed what was going on between us, Ruth apologised for complaining; on the contrary, I told her, I was glad she had. It opened up a conversation that had been too hard to tackle head-on.

How can you possibly remember all those things about all those people?

Do you mix up your friends’ life stories? The names of their siblings or significant others? 

I’m working with at most 30 patients at any given time. Our conversations are intense, and I’m seeing each of them at least once a week, some of them three times. While it can be difficult to recall details out of the blue when I’m not in my office, once I’m face-to-face with a patient, everything pours back in. 

Patients comment on their therapists’ “amazing” memories. What’s amazing to me is that patients don’t expect us to remember everything about them.

Isn’t it hard to have empathy for people all day? Isn’t it hard to care that much?

Empathy doesn’t imply caring. The word derives from the Greek em-, for ‘in,’ plus pathos, for ‘feeling’. It’s the ability to experience vicariously the thoughts and/or feelings of another person from the inside out, to see the world through that other person’s eyes. 

It’s a tool, that’s all. In the wrong hands, it can be used for malevolent purposes, in fact. Empathy is a technique for learning deeply about someone; what you do with what you learn is another matter. Your empathy is likely to help them feel heard, but it only involves caring if you care. 

In the case of therapists, we do tend to care – a lot. We do that without depleting ourselves by respecting each patient’s right to run their own life, and respecting, as well, our right to our own downtime. 

So are you analysing everything I say right now in your head?

Possibly, as a defence – if I’m feeling really attacked. But I’m trained to hear myself doing things like that and to question myself about my thoughts. Do I really need to safeguard my sense of self against questions at cocktail parties? Isn’t this more of a chance to educate? 

Unless you’re really bombarding me, I’m probably just listening. It’s the end of a long day.

Maggie Robbins, MPS, LP is a psychoanalyst in private practice in New York City and author of the novel in verse 'Suzy Zeus Gets Organized' (Tin House/Bloomsbury USA, 2005). Her work has appeared in 'The New York Times Magazine', 'Forever Barbie' and 'The Noonday Demon', among other publications.

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Maggie Robbins

Author

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Maggie Robbins gives her personal take on the common misconceptions around her field of work.

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BL Royal 10 E IV, f. 270v, Woman making a confession

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From confession to psychoanalysis, read our stories on the history, culture and practice of therapy.

Therapy

Questioning the psychoanalyst

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Buddhist Man Meditating

‘Mindfulness’ has become a household word, standing for inner peace, wellbeing, and cutting-edge healthcare. For four years, I researched how it’s become such a compelling force in Western culture.

“Well I think it’s disgraceful! You tell them from me, it’s disgraceful!”  

In the chair opposite me sat JP, a senior teacher from one of London’s many religious Buddhist organisations. He was also a friend of several years; JP and I practiced the same type of Buddhism. He was grinning at me, eyes fierce: ironic, playful, but genuinely angry.  

As he finished speaking, I had nervously bitten off a large piece of the chocolate that he had given me when I arrived, bought for him from a trendy East London boutique by one of his many disciples. I gulped it down with my herbal tea; the smell of incense – burning on the small shrine in the room’s corner – was overwhelmingly sweet.   

It's never too early to begin meditating, as this depiction of a baby Bodhisatta mediating under a tree shows.

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Ploughing ceremony with the baby Bodhisatta mediating under a tree

Around two-thirds of my interviewees had long-standing relationships with Buddhism. Many of them had even received ordination and been given Buddhist names – names taken from scriptural languages of Buddhism, such as Pali or Sanskrit.

And yet, when they became mindfulness teachers they decided not to foreground their Buddhist commitments and identities, let alone identify themselves by polysyllabic Sanskrit names. This had especially incensed JP: in neglecting to use their Buddhist names, they were – in his view – betraying the solemn promise of loyalty they had made at ordination.  

More: The history of yoga in its many forms.

I had been speaking to JP about my recent experiences of the British mindfulness community. It was the summer of 2015, and I had just spent almost a year immersed in the growing network of people using the Buddhist-meditation-inspired practice of mindfulness meditation as the basis for a diverse range of therapeutic mental health and wellbeing interventions.

Mindfulness is a kind of mental training, based on the practice of deliberately bringing your attention to bear on physical sensations, emotions and thoughts. Using these techniques – the proponents of mindfulness claim – it is possible to cultivate a kinder, more accepting relationship with yourself and the world around you. A growing body of evidence shows that applying these ideas and exercises can offer relief from a range of symptoms, from stress and poor concentration to psoriasis and IBS.

Buddhist monks drinking tea and eating sweets.

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Buddhist monks sit with tea and sweets. Thai MS 3.

My aim for the PhD research I carried out from 2013 to 2017 was to find out how the traditional Buddhist practice of mindfulness had gained legitimacy in the secular world of science and medicine.

JP’s outrage had been sparked by one of my preliminary research findings: many of the key players within the British mindfulness movement were downplaying their Buddhist ties.

This Burmese-Pali manuscript of a Buddhist text.

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Burmese-Pali Manuscript

Teachers I spoke to were largely unabashed about how they presented themselves. They were keen to use the growing public acceptance of mindfulness to bring the essence of the Buddha’s teachings to new audiences. But to say this out loud might be off-putting. One senior British mindfulness teacher even said she believed it was “irresponsible” for mindfulness professionals to use their Buddhist names in secular contexts.

Most teachers presented mindfulness along the lines set out by a 2015 parliamentary report on the potential uses of the practice for British society: while mindfulness had its origins in Buddhism, it had been “freed from any religious or dogmatic content”.

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Practising mindfulness

My training in the history of science and medicine told me that things were not that simple. When you move a technique from one place to another, you also take a huge, complicated web of tacit assumptions and practices with you. Put simply, if someone spent years trying to practice the Buddha’s teachings and were now working hard to bring them to others, wouldn’t that make them a Buddhist? 

Although I didn’t feel as strongly about it as JP did, it seemed to me too that something strange was going on. It was hard not to see the idea of mindfulness being “freed” from its religious context as a ruse.

Responses from my interviewees were variations on a theme. Buddhism doesn’t have exclusive rights of ownership over mindfulness. Mindfulness is in lots of different religions – or, at least, something very like it. Mindfulness is bigger than Buddhism, even if it came (partly) from Buddhism. Anyway, the label ‘Buddhism’ is a modern invention used by Westerners obsessed with their identities.

I remained sceptical. These ideas smacked of post-hoc justification. The fact was, surely, that if they told people they were doing Buddhism, nobody would have been interested in mindfulness.

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Mindfulness and meditation

Then I dug deeper into the history of the contemporary mindfulness movement. Its earliest proponents were children of the 1960s with a deep mistrust of traditional authority – especially religion – and a desire for radical psychological and spiritual experimentation. This was where the idea emerged that mindfulness could be practiced independently from religion.

In the summer of 2015, I travelled to America to interview those who had worked closely with the acknowledged founder of mindfulness as we know it: Jon Kabat-Zinn. 

One afternoon, I met Peggy Gillespie in a leafy part of Amherst, Massachusetts. An enormous, friendly dog met me at the door, followed by Gillespie. She was a robust, healthy-looking woman in late middle age. Her smile was huge and warm; her hair a mass of curls, her clothes comfy and well-worn. Her garden, like her dog, had a friendly but untamed feel to it.  

Gillespie had worked with Kabat-Zinn on mindfulness from 1979, almost from the beginning. They taught mindfulness to outpatients at the University of Massachusetts Medical Center; patients suffering from a wide variety of hard-to-treat conditions like chronic pain, hypertension, and gastrointestinal syndromes.  

Gillespie, an experienced meditator and palliative care worker, was Kabat-Zinn’s second-in-command from 1979 to 1983. She published the first book on mindfulness: her 1986 self-help monograph, ‘Less Stress In 30 Days’, based closely on their work together. She walked me over to her swimming pool, and to the sounds of water lapping and her dog’s panting, recounted how she had first got involved with mindfulness.

Jon Kabat-Zinn leading a Mindfulness Meditation session at the 2015 Annual Meeting of the World Economic Forum in Davos.

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Jon Kabat-Zinn leading a Mindfulness Meditation session

“I was very agnostic, anti-religion. I was brought up with no religion and I hated organised religion and thought it lead to so many problems and divisions.” But then, in the late 1960s, she tried the hallucinogenic drugs LSD and magic mushrooms for the first time. “They just were amazing. It opened me!”

Gillespie’s experiences left her wanting more, and she began to meditate, practicing with the American ‘Insight’ tradition – a tradition that agreed with her view of Buddhism: “It’s not a religion to me; it’s a philosophy and psychology and a great teacher [the Buddha] who was a human being. I still don’t call myself a Buddhist.”

Her story was typical among the first generation of mindfulness teachers. Not all had been introduced via psychedelics – though many had. But nearly everyone agreed that although religion was objectionable in many ways, religious practitioners through the ages had been able to access an ‘experience’ that was important and healing.

William James, author of ‘Varieties of Religious Experience’ and inspiration behind Dharma.

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William James

The famous psychologist and philosopher, William James, helped shape this view. In the early 20th century, his book ‘Varieties of Religious Experience’ posited that although religions differed, they pointed to the same experience. 

The book was hugely influential in 1960s counterculture. For figures such as Aldous Huxley, New Age icon Ram Dass and their followers, psychedelic drugs, meditation and religious experience were all gateways to the same ultimate truth. Kabat-Zinn, part of this scene too, called this universal, experiential truth “Dharma” – a Sanskrit word also used to refer to the Buddha’s teachings.

As Gillespie described her encounters with LSD, meditation, and mindfulness, I was brought in touch with my own meditative experiences, and I also began to think that we were talking about the same thing – the same truth. This was why mindfulness was important to her; this was why Buddhism was important to me. Why make superficial distinctions?

Our conversation ended after an hour and a half: I had to meet another interviewee in a nearby restaurant. Gillespie, who had moved on from her work with Kabat-Zinn to teaching more explicitly Buddhist meditation, evidently saw how much our conversation had affected me.  

“There’s a young Dharma Leaders training course running soon, maybe you should apply!” 

According to legend, Buddhist deity Guanyin was once found sitting in this position, meditating on the reflection of the moon in water, a symbol of illusion and transience in Buddhism. His pose and face embody inner peace and concentration.

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Guanyin

I hesitated, suddenly embarrassed. In my mind’s eye, I saw JP’s disapproving frown. Either you’re a Buddhist, or you aren’t.  

We said goodbye a little awkwardly. As I drove away, I felt confused. My skin tingled and my heart sang. I loved and believed in what she told me. At the same time, I knew we came from different worlds.

Gillespie believed there was a truth to be found both within and beyond religion. This was a truth that mindfulness captured. The longer I spent in the mindfulness world, the clearer it became that it was a faith of sorts, and one quite different from what I knew as Buddhism. It was a faith not in religious hierarchies, or creeds, or gods, but in the ideal of ‘experience’. Since everyone has experience, it can’t be owned by a religion; it belongs to all.

JP’s outrage – and my disquiet – were perhaps misplaced.  As my research progressed, I came to see that the debate over the secular status of mindfulness had less to do with Buddhism as such, and more to do with a conflict of worldviews whose origins were much closer to home. There is a very long Western tradition claiming beneath the external trappings of religion that there is a fundamental truth to be found – a truth of experience. William James was part of that tradition; so were Gillespie and Kabat-Zinn.  

Religious historian Jeffrey Kripal has called this tradition “the religion of no religion”. While JP and I were self-identified Buddhists, it was clear that Gillespie and her colleagues genuinely saw themselves in a different way. If mindfulness was a religion, it was a religion of no religion. This was a deep conviction, not a ruse. When they said that mindfulness had no religious context, they meant it.  

Whether the religion of no religion really counts as a religious context to mindfulness is still an open question. Maybe it isn’t even quite the right question to ask.  But it seems to point towards important issues – issues that many of us  will need to face as mindfulness takes an ever more prominent place in public life.

Matthew Drage is an artist, writer and Buddhist living and working in London. His academic and artistic research focuses on the intersections between religion, science and medicine, and gender and sexuality. He recently completed a PhD at University of Cambridge on the emergence of mindfulness meditation as a biomedical intervention in America and Britain since 1979, and is a founding member of artist collective SSEA.

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Matt Drage

@mndrage

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Matt Drage questions how an ancient religious practice became a secular cure for stress.

A history of mindfulness

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Fresco in the Pellegrinaio of the hospital of Santa Maria della Scala, Siena

The line between confession and counselling has been blurred for centuries. In fact, confession in the Middle Ages was thought to improve physical and mental wellbeing and was even used as a treatment for all sorts of illnesses. Katherine Harvey explores how confession was regarded in the medieval period.

In recent years, the Vatican has reminded its followers that ‘confession is not therapy’, and urged them not to confuse the confessional with a psychiatrist’s couch. But the blurring of boundaries between the two practices is a centuries-old phenomenon: long before the birth of Freud, people in the Middle Ages shared intimate details of their lives with priests.

Medieval confession wasn’t therapy, but it was therapeutic: besides the obvious spiritual benefits, it was thought to improve both physical and mental wellbeing. 

Roman Catholics have been required to make regular oral confessions to priests since 1215, when the Fourth Lateran Council ruled that they must do so at least once a year. The same council pronounced on the relationship between sickness and sin:

Internet Medieval Source Book, Fordham University — Canons of the Fourth Lateran Council, 1215

As sickness of the body may sometimes be the result of sin… we command physicians of the body, when they are called to the sick, to warn and persuade them first of all to call in physicians of the soul [ie, priests] so that after their spiritual health has been seen to they may respond better to medicine for their bodies; for when the cause ceases so does the effect. 

It was important to be attended by a priest when you were sick, as this deathbed scene shows.

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BL Harley 1310, f. 86, Sick man

If sin could cause disease, there must be a literal connection between spiritual and physical healing. And confession – which treated the spiritual disease of sin – could also treat bodily diseases caused by sin. Consequently, confession was essential for the dying, but also beneficial to those who might recover, and to those who hoped to avoid sickness altogether.  

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The healing power of penitence was also reflected in the language that churchmen used to describe confession: they compared it to common medical treatments such as purging, blood-letting and surgery. William of Auvergne, Bishop of Paris from 1228, used a particularly memorable metaphor: 

Lesley Smith, ‘William of Auvergne and Confession’ in Handling Sin: Confession in the Middle Ages, edited by Peter Biller, Alastair J Minnis — William of Auvergne

Vomit is the emptying of the belly via the mouth… In the same way, the belly of the heart, or conscience, is emptied or relieved from vices or sins, by the agency of the mouth, by speaking or revealing these things to a priest. Therefore, just as someone with an upset stomach, straining to expel what is harmful or unsuitable to it, distends his belly and opens his mouth wide to get rid of it, so too someone with an upset to a holy and noble conscience strains and searches the belly of his heart to throw out and expel detestable and filthy vices and sins, opening his mouth wide for them to leave via the words of confession. 

This powerfully repulsive image revealed a keen understanding of medical theory. In an age of humoral medicine, sin was just another excess in need of expulsion. And since confession often involved weeping, it could provoke purgation that was both literal (tears) and metaphorical (sin).

Better out than in: confession was like vomiting out the conscience.

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BL Royal 6 E VII, f. 195, Gula

But if confession cured the sick by removing the sin that caused their illness, it also had psychological benefits comparable to modern therapy. Medieval physicians understood that the mind influenced the body. They believed that unruly emotions could cause physical illness, and treatises on healthy living advised readers to strictly manage their emotions. Doctors were careful to reassure their patients, believing that a positive attitude made recovery more likely. Some even fretted that telling a patient to confess would decrease their chances of recovery, since they would assume that death was imminent.

Despite this risk, confession was often incorporated into the healing process. Medieval hospitals required their patients to confess on arrival, and at regular intervals thereafter. In one dramatic example from the 13th century, when Archbishop of Canterbury Hubert Walter was on his deathbed, his doctor (who was also a priest) advised him to confess his sins. When Hubert did so, “the fire of his remorse and charity” dissolved the moisture in his brain, producing both floods of tears and temporary relief from his fever. The Archbishop was then able to eat and drink, and to make his will. Hubert’s recovery was brief – he died the following day – but his case offers an intriguing insight into medieval beliefs about confession and how it was thought to impact on the body.   

Weeping could help to expel an excess of liquid.

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The Hague, RMMW, 10 B 29, fol. 3r, Weeping

Remarkable longer lasting recoveries after confession were recounted, too. Gundulph, Bishop of Rochester from 1077, heard the confession of a dying woman. She experienced “heartfelt contrition”, and after “the wholesome remedy of penitence was applied… [she was] fully restored to health”.

Confession could even play a part in healing miracles. Odo de Beaumont, who contracted leprosy from a prostitute, was cured after he confessed his sin, fasted, and promised to go on pilgrimage to Thomas Becket’s tomb. 

Stories like this suggest that medieval folk viewed the relationship between body and soul very differently to us: physical, mental and spiritual wellbeing were inseparable, and the health benefits of confession seemed to prove the power of God. 

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In the 21st century, conversely, the needs of body and soul often seem to exist in opposition, and so to compare confession to therapy is to reduce its significance – at least in the eyes of the Church. 

But while clerical perspectives on confession have changed, it seems that the faithful have always derived something more than spiritual succour from the practice. If confession is not, and has never been, the same as therapy, it has long been therapeutic – and, despite the best efforts of the Vatican, will surely continue to be. 

Dr Katherine Harvey is a medieval historian based at Birkbeck, University of London. She is the author of ‘Episcopal Appointments in England, c. 1214–c. 1344’ (Ashgate, 2014), and is currently writing books on the medieval episcopal body (for OUP) and medieval sex (for Reaktion).

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Katherine Harvey

@keharvey2013 on Twitter

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Fresco in the Pellegrinaioof the hospital of Santa Maria della Scala, Siena

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The line between confession and counselling has been blurred for centuries.

Confession as therapy in the Middle Ages

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Anxiety

Who do you turn to when you're in 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. In the second of two extracts, we meet Douglas for a follow-up session with Susie, just before he has to deliver a difficult verdict.

Douglas: Thank you. So, thank you for the last – thank you. I, um, I shall have to be in court in an hour and a half, and I have to sum up and I have to, really, I have to decide what I am going to do with this man who I find so challenging. So I am in a quandary really because I want to punish him severely and I suppose I feel that I should be punished too, and if I am lenient with him it is an injustice because the man is an appalling criminal. If I am hard with him, I am a complete hypocrite because he is only doing something that I have helped to create. 

Susie: Could you tell me a little bit more about your relationship to the women you see him trafficking? 

Susie: Well, to women who you have bought sex from. 

Douglas: Oh God. You see, I think I never quite understood why certain things that the world thinks are wrong are wrong. When I was younger, I was guilt-free really about using women in that way, and … Well, that’s not quite true.

The magic of therapy is that it allows space for the person to go back on themselves and question their actions and their motivation. Therapy is not a linear process where a line of enquiry is followed sequentially. It is about associations made, the stuck places, the hot spots, the confusion which we come at in different ways, and while a therapist may ask a question, it isn’t the answer per se that is important but what it can open up for the individual.

Douglas: My relationship with these girls is quite perfunctory, of course, because you don’t get to know them, but I did have romantic fantasies about a certain girl especially but – and I think in a way that allowed me to feel guilt-free because I thought, well, I am treating them as human, I am not violent, I pay them very well, I asked one of them to meet me outside, you know, which she refused – but I kind of feel that I was humane in my relationship with these girls, but there was one Polish girl who I got to know a bit, and who I realised was indeed trafficked, exploited and wanted me to help her. In fact, she was the last girl that I saw in this way. 

Douglas: This was a long time ago, ten years ago. Um, and I feel guilty about her because I didn’t quite realise at the time, but quite soon after I realised that she was frightened and in trouble, and needing to be liberated from the grip of a man like the man who is standing in the dock in front of me at this trial. 

And I let her down because I did nothing. I think I was ashamed and embarrassed about the possibility of being discovered. 

And so I walked away from that part of my life and buried it and left it, and I think it is these girls that I hear about now, this past week, have reignited this dilemma within me. I think I wanted love but I was paying for sex, and I kind of made that alright in my mind, and suddenly the anger has come up again with regard to this man and it is not alright. 

Susie: Because not only does he exploit these women, but he exploits both their need for love and men’s need for love? 

Douglas: Yes, exactly, and that is why I said about your being a feminist, or women I have talked to about these things, without of course telling them of my own particular involvement. But I find sometimes that certain people, they don’t see the man as a victim as well as the women. 

Susie: Well, I wonder if you could see yourself as a victim. 

Douglas: Yes I do, but then how can I be a victim? 

Susie: Could you slow down a second, instead of rejecting it? This is a new idea for you, Douglas, and would you just consider it for more than a millisecond? 

Douglas: Well, I have agreed with you. I mean I have agreed, I have agreed. You are right.

Douglas’s voice turns irate. His whole body looks inflamed. Some of his vulnerability has shown itself and made him uneasy. I’m still on the mission helping him see how anger becomes a portmanteau emotion, carrying many different feelings.

Susie: I think this is really helpful because you are showing me a piece of where the anger comes from. 

Douglas: I feel that you are going to judge me and punish me. 

Susie: I am actually more interested in trying to understand and… 

Douglas: I think you are like – it wasn’t an accident that I came to you.

Susie: What, you came for punishment from a feminist? And you are paying me very well. 

Douglas: You’re – I sit up there on the bench and I am very powerful. Um, and I am very aware of my power and I feel like a lonely child all at the same time. 

Douglas: Yes, but I sit up there and I feel like a preposterous ten-year-old wearing a wig. Actually not ten, more like sixteen, um, with impossible – how can I do this job, how can I judge people’s emotions, behaviour, when I am so confused, and I think … I knew you were of a certain type, you are a woman, and I think I, ah, I, ah, yes, I don’t know. 

Susie: Do you think you really came here to be beaten up? 

Susie: Unless you think that is a form of help. 

Douglas: But I mean what I did was bad, and what I am doing now is bad and… 

Susie: Well, I am interested in that, and I hope we will come to understand it, but at the moment I have got this very strong image, the one you just gave me, or gave us, of the young man sitting up there in fancy dress. 

Susie: As though there can’t be a vulnerable part of you at this age, as though you have to somehow diminish your vulnerability and speak of yourself as a sixteen-year-old rather than you as a grown man, with a big job, who feels vulnerable himself, and has complicated feelings.

Douglas: I think the difference is that this counsel who is arguing for this man – well, I know things about him, he has a complicated emotional life – but when I hear him, when I see him, he gets under my skin. It is as though I am looking at an adult with issues, with complications, and he makes me feel like a child, and that is the difference really. It is not like being an adult with vulnerability. I feel like a child sitting there, and I feel – the rage I feel, the tearfulness I feel when I had to call the recess, it was like being a child afflicted by a storm of emotion that I had no control over or context or perspective. 

Susie: But actually it was very wise for you to call the recess, wasn’t it? 

Susie: You were trying to take care of the situation, trying to take care of… 

Douglas: I wasn’t wise, it wasn’t wise. It was just, if I hadn’t done it I would have been sobbing in court. 

Susie: Well, I guess that wouldn’t have gone over big, so the fact that you knew… 

Susie: The fact that you knew that you might have been sobbing actually helps us a lot because sobbing is quite different from rage. 

Douglas: Rage leads to sadness, leads to rage, yes, they live together, one is the reverse of the other, two sides of the same coin.

Susie: Well, I’m intrigued by that because one bit doesn’t seem to get much expression. What you have told me so far is that rage is the thing that gets expression. The sob is hidden. 

Susie: No, I accept that, but I think you are sobbing inside somewhere, and that is almost hidden from you and that is causing you difficulties. 

Susie: So that’s worse than the rage, I don’t mean in the public forum, I mean inside of you. 

Now I feel we have done some parsing. We have been able to take apart what is bundled up by Douglas’s response of rage. We have been able to identify his shame about his past behaviour, his disgust at the trafficker, his feelings of illegitimacy to judge another and his sobs about his predicament. I didn’t pick up on what he knew of the defence counsel’s ‘complicated emotional life’ because it would have broken the flow of dealing with the recognition of his own vulnerability, and that was primary. I was interested in what he was seeing or projecting on to the defence counsel that he thought he got away with while Douglas was beset with upset, anger and confusion. I set that aside in favour of exploring the feelings that came up that constitute his anger. 

In my first session Douglas was angry because he didn’t know how therapy worked, so now we have some of the elements of the bundle called rage which was scaring him. It is like a pressure sitting on top of a mix of contradictory feelings.

Susie: You hurt in a lot of different ways. You are confused, and the rage is a kind of cover story for you endeavouring to hold yourself together, except it has got cracks in it. 

Susie: We have got to stop shortly, but one of the things that I am thinking about that must make this summing up so very difficult for you is that you want to convey empathy for the girls, the women, but you have kind of empathy deficit in relation to yourself, so you come in with the rage, and that is part of your dilemma. 

Douglas meets psychoanalyst Susie Orbach for a follow-up session, ahead of delivering a difficult verdict.

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