The Gossamer Thread. My Life as a Psychotherapist  

(Karnac Books. 2010)

The Gossamer Thread is a memoir of my work as a psychologist and psychotherapist covering almost four decades (from 1969 – 2006). I wrote it because I wanted to show psychotherapy from the inside, from the perspective of the therapist or, more accurately, from one therapist’s perspective. Therapists have written about their personal experiences before. However, no one to my knowledge has written about the therapist’s personal journey as I have done, how I changed from a bumptious, self-confident and ignorant believer in the power of behaviour therapy to a more mellow, reflective, less certain and more attentive therapist working in a psychodynamic and person-centred way. The book is a story, my story, but it also the story of just a few of the people I met, people I tried to help sometimes successfully, sometimes not. As I explain in the Preface to the book, these stories are based upon actual cases but fictionalised to protect client confidentiality.

Four extracts from the book

From The Preface: 

‘That’s the typical guff you psychologists spout!’ Kevin glares at me across the low table that divides us. I’m startled. What have I said? Kevin is convinced that the person in the flat above him stomps noisily across the floor whenever Kevin switches on his television. It’s a deliberate act of provocation according to him.

‘Are you sure?’  I’d said, unwisely I now realise.

Kevin snorted. Of course he was. The man hated him.

‘Might it not have been a coincidence?’ I enquired. Tactfully, I thought.

Kevin shook his head angrily at my stupidity. ‘I know he does it.’

It was then that I spouted my typical psychological guff. What I’d said was that Kevin could test out the hypothesis by keeping careful records of when the stomping occurred and if it did coincide with his switching on the TV, then he would be proved right. If not, it would be a coincidence. Kevin is a scientist so I thought he’d appreciate the idea. But he was having none of it.

‘I know he does it,’ he repeats, contempt oozing from his voice. ‘You psychologists know nothing.’

Suddenly I am feeling very angry. I just stop myself saying, ‘So why the hell do you come to see me?’, my contempt a match for his own. Anyway, Kevin’s not listening. He is going off on another rant about some bloke he’d met in the pub who completely misunderstood quantum physics and wouldn’t listen when Kevin wanted to put him right.

From Chapter 4. How many psychologists does it take to change a light bulb?

I park my car on the road that borders the estate, thinking that the safer option. Graham and I walk down the hill seeking to locate Arlington House where Mrs Hewittson lives. I’m aware that we stand out, dressed in our smart, professional clothes, each carrying a leather briefcase. But no one bothers us and we find No. 7, a ground floor flat fortunately, so we don’t have to negotiate what I imagine to be urine-smelling lifts or flights of bare concrete stairs. I ring the bell and wait.

I had briefed Graham beforehand. This is to be an assessment. Given that this is behaviour therapy, it would of course be a behavioural assessment. My plan was that flanked by the two of us, Mrs Hewittson would come out of her flat. Then we would send her off on her own as far as she could go until she couldn’t go any further. And I was going to be really scientific about this, for we would note down exactly how far she went, how long she took and how much anxiety she experienced on a scale of 0 to 100. This would be the baseline against which her recovery would be measured. In my mind, I fantasised Mrs Hewittson going further and further each week until we had her travelling all over London.

The door is opened cautiously by a young girl, no more than nine. I explain that we are psychologists and that we have come from the Maudsley hospital to see Mrs Hewittson.

‘Nan,’ she yells back into the flat, ‘there’s two psychos from the hospital to see ya. Waddya want to do?’

We hear the sound of talking from inside the flat, two voices, one female sounding very tremulous. Graham and I exchange looks. The door opens wider. ‘Nan says you can come in.’ The girl disappears into the gloom of the flat. When we get used to the darkness, for the curtains are drawn and the main lighting comes from a TV blaring away in the background, we see that the room is full of people. There are three girls, including the little girl who opened the door, playing around a Wendy house in one corner. A woman, barely in her teens, is seated at a table holding a baby who is guzzling milk from a bottle. A tiny, wizened man in an old grey suit sits on a huge settee, a cigarette dangling from his hand. And, in a rocking-chair in the centre of the room, there is a woman in her fifties, strands of mousy brown hair straggling down either side of a pale, thin face in which watery blue eyes stand out like on those odd goggle-eyed fish one sees in aquariums. She is staring at us unblinking. Mrs Hewittson I presume.

It is an unnerving situation, not what I’d expected. I’d imagined Mrs Hewittson stuck on her own, lonely perhaps, even pleased to have a bit of company. Not in the midst of a melee of people. But I’m the professional. So I take charge.

‘Mrs Hewittson?’ I say, addressing the lady in the rocking chair. ‘We’re psychologists from the Maudsley. We’ve come to help you get better.’

The woman says nothing. She rocks forward and back in the chair. I am uncomfortably reminded of the Bates motel in Psycho and the skeletal mother in the basement.

‘Your daughter,’ I press on, ‘arranged for us to come and help you.’

‘Did she now?’ Mrs Hewittson says. It’s a rasping, throaty voice, the product no doubt of thousands of cigarettes smoked in the gloomy flat. ‘That was nifty of Jean.’

Somehow I feel that being ‘nifty’ is not something Mrs Hewittson approves of. The tiny man on the settee leans forward. ‘My Madge is not well, you know,’ he says confidentially as though she cannot hear him. ‘Trouble with her nerves. Had it a long time.’

‘That’s why we’re here,’ I say triumphantly. ‘To get her better.’

‘How are you going to do that then?’ puts in the woman with the baby.

‘First, we’ll go out for a short walk, say, to the post box.’ We’d passed the post box just twenty metres along the road. I turn to Mrs Hewittson. ‘You might have a letter you want to post and we could do it together.’

‘Sammy takes all my letters. He delivers them and takes whatever I’ve got. Don’t need to post anything, thanks all the same.’

‘Anyway, it’s an assessment, a sort of test, to see how far you can go. You don’t have to go far,’ I add hastily. ‘Just as far as you feel you can go.’

‘I can’t do that, doctor. Sorry, I can’t do that at all.’

‘Oh.’ This blanket refusal takes me back. ‘Well,’ I press on gamely, ‘what about going out of the front door and down the path to the gate? It’s only a couple of yards. I’m sure you could do that with our help.’

‘I would do it, sir. But it’s the fits, you see. Can’t risk it. I have these terrible fits.’

‘She does,’ interjects the man in the grey suit who I take to be her husband. ‘She has these fits. She’s a martyr to them.’

I sense I am losing the battle. What are these ‘fits’? Could they be epileptic fits? If they are, what do Graham and I do if she has one? I have never seen an epileptic fit. All I know is what everyone else knows from the films, how you have to grab the tongue, but then what? I curse myself. I should have read Mrs Hewittson’s case file before we came. Before I have time to say anything, the front door opens and in breezes another youngish woman with a two-year old in tow.

‘Madge, darlin’,’ she starts, then stops having spotted us. ‘Sorry, love, didn’t know you had visitors.’

‘They’re from the hospital. Psychiatrists,’ says Madge.

‘Psychologists.’

‘Sorry, didn’t mean to offend and all that.’

‘No offence.’

‘Thing is,’ says the new arrival, ‘I was hoping you’d look after Darren while I go to the Social.’

‘No problem, love. You leave him here with me.’ Mrs Hewittson turns to me. ‘Very sorry about the walk. But you see I’ve got my hands full. Another time, doctor.’

‘Yes. Right,’ I say decisively. ‘What about Friday morning? At 11?’

‘That would be ticky-tack. I’ll be more meself then, I expect.’

Unfortunately, that’s exactly what worries me.

From Chapter 10. Microbes in the vast universe

One week Frances fails to attend a session, something she has never done before. We are well into the therapy. We have moved on from changing negative thoughts to identifying the underlying beliefs, what Beck calls schemas. These are the major drivers of depression, ideas that are often formed in childhood and become reactivated in current crises. They can be encapsulated in key phrases or prescriptions like To be happy I have to be accepted by everyone all the time, I must succeed in whatever I do, I have a fatal flaw in my personality, I am fundamentally a bad person. According to Beck, to produce lasting change it is essential to get to these core beliefs and deal with them.

In the session before Frances failed to attend, she had complained that her work as an administrator was boring. I asked why she didn’t try to get a more demanding and interesting job, something that drew more on her academic ability perhaps. She said vaguely that there was no point. Puzzled, I pursued this and we came to an example of a powerful underlying belief. Life is meaningless, she claimed. In the end we all die.

‘How do you know life is meaningless?’ I ask.

‘I just do.’

‘Come on. You know that won’t do. Let’s do some cognitive work on this. List ‘pros’ and ‘cons,’ for example.’

Frances says nothing. I try to read her face but I can’t. It’s expressionless.

‘Don’t you want to challenge this belief?’

‘I can’t see the point.’

‘To get better. To deal with your depression.’

Deal with it,’ she says sarcastically. ‘You don’t deal with the meaningless of our existence.’

I am startled by Frances’s tone. It’s the first time I’ve heard her talk in this angry way. I backtrack. ‘Okay. I’m sorry. A poor choice of words. But I do think we should examine this belief, don’t you? It seems central to your depression.’

Frances stares at me. For the first time in the therapy I feel unsure. More than that. I have a sense of unease.

‘Maybe,’ she says at last. ‘But not today. Can we leave it to next time?’

‘Okay.’

Later, I wonder if I should have agreed so readily. Was this avoidance on my part? Up to now the therapy had been going smoothly. Frances was the model patient. This was our first glitch. I’d told myself that it would be better not to push this. We could work on it in the next session. The only problem is that Frances failed to turn up for the next session.

I ring Frances. I don’t normally do this when patients fail to show up. I wait a couple of days and if they don’t contact me, I drop them a line. But Frances is a special case, my first cognitive therapy patient, and I’m worried about her. The phone rings on and on. I’m about to hang up when at last she answers, a slow ‘Yes, who is it?’ as though I have just woken her up.

‘Frances, it’s John. I was wondering if you were okay.’

‘What time is it?’

‘Just after two. Have you been asleep?’

A long pause. ‘Sorry. Just very tired.’

‘You didn’t make the session this morning. I wanted to know if you’re alright and if we should reschedule.’

Another long pause.

‘Are you feeling depressed?’

‘You could say that.’

‘Is that why you didn’t come to the session?’

‘What’s the point? I’m not going to get better.’

‘That’s your depression talking, Frances. You’ve had a downturn in mood. All the more important for you to see me at this time. We can work on it together and help you get out of it.’

‘I don’t know.’

‘I do.’ I’m being the decisive, no-nonsense therapist though it’s the last thing I feel at this moment. My shoulder muscles ache with tension. My heart is beating fast. At the back of my mind is the thought that Frances will kill herself. ‘How about later on today, at 6? Or tomorrow morning?’

‘No. I need a bit of space. I’ll come to next week’s session. Don’t worry, John. I’m not going to do anything stupid. I haven’t the courage to do that anyway.’

I try to persuade Frances to see me earlier but she’s adamant. She promises to come next week. I wring a further promise from her that she will contact me immediately if she feels suicidal.

What has happened? The therapy was going along really well. Is it just a blip, a random change in mood? Has something happened to Frances to trigger the increase in her depression? Was it related to our discussion of her core belief that life is meaningless? I ponder these matters but come to no conclusion.

When Frances comes to our next session, I immediately notice a change in her manner. There’s a slowness to her movements, a hesitancy that I have never seen before. She doesn’t look directly at me and when I study her face, all I can see is blankness. I ask her how she is. She takes a while to respond. She says she feels lousy, tired, depressed, no energy, completely zonked. All signs of depression.

‘I’m sorry you’re feeling so bad but I’m glad you came,’ I say. ‘It’s a chance to do some work and improve your mood.’

She looks at me and sighs. ‘The good doctor’s going to make me better. Hooray.’

‘Well, I’m going to try. Tell me right now and in all honesty what you think of coming here.’

‘A waste of time.’

‘Why?’

She shrugs. ‘Nothing works and anyway what’s the point. I get better for a bit and then I get worse. I’m just useless.’

‘Several very negative thoughts in that statement, I’d say. Do you remember how we dealt with, I mean, worked on your negative thought, I’ll never get better? We listed the ‘pros’ and ‘cons’ and came to a more realistic thought. I have it here.’

I search through my notes and read it out to her:

I can’t know that I’ll never get better and I recognise that this absolutist negative thought is a product of my mood state rather than a realistic appraisal of what will happen.

‘Do you believe that now?’

‘It’s irrelevant what I believe,’ she says in a lethargic tone. ‘Life’s meaningless anyway. We are microbes in the vast universe. Specks of cosmic dust. What does it matter? What does anything matter?’

‘Something mattered enough for you to come here today. You’re depressed, Frances. Something brought you right down in the last week. I don’t know what. But I am absolutely convinced that your view that life is meaningless is caused by your depression.’

‘It’s not,’ she says emphatically. ‘Life is meaningless. It’s not a product of depression. It’s true. And anyway I’ve always believed it so it can’t be a response to a change in mood.’

For the moment I’m stumped. I’m also feeling pissed off with Frances, with her certainty and resistance to my attempts to help her.

‘Always?’

‘Always.’

‘So you sprung from your mother’s womb with the thought Hey, why am I here? Life is meaningless. Let me back in?’ I have spoken without thinking. I’ve let my feelings show. I’ve broken a cardinal rule: don’t mock your patient. I’m a crap therapist. But a small smile appears on Frances’s face.

From Chapter 23. Unanswerable questions.


The doorbell rings. A short burst. A pause. Then another longer one. Opening the door I find a small, auburn-haired, smartly dressed, thirty-something woman. In her hands she holds three very large white shopping bags, two in one hand, one in the other. Monsoon. Whistles. Jaeger.  The best designer clothes shops. A smart leather handbag, almost as large as a shopping bag, hangs from her right shoulder.

‘Leone?’

‘Hi.’ She pulls a wry face. ‘Can’t shake hands. Been on a shopping spree as you can see. I thought while I was in Oxford I’d…’ She leaves the sentence unfinished.

‘Combine business with pleasure?’

‘Spot on.’ A lovely smile transforms her face.

‘Come in,’ I say, stepping aside as Leone and her shopping bags slip into the house. I’m already aware of something different from normal. A frisson that has passed between us that is more to do with a man and a woman than therapist and patient.

Leone was referred to me by her GP, Dr Forsyth. He mentioned depression and marital problems. She’d been in therapy before. She and her husband, Philip, had had a few sessions at Relate, what used to be called the Marriage Guidance Council. She would like some help of her own is what Dr Forsyth had written.

Leone places the bags on the floor next to the chair. She looks at me enquiringly. ‘Do you mind if I take off my boots? They’re really too tight.’

‘Fine,’ I say without thinking though it’s an unusual request, certainly in the first session. I watch as she unzips each black leather boot, exposing the curve of her calf. It’s an intimate act and, frankly, erotic. When she’s finished, she curls her feet up under her in the chair, looks up at me again and says, with an air of innocence, ‘What happens now?’

‘You tell me what’s brought you here.’ My tone is different from normal. There’s a playful element to it. Flirtatious even.

‘Oh, yes.’ A sigh. ‘Where do I begin? It’s so difficult this business. You must get bored listening to neurotic women telling you their problems.’

‘It’s what I do though I wouldn’t put it quite like that.’

‘No I’m sure you wouldn’t. You probably have clever words to describe it all. The Oedipus complex. Stuff like that.’

I note the undercurrent of anger. I suspect that this is about men and how they treat women, how Leone has been treated.

‘Dr Forsyth said you are the best in the business.’

I hardly know Dr Forsyth. I have seen at most two patients he has sent me. How could he know that? Would he say it?

‘But then I think, Dr Marzillier – or can I call you John?’

‘John is fine.’

‘…that I’m wasting your time and Philip’s money coming here.’

‘That you should just pull yourself together and get on with life?’

Leone laughs. ‘Spot on. The truth is, John, I don’t know what I want. But I’m not happy. I know that. But then who is?’

Her eyes stare into mine. They are large and round, a light shade of green, carefully highlighted by the application of mascara to her eyelashes and the soft tones of make-up below the eyes. There’s no escaping the sexual overtones to her look. I am drawn to her for that reason, no doubt like many other men. How easy it is to be seduced, to flirt with this attractive yet vulnerable woman as I have already found myself doing? But I have a professional job to do. I need to keep that in mind. It is not often that I have to warn myself about this as I’m doing now. Leone is going to be a challenge for I’m pretty sure that the flirtation will continue, that it is her way of engaging with men, of bending them to her will. Until, that is, they disappoint her or let her down, which is when all her fierce anger will come out, the claws unsheathed and ready to scratch. You may think it’s not believable to reach this conclusion from such a very brief exchange. But I can assure you it happens. First impressions are hugely significant. The thoughts are not always articulated but they are there, often unconscious and, as they were in my case, expressed by a change in the way I would normally behave. I had learned the value of attending to these signs.

 


Photos by Martin James, Pickersgill Reef and Sharon Pazner shared under Creative Commons licence.