Fictional Clinical Narratives in Relational Psychoanalysis

Stories from Adolescence to the Consulting Room

Christina Moutsou

• Publisher: Routledge
• Year: 2018
• Print ISBN: 9781138315471
• eBook ISBN: 9780429851292
• Topic: Psychology
• Subtopic: Mental Health in Psychology
• Index: Psychology

Fictional Clinical Narratives in Relational Psychoanalysis explores the therapeutic space between the patient and therapist in psychoanalysis and the transformative effect of the therapeutic relationship through a collection of twenty-two short stories beginning at a moment of trauma in adolescence. Christina Moutsou illustrates both contemporary clinical issues as well as the relational and intersubjective nature of the therapy relationship.

First, six teenagers narrate in the first person their experience of battling with sexual abuse, eating disorder, body image, the first sexual awakening, loss of a parent and the intricacies of teenage friendship. The stories then unravel years later as adults in the consulting rooms of Ellie and Jake, two middle-aged therapists working in London. The reader is offered an intimate look at how the therapists work through their personal losses and past wounds, while facing their patients' conflicts and dilemmas including adoption, bereavement, pregnancy loss, lack of intimacy in the couple relationship and a diagnosis of borderline personality disorder.

What distinguishes this collection of fictional clinical narratives is the focus on an internal point of view, where the reader is invited to experience first-hand the tribulations of the psychoanalytic dialogue and the enduring marks that trauma and loss leave on each member of the therapeutic dyad. The focus here is on how narratives are constructed and deconstructed through the intersubjective dance between the therapist and the patient. Both are transformed in the process. The fictional nature of the stories also allows for the exploration of sensitive issues that are difficult or awkward to explore adequately using direct case studies from real-life examples.

This fascinating and unusual work provides an innovative method of exploring everyday clinical dilemmas, using an accessible, easy to follow narrative path. It is written from a broadly relational perspective but will appeal to all psychoanalysts and psychoanalytic psychotherapists.

Part I

A moment in my teenage years

Adolescence is a pivotal time for forming one’s identity and for psychic development. Though this fact is recognised clinically (many therapy resources are dedicated to offering counselling to teenagers and young adults), psychoanalysis focuses on the early years as pivotal for the formation of the ego. Yet, it is in adolescence that the dark forces, perhaps first encountered at the beginning of life, often get unleashed. This collection of six adolescent stories is written in the first person, attempting to offer close-up insight into the experience of turbulence and psychic fragility during adolescence. All stories focus on a moment of trauma which divides life into the time before and the time after.

On the beach

What is the boundary between teenage play and experimentation and abuse? As a society, we have a complex relationship with abuse, especially in its sexual form. We often fail to name it for what it is, and in doing so, we perpetuate the cycle of shaming the victim, covering abuse over with secrecy and indirectly perpetuating the vicious circle of both the victim and perpetrator remaining unprotected. Research indicates that sexual abuse often takes place between children as well as within the family. The story below is a close-up glimpse of the intrusive and violating nature of sexual abuse as well as how difficult it is to stop it.

Late afternoon of the last day in August on my favourite beach in Chalkidiki. A long golden strip of fine sand ending in the green wooden cabins by the pointy rocks I loved to climb on. The sun had mellowed, its rays hitting the water and the hot sand sideways. I went for a swim. Water was my element, my realm, where I felt alive. Diving under, swirling around, expertly moving up and down. Head down, legs up, lying on my back at the bottom of the sea staring at the sun rays spreading colours on the surface of the water, turning it golden. I floated up to the surface, took a long breath in, water dripping down my face, sticking to my eyelashes, forming rainbows in front of my eyes.

I nearly gasped as I made out Petros’s silhouette on my journey up to the foamy water surface. He had followed me in. He was there, waiting for me to come up. Only the bottom of the sea was safe, only there my body belonged to me, only there me and my body were at one. He got hold of my shoulders.

‘I can dip you in’, he laughed.

‘No, you can’t’, I cried.

I swam, kicking my legs back, raising foam high, hoping it would get into his eyes. He got hold of my legs now, and with his arms around my waist, he tried to swirl me around.

‘Come on, let’s dive in together’, he said.

I held my nose, he tried to move my hand away.

‘Don’t be a baby’, he giggled just before going under. ‘You don’t need to hold your nose, just breathe the water out.’

‘I like diving alone’, I mumbled, but there we were, going down together, his arms firm around me, dragging me down, our bodies intertwined.

I breathed water in through my nose. It made me dizzy. Out of my depth. I knew what this felt like from before. He was hiding behind the white lacy curtains in our living room, the big fluffy plum-coloured sofa turning darker under the dimming light of dusk. Where was everybody? Where was Mother? What was I doing alone in the dark living room? Were we playing hide and seek? He jumped in front of me from behind the curtains. I let out a little scream that seemed to amuse him. ‘Touch’, he said. He was holding a batch of matches, their tips black, burned. I did. They were hot. I stepped back and cried. He laughed with delight. ‘Cry baby!’ he hummed. Did I run to Mother?

Panic set in; what had been my element a minute ago was going to drown me to death. Underwater, I could feel his tongue trying to push into my mouth and something firm pressing against my belly. I kicked my legs hard to come to the surface, gasping for air.

Mother was lying on her back sunbathing, her eyes firmly shut. For all the time I had been chased after in the sea, she had not moved or opened her eyes once – or had she?

‘I am getting out now’, I said. I was feeling defeated. Here I was, being banished from my realm of the sea, being chased out of it onto the hot sand, to feel the boredom of aloneness. Then I noticed her, the old lady discreetly observing us, her eyes following us as we moved about treading turquoise water.

‘Come on, one more dip’, he said. ‘Have a jump from my shoulders.’

Father had a soft spot for him, I remembered. ‘The first, the only boy in the family’, Father always said. I felt like saying, ‘but he is not part of our family’, but I never did. Father always knew best. He and Petros spent time together doing boys’ things. They would go out holding a ball, they would come back hours later carrying shiny red cars and ride-on toys and, once, a cowboy dress-up costume. I knew then that being a girl could not ever be as exciting. I was Father’s favourite, or so he said, but we never came back home together, our faces glittering with conspiracy and fun. Father sometimes had private talks with him. Talks in whispering voices full of intensity. It was adult stuff that he was teaching him, Father would tell me, if I tried to join in, and I would know better than to stay in the room with them for more than five minutes.

He looked very much like Father, or so other people said. I could never see what they saw. Father was dressed in smooth suits, their fine material enveloping elegantly his body. Father smelled of discreet cologne and freshly applied aftershave. His voice was deep and commanding. His voice was tender and warm and bubbly. Father was not clumsy, spotty and full of sweat. The problem was that Petros thought he was like Father too and, like him, he could give me orders, tell me what to do, and I would. The problem was that I could not say no.

He dived behind me, his head coming up between my legs, his arms gripping my thighs firmly. I was being raised high, riding on his shoulders.

‘Ready, steady . . . go!’

Here I was, falling backwards in the water, feeling whole again. I stayed at the bottom for as long as I could hold my breath, as deep as I could, no body part coming through to the surface. He was there when I came up, waiting to grab me.

‘Hello, my chubby dolphin’, he cackled, grabbing hold of my shoulders.

I turned my head to look for the lady. She was still there, staring at us.

‘Come on, a last dip’, he said, pressing me against his body.

I felt the old lady’s gaze burning my back.

‘This time we go down as one body, stuck together, OK?’ he said, his breath becoming short.

He got his legs around my hips and trapped me tight against his body. Before our heads were under, I could feel his lips pressing against mine, his tongue full of saliva going deep into my mouth, his bad breath. As soon as we were under, water started filling my mouth. I swallowed hard and almost choked. I kicked against his groin, finally came up, gasping for air.

The lady was there by our side, her expression stern, austere.

‘Children,’ she said, ‘how old are you?’

I could tell from her tone and use of language that she was a well-educated, probably cultured woman.

‘Let’s swim away’, he whispered in my ear while I was still trying to catch my breath.

‘Children,’ she repeated firmly, ‘are you here unsupervised?’

‘No,’ I mumbled, ‘my mother is over there.’

I pointed at the woman in the black swimming suit, lying still on her back, her eyes firmly shut.

‘I am going to have to go and talk to her,’ she said, ‘because the things you are doing are just not right for children to do. I suggest you follow me out of the sea now, if you don’t want to be in even more trouble.’

He shrugged his shoulders and swam off. I swam slowly towards the shore, letting the lady get out of the sea first. I hesitantly got out of the water, but rather than follow the lady to the umbrella where Mother was lying unperturbed, I sat on the hot sand, two metres away, turning my back to them, looking at the pale horizon merging with the deep dark blue far away. My ears tried to get hold of the broken syllables through the breezy wind, the shrieks of nearby children and the soft lapping of the water on the sand near my feet.

‘Sorry to disturb you, madam,’ the lady said, ‘but I have been watching your children for some time now, and I am very concerned about what they are doing. Are they both your children?’

‘He is my nephew, from my husband’s side . . .’, I could hear Mother mumble.

‘So, they are first cousins. And how old are they?’

‘My daughter is eleven, he is nearly sixteen. What’s this about?’

‘Well, they are far too young to be kissing on the mouth and they are first cousins too. I have to say I am very concerned. . . . Have you thought about asking your daughter to tell you what’s going on?’

‘Oh, I would not worry as much, madam . . . can be naughty . . . they are only children . . . please . . . own business . . .’

I stood up and walked towards the umbrella as soon as the lady had turned her back, a sense of foreboding heavy in my stomach.

‘It’s time to go home’, Mother told me coldly.

I took a deep breath in, a salty bitter taste overwhelming my mouth. The taste of the sea had now turned into the taste of his dirty saliva. I swallowed hard to send away the waves of nausea which gave me goosebumps.

‘What was the lady talking to you about?’ I dared to ask.

‘She said that you were both naughty.’ Mother’s voice sounded like cold metal. ‘You can’t help it, Natalie. You have just got your father’s blood, a genetic predisposal to all the wrong things in life’, she added. Her contempt for me felt like a cake she could not have enough of.

‘But . . .’

‘You know how much I hate drawing people’s attention to us, especially if it is through your filthy actions.’

He came out of the sea just at that minute, when I would either speak up or cry. Words and tears evaporated like burst bubbles under the hot August sun.

‘Change into dry clothes now’, Mother said to me curtly. ‘You look cold.’

I took a look at his hungry gaze. Another shiver ran through me. I felt overcome with nausea.

‘I am not taking you out to the beach with us again, Petro’, she told him sternly. ‘You have been naughty.’

I collected my clothes and a towel. ‘I’m going to the changing rooms’, I whispered to her.

I walked where the water reached the sand turning it into smooth, silky mud. I let my feet dip into it and felt the little pebbles that embroidered it tickle my soles. ‘Just like Father.’ I was getting confused. Was it Petros or I or both of us that were like him? And if it were both of us, did that mean that we were both the same? ‘Filthy.’ The nausea came back. I felt like dipping into the sea again, swimming to the deep this time, so nobody would know where I was. The soft pile of clothes hanging round my bent arm stopped me. The sun had started to turn orange; its sideways rays fell burning on my skin. I needed to get out of here.

The changing rooms were at the other end of the beach; five green wooden cabins smelling of seawater, sand and urine. I loved the scent of wood and sea mixing together, but I would always try to block out the acidic smell of urine rising from the ground. When I was a breath away from the first empty cabin, a hand tapped on my shoulder.

‘I’m here’, he said, huffing and puffing. ‘Nobody can see us here.’

I ran for the cabin and quickly slammed the door shut behind me. I forced the metal hook on the round rusty ring attached to the door, just before he had time to push in.

The divorce

It is both easy and customary to pathologise teenagers and to attribute labels to their distress such as suffering from anorexia and, later on, possibly a BPD diagnosis. The dynamics in a family that can lead to accumulative distress as well as a sense of emotional isolation for a young person are not always easy to spot. Especially in the context of middle-class and apparently privileged families, teenage angst and self-harming behaviour can look like an internal state of pathology. This story offers insight into a difficult mother–daughter relationship, which feels deeply depriving to the daughter. It offers understanding and empathy with teenage distress rather than focusing on the diagnosis of pathology.

It was the quiet time after our midsummer lunch, when my sister and I were supposed to retreat in our rooms and do some homework, while Mum was getting ready for her evening teaching, English as a foreign language to summer students.

‘I will pop into Tracy’s for a quick coffee before my lesson’, she told me hastily. ‘Please, mind your sister.’

She did not seem to notice how I rearranged my food around on my plate, how I slowly chewed the peas one by one, giving the rest of them a gentle push, as though they were a hundred tiny footballs trying to score a goal on the other side of the plate. The chicken was lying almost untouched when I finished, cut up in many small pieces, most of them expertly hidden under the roast potatoes.

‘I don’t like potatoes any more’, I mumbled when we had all finished and she was clearing the plates ready to stack them into the dishwasher.

‘That’s all right, my darling. Potatoes are not good for our waistline’, she said absentmindedly.

I felt a knot in my throat. How could I get to her, if even not eating was a way of joining her club, that of the slim and the fit middle-class and middle-aged mums living in our leafy neighbourhood, who frequented our local Pilates studio and dressed as though they were sixteen at most. She had taken to asking me to join her in our club’s swimming pool this summer and I don’t know if I imagined it, but it felt like she was keen to show off my slimming figure.

‘Such an athletic body you have’, she would say. ‘A real gift for a growing girl!’

A couple of her friends had noticed my weight loss.

‘Are you on a diet, Bella?’ Tracy had asked me when we bumped into her by the swimming pool, looking half interested and half concerned. ‘Every time I see you, you look thinner and thinner.’

Mum seemed in a hurry to get rid of her.

‘So good to see you, Tracy. We just popped in for a quick swim. Good to see everyone is getting fit this summer’, she added in her usual not-stopping-to-take-a-breath way and she squeezed past her to get into the pool.

‘She is such a pest’, she whispered in my ear as soon as we were in the pool. ‘Always wanting us to be best friends, as though we are at nursery school.’

I had not had a period since early spring and in many ways this felt both good and normal. It was a return to a time in my life, my childhood, when Daddy would always have lunch with us and he would wolf his food down, despite Mum’s remarks about his unfortunate table manners and his working-class origins. A time when Anna was a little, cute toddler and she used to climb on my lap, plant a wet kiss on my cheek and call me ‘her Lelly’. A time when we did not all hide in our rooms and when Dad used to occupy the living room with the TV on, watching his favourite match with a can of lager in his one hand rather than be unseen and unheard of in the house. With the prospect of redundancy lurking over him and his salary reduced, he needed to put in the hours, I had heard him saying to Anna who had climbed on his lap one late evening. She was by far his favourite daughter, the only one who was happy to join him in cheering Man U.

I did not feel like reading today, although reading had been my best place of escape since school had stopped. I could hear Anna tapping her foot, as she was yet again on her PlayStation, but for once, I did not feel the burning guilt in my stomach of trying to save her from Mum’s oblivion, trying to be the best possible big sister like my mother always wanted me to. Eight years between us and yet, at times, I knew exactly how she was feeling, the sinking feeling in her heart, as she was trying to lose herself in her digital games, to forget that she had been forgotten.

I spread myself on the sofa and I toyed with the idea of switching the TV on. Surely, Anna would hear and she would be down in a second, asking that we watch a DVD and eat popcorn together snuggled up in front of the TV. Then, any prospect of homework or, at least, of reading her a book, as I had taken to doing every afternoon when Mum was out for her teaching, would be out of the window. Then, we would both sink together in dead-brainland. Besides, I would not want Anna to see me not eating popcorn. She was too young to know any of that. I wanted my little sister to have the life I used to have at eight, a life full of exciting stories that Mum would read to me and trips to cool theatres, museums and parks in central London. Yet, despite my best intentions, I failed to be the good big sister she deserved. Why was I so much better at not eating, let alone the other stuff I would never want her to know about, than at entertaining her?

The other stuff was the only thing that Mum had noticed about me lately, the fresh scars on my arms.

‘What is that, Bella?’ she said very seriously, pointing to a long straight red line on my upper arm. She had caught me with bare arms, as I wa...

Table of contents

• Cover Page
• Praise
• Fictional Clinical Narratives in Relational Psychoanalysis: Stories from Adolescence to the Consulting Room
• Title
• Copyright
• Dedication
• Disclaimer
• Contents
• Acknowledgements
• Introduction
• Part I A Moment in My Teenage Years
• Part II Ellie
• Part III Jake
• Part IV Ellie and Jake