Tales from the Therapy Room

Shrink-Wrapped

Phil Lapworth

• Publisher: SAGE Publications Ltd
• Year: 2011
• Print ISBN: 9780857024954, 9780857024947
• eBook ISBN: 9781446245323
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

These ten fictional short stories give students of counselling and psychotherapy a unique insight into what actually goes on in therapy. Exploring aspects of the client-therapist relationship, the reader is given a fly-on-the-wall view of the therapeutic process. Rather than suggesting a ?correct? approach, they explore possibilities and provide entertaining, vivid and thought-provoking descriptions of the therapeutic journey. Issues explored include:

- contracting

- boundaries and confrontation

- self-disclosure on the part of the therapist

- dream interpretation

- the influence of the consulting room environment

- conflicting belief systems.

These are much more than just engaging stories - Phil Lapworth draws on over 25 years of clinical experience to show how the student can integrate theory into real practice with real clients. The final chapter explicitly highlights the specific theories, models and issues that are illustrated throughout and provides questions, learning objectives, exercises and further reading to encourage critical thinking.

A door into the often-hidden perspective of what a therapist might think and feel within the therapy session, this ?shrink-wrapped? resource will be treasured by counselling and psychotherapy trainees and practitioners for years to come.

Reader Responses to Tales from the Therapy Room:

?Delightful, moving stories, recounted with pith and wit?

?What a little gem this book is. Each short story distinct, crisp and unpredictable?

?A delightful, thoughtful and often funny peek into an imaginary therapy room?

?I?m limiting myself to 1 tale a night, so that I can savour it a bit longer?

?These tales have something of a detective story about them...unnerving and compelling at the same time like a good thriller, with a wonderful twist in the end?

?Beautifully constructed and lightly executed?

?Distinct, crisp and unpredictable… I came to believe that even the author was surprised by what came next?

?I found this book un-put-down-able and re-read several of the stories?

?Phil Lapworth seems to have invented a new genre of his own. Each story is a little jewel, and I had to keep reminding myself that they were fictional?

?He has caught the poignancy of human vulnerability as well as its absurdity and humour?

?These stories stand undeniably on their own as surprising and delightful duets of the psychotherapeutic relationship, often concluding with a wry and humorous twist, always entertaining and warm-hearted. We look forward to reading more such tales?

The Carving

Like most psychotherapists, I work in a room intentionally neutral in its décor and furnishings to allow my clients and their therapeutic relationship with me to be as unencumbered by extraneous intrusion or distraction as is possible. Family photographs and personal memorabilia have no place here, but to distinguish the room from a prison cell or a medical clinic, it does have bookshelves (admittedly housing only psychotherapy books), comfortable sofas, low tables, even a bowl of dried gourds – all of which must give away something of my stylistic tastes and preferences and say something about me, though limited to the confines of the consulting room. Equally, my choice of clothes, shoes, even the boxes of tissues I provide or my appointments diary must evoke some associations for my clients that might usefully be explored at some point in our work. Unlike more classical, psychoanalytic therapists, I’m not attempting to be a ‘blank screen’ or a ‘non person’ but to provide a fairly neutral and mutual exploratory space, the room as background to our relationship and our work together.

Recently, however, a wood-carver friend of mine gave me one of his carvings that I had coveted for some time but couldn’t afford to buy. He entitled this generous gift, ‘Tree in Wood from Tree’. It’s an old, elm chair-seat through which have been carved three circles, two side by side above a larger one. Inside of these, the trunk and branches of a miniature tree have been ‘exposed’. I use this word purposely as the carver’s skill and artistry lies in the fact that the wood is all of a piece and the delicate, intricate branches within the holes have all been painstakingly created solely by carving from the chair seat – no insertions, no glue, just the removal of wood. I fell in love with it on first viewing and immediately made an association to the process of therapy – the painstaking uncovering, the exploration, the clearing away – to rediscover the unadulterated self hidden in the life-adapted person we all become. The young tree exposed in the old wood symbolized, for me, the potential of that original, unspoilt self still to be found (and reclaimed) within the ageing, and also to be treasured, adult through the process of psychotherapy. Its place in my therapy room was inevitable. There was even a wall, shared by the ends of the adjacent sofas but peripheral to my and my clients’ view, that had a space just waiting to be filled.

For several weeks after hanging, the wooden carving appeared to have only singular influence. As clients arrived for their sessions, I was acutely aware of the brown square on the wall, like a vague shadow on the periphery of my vision, but none of my clients seemed to notice it, let alone remark on it as I had assumed they might. Quite rightly, of course, they were involved with themselves, with their own issues. They were drawn into their inner life, their past and present and projected worlds. A piece of wood on a wall was not their focus. I tried not to make it mine but I must admit it took some weeks before I got accustomed to its presence and could lessen its visual distraction.

Olive was the first to be affected by it – but only indirectly. She didn’t seem to notice the carving at all. Instead, as she came into the room, she looked at the bookshelves and remarked, ‘Oh, you’ve brought your books in here. It feels much more like a study now.’ (This from someone who had sat in this room on a weekly basis for three years and had often stared at the bookshelves for long periods of time.) I can only surmise that the carving had made a visual, if indistinct, impression on her and that this had registered in her mind as ‘there’s something different in this room’. Quite why she thought it was the books was not immediately clear to me but she sat down still looking at them in a rather perplexed and anxious way.

‘Does the room being more like a study have a particular meaning for you?’ I asked, remembering that her father had been a vicar and that she had spent her early childhood living in a large manse. She had not talked much about him in all the time we had worked together, despite my prompting. Her depressed and narcissistic mother had monopolized Olive’s focus in therapy as much as in life.

‘It reminds me …,’ she began, but halted with trembling lips. Breathing deeply, she looked away from the books and into my eyes. ‘It reminds me of things … things to do with my father. I feel your books have given me permission to talk about him now. He was a dear man but … ’

And so a new and important phase of our work began.

Jack, in his mid-seventies, my oldest client at that time, was the first to notice and remark upon the carving directly but his association was very unexpected.

‘We had those when I was a child,’ he remarked as he leant a little in the direction of the carving, squeezing his eyes to narrow slits the better to see.

‘Did you Jack?’ I asked, assuming he meant that the wooden seat was familiar to him from his childhood home. ‘Where was that?’

‘Oh, that would be in Leicester,’ he replied after a moment’s reflection. ‘We kept them under the stairs.’

‘Last week you referred to your mother’s proclivity for “keeping things for best”’ I said. ‘Was that why the chairs were under the stairs?’

Jack looked puzzled. ‘I don’t understand.’

‘The wooden chairs, like the seat on the wall?’

‘Seat on the ….’ He petered out, a look of bewilderment on his face.

‘I’m sorry,’ I said. ‘I wonder if we’re talking at cross-purposes. I was assuming the wooden seat reminded you of chairs in your childhood home.’

‘Chairs?’ queried Jack. ‘Who said anything about chairs? I’m talking about gas masks, you know, during the war?’

‘I see,’ I dissembled, not seeing at all. I glanced to the side to see what I was missing but saw only the carving, the tree within the wooden seat. ‘Is that what the carving reminds you of?’

‘Isn’t that what it’s meant to be?’ he asked somewhat incredulously, an incredulity that was mutual in that moment (after all, why would I have a gas mask on the wall?). There was only one way to solve this puzzle.

‘Can I come and sit next to you?’ I asked on impulse, wanting to see what he was seeing. He readily agreed and I moved to sit at his side and looked directly at the carving. The winter sun was at such an angle that from Jack’s position the intricacies of the tree, its trunk and branches, were in shadow and unclear. The three holes gaped dark and starkly within the seat. I could see clearly the two round eyes of the goggles above the larger mouthpiece where the canister of charcoal would have been. Though obvious now, it would never have occurred to me to see a gas mask unprompted. It was now hard not to see it.

Jack gently reached across and patted my hand, ‘Before your time, young man,’ he chuckled.

‘Only just,’ I protested. ‘But it’s a very big “just” isn’t it? Your wartime childhood must have been very different from mine.’

‘I’ll tell you about it. You probably need to know,’ said Jack.

I couldn’t tell if he meant for my own benefit as a comparatively lucky post-war baby or for my professional knowledge in order to help him. Either way, I looked forward to hearing of his experiences, including what it must have been like in those threatening times to have gas masks hanging ready under the stairs. However, I realize now, I never did discover why he thought I might decorate my wall with a gas mask, carving or not.

As it happened, the mask theme continued when I was working with Deborah, a young and successful actor now training as a psychotherapist who came to therapy as part of her training. She was not, like some students I’ve worked with, simply clocking up the required hours. She was a dedicated client, keen to explore and examine her life, eager to bring into practice the theoretical concepts she was learning about and apply them to herself. In the session just after Jack’s, it was she who introduced Winnicott’s idea of the ‘True’ and ‘False’ self as it made a lot of sense to her in relation to her acting career. She felt her success on the stage was due to her effortless ability to present a false persona so convincingly. When acting a part, she was that person. She ‘lost’ herself in the character of another. It was a very creative way to employ a false self.

I appreciated her application of the theory and I admired her willingness to analyse herself in this way but I felt she was missing something by applying the concept solely to her career. I suggested this was perhaps not a phenomenon restricted to the stage. More challengingly, I told her that I sometimes felt she was not there, that the persona I saw – albeit a delightful, laughing and bubbly young woman – was hiding her real self away, protecting her, keeping her safe. I clearly touched upon something true for her as her eyes filled and tears rolled down her cheeks.

‘You’re right, I don’t feel real when I’m off the stage. In fact, I sometimes feel more real when I’m acting a part,’ she sobbed. ‘I sometimes feel I can’t take it off.’

‘Take it off?’ I enquired.

‘The mask,’ she answered. ‘It’s like your laughing mask is welded to my face.’

Sensitized by Jack’s gas mask, I immediately knew she meant the carving. Indeed, this time I didn’t need to look to know what Deborah meant by the ‘laughing mask’. Those three holes – the wide, circular eyes and the gaping mouth – were clearly the apertures of a dramatic mask, a face of fixed hilarity, a mask to hide the tears. I suggested she turn and face the carving directly and to see what came to her mind.

As she did so, she said unprompted, ‘Hello sunshine’ and burst into tears again.

I waited. Eventually she glanced across at me. ‘It’s what my dad called me … still calls me …’

‘Sunshine,’ I repeated.

‘… but it’s not real … I can’t be his sunshine all the time.’ She sobbed again. ‘I shouldn’t have to do that to be special.’

She faced the mask again and stared at it in silence for quite some time.

‘Is there something else you want to say?’ I asked eventually.

‘Thank you,’ she said unexpectedly.

‘Thank you for …?’ I prompted.

‘Thank you for getting me through as best you could.’ She sighed as she addressed the mask. ‘I gained a lot through you. I lost a lot too. Maybe I need to find what I gave up on all those years ago. Maybe then I can be more real.’

For many of my clients the carving seemed to have no impact and figured not at all in our work together (at least consciously). For others it became a focal point for a while and for some a reference point to be returned to every now and again. I was amazed at the variety and ingenuity of human perception and interpretation. It reminded me of a truism from the Talmud that says, ‘We do not see things as they are. We see things as we are’.

For Serena the holes were circular windows screened by the branches of a shrub: the garden den in which she hid, frightened and alone, to avoid the savage fights between her parents indoors, terrified of what she might find on her return. For Alice, the intricate, interlocking branches reminded her of the lace her grandmother would crochet as she sat by the fire and told fascinating stories of the past, while for Jon the carving more concretely evoked memories of his father and the smell of saw-dust and wood shavings, a sweaty masculinity that entered the house in the evenings on his father’s return and which he realized had been his saving grace within the cloyingly feminine environment of his mother and five sisters.

The most recent, and most unusual perceptions of the carving have come from one of my younger clients, Brian, a wiry, bespectacled 18-year-old with strabismus in his left eye which he says doesn’t bother him (his glasses correct the tendency of his eye to turn outwards) but which sometimes makes him look as if he’s daydreaming. Though now clean for a year, Brian regularly smoked skunk from an early age and, according to the referring psychiatrist, may be severely damaged by his frequent and continuous use of the drug. Suffering from episodes of paranoia and confusion, Brian fears so too. But most of the time, and always with me, he’s a presentable, intelligent and likeable young man indistinguishable from many a late-teenager struggling with the demands of growing up, finding a career, a girlfriend and a meaning to life. And these have been the recurring themes of our work together over the past few months though more in the realms of discussion than action. The problem is that what he calls his ‘bonkers episodes’ interfere with each of these, at least, his fear of the occurrence of these episodes does. He’s reluctant to commit to anything that might expose him as ‘bonkers’ despite the fact that the episodes occur infrequently. Unfortunately, this means he isolates himself in his bedroom at home, watching daytime TV, surfing the Internet, or sleeping a great deal and avoiding taking action in any of the areas in which he would otherwise be more actively engaged. He hasn’t yet applied to university to follow his former enthusiasm for the Arts in general, and Modern English Literature in particular. Likewise, his reticence to socialize prevents the possibility of meeting any young people for friendships let alone deeper relationships. He makes do with fantasies of female pop stars and Internet ‘chats’ with young women. He claims to meet hundreds of girlfriends on Facebook but I challenge his use of the words ‘meet’ and ‘girlfriends’ when all he’s doing is looking at photographs (sometimes not even that) and typing words into the ether. He doesn’t like me to confront his fantasy life but I sometimes point out that in some ways it’s just as out of touch with reality as his so-called ‘bonkers episodes’. Not surprisingly, finding meaning in life from the confines of his bedroom, cut off from others (even his parents seem to leave him to himself in the belief he’s going to ‘snap out of it’ spontaneously) and with nothing to excite or engage him is almost a non-starter. He has, however, following a visit from the local vicar at his parents’ request, started to believe in a god – unfortunately, an Old Testament one who is watching in judgment and about to administer some dreadful punishment at any moment. This doesn’t help his paranoid thinking at all so I challenge his belief quite strongly: it’s always struck me as odd that approaches to psychotherapy that specifically encourage the confrontation of irrational beliefs ignore the most glaring of them all. I’ve suggested we call his god ‘Yahweh’ just to put him in some sort of context, namely the superstitious belief of a primitive tribe a few thousand years ago in a Middle Eastern desert.

Never having witnessed Brian in the grip of a ‘bonkers episode’, I’ve yet to be fully convinced of the psychiatrist’s diagnosis of ‘cannabis psychosis’. I can see that he is generally unmotivated, and at times extremely apathetic (like most teenagers) but the attendant criteria of memory loss, auditory and visual illusions or hallucinations are not present (or reported on). The one thing he does report is his occasional paranoid thinking that god or others are watching him though, again, this has not occurred in our sessions. Brian only reports on his paranoia outside the sessions, and even then I’m not convinced he really believes in thunderbolts from heaven except by way of a metaphorical punishment: ‘Surely something bad will happen if I stay in bed all morning’. Even his belief that others may think he’s rather strange and, therefore, want to persecute him seems to me to have become a cultivated avoidance-technique for isolating himself, almost certainly not psychotic. Basically, I think the calming, slightly euphoric effect of dope held off an underlying depression for years and, without it, he’s experiencing the reality of his unhappiness.

But, a few sessions ago, I started to question my more benign diagnosis. Brian began expressing some strange thoughts, out of the blue, totally unconnected to any topic we had been discussing. It was almost as if a switch had been thrown in his brain. On one such occasion we were exploring ways in which he might safely stru...

Table of contents

• Cover Page
• Title
• Copyright
• Contents
• Acknowledgements
• Introduction
• The stories:
• Unwrapping through discussion
• References