"How will it feel?" Seeing into the consulting room

A review of Couch Fiction; a graphic tale of psychotherapy. Story by Philippa Perry and art by Junko Graat. London, 2010, Palgrave MacMillan.

Do you wonder, perhaps worry, about what it might feel like to go to a psychotherapist? It’s often hard enough to make the call to ask for an appointment, and then getting through the therapist’s door can summon up all sorts of anxieties about how others may perceive you, about showing something that might be called weakness or self-indulgence, about whether this stranger, the therapist, will be shocked or disapproving about what you have to say. Or might they see your pain as something trivial?

Philippa Perry is a therapist who wants you to be able to imagine how sessions might feel – for you and for the therapist. She tells the story of one therapeutic relationship between “James Clarkson Smith” (client) and “Patricia Phillips” (therapist). The story is a fiction, but is based on real events. (She asked her clients’ permission to use some material and it is heavily disguised.) We begin at the beginning, in the therapist’s office, laid out for us to see through the graphic art of Junk Graat. (Patricia seems to be in a nice neighbourhood, but her office has none of the glamorous fittings seen on television’s In Treatment or the Soprano’s.) The layers of pictures, thought bubbles and, at the bottom of the page, Patricia’s reflections on the work, and theories, mimic the many layers of thinking, feeling and reacting that are the essence of a therapeutic relationship. Because therapy works best if therapist and client can form an alliance to see and understand what seems to be going wrong in the client’s life; the tipping point that brought him or her to the therapist in the first place.

It is a delightful, sometimes amusing, sometimes quite moving tale and rings true to some of my own experiences. Not surprisingly I take comfort in Pat’s comment that the idea in real practice is for the therapist “not to be perfect. The idea is to remain authentic [which means being human, which means sometimes getting it wrong] while striving for the unknowable truth.” She and James work through a year in which very difficult feelings are expressed, occasional tensions make the work difficult, and moments of breakthrough understanding which make it possible for James to leave with a life, and relationships, in better control. He came because, although successful and wealthy, he had impulses to shoplift. When he left, he knew what those impulses meant and how to avoid the triggers that led him to act upon them. So, he was perhaps not cured, but rather aware and therefore in control.