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As Dr. Tillman has reported, she initiated the process of psychotherapy consultation. Her words about this are interesting, and reflect, I suspect, the gap between her inner experience and her actions with her patient. She describes the treatment situation as “nearly intolerable” for her, but with her patient, she “propose(s) (an) idea.” The affect and the action do not match. If consultation works, it works first of all for the person requesting it (and so Mr. B would not necessarily return from it “a changed man”), and it works toward both the therapist's greater ability to contain experience formerly considered intolerable as well as her greater ability to get it into the work.
Mr. B's initial rejection of the proposal for consultation, as well as his regular attendance at sessions, suggested to me that the evolving transference-countertransference relationship might well be in a direction necessary to the patient's growth, therefore progressive, even if deadly and deeply inarticulate. I think hereof Nina Coltart's (1986) brilliant reflections on Yeats's poem: “And what rough beast, its hour come round at last, Slouches toward Bethlehem to be born?” (p. 186) “Some people have seen this as pessimistic,” she says, adding in a tone so collected and willfully independent as to seem almost regal, “you will gather that I have seen it differently” (p. 186). She continues:
However much we gain confidence, refine our technique, decide more creatively when and how and what to interpret, each hour with each patient is also in its way an act of faith; faith in ourselves, in the process, and faith in the secret, unknown, unthinkable things in our patients which, in the space which is the analysis, are slouching towards the time when their hour comes round at last. (p. 187)
Mr. B's silence and self-described shiftiness constituted a new depth of