You do not currently have permission to view the full text for this document. Please sign in to an account with an active subscription or contact support.
The woman and I are meeting for the first time to discuss whether or not she might like to pursue psychotherapy with me. She is a woman in her forties, with three teenage children and two insane men, her ex-husband and her live-in boyfriend. As the men have become more and more insane, and her concerns about her children have grown accordingly, she has begun to wonder if she, too, is insane. She is having episodes of blind rage in which she smashes things in the house. She thinks she might want to take poison. She is afraid she might need to kill her boyfriend to prevent being killed by him.
“Holy cow,” I say to myself. “Do I need this?”
She has been referred, as so many of my patients are, by a friend, or a friend of a friend's friend. So she knows very little about me, about how I work, except that I am rumored to be a good therapist. Toward the end of this first hour, then, I give her the opportunity to get to know me a little better before we begin. “In order to help you decide whether you want to work with me,” I say mildly, “is there anything you need to know about me?”
She fixes me with a glassy stare and says, “What kind of therapist are you?”
“Well. I'm not sure what you want to know, but in terms of clinical practice, I describe myself as a psychoanalytic psychotherapist.”
She leans forward. “Psychoanalytic? You're not a Freudian, are you?”
Before I tell you what I said, I will describe the chasm of anxiety that opens up at my feet when I hear these words. As Dr. Lionells' paper describes, contemporary patients who are referred for psychoanalysis