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I shall have very little to say about how I would have conducted this session if I had been the therapist. Any particular session is a joint creation of the therapeutic couple. This particular session is the product of a joint working and shared understanding developed over two and a halt years - as ‘outsiders’ to the therapy, we are excluded from that shared perspective as much as we are from the intimate events of someone else's marriage. What we can do in an exercise like this, without being too presumptuous, is to expose the process of our own thinking and to share with others the working concepts which we use in therapy.
I will start with the background data in order to show how the various details of the ‘text’ mobilise thoughts and impressions in the therapist's mind, how these begin to come together and make a ‘story’ about the patient, and how when this occurs we feel we are beginning to understand the patient. I shall italicise fragments of the therapist's ‘text’. My own associations will follow in normal typescript.
Man of 40 … member of religious community … practising homosexual since childhood.
Thoughts about monks … retreating from life … searching for something … trying to find or serve God … God the Father perhaps.
Public toilets … cottaging… I think of other patients who have indulged in this activity. One was a priest, another a successful professional man. What were those patients looking for? - The sight or touch of another man's penis. In each case the patient felt his life depended on it. With one patient it seemed to be an attempt to cope with gaps in early mothering. Uncertainty with the (un)structure of therapy … That says something to me, I don't quite know what … fear of unstructure, loss of control, falling apart?
Increasing frequency of sessions over 2′/, years … The patient is hooked in some way … keeps wanting more.