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Many years ago, I worked regularly with extremely physically and intellectually disabled patients, most of whom simply could not travel to my consulting room by
themselves and thus had to be accompanied by nursing assistants or by professional carers. Likewise, I treated numerous forensic patients, including many convicted felons, all of whom would be transported to my office by social workers or by probation officers. In each of these instances, the escorts would always remain tucked away in the waiting room while the patient and I would meet in my consulting room for our regular 50-minute sessions.
By contrast, distressed couples undergoing marital psychotherapy will never arrive at the office with nursing assistants or social workers. Indeed, both partners in a couple relationship will generally enter the office simultaneously and will embark upon treatment together.
Thus, when I discovered that the patient ‘Becky’—a seemingly competent and physically capable adult—would require her husband ‘Ike’ to accompany her to the psychotherapist's office and to seat himself in the waiting room, I found this an extremely unusual episode. Ike did, on at least one occasion, join Becky for a session, as readers will know, but, for the most part, he remained outside of the office. Thus, one must wonder whether Becky and Ike engaged in this unique style of arrival as a secret, unconscious wish to immerse themselves in proper couple psychoanalysis, or whether both partners actually knew that Becky suffered more extensively from psychotic or borderline illness and that, rather like a disabled patient or a convicted forensic patient, she really did require a nursing husband who would care for her in this unusual fashion.
Having now absorbed this well-written clinical commentary at least 10 times, endeavouring to comprehend this rich and complex material as well as possible, I have developed the hypothesis that, in spite of Becky's seemingly sturdy capacities as a woman who managed