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As soon as I began to read this very moving clinical session, a book entitled The Diving-Bell and the Butterfly by Jean-Dominique Bauby (1997) came to my mind. The author of this book, who was editor-in-chief of French Elle magazine and the father of two children, suffered from locked-in syndrome, that is he became completely paralysed and speechless, following a massive stroke. Bauby dictated the entire book by blinking with his left eyelid, letter by letter, using an alphabet in which each letter is placed according to the frequency of its use in the French language – his only means of communication. Having myself undertaken a very small amount of clinical work with patients who do not speak and have severe physical disabilities with extremely limited means of communication (on my part,
mainly assessment and observation work, not long-term therapy like the therapist in this session), The Diving-Bell and the Butterfly is a salutary reminder of the high levels of cognitive and emotional intelligence that can be present in the mind, even when the body is virtually out of action. The therapist shows in the session a remarkable capacity to use her countertransference and perhaps also at times her imagination as a convincing means of being in touch with a patient so severely disabled that almost all normal means of communication are profoundly impaired.
She begins with a description of Corrie and we are immediately aware of the daunting task of trying to make and to sustain a therapeutic link with a patient with such limited means of expression. However, the therapist introduces us to a heart-lifting aspect of Corrie; his big smiles and his evident wish to communicate despite all the difficulties.
I was also very impressed by the therapist's description of the setting, which in itself relies upon her focussed and dedicated attention to her patient. She writes: ‘When the door is shut, and we settle into the silence, very small sounds can be heard and very small details n