A Day in the Life of a Therapist

James tells me he tried to hang himself when he was nine. He wrapped his school tie around a wooden post on his bunk-bed but it didn't work. “I couldn't even get that right,” he says with an unconvincing smile. He never told anyone.

I reflect on my own life, aged nine. If asked l may have been able to offer you a trite dictionary definition of depression but, truthfully, I doubt I would have known what it was. Sometimes lack of knowledge is a privilege.

He talks to me about running and cycling, the things that eventually replaced the self-harm of his teen years and helped channel his rage. Instead of cutting he would run. He would run until his muscles screamed and his pounding heart threatened to crack through his ribcage. And when he couldn't run anymore, he would cycle. Now, sitting before me, is a young man carved of stone. Physically and emotionally. But six months ago his older brother died and James discovered he couldn't outrun grief. Day to day James still needs to be controlled and detached, externally at least, but within the relative safety of my poorly lit therapy room, he can cry. He does today and his whole body shakes.

Today I will see six clients as part of an NHS counselling service: three, an hour for lunch, then another three, with a ten-minute “break” between each client. Moments ago l was discussing self-harm and suicide. Now it's 9:52 am and I'm thinking about a croissant.

I'm not sure the management of this client conveyer belt was ever discussed when I trained as a therapist. Clients were often relayed as nice, discrete therapeutic packages and one's daily client list can certainly appear as such on paper. But it's not uncommon for grief, despair, or whatever it is the client brings that day, to fill the consulting room like a dense fog. Often the air will clear as the next client walks through the door. Occasionally languid, wispy clouds envelop you, dispersing slowly as the next session proceeds.

An effective therapist, I've come to realise, is