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Child analysts and psychotherapists, more than their adult counterparts, are very familiar with the myriad psychic meanings and functions of human excretions and of the toilet. As Ferro and Basile aptly observe in a discussion of how work with children differs from work with adult patients: ‘A child does not evacuate projective identifications or sophisticated beta elements: he actually shits!’ (Ferro and Basile, 2006: 494). Scattered throughout the literature we can find papers about analytic work with adults where mention is made of the patient’s use of the toilet but typically this is not the main focus of these papers (for example, Asseyer, 2002; Proner, 2005; Clark Nunes, 2006; Steiner, 2011).
Alongside the consulting room itself the toilet is an important part of the analytic setting. Clinically it is helpful to remain curious about how patients relate to and use the consulting room toilet, about why it may not be used and when it is used, how it is used and so on. Indeed, in the patient’s mind, this is often not the ‘consulting room toilet’; rather it is felt to be quite specifically, and very personally, the ‘analyst’s toilet’.
It can prove difficult to bring the patient’s use of the toilet into the analytic dialogue if the patient does not make direct reference to it. This is especially so when the use made of the toilet is split off. It is much easier to analyse what the patient is doing if they get off the couch mid-session to go to the toilet. It is harder to find a helpful, non-intrusive and non-arousing way to bring up with the patient, for example, the meaning of the mess left behind in the toilet once they have used it after the session has ended.1 In this latter scenario, if one subsequently brings this up, the potential for shaming or persecuting the patient always needs to be carefully considered.
The difficulty we may experience in bringing up the use of the toilet within the analytic dialogue most likely also reflects the fact that despite our own