July 1998

Betrayal and love. Right from the beginning, the end was painted as a tidy thing. Impasto, bold, and bright; a bounding down the stairs, a shake of hands, a smile and then a wave in the street, warm with the inner glow of a physician's gift of love, ready to move through life, toughened up against the blows of work, and relationships. An easing of pain, some insight and strength, change. That was my goal. But the way towards it was never as clear.

How to move from despair to hope, from depression to joy, from child to woman and then with a skip and a jump, pass through the door, out onto the street to disappear. I read of a woman who had become so attached to her therapist that for months after she had left his care, she found herself wanting to see him, wanting to let him know of what was happening in her life, wanting to talk to him.  Some years later, she met him again at a party. She wondered what she had seen in the old conservative looking man that now stood in front of her.

Betrayal is the most unbearable part of therapeutic attachment. The betrayal of an existing lover through a moving towards another soul. If a therapeutic relationship is, as You have said, like 'a love affair without the sex', then it has been an even greater betrayal of real love. If a therapeutic relationship encourages a therapeutic affair, it underestimates the desire of the patient for truth. The danger does not lie so much in a sexual acting out, as in the destruction of a real and existing love in the patient's life that relies as heavily upon emotional fidelity as physical. Not all of us can have affairs. Some of us demand something higher of ourselves; demand some purity of emotion, some clarity of loyalty, some fidelity in spiritual love.

The betrayal of a real lover, by the substitution of a therapeutic one, is unbearable; even if the substitution is a parental 'filling in' of emotional or developmental gaps. As a child/woman, I have a need. Instinctively I imagine and know that somehow that need will be gratified, will be fulfilled. But the shape and form of the reality which comes to meet that need, has not always fit the need, nor has it always fit my imaginings. Reality bites and bites hard. The lesson has been in learning to bite back, biting the heart that has tried to feed me.

I cannot change my need, and I cannot change the form of the reality that has come to meet it; perhaps it is in my imagining that I am failing to see the truth. Perhaps it is only through imagination that reality will fit, but what kind of truth is there in an imagined reality? How much sadness and pathos is there in the creation of other worlds, how much escaping of truth instead of discovery of self? Perhaps, like a good painting, if looked at too closely you see only brush strokes of paint; perhaps it will make more sense from a distance.

Then, what of You. The opaque therapist, the one who is hidden. The one who believes it is so important not to have too much of himself in the room, nor to show too much of himself as a person. So what do I know of you - have you really remained so hidden? I know you as a self psychologist, in the style of Heinz Kohut. You were a GP.

You live in a large pink house, which you proudly painted in original heritage pink hues, before any of the other gentry got the idea that it looked better than white. You rent an attic room from one Friday morning each week for private practice in the art of dynamic psychotherapy. You have a house full of women who have you wrapped around their little fingers.

You are married, with daughters, one wants to be an opera singer - who sings when she's happy and sings when she's sad - music may be what saves us - one who is in London, and deciding whether to follow a medical career, one who has been a vegetarian since she was five - she has changed the way you eat as a family. You are not a vegetarian. 

You climbed Everest to Advanced Base Camp and experienced fear and something spiritual. Your boss you love at some level. He trained you and you walked on Everest together. You bushwalk, swim, go to the gym, have taken up aikido: you like the philosophy; you have taken up surfing again. You went white water rafting soon after having cancer.

You go to the movies a lot - and they affect you. Your father died when you were thirteen and you hated him. After he died, you were afraid that he would come after you. Your mother died after much suffering last year. You are tired of your work, but are a workaholic. If cancer had been found in your foot, you would probably have kept on working. You had cancer of the thyroid, and had your thyroid removed. It hurt. Even your wife said you complained too much about the pain. You have a scar. You take medication each day to stay alive. You feel the cold. You were ashamed of your sickness, yet can't recognise shame in others.

You have many secrets. You were betrayed by your specialist, yet still see him. Reading a little between the lines, you are an optimist, gregarious, you love laughter and joy. You love young people, you have followed a few nice arses up the stairs to your room, and you enjoy female company. Some people think you're gay. You don't think you are. You are vain. You once grew a beard to appear older. You are arrogant and hate being wrong. You believe in what you do. You like to talk, sometimes to mask anxiety, sometimes just to talk. 

You use lists, one liners and all encompassing reductionist words. You have a great capacity for empathy. You blush easily. You smile easily. Joy is natural in you. You like photography. You believe in the brain. You can be overwhelmed with rage. When someone strikes you on the knee you choke with rage. You are often angry. You growl at your children if you haven't exercised. You like the colour purple. Your clothes are your uniform - blue, with straight lines and contrasting ties, sensible black shoes. You have uncontrollable red grey hair, blue eyes and an easy smile.

You have many expressions. You speak out loud to yourself, and never finish sentences. You are comfortable behind a desk. Especially with a pen in your hand. You are highly intelligent and have a great depth of knowledge of medication and its effects, of disorders of the brain and of suicide. You enjoy teaching and are often surprised at how much the registrars already know. You drive a clean Subaru. You watch the X Files. You have a study much different from your desk. It is busy, with books and wood. You would like me to see it sometime.

You do not give advice, but show you disagree by opening and closing your mouth like a fish out of water. You have changed. You have great hope for me. You read Adam Phillips. You love Winnicott. You think Freud was a genius even if he was wrong. You read authoritative sites on the Internet. You have never been to England. You think you are conservative but not in everything.

You have never had therapy. You would like to believe in God, but don't. You believe that all parents let their children down. That falling in love with patients is an occupational hazard. That touch is a boundary violation. You have been intimate with six other people in your life, including me. You have bared your soul.

This is who has been revealed to me, some by calculated degree, most in moments of connection and love. These are only some of the many facts that I have noted about a person who claims to have hidden from me. I have more. I am not here to judge if what I have been told is true. I trust that it is.

But what does that mean for transference? Who are you to me? The room may once have been filled with many shadows; they were all there in the half-light, all in various stages of undress, as I confronted past events and their connection to my present. But now they are mostly gone, what remains? Still the shadowy figures of men and one real yet partially hidden one who has let me down.

In my search for peace, my body and soul have become fragmented - laid down in various hands in medical files and folders around the world.  A medical history is a poor, disjointed, fragmented record of a life.


This page was last updated on: June 6, 2011


Registrars in Australian hospitals are new medical graduates, still under instruction from senior lecturers in teaching hospitals, but practicing - I think you may call them interns.
"In our sessions, he often made reference to the deliberately sparse nature of his own working environment - his desk in particular -there was nothing personal on it, or surrounding it - no indication of his own life.

He would often say that he deliberately kept his office devoid of himself - but then described his study at home as being rich with books, a room lined with old wood timbers, making himself interesting, hinting at some deeper passionate "other".

He would then say that he would like me to see his study - some time. He was very good at talking about himself during my sessions!!! "