What is a Therapeutic Response?

Abstract

A young woman has been coming to see me for a few weeks. She is in her twenties, good-looking, rather wan and shy. On the occasion that I am writing about she looked at me with her usual directness as I opened the door, gave me a quiet smile and came in. Then she said: “May I use your loo?” “Yes. Of course,” I replied. The hesitancy with which she asked the question prompted me to emphasize my answer: “Yes. Of course.” I felt I needed to convey to her: “You do not need to ask with such hesitancy. You are welcome to use the loo. I do not regard your request as unusual or disturbing in any way.” I could, when the session began, have made what is commonly called an interpretation. I could, for instance, have said: “I notice that during sessions, you are at pains not to be a nuisance to me. You never show any aggression, you speak little and quietly, you try to be ‘good’. May it be that in going to the loo just before the session you try to get rid of the messy, dirty, unacceptable bits of yourself in case they emerge in some form during the session” This would have been, I think, quite a legitimate response. It makes sense, provided that one can accept the resemblance between the excretion of physical waste products and the expression of feelings, thoughts and attitudes which may be unacceptable to another person: and it may, in this case, have been relevant. However, I made no comment. This was not a conscious decision on my part and I can only guess at my reasons for the silence on the matter.