During the decade when I treated patients in psychoanalysis, from 1994 to 2004, I sat behind the couch, notebook in hand, attempting to write down every word my patients and I said, the dialogue annotated with stage directions — coughs, tone changes and of course tears — and reports of my inner weather: fantasies, fatigue, confusion and, on occasion, a heart-pounding interpretation. These notes, taken at first for purposes of supervision and later as a way of imprinting the material in my mind, filled 47 spiral-bound books.
At the time, I was also, as I still am today, a fiction writer. The two pursuits felt like a happy marriage: My work as a therapist was enriched by the understanding I’d gained as a writer of how narratives unfold and how language congeals or reveals emotion; my work as a writer was enlarged by the appreciation I had as a therapist of the dimensions of the psyche and the paradoxes of human behavior.
Why, then, as a writer have I never used so much as a phrase from any of those thousands of notebook pages in any of the academic papers, essays, stories or novels I’ve published?
There is no doubt that it would have been professionally acceptable to do so. Case histories, beginning with Freud’s, have been central to the development of many schools of therapy, and clinicians have thoughtfully discussed ethical means for writing about patients, primarily by disguises of identifying information and requests for patient consent.
The answer is, at heart, personal, linked to what is for me a central analogy of the therapeutic encounter as a sacred space. No manual exists for fashioning sacred space, but for me, it requires abstinence: modest, unobtrusive dress; an office both timeless and gentle on the senses, free from clutter or a strong autobiographical stamp. Under these conditions, I could follow my patients into their inner worlds, through the stories they told, their transferences (the repetition with a therapist of thoughts and feelings experienced with the important adults of early childhood) and my countertransferences (the therapist’s response to the patient’s transference).