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English
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Published:
2012-03-20
Completed:
2012-08-27
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24/24
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In Confidence

Chapter 3: Therapy Session No. 1

Summary:

Confidential.
For training purposes only.
Do not circulate.
Date: 29.5.2002 11a.m.
Psychologist: Dr Carola Rivas, PhD
Patient: S.H., 25yo White male, cocaine and heroin user, mood disorder NOS.
Session No. 1.

Notes:

(See the end of the chapter for notes.)

Chapter Text

CR:      Good morning.

SH:      ….

CR:      ….

SH:      Are we just going to sit here? Aren’t you going to ask me more questions?

CR:      This is your time. We can use it however you want. Do you want me to ask you more questions?

SH:      No. I’m not going to tell you anything, anyway.

CR:      Yes, I knew that already.

SH:      You did not.

CR:      …..

SH:      Oh, I get it. You’re going to wait in silence until I talk.

CR:      It could be like that, yes.

SH:      But not if I don’t want it to be, right? That’s how it works?

CR:      You have been in therapy before, Mr Holmes.

SH:      Not since I was 15, thank you very much. I’d like to think that the technique has improved in the last ten years, but obviously, it hasn’t. Still harping on about what the patient wants, what the patient feels, when you overlook the most important fact of all!

CR:      Which is?

SH:      I don’t want to be here. I’m not like your other patients.

CR:      What do you think our other patients are like?

SH:      Which ones? Because I can tell you about the ones in my group this morning. Did you know that they actually sent me to a Social Skills group? Of course they don’t call it that, they call it something else, like “Conversation”, to not offend us, but I know that’s what it really was. Why does everyone think that I have no social skills? Just because I don’t use them doesn’t mean that I don’t have them. They put me in there with, oh, let’s see, where to begin. The man in the corner who rocked during the entire session and wouldn’t look anyone in the eye? Schizophrenic. Good luck teaching him skills. And then there was the woman who kept leaning forward so that the men across from her could look down her shirt. Borderline, I’d guess. And—

CR:      What about you?

SH:      What about me?

CR:      We’re not here to talk about them. We’re here to talk about you.

SH:      I thought you said that this was my session. That I could talk about anything I wanted to.

CR:      …..

SH:      Fine. Let’s talk about me, shall we? Shall we talk about the fact that I don’t want to be here? How’s that for a promising beginning? ‘Involuntary patient in mental asylum.’ As if there could ever be a voluntary patient, with the food that you serve here. And don’t let me get started on the bedding. When did you last buy sheets, during the Cold War? I’ve counted three new ingrown hairs on my hamstrings, since I arrived here.

CR:      I thought you didn’t eat.

SH:      I don’t sleep, either, but that doesn’t stop me from observing. Oh, and by the way—I brought you something.

CR:      Yes?

SH:      A gift, in your parlance. Isn’t that supposed to be significant, for you psychoanalysts? The patient is bringing you a gift.

CR:      What is this?

SH:      Your intake form.

CR:      Mine?

SH:      I did one on you.

CR:      …..

SH:      …..

CR:      …...

SH:      What do you think?

CR:      What do you want me to say?

SH:      Was it right? Did I miss anything?

CR:      Is that important for you? To be right?

SH:      Oh, very clever. I see where you’re going with this. The line between your eyes gives you away. You’re annoyed with me. You’re trying to pretend you’re not, trying to put on that sympathetic-therapist face, but I can see the tension in the line of your jaw. You want me to admit that it’s important for me to be right.

CR:      You act as if I have an agenda.

SH:      You do. You want me to quit. You want to save me.

CR:      Do I?

SH:      Didn’t you read the report that I gave you? The part where it said that you entered the profession because of an alcoholic father and a depressed mother? You weren’t able to save them, either, so you chose a career where you thought you’d be able to save others. Too bad you are working with people who don’t want to be saved. Must do wonders for your self-esteem. Next time, I’d reconsider. Instead of working with addicts—all too prone to relapse, you know, plus they have the terrible tendency to talk the ears off of anyone who wants to listen—you might put your services where they are wanted. Agoraphobia. Sexual dysfunction. Obsessive-compulsive disorder. Insomnia. Treat the ones who want to get better, doctor, and you might be thanked, one day. That’s what you’re waiting for, aren’t you? To be thanked? To save someone? Is that your phantasy? That I’ll come in and say, ‘Today I want to stop being an addict?’ Because that won’t happen. And do you know why? Because you have to be an addict in the first place to stop being an addict. I am not an addict, therefore, I cannot stop being an addict. Simple logic.

CR:      Nothing is simple, Mr Holmes.

SH:      Yes, thank you for stating the obvious, Dr Freud. Tell me, are you a Freudian? Envious of my penis? Or Lacanian? As a narcissist, I like the idea of a mirror stage. Or do you prefer Melanie Klein? I always thought that, if I were in analysis, I’d prefer a Kleinian analyst. All of that aggression to deal with. Good breast, bad breast, the mouth that bites the breast that feeds it. Peachy. Aggression is so much interesting than sexuality, wouldn’t you agree? Then again, thwarted desire can lead to aggression. Which reminds me, as I’ve said to your superiors, and it is worth repeating here, for all I know, the murder that I could have prevented has already been committed, and here I am, WORTHLESS, absolutely worthless. My brain is going to wither and rot in this place. How long did you say until I can leave? Twenty-eight days? Who decided to use a lunar calendar?

CR:      I am surprised to hear you call yourself a narcissist.

SH:      Really, doctor? You can’t tell just from looking at me?

CR:      Narcissists usually like to talk about themselves. You don’t.

SH:      Boring. I already know about myself. It’s much more interesting to talk about you. Or about the murder that isn’t being solved, as we sit here discussing trivialities. Do you really want to have blood on your hands? Because that’s what is going to happen here. A man is going to murder his lover so that his lover doesn’t tell his wife—his male lover, I might add, which certainly puts an interesting twist to things—the tragedy of the married man who loves other men. So twentieth century. Why do you think he married that woman? No, I have a better question for you. Why do you think he is going to murder his own lover? There’s the Freudian bit. Is it because his lover is going to out him? Oh, stupid. Stupid. I didn’t tell you about it yet, did I? That was a different doctor, yes? Or did I mention it in the Drama group? They don’t have any musical instruments in the Drama and Music group. Mycroft said he’d bring my violin but he hasn’t come by yet. Do you know when he’s coming? If you talk to him before I do, can you ask him to bring the Cremona? I wouldn’t want to leave the Strad lying around here.

CR:      All phone calls have to go through the director’s office.

SH:      I am not going to call Mycroft. I want you to talk to him. I know he’ll call you to ask you about me. You can tell him then.

CR:      I don’t discuss my patients with people who aren’t staff here.

SH:      Ha! That’s a lie.

CR:      …

SH:      …

CR:      I don’t.

SH:      It doesn’t matter. He’ll find a way to talk to you. And when he does, ask him to bring the Cremona.

CR:      …

SH:      …

CR:      …

SH:      Oh, don’t be so predictable. Now you’re doing that therapist trick again. Staring at me, expecting me to reveal some early childhood trauma that you’ll tear apart with your superb analytical skills.

CR:      …

SH:      Tell me. I know you want to tell me something.

CR:      …

SH:      …

CR:      You are the second son in a family of brilliant people. Your older brother took after your father, going into public service, and you took after your mother, a musician. Your mother died when you were young, in essence abandoning you to your father and brother, who were always a pair, united in their similarity. You stood out. You weren’t like them. More sensitive. Easier to hurt, I’d say. And then, let’s see.

SH:      Go on.

CR:       Your father felt guilty for your mother’s death—in an automobile accident where he was driving.

SH:      Of course he felt guilty. He was drinking. He was responsible.

CR:      And you blamed him for her death.

SH:      I blamed him because he was responsible.

CR:      You were a reminder of your mother, and your father sent you away to school. In a foreign country, no less, where you didn’t even speak the language. You learned quickly, perhaps too quickly. Learned the naughty words first. Learned to defend yourself in any language. But there were wounds that words couldn’t prevent. Am I right? And then, coming home on holiday, you began to smoke cigarettes. To make him angry. Let me guess—was he an athlete? Did another relative have lung cancer? Or was it your resemblance to him that he hated, the fact that you were also looking to chemicals for solace?

SH:      A tennis player. He hated to see me light up. You can walk off a hangover. Lung cancer is more insidious.

CR:      Both of you had lost her. She must have been quite the woman. Your mother, his wife. And you couldn’t console each other. So you’d come home on holiday smelling of cigarettes. You were twelve, thirteen years old. What did your father do about it?

SH:      Made Mycroft steal my cigarettes and throw them in the pond. The first of many times.

CR:      So, your father set your brother up against you. And now your father is dead.

SH:      Obviously.

CR:      Did I get anything wrong?

SH:      Are you mocking me?

CR:      Not at all. But I’m afraid that time is almost up.

SR:      What?

CR:      I’m sorry, our time is up for today.

SH:      You can’t be serious.

CR:      Next time we can discuss your father in more depth. You’ll have some time to process things.

SH:      I don’t need time to process anything. There’s nothing to process.

CR:      Thanks for coming today.

SH:      It’s not like I had a choice, did I?

CR:      There’s always a choice.

SH:      What is that supposed to mean?

CR:      We’ll discuss it next time.

 

 

 

 

Notes:

Thanks to Roane for reading along as I wrote this and giving me feedback and encouragement. If you like psychology and Sherlock, you should check out what she is doing with psychoanalytic defense mechanisms in her fic "Displacement" and its sequels.