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Kober, C. (1987). Shifting the pavement: Thoughts from the patient's side of the couch. Free Associations, 1(10):94-101.

(1987). Free Associations, 1(10):94-101

Shifting the pavement: Thoughts from the patient's side of the couch

Catherine Kober

Most papers in the field of psychotherapy are written from the therapist's point of view. This article presents the other point of view. Though I am a therapist, I am also a patient, writing now from my perspective on the other side of the couch. Writing is painful. I am tempted to edit out the flaws in my thinking, the lesions in mental substructure on which thoughts might cohere. Yet the difficulty in linking thoughts is central to my experience and understanding as patient.

I am trying to write about a mutative moment in one of my sessions with Abe, my therapist. But as I write, any single thought or idea multiplies and splinters whenever my attention approaches it. This problem is compounded by the fact that my theme, a moment of transformation, is itself a moving target. Attempting to conceptualize it utilizing my troubled thought processes is like trying to catch a protean fish in a disintegrating net, or shooting at a bird with an arrow that explodes midair. Clinicians reading this paper may find it as much a study of the attempt of schizoid thoughts to relate to one another as a discussion of a shift in psychic structure. These difficulties in the cohesion of my thoughts have been immutable for years, enduring through several therapies. But now, with my present therapist, something may be changing.

Abe is the third therapist I have seen as an adult. When I began therapy with him I felt that nothing I did was right, although I hoped that by seeing him I was making ‘the right decision’. It was so hard to know. Making decisions was torture for me and I had so often made bad ones. I was dominated by a judgement I could not trust. My faulty judgement seemed to have replaced common sense or the capacity for discrimination.

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