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Fisher, J.V. (2009). The Macbeths in the Consulting Room. Fort Da, 15(2):33-55.

(2009). Fort Da, 15(2):33-55

The Macbeths in the Consulting Room

James V. Fisher, Ph.D.


In this paper I want to explore some ideas about couple relationships and therapy with couples. Although I will be describing dynamics that are largely familiar, I have found them difficult to work with effectively without a clear conceptual framework. In order to help clarify the nature and structure of these dynamics, I want to introduce new terms into our psychoanalytic vocabulary. These ideas derive from three sources. One source is Wilfred Bion's early clinical thinking that draws on his analysis of psychotic patients in the 1950s. These ideas constitute an important extension and development of Freud's discussion of the reality principle. The second source, perhaps surprisingly, is Shakespeare's tragedy Macbeth, a play in which we are presented with a remarkably astute picture of a psychotic state of mind, which I am describing as the “proleptic imagination.” The third source is my experience working with couples, which is an important source for exploring psychoanalytic theory — especially, perhaps not surprisingly, Bion's theory about the origin and nature of psychotic states of mind.

Consider the following scene from a session last week. I heard the outside door exactly at 7:10, the time the session was due to begin. However, when I went to the waiting room, only Mrs. A was there. She had talked with Mr. A half an hour before and he said he might be late, she thought perhaps ten to fifteen minutes late. I said we would wait for him and went back to my room, leaving her in the waiting room. After half an hour I heard her on her mobile phone and went to check, finding her very distressed and saying he would be another eight minutes. He finally arrived 40 minutes late. I told them we could carry on for an additional ten minutes, giving us half an hour.

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