Review by Adair Rispoli.
In the leading subtitle of In Therapy: How Conversations with Psychotherapists Really Work (Profile Books, 2016), Susie Orbach suggests to the curious reader that they will discover “how conversations with psychotherapists really work” should they decide to peruse the dainty book. The brevity of one-hundred-and-seven pages on psychotherapy conversations seem to belie the weighty subject. Nevertheless, one finds a partial clue of the succinct book in learning that it is dedicated to Orbach’s wife, Jeanette Winterson, a celebrated writer in her own right, whose curiosity evidently “always wanted to know what goes on in the consulting room” (dedication page). In pointing out these two facets, one can see the book has a niche goal: it is not to add to the arcane knowledge of psychology and psychiatry, nor is it to defy the patient-provider relationship to satisfy psycho-voyeurism, but rather, it is to provide a show of composite conversations that might plausibly occur in therapy rooms across the globe.
In the preface of Orbach’s In Therapy, one learns that Orbach’s radio mini-series of these conversations within the covers previously aired on BBC’s Radio 4 (in February and July 2016). The book’s format brings into the mix Orbach’s own illuminating professional perception of each situation brought to her consulting room that range from explaining why she must let Louis and Richard sustain a lover’s spat as she remains silent, to the monologue of queries she finds herself posing when John declares his love for Orbach. In short, readers repeatedly witness Orbach “use[s] the therapy relationship a bit like a laboratory” (xvii) to prove that “complexity and category making are the dialectical prerequisites of being human. We all struggle with the tension of between the two poles of questioning and certainty. Out of that tension comes enormous creativity” (39).
Astutely, Orbach omits to explain whether that sort of “creativity” carries a positive or negative connotations. The conversations’ subject matters range from the overachiever who does not know her true self, the failed relationship originating from infertility (which uncovers a host of other traumatic issues), a bickering couple expecting their first child, and lastly, the overly cliché patient that falls in love with their provider. Despite the glaring artificiality of these conversations, which Orbach acknowledges early on in this book, the intellectual kernels of her own craft follow a tidy pattern: presentation of the script between herself and patient(s), her own cognition of her role in this patient(s) conversation, and finally, proving the script’s worth by tantalizing us with snippets of her professional philosophies that end up justifying the general need for access to psychotherapy.
Above all, the hidden gems of In Therapy are found in the poignant ‘Afterword,’ which reads more like a quiet manifesto that Orbach could have only written from the vantage of a robust career in her field spanning eras of trends and cultural waves of the last forty years. Therein, one finds her articulating her rationale—as best as one possibly can in the field of human psychology—for the existence of therapy arises from the “aesthetic of psychoanalytic therapy … probably [has] to do with the struggle for truth” after candidly explaining how she must perform a different act of being a therapist for each patient(s) she encounters in her practice (100). Admittedly, therapy is only one piece of a dynamic treatment plan for achieving well-being: “much of what we do and how we go about it is unconscious. Therapeutic ideas can’t make us fully conscious but they can make us less arrogant and more humble in a generous manner about what it means to be human and to live” (107; emphasis added). Indeed, In Therapy’s leading subtitle might prove itself worthier of your bookshelf space if it read more accurately along the lines of what non-patients prefer to know: how a psychotherapist of caliber really meditates upon patients’ conundrums.