Transference – that mysterious tendency of the client to generate strong feelings for the therapist – is an essential component of psychoanalytic theory and practice. There are numerous books and papers discussing the difficulties of transference for the therapist and its effects on the progress of the therapy: few deal with the suffering of the client who is experiencing the full force of transference during therapy, or who is unable to dissolve the transference after termination of therapy and return to a normal life. Folie a Deux is one of the few.

Rosie Alexander’s account of her experience is unusual also in that it is a description of therapy written by the client. When a therapist writes up a case study, the descriptions of the patient’s feelings, state of health, moments of insight, progress and relapses are all selected, filtered and interpreted by the therapist. This environment can provide comfort for the reader, an assurance that, whatever the problems of the client, they are still under control and that there will be a happy, or at any rate, reasonably satisfactory ending. In Folie a Deux there is no restraint on the description of the client’s emotions, nor is there a happy ending, and most readers will, I suspect, find the book distinctly uncomfortable.

The story of Alexander’s therapy begins, innocuously enough, with a session at an assertiveness workshop to sort out some emotional difficulties in Alexander’s life. She begins weekly therapy sessions with the workshop coordinator, which are initially helpful, but then Alexander develops an obsession with the therapist, who, realising she is out of her depth, refers Alexander to a psychiatrist. She quickly becomes dependent on the psychiatrist, despite having a poor opinion both of his personality and his professional competence. She stops seeing him because she is about to go and work abroad for a year. However, the day after her last session with the therapist, Alexander finds herself in a state of emotional collapse triggered by the thought of having to do without him, and contacts an emergency medical service to find another therapist. When she returns from abroad, she begins psychodynamic therapy with this new therapist, and develops feelings for him in place of those for the previous therapist. The feelings increase in strength until they become hallucinatory and profoundly debilitating. She carries on seeing the therapist because she cannot stop, despite the terrible suffering the therapy is causing her. Eventually she does stop seeing the therapist. However, the pain of separation does not heal as the months pass, and eventually she is admitted to a psychiatric clinic where tranquillisers, bed rest and a good diet help to combat the physical effects of the ordeal but can provide no permanent resolution.

Two questions dominate Alexander’s story: “Why is this happening?” and “How can I stop it?” Alexander never finds the answers to these questions, but that is not for want of trying. She consults other doctors and therapists, but the advice is often to persist with the therapy, despite the destructive effect it is having, or she is given drugs to temporarily ease the suffering. The only course of action which does help her is to join a support network for people who have had negative experiences of therapy. She finds their down-to-earth approach very reassuring, but even they have to admit that they do not know the cause of her pain. She asks, “Why do I feel like this?” A group member answers, “We don’t know. As far as this sort of thing is concerned we’re just emerging from the primeval swamp.”

Folie a Deux is written in a fluent, lucid and non-technical style and can be appreciated by therapists and clients of therapy alike. Dr Spinelli, a practising psychotherapist, has written an afterword, which discusses some of the issues raised in the book and expresses the hope that “her account will at least have the positive impact of challenging therapists to address the issues raised in an honest and non-defensive manner so that we will all – therapists and clients alike – benefit from such.” My own hope is that the tragedy recounted in this book will stimulate more research into the nature of that client-therapist bond, which is known to have such a profound impact on the outcome of the therapy, whether positive or negative, but which is still so poorly understood.

Natalie Simpson is a mathematics graduate of Oxford University, England, and holds a diploma in hypnotherapy. She developed an interest in psychology, psychotherapy and hypnosis after experiencing abuse as a hypnotherapy client. Her specific concerns include the assessment of the effectiveness and risks of psychotherapy, and the difficulties of obtaining informed consent of clients.

Categories: Memoirs, Psychotherapy, MentalHealth

Keywords: Psychotherapy patients