A psychotherapist for more than 40 years, Susie Orbach ranks among the best known in her profession. Famously, she advised Princess Diana (if ever there was a woman who needed advice!), and also wrote such tomes as Fat Is a Feminist Issue, which placed body image firmly at the centre of feminist debate. More recently, she aired views on young women facing a mental health crisis (a theme she further explores here). With In Therapy, a companion piece to the recent Radio 4 series of the same name, Orbach attempts to explain the process of psychotherapy – how it works, why it helps people, and whether it’s beneficial for everybody.
At once there’s the question of whether In Therapy’s central premise is somewhat niche. The book is dedicated to author Jeanette Winterson (“who has always wanted to know what goes on in the consulting room”), and of course many people seek help or consider it – perhaps, in these self-regarding times, not always for the most edifying of reasons (“Tell me about ME!”). However, it remains debatable whether that many people are intrigued by the nuts and bolts of psychotherapy itself. Perhaps realising this, Orbach has eschewed a dry professional exploration in favour of introducing fictional characters, thus also sidestepping the issue of patient confidentiality.
In the radio series, Orbach worked with director Ian Rickson and Kevin Dawson, and a small team of actors who had been given character outlines and with whom Orbach improvised “sessions”, reacting as she would during real-life encounters. This book features transcripts of the radio sessions, interspersed with Orbach’s observations about how they are playing out and what psychotherapy insights and skills need deploying at any given point. This approach makes the project both intriguing and problematic. It achieves its aim of portraying real-life dilemmas (for the patient and the therapist), and there’s an element of social experiment. However, perhaps unavoidably, and despite Orbach saying that the aim was to be “anti-drama”, there’s also a niggling “high-end scripted reality” feel, a distinct whiff of “The Only Way Is Psychotherapy” – which, in fairness, wasn’t the case (it was all improvised, with no scripts).
It helps that the “patients” Orbach encounters are far from navel-gazing caricatures. One couple are anxious about the imminent arrival of their baby (Orbach attempts to stop the relentless cycle of blame and counter-blame). Another woman has endured the failure of IVF treatment and relationship breakdown (“She needs somebody with her who can bear to go into the horror and the blackness she feels”). Someone else laments her failed career and bad relationship choices. A man in his 60s excruciatingly declares that he’s fallen in love with Orbach (she explains about transference and how he’s really fallen for the newly invigorated version of himself). Then there’s “Helen”, who is successful, privileged, educated, and seemingly has it all, but who feels strangely lost, and has cheated on her fiance with an older, powerful man. Orbach is compelling on the mental health issues afflicting young people such as “Helen”. In her view, they are not spoilt, but “digital natives who live with medium-level anxiety all the time”, trapped by “consumerism, the notion of the individual as a brand”, whereby “life can be turned into a performance”.
One recurring problem with In Therapy is the conceit of the “normal conversation” when transcribed verbatim. While this approach worked well on the radio, giving a realistic cadence to the sessions, on the page the pauses, umming and ahhing and the rest of it become repetitive and irritating. Orbach makes the point that how people present themselves lends valuable insights to therapists, but in such a slim volume the point is overplayed, doesn’t add much, and could have been more sharply edited to make more room for Orbach’s much more interesting professional asides and observations.
This latter element (how a real psychotherapist would react to the proceedings) is where the book comes alive. Throughout In Therapy, Orbach has two voices – the one she uses with the patient-ciphers, and the other with which she converses with the reader, explaining why sometimes she asks questions, and other times remains silent, why some conversational or behavioural tics are more revealing than others, and whether therapy (what Orbach refers to as “the struggle for truth”) is going to provide the answer for everyone. If therapy isn’t for everyone, then neither is this book, but ultimately it succeeds in twitching the curtain on a notoriously mysterious and secretive process, thus enabling people who are interested to make their own choice.
In Therapy is published by Profile and Wellcome Collection (£8.99). Click here to buy it for £7.37
