One of my patients came to see me last week and asked me to “check” his homework. He had been keeping a thought diary in which he recorded the good things that had happened to him that week. His boss had given him a compliment, he had made his mother a cup of tea, friends had commented on how he had changed. He was pleased with these achievements but still left feeling empty inside.

Some years ago Nice- the band, not the NHS watchdog- wrote a song “America” which had the line “America is pregnant with promise and anticipation but is murdered by the hand of the inevitable.” I was thinking about this line as my patient told me about his homework. There was a mismatch between his attempt at boosting his ego using “external” information and the messages he took from his inner world. His father had been a violent and abusive alcoholic who took pleasure in denigrating his family -presumably to deflect from his own feelings of emptiness and failure. The message my patient took from his father for the first five years of his life was that he was a complete failure and a waste of space. And that nothing he said or did was anything more than a confirmation of his utter uselessness. Eventually his mother left her husband and moved out taking her children with her. Sadly the damage was done and my patient’s self worth was “murdered by the hand of the inevitable”.

My patient still struggles with any idea of self worth. He is scared to ask a girl out because he “knows” she will reject him. He “knows” his boss  is against him because he is stupid and clumsy. His default position is to be permanently angry with the world whom he knows is out to get him. And so begins the classic vicious cycle seen so many times – and which I wrote about in my blog on Anger Management. My point here, however, is not to comment on anger management classes, which can be helpful. The point is to return to the line in “America” – about hope being murdered by the hand of the inevitable.

The analyst Michael Jacobs coined the phrase “the presenting past” by which he meant that we carry our past with us. It is not like an old snake skin that is sloughed off when it is no longer useful or needed. (I am reminded of a children’s TV show “Crackerjack”. The final part of the show was a quiz whereby the competitors were loaded up with prizes which they had to balance one on top of the other. As well as balancing these prizes, they also had to answer new questions – which got them more prizes. And so on. My memory is that the game had a slightly persecutory element to it. That success came at a price. But that may just be my memory!)

My patient lives in a kind of “negative Crackerjack” world whereby his arms are so full of bad presents that he has no room for new gifts. In counselling there is a chance for him to make me into whatever person he needs me to become. I may become a persecuting, bullying father who has no time for his son. I may become a boss who picks on him. I may be experienced as a father who loves his son and wants the best for him. All these elements are at play in our relationship. And there is time and room for us to explore how and why I have become any of these things. And what it means to him that he can come back week after week and play out these roles until he discovers a real me and a real him. My task as his counsellor is to keep on pointing out to him what he is turning me into in any given session. And what he may be trying to achieve by doing this.

I do not expect this change to happen quickly. He has a lot invested in his current view of himself. It may be a cold and lonely world that he inhabits currently but he knows his way around it! Changing will have losses as well as gains for him. But hopefully he can live his life on his terms.Freud observed that the aim of analysis is “… to convert neurotic misery into ordinary unhappiness” When my patient leaves me he will not lead a life of unbridled joy “where every day is the first day of Spring.” But he will be able to lead a life of “ordinary unhappiness” which has to be a much happier world than the one he currently occupies.