I finished yesterday’s blog with a quote from Bion to the effect that the therapist should enter their session with their patient with neither memory or desire or expectation of outcome. That takes some doing! I have lost track of the number of times my patients have confounded my expectations- both positively and negatively. Patients whom I thought would stay for at least a year leave unexpectedly after a month. Patients whom I knew would gain nothing from seeing me stay for a year or more and take a huge amount from the work. Sessions where I have been in fear and trembling of the attack I knew would come prove me wrong. And vice versa. In a week I move from being invaluable, generous and understanding to being greedy, rapacious and useless. Which proves the value of Bion’s maxim.

It is a rule that I’m learning to practice. To “trust the process”. To believe that between us, me and my patient can come to a shared understanding in the session of what it is that I am required to know. (As usual it’s this point at which I mildly envy my CBT colleagues who have a fixed programme which they can follow.) Working my way has advantages and disadvantages. As a nurse it meant that I never could write a “proper” Care Plan because I always worked with the transference-  which was unpredictable. It also made my teaching slightly difficult for similar reasons. I still can’t write a lesson plan with learning outcomes etc. I taught in the transference. (A way of working that took some of my students a long time to get to grips with. Some never did.)

How does this relate to Consultants, Experts etc? For me the Expert is the one who is comfortable with not-knowing. The one who can respond to a question with an honest answer and not bludgeon me with their knowledge. (My G.Ps are brilliant examples of how to listen to their patient.) Why does it matter if I’m heard or not? Because not being heard invalidates me. It wipes me out and reduces me to a set of symptoms that only they can fix.(As you might imagine, I am not necessarily a “good” patient.I expect from others what I try to practice myself. Certainly in the clinical realm.)

The picture above picks up the idea of an expert.The climber has reached a peak with hard work, skill and endurance. And has earned the right to enjoy the view. But the number of unclimbed peaks still outnumbers the one on which he stands. That knowledge should keep all of us humble-no matter how expert we consider ourselves.