Under fire in the consulting room

Abstract

A slow match is a very slow-burning fuse presenting only a small glowing tip whereas a quick match is one, which once ignited, burns at top speed. In this paper, I will present a number of clinical vignettes to illustrate situations when the therapist realised there was a sudden unexpected rise in ‘temperature’ of a patient’s mind and why this may have occurred. A fuse was lit but was it a slow or a quick one? I will relate this ignition to the possibility of premature interpretations, or a failure to notice how anxious the patient was in the presence of the terrifying object-therapist and also, patients’ unexpected responses to external interferences during a session. Descriptions of how these situations unfolded during sessions are given, and how, upon reflection, these could have been diffused differently. The emphasis will be on how best to maintain a psychoanalytic stance but also how to clinically judge when a session must be terminated in order to protect patient and therapist from exploding ‘bombs’ inadvertently ignited by patient or therapist. The importance of supervision and consultation with colleagues will be stressed.