Patients who are wedded to this myth, that there is a perfect place to be, a code or schema that says they should be doing certain things, beat themselves up because these kinds of patients feel that they cannot deliver. Here is an example from a patient who rarely complains about the timing of his sessions:
He is finding the timing of our sessions a bit of a problem. (Where I live is between where he lives and his work.) He complains that he can’t leave work before six o’clock, because nobody leaves before six. Nobody has ever said that he can’t leave before six, but nobody seems to and he has only just started and he is finding his way. So he gets home and just sits down for half an hour and then he’s got to get up and come out to therapy again and if it was an hour earlier it would be much better etc, etc.
All this is fair enough but it was odd to hear him say this because he doesn’t say things like this generally. The patient’s story continues:
He is getting really anxious about, this ‘other Steven’ over there who, if he did all these things,(in this particular case he has been going to rock climbing classes for years with two friends and now has become obsessed with extending it to outdoor climbing and mountaineering. He has bought mountaineering books, studied them obsessively and he gets anxious because, if he isn’t climbing Mount Everest he’s not ‘complete’. He imagines that there is this ‘other Steven’ over there somewhere who will be ‘complete’ if he does x, y, and z; but he finds that when it comes to Friday, he dreads the weekend because he spends all his weekend saying ‘I should be doing this, and I should be doing that, and it’s sunny this weekend. Why can’t I just go and sit in the park and read a book? He can’t because he gets so anxious about all the things that he should be doing.
Then he would say ‘Look at me, I haven’t achieved anything. Has all my life come to this? I was skinny as a boy so I wasn’t man enough. I went to Cambridge and I shouldn’t have been there; everybody thought I shouldn’t have been there; I haven’t achieved anything, and I have my own flat and I don’t like it and I can’t take anybody there because I am ashamed of it. I have achieved nothing.’