Moments of spontaneity and other unusual clinical events which might, however briefly, reveal the nature of the therapist's personal thoughts and feelings, can often be viewed as breaches of technique and the boundaries of therapy. The therapist may feel that more of his or her private self than is advisable has come through the consulting room door and intruded on the session, and of course there are times when this may well be the case. However, there are other times when this kind of experience proves to be surprisingly productive of positive change, suggesting that these unusual and disconcerting experiences need to be understood in a different and more positive therapeutic and theoretical light (Symington 1986; Carlberg 1997; Stern et al. 1998).
This chapter describes some unusual clinical events that took place during a period of crisis in the treatment of Hilary, a suicidal adolescent girl, which seemed to be helpful in keeping her safe during this time. The once-weekly treatment lasted for nine months, and for a good deal of this time I had to work extremely carefully with her as I did not feel that she was sufficiently held outside the sessions to allow me to interpret other than with great caution. Her treatment with me ended when she was admitted to a therapeutic unit where she was able to have intensive psychotherapy and explore the depths that I felt I had to leave alone while I was working with her.
Her therapy during this period between living at home in considerable danger of killing herself, and seeing her safely admitted to the therapeutic unit, very literally saw her through a vital transition in her life. Hilary had all the hallmarks of someone who was stuck in a very dangerous place but was terrified of moving into a freer but unknown space. Even when she started to make this move, which she found terrifying, I often felt that she was stuck in quicksand and rapidly being sucked under, unable to move
1 This chapter is based on the 2001b paper, 'The symbolism of the story of Lot and his wife: the function of the "present relationship" and non-interpretative aspects of the therapeutic relationship in facilitating change', Journal of Child Psychotherapy, 27(1):19-33.