An Eye For An Eye. Arthur Klepfisz
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that. On the other hand, confronting the patient could result in them terminating therapy and obviously one couldn't treat a patient who did not attend.
Still, this wasn't a valid reason for avoiding facing issues with the patient. He was determined to start confronting Mr R in a manner that hopefully would not drive him away, but would make the sessions more meaningful for him.
Mr R suffered from a moderately severe obsessive-compulsive condition with associated depression and anxiety, but he did not have the emotional fragility of say, a young schizophrenic patient, where confrontation would be inappropriate.
Mr R’s life and emotions were severely shackled by his psychiatric condition, where he could not cope with the intensity of his emotions or the uncertainty of what each new day might bring. He had developed a rigid and restrictive set of rituals to create the illusion that everything in his life was predictable.
Andrew realised that his thoughts were drifting and that he had stopped listening to his patient. It was close to the end of the session, but he had come to a decision that from the next session onwards, he would commence sharing his thoughts with Mr R, including describing how the sessions made Andrew himself feel, thus providing a mirror where Mr R could commence looking at himself, to facilitate seeing the real person underneath all the restrictive defences he had built up.
4.06p.m.
By the time he reached the last appointment of the day, Andrew had to admit to himself that he was looking forward to finishing work and going home. His last patient, Samantha, was a 41-year-old woman with a Rubenesque build, who tended to be clinging in therapy, and had been attending for close to 12 weeks now.
As Andrew gently guided her to the door at the end of the session, his hand on her left shoulder, she turned towards him, addressing him by his first name and asked if she could have more frequent sessions. She explained that she felt she would make more rapid progress that way. Hesitantly he clarified that it wasn't necessary and wouldn’t speed up her progress, but he knew that the query would arise again.
6.08 p.m.
Andrew nervously fiddled with the car radio, trying to distract himself from the flood of the many emotions and thoughts enveloping him, and he felt as if there was a weight on his chest causing his breathing to be shallow and rapid.
Just before entering his driveway at home, he stopped his car and heard himself phoning and talking to Samantha, as if a stranger to his own thoughts. He was aware of an awkward, detached voice telling her that he had thought about it some more and decided they could give weekly sessions a try.
Prior to then, Samantha had been attending therapy every three to four weeks, so Andrew reassured her that he would avoid her being out of pocket by continuing to bulk bill the sessions.
Each progressive step Samantha took towards intimacy met no resistance, so she continued. Two months after her weekly sessions began in August 1986, they commenced having sex in a motel room that he rented not far from her home.
By now Andrew was experiencing a kaleidoscope of feelings and found himself immersed in lies that brought him no peace. He had difficulty looking Karen in the eye, and the blue ink shadow of guilt slowly enveloped his life from 1986– a year he would never forget.
He became increasingly anxious about being trapped in what felt like a sexual spider web, where he began to fear that the moment he attempted to stop the relationship with Samantha would be the very moment she would retaliate, reporting him to the Victorian Medical Board. Not that he wanted to leave the relationship, as he clung to her throaty laughter, to the scent and feel of her fulsome body. He allowed her to continue calling him Andrew and whilst he referred to her as Mrs Richards, he thought of her as Samantha. In their intimate moments, he did not call her by any name. He didn't usually address patients by their first name and didn't encourage them to call him Andrew, but a few, like Samantha, chose to do so.
He had always strongly believed that it was important to maintain a doctor – patient relationship, where his own personal life and needs would not intrude on the therapy, nor would there be inappropriate intimacy. At least that's the theory, he said to himself with heavy irony.
After several months of therapy and sex, unsurprisingly, Samantha continued to be a needy soul, prone to recurrent bouts of depression and occasional suicidal thoughts. Her childhood appeared to have been a normal one until her father died from a massive heart attack when she was eight years of age. Her mother then struggled to cope with four young children, aged from fourteen years down to the youngest, aged three. There followed a procession of men intruding, as her mother attempted to replace her husband with an urgency akin to a woman dying of thirst. Unfortunately the men she chose were totally different to her late husband, and had no interest in supporting a young family.
Samantha married when she became pregnant at the age of nineteen and escaped the family home, but found no solace in her new home either. Her husband was four years older than her, worked as a bricklayer and outside of work his only interests were the local pub and the local football team. They separated soon after their daughter was born, following three years of a loveless marriage.
Samantha and her daughter lived on their own at first, but in time, like her mother she began inviting a regular stream of men into her life. They accepted her invitation, took what they wanted and left.
Six months after the affair began, Andrew found himself becoming increasingly concerned about ending the relationship with Samantha and encouraged her to form a relationship with another man that she had recently met, in the hope that this would offer Andrew the escape route that he so desperately sought now. Privately, he wondered why he wanted to end the affair, and the best explanation he could arrive at, was that with diminishing excitement he had started to look at the destruction he was causing to his marriage and to the ethics and morals that had guided his life in the past.
For twelve months, his manipulation (for he could not call it ‘therapy’) failed to achieve what he so desperately craved by then. Then when he had stopped hoping, Samantha stunned him with the news that she had met a widower with two young children, who appeared to genuinely care about her. She rang Andrew, and told him that she wanted to terminate therapy as she was not prepared to risk damaging her new relationship. She no longer needed Andrew's therapy nor his sex.
Having penetrated that moral barrier once, Andrew struggled to avoid doing it yet again – and it was a struggle at times. He determined that if a difficult transference developed in treating a female patient, where either he or they developed a strong attraction to the other, he would refer them on to another psychiatrist. He was aware that in psychiatric practice, there was only he and the patient in the room and no nurse to chaperone the situation. Whilst errors tend to occur in the company of other errors, he knew that this was not the type of company he could afford again, as he would risk losing his family, his profession and his self-worth.
Andrew now felt a foreigner in his own moral landscape, struggling to make himself understand what had occurred and why. Karen and his friends noted that he appeared distracted and at times daydreaming. He came very close to confessing to Karen, but avoided giving in to that urge, knowing it would be disastrous to do so.
He had believed for a long time that to confess all was self-serving and the wrong approach. He had seen it happen in many of his patients, where in the guise of an open relationship they confessed wrongdoings, dropping the grenade in the lap of their partner. For a short while it seemed to ease their own guilt, but at the expense of burdening their partner and destroying the relationship.
Andrew had felt for some time, probably since late 1986, that things had cooled in the way Karen related to him. Silently he queried whether Karen could have possibly suspected he had been having an affair, and he continued to live with a lie that brought no peace. He knew he had to sort it out himself, possibly with professional help, rather than dumping the problem onto Karen.
During his medical training he came to understand that the basic goal in medicine was to cause no harm, and then to try and help the patient. He struggled to understand why he had failed to adhere to these guidelines when treating Samantha. Certainly he had recently lost both parents, and struggled to grieve over the