The Impossibility of Sex: Stories of the Intimate Relationship between Therapist and Patient

by Susie Orbach

The conventional view of a patient in therapy has been that of someone who forms a powerful, erotic bond with the therapist. On the other hand, the view of the therapist has been that of a neutral listener, emotionally unaffected by the patient. But what really does go on within the sacrosanct space of the therapist's office?
Distinguished psychotherapist Susie Orbach provides the answers as she presents six stories of patients, all of whom suffer from such common afflictions as depression, loneliness, compulsive eating, consuming sexual desires, and fear of attachment. In each story, Orbach reveals not just the client's problems, but -- with startling honesty -- the effect the client has on her as therapist.
The Impossibility of Sex breaks new ground by taking us into the center of the therapy relationship, one usually shrouded by therapist-client confidentiality. From the unlikely role the therapist plays in the troubled relationship of two lesbians to the unsettling dreams the therapist experiences while treating a man consumed by sexual desire, Orbach illuminates the complex human interactions at the heart of the therapeutic process and the "joint discoveries" that contribute to its effectiveness.

Genres: Psychology, Nonfiction, Psychoanalysis, Feminism, Relationships, Counselling

256 pages, Paperback

First published May 27, 1999

About the author

Dr. Susie Orbach - the therapist who treated Diana, Princess of Wales, for her eating disorders; the founder of the Women's Therapy Center of London; a former columnist for The Guardian; a visiting professor at the London School of Economics; and the author of 1978 best-seller Fat is a Feminist Issue - is, aside from Sigmund Freud, probably the most famous psychotherapist to have ever set up couch in Britain.

Reviews

[Karen deVries · Rating 4 out of 5]

I've heard of Susie Orbach for years, and when reading Jeanette Winterson's recent memoir (they are partners), my interest was further piqued. This book was (1) an interesting sojourn into the kinds of problems people bring to therapy situations, (2) an incredibly savvy treatment of those problems, and both (3a) a window into the both the transformative possibility of conversation AND (3b) the ways in which therapists are challenged and changed within the therapeutic encounter. I am a lifelong student of the ways in which we all fashion our understandings of ourselves, and I thoroughly enjoyed this book. I appreciated Orbach's honesty, courage, and strength in her self-examinations. Looking forward to reading more of her work.

[Meaghan Gosling · Rating 4 out of 5]

This book gave me loads of food for thought. I don't subscribe to the psychodynamic theory like Susie, but there was a good deal that seemed to hit home with me in terms of her reflection and assessment. Reading the insights of Susie as she sits with her clients, how she questions herself at time and allows the clients to take the long road on their own others, is almost like a play by play for a therapy session. I thoroughly enjoyed the stories of the clients, and feel like I'm learning at the same time.

[Closetnarnian · Rating 4 out of 5]

Sensitively written, it manages to interweave the concrete (the stories, the individuals) with the abstract (short sections of theory and conceptual understanding of what is going on) in an elegant way. The kind of book you want to read to reflect on yourself and others in a deeper way.
My only disappointment is that only at the end is revealed that the stories are fictional - I feel like the blurb deliberately left that out to draw people to the book (we're most curious about people's hidden, secret qualities and the editor knows it). Good marketing, but you can't help but feel a little hoodwinked.

[Hannah Ruth · Rating 5 out of 5]

Outstanding. Nuanced and astute discussion of sex, sexuality, gender, race, class, violence, self-harm, and the problems that show up over and over in intimacy. Susie I worship at your psychoanalytic altar.

[Kristina · Rating 5 out of 5]

I can't believe I didn't complete my "date read" or add this book to my "read" shelf! I received a prompt in the recent newsletter and fully recognize that it is because I don't have the words to sufficiently express how much this book did for/meant to me, an aspiring therapist. I felt so uncomfortable with the palpable sexuality described between therapist and client in the first chapter that I didn't think I'd finish the book (tells you something about me, hey?). However, I learned depths about myself and psychology that I didn't know were possible at the onset of this read. I can't wait to read more by Susie! Her insight is earth-shattering.

[Bernadette Moran · Rating 5 out of 5]

I’ve given this 5 stars because I genuinely loved it; reading it as a student psychotherapist, I particularly enjoyed the interspersed theoretical explanations throughout each story that illustrated how the theory was applied with each imagined client. Without spoiling any of it, some of the client stories made impacts with me and prompted me to explore parts of myself that I identified in them, which to me is always the marker of a good book. 💜

[KL Baudelaire · Rating 4 out of 5]

I found this book a little hard-going; it is heavy on psychoanalytic theory and interpretation. As a counsellor taught primarily using the person-centred model, I've held a lot of prejudice against psychoanalysis - it can be reductivist, directive, it can miss the client's experience in a determination to force them to fit the model, rather than vice-versa. There is also a lot of intellectual content in an analysis; I had to concentrate, re-reading paragraphs, rather than reading casually.

That said, I found this book interesting and useful. While I still don't think that Freudian analytic theory is going to become a mainstay of the therapy I undertake, the author's attention to detail in her fictional clients' accounts of their experiences, is inspiring. The emotional and intellectual depth to which she follows and analyses them, is fascinating to read.

I was particularly interested by the points at which I responded very differently from the narrating therapist to the fictional clients; there was one for whom the fictionalised therapist was very concerned, but whom I felt threatened by. It's refreshed my alertness about the need to be aware of my own response to clients; to notice how I feel when I'm with them, and to use that information in working with them.

[Susan Katz · Rating 1 out of 5]

Truly odd book, which I did not like at all. It struck me as poorly written, self-serving, and inappropriate. It's listed as fiction, but also supposedly true stories of people who the author worked with (as their therapist). I confess that I did not read much of it. . .when a therapist starts out by talking about how thinking about one of her clients makes her vagina tingle, I'm done. Well, okay, I read a bit beyond that. And even tried skipping to a different "story," but couldn't do it.

[Connie · Rating 3 out of 5]

If you've ever wondered what is going on in a therapist's head during a session, this book will give you an idea.

[Leslie · Rating 5 out of 5]

Very interesing

[Dorothy · Rating 3 out of 5]

This is not the book I hoped it would be. I’d hoped for a therapist’s introspection on client interactions; this was a lot of rambling and not much else.

[Moglan Radu · Rating 3 out of 5]

Some of the notions mentioned in the book are truly thought-provoking and helpful when considering therapy as either a career choice or a personal journey for self-growth.
What I found sincerely disconcerting was that all the stories in the book were just make-believe...The book would have had much more of an impact on me if the cases discussed were of real people.
The amusing thing is that mid-book you forget that the cases are just "what-if" thought experiments and you really get into the stories and are rather fascinated by the cases discussed and at the end again you are brought face to face with the fact that they were all make-believe.
To me, the author's explanation for why she doesn't present real cases seems to be more of a personal choice as there have been a LOT of authors that posted cases with real patients that they had in therapy and no one has burned them at the stake for it...
Nearing the end of the book I felt like I just "had to" finish it just so I can set it aside and never touch it again. Nothing personal against the author, I do get the impression that she is a very nurturing and supportive therapist and person but the book was not what I was expecting ...
I hoped for a book that went more in-depth about the therapeutic relationship involving real people and real cases.

[Bradley · Rating 4 out of 5]

An interesting collection of characters through which analytic thought and therapy is explored. While it is entertaining it is also meant to be educational and can be somewhat heavy at times. However, if you are interested in analytic thought it is worth a read.

[Oliver · Rating 4 out of 5]

Very useful on transference and countertransference - I do find these fictionalised encounters annoying, but it's not really ethical to do it another way, so a necessary evil. And Orbach's additions on her own process of writing them is fascinating.

[Michaela Wilkinson · Rating 3 out of 5]

A little disappointed to realise these are completely constructed stories and not based on actual client experiences. Some reflections were interesting, but other sections were repetitive and really labouring a point which had already been communicated

[Camila Cardwell · Rating 4 out of 5]

Interesting way to approach countertransference and refute the narrative of an omniscient therapist prescience but would have been better if it was real patient stories

[Simon Slidders · Rating 3 out of 5]

This did not start out that well, and I was a little unclear as to what Orbach was trying to achieve, but the cases became increasingly interesting and particularly her somatic reaction to them. So I was very pleased I had read it .

[Ilze · Rating 4 out of 5]

Author of Sex is a Feminist Issue, Susie Orbach, gives readers a glimpse of what happens when a psychotherapist closes the door behind her and a client. It is fiction, but answers a few burning questions. Unfortunately, as the title implies, sex is … an issue. Orbach makes the point at the end of the book that even Freud, for all his famed research into sexual fantasies, didn’t understand “the erotic”. Simultaneously, she views sex as a metaphor for communication, which language is in and of itself. Language is however, also a product of the culture in which it is used. I believe the reason psychology and the medical profession are forced to focus on sex more than ever before is because our culture is being threatened by Aids. Wherever one looks, signs of Aids cannot be ignored, neither can its source. As far as I’m concerned the whole issue of sex is blown completely out of proportion and that questions into the erotic are a cul de sac.

Without intending to be punny, the reader is taken through the therapy of six individuals (the last, a couple). “Joanna” brings up my consuming question: “And what of my [therapist’s:] story? What had I encountered, where had I been …?” Where indeed, because once a “client” leaves that room, something stays behind. According to Orbach, it pervades the room. Surely it does more than that? Surely there’s more to this whole scenario, as Orbach states: “Although a patient often feels that the asymmetrical nature of the relationship means that she is merely of clinical interest and has little personal or emotional impact on the therapist”, so could very well mean absolutely nothing to the therapist. For a while, though, the therapist is all the patient can think of, is the only reason suicidal impulses are ignored and in this way becomes a lifeline.

The therapist is given insight not only into personal family problems, but the most intimate details of a person’s psyche. Once the client’s trust has been won, that therapist becomes “everything”! In addition, because of a therapist’s book knowledge, he has insight beyond what the client thought they’ve said. On page 62 Orbach goes into Winnicott’s theory of “false selves” which are unconsciously created by an infant in order to feel loved. This leaves the “true self” in the gutter until things become unbearable and they turn up for therapy. Orbach was able to see beyond “Belle’s” false self and recognize the pained true self that she was hiding. Inevitably, “Belle was able … to acknowledge her need of me a bit more, … almost drinking in my presence, as though she felt for the first time another’s respect for her.” How does a therapist extract himself from this? Once the therapist has recognized this need on the side of the client, can it be thrown to the wind? “Belle”’s therapy is interrupted because the therapist has a death in the family. “Belle” is left to fend for herself during this time and eventually never returns for another session. Does the therapist even comprehend what happened? With all his theories of “attachment” (and abandonment), how could a therapist leave this kind of message on his phone: “You have reached … please leave a message.” In truth, nobody has been reached. The person making the call ended up at a machine which might or might not record the caller’s voice.

At the very least I now understand that patients do exist for the therapist and that they are a little more than “a case”. For this I’m grateful for Orbach’s valiant attempt to write about it. In spite of this, there is a sliver of doubt as to whether contact has really been made between two people. They might cry together (or, as has happened, the therapist fall asleep while the story gets told), but to admit that a doctor’s attempt to write about his patient could be equated like this: “a poet and a novelist have about as much in common as a jockey and a diesel driver”! If that therapist has really understood the essence of who you are, they would never start to think of you as a diesel mechanic, because they know you are not. In fact, they would not leave you behind when they know you have an issue with attachment. They would find ways to “hold you” so that the trauma of abandonment doesn’t repeat on you. But a therapist has “boundaries” and “a profession”, let’s not have emotion interfere with that.

[Lus · Rating 5 out of 5]

O carte care mi-a plăcut mult pentru profunzimea și analiza cazurilor pe care autoarea le creează din vasta sa experiență profesională. Multe legături între simptome și cauze, explicații detaliate și descrieri bogate ale gândurilor proprii legate de pacient și ce simte ca terapeut în relația cu acesta.
O recomand pentru claritatea pe care poate să o aducă oricărei persoane ce se află în proces terapeutic sau lucrează în domeniu.

[John · Rating 3 out of 5]

I'm not in a position to evaluate the theory the author is working from, though some of it strikes me as baseless or heterosexist. The text reads well, especially at the start of the book.

Should this be shelved as fiction since all the case studies are made up? If so, it's only engaging fiction up to the last case study. The last, titular case study is the most theoretical, and it's followed by two chapters of discussion that seem part theoretical review, part author's extremely indulgent afterword.

Of the recent examples of psychoanalytic case studies I've read, this book is the most theoretical, and maybe tied for least readable. It also contains the most outlandish ideas, including the fictional therapist taking on the physical symptoms of her fictional clients and other explanations for the fictions clients' psychology that stem from the author's theoretical background but don't seem connected to the patients' lives. But I don't suppose I know enough about the field to really judge.

[Lee · Rating 2 out of 5]

An unusual book that may be best described as a 'fictional memoir'. I picked it up for the author (Dr Orbach) and figured that the content she wrote would be interesting by default.

Not the case - only about half of it was interesting. Each chapters details a different character that presents for therapy, and I found their stories mostly interesting. At some point in each chapter, however, my interest would wane and I would find myself struggling to complete the chapter.

If I was more interested in the practice of therapy or psychoanalyst, maybe I would've been a more appropriate reader for this book. As a layman, not really.

[Dom · Rating 4 out of 5]

Spoiler alert: these stories are just so, fiction. While Orbach writes elegantly and intelligently the patients and their interactions with her projected self are merely products of her vast imagination.
It would be an interesting professional exercise to produce fictional clients and work through their concerns solely in ones mind, a working role play. Still, I can't help but feel a bit cheated.

[Lesley · Rating 3 out of 5]

Interesting stories. The many grammatical and spelling errors, with the occasional wrong word in a sentence, made it laborious reading at times for this book snob. But overall not a bad read.

[Dana · Rating 4 out of 5]

What a great Freudian vacation from FBAs, BIPs, ED and RTI