Every year, I spend a comparatively large amount of money on tissues. No doubt many householders purchase a few boxes of tissues from time to time, but I do so perhaps more regularly than most.
I suspect that the young woman who operates the cash register at Boots the Chemist on Hampstead High Street must find me a bit dotty. Each month, I come into the shop and instead of purchasing shampoo, nail clippers, shaving foam, or aspirin tablets as all the other customers do, I buy six extremely large "Man-Sized" boxes of Kleenex. Although the salesgirl does seem to arch her eyebrow in curiosity, she has never asked me why I need quite so many tissues. Perhaps she has comforted herself with the thought that I have a particularly nasty, lingering head cold, and therefore need to blow my nose many, many times each day.
My fellow comrades who work in the mental health field may have their own versions of this story, although I suspect that I buy more tissues than the average workaday psychotherapist. I use these "Man-Sized" Kleenex for two distinct functions. First, as one might expect, I place a box of tissues on the bottom shelf of my bookcase in my consulting room, within easy reach of the patient's leather chair, so that in the event of a sudden stream of weeping, those who feel so inclined can help themselves, and thus stem the tide of tears and mucus. But I also use the tissues for another purpose.
Although I do work with patients who sit upright in the chair, and I also see couples and families who, likewise, adopt a vertical posture, I suspect that 65% of my patients use the analytic couch, and hence will lie down. This arrangement suits both me and my patient simultaneously. The couch provides [End Page 299] me with the opportunity to listen very acutely, unencumbered by the need to make eye contact; and the patient, likewise, can engage in the highly special experience of regressing in the service of the ego and embarking upon a magic-carpet ride of rich and intricate free association.
Of course, when patients choose to lie down, they invariably rest their heads on a pillow, placed strategically at the upper end of the couch. This raises a very important question of both technique and hygiene: When patients utilise the pillow, do we provide them with some sort of coverlet, and if so, what variety should we offer? My beloved old training analyst used to have a selection of fabric squares which matched the upholstery on the couch. He claimed to have a different square for each patient and would change the squares moments before the arrival of each new analysand. One of my clinical supervisors—a playful Winnicottian—used to have a large and colorful selection of terry cloth towels, one for each patient. Another supervisor—a fervent Kleinian—used no covering at all. Each patient would rest his or her head on the same battered leather pillow for decades on end.
I must confess that I warmed to none of these arrangements, and instead I have opted to cover my couch pillow with two large Kleenexes, which can be placed on the pillow shortly before the arrival of the patient and disposed immediately after the end of the session. Perhaps other colleagues have employed a similar system. Certainly, I find this satisfies my need for cleanliness; and although all of my patients seem to have very properly washed hair, some do have marked obsessional tendencies and would balk at having to rest their own heads on a cushion used by other people.
Whatever the most felicitous arrangement might be, I have become quite happily accustomed to this one, spreading out two large tissues for each patient just before the start of the analytic session. Thus, I use tissues in a twofold manner—for drying tears, and for resting the head.
As the years have unfolded, I have come to realize that the tissues function not only in practical ways, keeping the consulting room protected from dandruff and free from lachrymal floods. They also function as...