Baseball Caps, Overcoats, Orange Suits, and Neckties: On Patients and Their Clothing

I should like to begin with a cautionary tale.

Some years ago, a very frightened and suspicious gentleman came to see me for a consultation. Mr. W. told me immediately that he had already tried to engage with a psychotherapist once before, but that he found my colleague to be reprehensible. I inquired delicately as to the nature of his discontent, and he responded, "Well, she kept analysing my baseball cap."

Apparently, the patient had come to his first consultation with this highly regarded colleague, wearing his headgear throughout, and the psychoanalyst in question had made a number of remarks about this. The patient recalled, "Within seconds of meeting me, she made some really clumsy comments. She told me that by wearing my hat in the session, I didn't want her to know what might be going on in my head. Can you believe the arrogance? Anyway, I found this very intrusive, and so I left her. I'm not going to have my clothes psychoanalyzed."

The patient had told me the name of the colleague who had, purportedly, psychoanalyzed his baseball cap. I know this woman to be a decent and thoughtful person who would not, I suspect, make gratuitous interpretations to a patient, and certainly not in the very first moments of the first consultation. But, nevertheless, Mr. W. felt intruded upon, and consequently he bolted.

This vignette raises a number of questions relating to the way in which we as clinicians make comments about patients' clothing, or refrain from doing so. I suppose that one could host a very interesting seminar on the baseball cap incident alone. Should one make mention of the fact that the patient has covered his head up indoors during a first consultation, especially with a paranoid patient? Should one interpret the patient's fear of having his mind penetrated? Or should one, perhaps, note the creativity in a paranoid patient coming to the session with some protective headgear? Or should one say nothing, merely clock the hat privately and be reminded of the patient's fear of the process, and thus proceed diplomatically?

It surprises me how little attention psychotherapeutic workers have paid to the way in which our patients dress, at least in our published writings. It seems that if we do notice the patients' clothing, we prefer to be very reticent in writing about this topic. This reluctance to theorize about clothing makes great sense, in view of the potential sensitivities surrounding this topic. I must confess that I rarely make comments about patients' clothing, as I have a strong awareness of the way in which such verbal observations might be construed as intrusive, seductive, or unnecessary. So I would always proceed very cautiously. But at the same time, one can become too phobic about mentioning clothing, particularly when it may provide a source of much important information.

Mr. X. and Mrs. X., an attractive young couple, came to see me for ongoing marital psychotherapy. I found this couple to be reasonably healthy, highly motivated, greatly intelligent, and deeply committed to improving their marriage. I enjoyed working with them very much and I had the impression that we could talk about difficult aspects of their histories and of their family lives in a reasonably straightforward way. Over the last five years of marriage, Mrs. X. had given birth to three healthy children. Thus, I knew that this couple did have a sexual life. Indeed, Mr. and Mrs. X. told me that in spite of their rows they still enjoyed sex with one another, and that their physical relationship did not seem to be one of the contentious areas of their marriage. I suppose that I took Mr. and Mrs. X. at their word in this regard.

On one occasion, Mrs. X. came to the session on an ordinary British spring day wearing a heavy overcoat, buttoned up all the way, which she kept on throughout the analytic hour. I certainly noticed the coat immediately, but I made no observation about this, and I could not find any references in [End Page 362...