Treating Special Clients in Psychotherapy By John Marzillier, PhD on 4/26/11 - 10:19 AM

In the film, The King’s Speech, George VI seeks treatment for his stammer from a maverick Australian speech therapist, Lionel Logue, played brilliantly by Geoffrey Rush. “My patch, my rules,” is what Logue tells the King when he insists on being given special treatment. He is, after all, the King of England, used to deference and privilege. Logue accords him neither, treating him just like any other client. Or so we are led to believe. As a therapist I applaud Logue’s resolution but how realistic is it? Are there not always "special" clients, people who demand and get special attention? It is hard to believe that the feminist therapist, Susie Orbach, whose most famous client was Princess Di, treated her as simply another disturbed, bulimic woman. How could she ignore all the razzmatazz that surrounded Diana for was that not a large part of the problem? It would be difficult, impossible I believe, to pretend that she was anything but a special case.

During my psychotherapy career I treated only a handful of well-known people and most were well-known only in their own communities. In Oxford where I had my private practice, I treated a fair number of academics, dons as they are called here, a few of whom were part of the media circuit, appearing on TV or writing in the newspapers. I never felt they demanded or needed any special privileges other than for me to take particular care not disclose who they were. Oxford is a small place. But then I was an academic myself and when you have worked in a University, you are soon disabused of the notion that academics are in any way special. I did, however, treat someone who was internationally renowned. I recall his all too brief foray into therapy with a mixture of chagrin and regret as I realised, too late in the day, that his specialness had undermined what good therapeutic sense I had.

The man had come to me for stress management. It was not surprising that he was stressed given the huge demands placed upon him by his work and his fame, not to mention those he placed upon himself. He had had a string of difficult personal relationships, one of which had just come to a messy end. I told him about anxiety management and he was very keen to try it even at one point stretching out on the floor while I instructed him in how to relax. We fell into this practical, problem-solving therapy before I had taken stock of the man partly because I felt pressurised to deliver something useful. It was an ill-considered decision and it set up a particular type of relationship in which I responded to what he felt he needed or, in truth, believed he was entitled to. The crunch came when he told me about an employee of his who, while brilliant in many ways, had problems with anger management. Would I see him too? I agreed and, a couple of weeks later, my famous client had gone. How I wish I had refused or at the very least queried why he was in effect palming me off on to someone junior to him. Was this his way of reasserting control? That he could "employ" me like he employed others to do his bidding? I sensed something was not quite right and perhaps with another, less special, client, I would have brought my unease into the open, or simply refused outright. I did neither and have regretted it ever since.


File under: The Art of Psychotherapy, Musings and Reflections