Fuses igniting in the consulting room

This article on fuses igniting in the consulting room is entirely based on clinical experiences without reference to any theoretical positions. Three clinical vignettes will be described to illustrate situations when the therapist realised there was a sudden unexpected rise in “temperature” of a patient’s mind and/or in her own mind, and why this may have occurred. A fuse was lit but was it a slow or a quick one? A slow match is a very slow-burning fuse presenting only a small glowing tip whereas a quick match is one, which once ignited, burns at top speed. I will relate this ignition to the possibility of premature interpretations, or a failure to realise how anxious the patient was in the presence of the terrifying object–therapist and also, unexpected situations arising during and outside of sessions. I will describe how these situations unfolded during sessions and how, upon reflection, these could have been diffused differently. The emphasis will be on how best to maintain a psychoanalytic stance but also how to clinically judge when a session must be terminated in order to protect patient and therapist from exploding “bombs” inadvertently ignited by patient, therapist, or external events. The importance of supervision and consultation with colleagues will be stressed.