A British object relations theorist, Bion, wrote about approaching each session without memory or desire. In my work with my patients, I try to hold this in mind. I take it to mean that I come to the hour without specific goals in mind, without a particular agenda, and without reviewing in any detail the previous session.
I try instead to allow each session to unfold on its own, raising as it does memory of previous sessions and pointing the way to future work. The shape of each hour is dictated by the patient, what she brings and where her gaze is. As I listen, I remember previous sessions and the threads of the fabric we are weaving. I keep in check my own desire for how things should turn out, for the direction to take, for goals to be set. I follow the lead of my patient.
This results in a path which is quite non-linear as one week we might talk about work and the next about childhood and the next about yet another issue. But all of these issues are woven together in the fabric of the patient's life and they form as well the fabric of our work together. The particular weave will become apparent as we go along. A habit developed in childhood as a defense against an intrusive parent will show itself again in adult life in work habits or in the way relationship issues are handled.
This approach takes time, it is true. And that runs against the grain of many for a quick fix. Both the therapist and the patient have to be patient with the process.
Does this mean I think that long term therapy is for everyone? No, I don't. I think it works well for people who have the desire to look deeply within and who see therapy as personal education. Short-term therapy, meaning 6 months or less, works well for a lot of people and for well-defined problems.