‘I wanted to write something that put the psychology at the heart of the drama’

Did you have a reader in mind as you were writing?
Not especially – but I did embark on writing the novel thinking that books about therapists were underrepresented in fiction. Often the therapy just serves as a plot point to move the narrative forward, and I wanted to write something that put the psychology at the heart of the drama. It was an opportunity to open the door to the secret world of therapist and client. But it's also a novel about families and, in particular about the responsibilities and limitations of motherhood, which I hoped would have universal appeal.

How much was drawn from your own experiences as a psychologist? Have you worked in the type of organisation Dr Hartland is within?
I haven't worked in a trauma unit, but I did work for a number of years as a clinical psychologist in a primary care service. Referrals that came directly from GP's were often complex, in that the 'surface' problem was often related to an underlying trauma, frequently from childhood. Our service worked with many of these clients, but we also referred on to a specialist service when necessary.

When I worked as a clinical psychologist, all my supervisors were psychoanalytically trained and I myself went on to do further training at the Tavistock Centre. In terms of the book, I was keen to make the world as authentic as possible and so the workings of the NHS, the psychoanalytic model of therapy, and the current state of mental health services are all drawn from my experience. 

Who was your favourite character in the book?
I really enjoyed writing Ruth Hartland, the main character. The joy of a first person narration meant I could really get inside her head. She's a complex person, with her own difficult past – and her grief about her missing son Tom, is at the heart of the book, as we witness how the ramifications of her decisions culminate in tragedy.

I also enjoyed writing Dan, the client she initially mistakes for her son. As a client, Dan is very tricky and it's hard for her to trust what he says and does. Their relationship becomes enmeshed. It's like a perfect storm; she's looking for a son – and he's looking for a mother. It's a disastrous combination.

How did you maintain the confidentiality barriers when writing? Did you ever find yourself describing a previous client too closely or reflecting deeply on those you have treated in the past?
While the world and the setting is real and authentic, all the cases are entirely fictional, and I really enjoyed the process of creating scenarios and back stories for all my characters. 

However, writing a novel did give me the opportunity to explore real issues I was interested in; the management of professional and personal boundaries, the search for neat diagnostic categorisations for clients who have experienced complex trauma, the impact of suicide, and the current crisis in our mental health services.

How long was this idea about writing the book ruminating before you got a chance to start it?
I've been writing fiction for a while, and I'd been interested in a story that explored grief and loss. I then read a piece about missing people, and how relatives are left in a particular type of unresolved torment as they wait for news. In their desperation, many described 'seeing' loved ones as they went about their daily lives; in the street, on the tube – and it was this, that triggered my story. What if a therapist sees a new client who bears a striking resemblance to her missing 17-year old son?

In terms of my writing process, I tend to have the idea germinating and developing in my head for a long time before I actually put pen to paper. Also, the actual writing was sometimes slow, as it had to fit around my working life.

Did you have any fears about what other psychologists would think of it?
This is my debut novel, and I now realise that releasing a book into the world always comes with a degree of trepidation. In terms of other psychologists, I did make a point of showing early drafts to colleagues in advance, and their support has been hugely appreciated. While I don't work as a clinician anymore, I do work supporting staff and teams in mental health services, so I was especially keen that the world was represented accurately. While it's a work of fiction, I aimed to describe the work in a way that properly represented the service and the profession. 

I've had experience of working with extraordinary clinicians over the years and I wanted to champion the excellent, and often unsung work that takes place quietly behind closed doors. People can read tragic headlines in newspapers, but don't necessarily think about how the people involved might go on to rebuild their lives. Writing the book was a way of highlighting this painstaking and exceptional work. I feel passionate about the psychanalytic model of therapy, and I wanted to find a way of representing some of the ideas in fiction. Transference and countertransference, for example, are such valuable concepts, and I've had people telling me that the book brought them to life, teaching them something they now see being played out in their relationships and at work. That's been a joy to hear.

How did you feel about openly exploring and communicating the issues faced by psychologists, supervisors and patients?
I think fiction has a responsibility to tell real and authentic stories about the world we live in. In this novel, I not only wanted the celebrate the world of therapy, but to also draw attention to the complexities of doing this very difficult work.

My book explores the line between personal and professional boundaries – and for many people, the line is sometimes a very fine one. Therapists are, along with many other people in the 'helping' professions, human beings. They have difficult lives that crumble and fall apart like everyone else and life events can leave them feeling just as vulnerable as everyone else. And we have this human frailty and vulnerability taking place in a system that is also stretched and under resourced. In my novel, supervision is depicted as a necessity in the life of a clinician, regardless of level of experience, and readers are party to those sessions between Ruth and her supervisor. However, we also see how a powerful emotion like grief, can trigger a state of denial that renders Ruth blind to the potential pitfalls of her actions, and of keeping things hidden from her supervisor.

While raising difficult issues, I very much hope the book will be of interest to people in the therapy world and that it will contribute to the ongoing discussion about some of the complexities of working in mental health.

- A Good Enough Mother is out now on Faber and Faber. 

A fascinating reflection
Reading non-fiction by psychologists about their areas of expertise is nothing new for most of us. But reading a psychological thriller by someone who has spent their career working in applied psychology is certainly something different, and this book was a real treat. It beautifully describes the realms, difficulties and approach of the fictional psychotherapist Dr Ruth Hartland interwoven through a fascinating narrative in a way that a non-psychologist would really struggle to achieve.

As a parent and psychologist, the interaction between personal and professional caused much contemplation, especially as Thomas skilfully draws the worst fears of both parents and therapists into one story, unveiling them slowly as the chapters develop. I felt the novel would be particularly valuable for those working on the outskirts of mental health support or for students wanting to understand the importance of barriers, honesty within supervision, reflection and process within psychotherapy in a far more accessible and effective way than any textbook. I imagine for those working in the field it would prompt a fascinating reflection on how they would approach clients similar to those Hartland treats. For those completely outside of psychology it is just a great read with some unexpected twists.

- Reviewed by Josephine Perry, chartered psychologist, Performance in Mind.

Image by Natasha Merchant.