ongoing cases – and she had little information about her, which irritated her beyond words. Whoever had done the initial referral notes had been nowhere near as thorough as she herself would have been. The scrawling signature on them could have been any of the others, and she made a mental note to bring it up as non-accusatorily as possible at the next team briefing.
Age: 23
Medical history: no diagnosed history of depression or generalised anxiety disorder. Family background unknown. No medication at present. Self-referral.
Reason for visit: tension headaches and irrational cognitive activity.
As she always did from the initial notes, Karen couldn’t help putting together a picture of the woman about to walk through the door. Probably well off, judging from the amount of money she was paying for fifty minutes of Karen’s time. Karen did a certain amount of pro bono work but Jessica Hamilton was self-referred and self-funded. She imagined that her friends called her Jess and her family called her Jessica.
There was a second knock, which was unusual for Molly. If Karen’s ‘In Session’ sign wasn’t on the door, she usually entered straight away. Karen got up, smoothing down her suit jacket, and opened the door to find not the smiling face of her assistant on the other side but a slight, timid-looking girl with a pale face, blossoms of red spreading out over her cheeks.
Karen hoped her own face had not revealed her surprise, doubted it had. Eight years of psychiatry had taught her reactions to hover below the surface, never breaking through to the onlooker. The ultimate poker player.
The young, attractive, rich-girl image the name Jessica Hamilton had conjured up couldn’t have been further from the reality standing opposite her now. Karen put out a hand for her to shake, registering quickly the chipped, bitten nails and the grip as weak as the smile she herself offered.
‘Jessica?’ She cast her eyes around the reception area, but Molly was nowhere to be seen. ‘My apologies. Our receptionist would usually be here to greet you. Come in.’ She ushered the woman inside, mentally cursing Molly and her out-of-character unprofessionalism.
‘Please, take a seat.’
Either Jessica Hamilton didn’t hear her or she ignored Karen’s request. Instead she walked slowly away from the sofa and around to the bookcases on the far wall of the office. She seemed to be drinking in every detail of the mahogany shelves, the leather-bound books chosen for their aesthetics rather than their appropriateness to the setting. For the first time in a long time, Karen felt as though her space was being scrutinised and found wanting.
‘Would you like to sit down so we can start?’
She thought for a second that Jessica was going to ignore her again, but after a moment she took a seat opposite and sat silently, waiting for Karen to lead the session.
Jessica wasn’t unattractive; certainly if her face weren’t so ruddied from the cold outside – or perhaps from nerves – she could pass for pretty. Her hair fell in natural kinks down to her shoulders, and was a blonde so dark it looked devoid of colour entirely, a grey mass that had resigned itself to sit on her head without attracting attention. Her whole look was designed to elicit the least amount of interest, it seemed.
‘My name is Dr Karen Browning. I don’t know if you’ve seen other psychiatrists, but here we like our clients to be comfortable. So I’d like you to call me Karen, though if you don’t want to, that’s fine. Similarly I’d like to call you Jessica, but if you’d prefer Miss, Mrs or Ms Hamilton, I’m fine with that too.’
She threw Jessica a wide smile, hoping to put her at ease. She sympathised with all of her patients; this had to be a daunting experience for them the first time around, sharing their fears and perceived shortcomings with someone who had no reason to care other than the money they were paying them. That was one of the reasons why she tried to look as approachable as possible: no designer labels on her suits like some of the other psychiatrists, no severe bun on the top of her head and no diamonds the size of the Blarney Stone – not that the last one was her choice.
Jessica nodded at the standard spiel as though she’d heard something profound, but gave no indication of what she’d like to be called.
‘Can I get you a drink?’
She shook her head almost imperceptibly. Karen got up, poured herself a glass