Books: Down with the inscrutable automaton

It's bad enough that novelists get badgered by acquaintances who "recognise" their off-guard selves in the novelist's more unattractive characters. But for a therapist to offer imaginary case-histories is surely to risk the fax and answer-machine combusting. And if the laying of patients' personal problems on the table might seem to undermine the confidential nature of the patient-therapist relationship, what is one to make of a much more lightly fictionalised therapist ("how I imagine I would be in these situations" says the author) spilling her own innermost thoughts about the far from far-fetched therapy sessions?

But all this is what Susie Orbach - author of Fat is a Feminist Issue and, famously, therapist to the Princess of Wales - has done in her new book, The Impossibility of Sex. And, as confessional as the style is, there is no detectable breach of confidence or of the therapist's clinical authority.

Orbach, who originally trained as a lawyer, first became a therapist as a result of being "incredibly involved in women's liberation" at the end of the 1960s. She was, she says, "intellectually trying to understand why women who had the economic opportunity to change their circumstances, were unable to do so". She had also been "thinking a lot about women's eating problems". Having experienced such problems herself - "nothing serious" - she was concerned that they "didn't exist as a category of problem".

Years on, she exudes the confidence of experience, and the candour conveyed by the therapist in The Impossibility of Sex comes from a position of strength, not vulnerability. Her openness is that of a person in control, not of somebody naive or insecure.

If women's difficulties were the mainspring for her choice of career - she helped set up the Women's Therapy Centre a couple of decades ago - Orbach is far from the conventional image of the pioneering feminist. And, despite the external trappings - she trained in the United States, is Jewish, practises in Hampstead, where she lives with her partner and two children - she doesn't conform to the stereotype of the therapist, either. She is relaxed, friendly and good-humoured, willing to admit to confusion over big issues and able to laugh at herself in an unselfconscious way.

She says she wrote the new book in order to offer as deep an insight as possible into the therapeutic process without being bound by the constraints of the anonymous, documentary case-histories of the professional journals. She also seems bent on restoring to the therapist a measure of humanity. Her fictional counterpart certainly appears to have blood in her veins and is a long way from the inscrutable automaton of psychiatric folklore.

The patients (or clients, or analysands: she can't make up her mind which is the proper term) Susie Orbach has constructed for her book include "Belle", a compulsive liar; "Edgar", an overweight trade-union leader; "Joanna", a self-mutilator; "Jenny", an adopted child who, in adulthood, experiences the traumatic disillusion of meeting her real mother; a lesbian couple, "Maria" and "Carol"; and, most colourfully, "Adam", who has fallen off a long-running sexual escalator.

Each of them is treated with sympathetic understanding by the therapist/narrator, the technique appearing to involve coaxing or encouraging them into a position from which they can confront the implications of what is troubling them and move on. Sometimes the therapist's attachment is so strong that it goes, as Orbach somewhat dauntingly puts it, "far beyond empathy", so that she can feel herself becoming fat, flighty or frightened.

There is a kind of spontaneous wisdom in all this that may perhaps flow from the written invention of the situations rather than reflecting reality. It sounds almost too good to be true. In any event, it must require - in addition to the weight of experience which Orbach stresses - an enormous strength of mind and personality. Which, given the mushrooming of self- styled counselling and psychotherapy services over recent years, shows how hard it must be for the unsuspecting patient to find the right therapy and therapist.

Susie Orbach doesn't seem quite as worried as I am by this. "It must," she suggests, "be speaking to something in the culture. Am I concerned about regulation and training of therapists? Yes. It means we need more dissemination of information in the public sphere rather than less."

Talk of "the public sphere" prompts me to ask whether she felt moved to intervene, even with a private word in an editor's ear, to correct or impose a more accurate perspective upon some of the sensational stuff written about her best-known client (or patient, or analysand) after the Princess's death. "It has been a very difficult episode," she admits. "I can't even answer your question because to do so would, I think, be a breach of ethics. One is always protective towards anybody one has seen and one is not in a position to do anything except to keep one's mouth shut."

It is not only the rich or famous who seek Orbach's help. She tailors her fees to her clients, she says, and when I ask if that means that she sometimes will see a patient for nothing, she answers: "Of course." The sorting-out, getting-to-the-heart-of-things nature of her role is possibly a legacy from her parents. Her father was a campaigning, left-wing MP (he died in 1979, on the day Margaret Thatcher became Prime Minister) and her mother was an American who became an English teacher after giving up the idea of being a lawyer. Susie grew up in Chalk Farm, just down the road from her Belsize Park home and consulting room. In a sense, she has returned to her roots. And, unlike the cliche of the screwed-up therapist, she seems to have her own life sorted out. She certainly believes in what she does: "Therapy is one of the great intellectual disciplines of the 20th century, both culturally and clinically important. What happens in the therapeutic space is pretty profound and so of course it enriches my life." And while she accepts we can get a bit over-analytical in our culture, "we need to be thinking more, not less. Otherwise," she asks, "how are we to account for a century of industrialised killing?"

`The Impossibility of Sex' is published on Thursday by Allen Lane, pounds 17.99