‘So the patient you’ll be meeting today is fairly typical of patients with the condition I have diagnosed. There are some interesting idiosyncrasies to this particular patient though, but I will not be providing any spoilers for you.’

The group of students chuckled. They were gathered in Dr. Ambrose's office.

‘Your time with the patient will be broken down into two one-hour group sessions - and then an individual interview. My expectations at the completion of this study will be for you to provide a high level diagnosis of the patient’s condition, as well as the recommended treatment plan. Any questions?’

A young woman put her hand up.

‘Yes Laura?’

‘Is there anything else you can tell us about the patient?’

‘Yes - the patient is a 29-year-old male. His employment history is sporadic, and involved mostly manual labor. A single child - mother deceased, and no relationship with the father. One previous period of psychiatric care for manic bi-polar disorder. Currently being administered 50mg of thorazine daily, down from a peak of 200mg daily.’

The students were all scribbling in their notebooks.

‘I think that is all you need to know. Shall we?’

They left Dr. Ambrose’s office and were led to a room where he was waiting. He was sitting in a chair, and there were six other chairs in a semi-circle opposite where he was sitting. Dr. Ambrose led the students into the room - there were four male students and two female students.

‘I will be present for this group session - but I will not play any part in it other than to deal with any issues, shall we say, that might pop up. Now the rules of this session are quite simple - the patient will answer all questions they are presented with, but only those questions. The patient will not volunteer information beyond answering the question that has been asked. Does everyone understand?’

The man nodded, and the students said they understood.

‘Well - I will let you get on with things. And time starts….now!’

He looked at the students - their bright and inquisitive faces. The young woman - Laura - smiled at him.

‘If it is alright with everyone - do you mind if I ask the first question?’ - Said a young man wearing a blue buttoned down shirt.

The students all murmured agreement.

‘Okay - so I think the first question is this. Did you have a happy childhood?’

####

An hour passed, and the students left the room as they were checking their notes. The man was led away by an orderly.

‘Okay - well done everyone’ - said Dr. Ambrose - ‘I will see you all in class next Monday, and back here next Thursday.’

The students all thanked Dr. Ambrose and started leaving.

‘Laura - might I have a word before you leave?’

Dr. Ambrose waited until the other students were out of earshot in the corridor - ‘I was wondering if you might be available for me to see you this evening.’

Laura smiled at Dr. Ambrose.

‘Of course, Dr. Ambrose.’

Dr. Ambrose looked up and down the corridor - ‘And at what time should I arrive?’

‘Anytime after six.’

Dr. Ambrose smiled - ‘I’ll tell my wife that I have to work late.’

Laura smiled at him.

‘Thank you Laura...’ - said Dr. Ambrose loudly - ‘Just remember to make sure that you keep your summary clear and concise.’

‘Thank you Dr. Ambrose’ - said Laura, who winked and then walked down the corridor.

####

Dr. Ambrose was naked and sleeping on the bed. She had been lying next to him, and when she was sure that he was asleep, she climbed out of bed and walked across the room. She lived in a room she rented in a shitty part of town. The room was tatty and drab, with sheets hanging as curtains and was decorated with a bed, an old armchair from a thrift store, and a desk and chair she had found left on the sidewalk.

Dr. Ambrose’s briefcase was laying on the armchair. She glanced over at him, and heard him snore a little. She unclipped the briefcase and lifted out the pile of folders inside of it. She flicked through the folders until she found the one she wanted. She slipped the other files back into the briefcase, and then laid the file on the desk. She picked up her phone and opened the folder, photographing each of the pages. Once she had photographed all of the pages, she slipped the file back into the briefcase and gently clipped it back together. She went back to the bed and laid down beside Dr. Ambrose. She put an arm over the doctor, kissing his cheek.

‘Dr. Ambrose….’ - she said gently into his ear.

He stirred and woke up - ‘What time is it?’

He looked at his watch, and then climbed out of the bed, looking for his underwear.

She lay on the bed naked and smiled at him as he looked for his socks.

‘I am very sorry to have to run like this’ - he said as he pulled on his trousers - ‘But my wife is cooking beef bourguignon with parmesan dumplings, and she gets quite upset if I am late, as the dumplings become soggy.’

‘Sounds lovely’ - she said.

He was buttoning his shirt - ‘Yes, my wife studied cooking at Le Cordon Bleu, in Paris. Her beef bourguignon is truly something to savor!’

He was tying his bow tie.

‘You better hurry - or your dumplings will get soggy.’

‘Quite’ - he said as he pulled on his jacket and walked to the armchair, sitting down to put his shoes on.

‘Before I leave...’ - he said - ‘I just want to remind you of the nature of this…’

‘This?’

He stood and looked at himself in the mirror, flattening his hair as much as he could.

‘Yes “this” - he said - ‘This is a transactional relationship Laura - where you get what you want, and I get what I want. It is nothing more than that.’

She smiled at him - ‘And what do I get out of it again, Jeremy?’

He was still looking at himself in the mirror, and straightening his bowtie - ‘I think it is better that you continue to call me Dr. Ambrose, so that we can remind ourselves of our relationship. In answer to your question - you get to satisfy your latent Electra Complex, and use me as a proxy for your father to spite your mother….’

He turned and picked up his briefcase - ‘I will see you in class on Monday!’

He turned and left the room. She walked to the window and pulled back the hanging sheet, watching the street outside. She saw Dr. Ambrose leave her building and get into his Mercedes coupe.

She walked to the desk and picked up her phone, flicking through the images she had taken.

####

The study had continued for another two weeks - and the group sessions had been completed. Laura was waiting in Dr. Ambrose’s office - with her note book open and ready.

Dr. Ambrose opened his office door and walked in. The patient was behind him. An orderly waited outside the office.

‘Make yourself comfortable on the chaise’ - he said to the patient - ‘How are you Laura?’

Laura smiled - ‘I am very well, Dr. Ambrose.’

‘That is wonderful - now today is the final session you will have with the patient, and the only one-on-one time allocated during the study, so use this time wisely.’

‘Yes doctor’ - said Laura.

Dr. Ambrose sat behind his desk - ‘Are you ready over there?’

‘Yes doctor’ - he said.

Dr. Ambrose smiled - ‘Then you may begin.’

Laura looked through her notes. Dr. Ambrose was reading through his unrelated notes and making new ones.

‘How are you today?’ - Laura asked.

Dr. Ambrose wasn’t paying attention.

‘Okay.’

Laura looked through her notes. There was a silent pause, and then - ‘Did your mother have sex with men for money?’

Dr. Ambrose looked up - a quizzical expression on his face. He looked at Laura and then the patient.

‘Yes. Yes she did.’

Laura looked through her notes again.

Dr. Ambrose stopped reading his notes and leaned back in his chair - now paying attention.

‘And was there an early encounter with your mother - when you were perhaps a teenage boy? A sexual encounter?’

‘Yes.’

‘And did this encounter involving your mother, result in you fantasizing about her, sexually?

‘Yes.’

More note checking from Laura - and Dr. Ambrose smiled behind her leaning back in his chair. Laura continued her interview - and by the end of it she had extracted from him all the information she needed. Laura thanked the patient and told Dr. Ambrose that she was finished. Dr. Ambrose looked at his watch and then stood. He walked to the door and told the orderly that the patient could return to the day room. He left with the orderly - but not before he smiled at Laura, and Laura smiled back.

Dr. Ambrose closed the office door and returned to his desk. He sat and looked at Laura with a serious look on his face.

‘I think, after witnessing that, that perhaps you have chosen the wrong profession, Laura.’

‘What do you mean, Dr. Ambrose?’

‘I mean - that your detective skills are quite impressive.’

Laura smiled.

‘So - after all of that, what would your diagnosis of the patient be?’

Laura checked her notes - ‘I would suggest that the patient suffers from acute schizo-affective disorder. I would suggest that the indicators - depression, anxiety, delusions of grandeur, delusions of persecution - would suggest the creation of a delusional architecture over a prolonged period of time.’

‘And….?’

Laura checked her notes again - ‘Most likely the delusional architecture is anchored in the mother / son sexual encounter - the masturbation the patient described - with an escalating intensity of delusion.’

Dr. Ambrose smiled - ‘And would you hazard a guess to the “escalating intensity of delusion” you have mentioned?’

Laura shrugged - ‘Without more time with the patient, I would just be guessing. But the delusion most likely involved the patient becoming - in his mind - notorious or powerful in some way. And then some form of persecution - but this would be hard to say. Nearly all acute schizo-affective disorder patients go through this kind of crescendo building delusion.’

Dr. Ambrose smiled some more - ‘Very good Laura - I look forward to reading your paper of this study.’

‘Thank you Dr. Ambrose.’

‘Will you be available this evening for me to visit you? My wife is going to the theater with some friends.’

Laura stood and put her note in her bag - ‘Not this evening, I have plans.’

Dr. Ambrose smiled - ‘Another time then.’

Laura left the doctor’s office - and he returned to his notes.