There is a dilemma at the heart of Susie Orbach. This caring, intelligent, kind woman has become a household name not because of her ground-breaking work as a psychotherapist, specifically with eating disorders and women's issues, but because of a high profile patient and the belief that it was Orbach's influence which gave Princess Diana the courage to change her life via the Panorama programme.
Diana's name doesn't feature on the cover of Orbach's new book, The Impossibility of Sex. Yet the press release and the information sent to booksellers makes the connection loud and clear. In the ordinary way of things a therapist spilling the beans about the therapeutic experience would interest a minority of people, one suspects. Orbach herself imagines her readers as being "people who are educated and who are interested", like the Guardian readers who have read her column over the years. Yet, as the publisher well knows, Orbach's By Appointment role changes everything. And although she insists that the people whose case histories she lays before the reader are wholly invented the ghost of the bulimic princess hovers above every page.
The Impossibility of Sex is a difficult book to categorise. At the core are six invented "stories". Each began, Orbach explains, as a counter-stereotype - a black man with eating problems, a lesbian relationship on the rocks, a violent woman - characters who, in true fiction-writing tradition (and Orbach breaks into a rare laugh as she admits this), soon took on lives of their own.
Their case histories ended up following trajectories that Orbach neither anticipated nor, necessarily, knew how to deal with. The result is a narrative of adrenaline-fuelled immediacy which mirrors, she believes, the roller-coaster of breakthrough and stalemate that happens in the consulting room.
The area Orbach wanted to explore was counter transference. Transference - therapy-speak for the way patients latch on to their therapist - is generally understood even by those who have never been personally involved with psychoanalysis, but it came as a surprise to me, not to say a shock, to discover that therapists themselves can become as hooked into the psychodrama played out in the consulting room as their clients. Freed from the constraints of patient confidentiality by her fictionalised "patients-on-the-page", Orbach presents an extraordinary picture of the therapist at work, mind and body. She writes bravely and what comes shining through is the risk, the balancing act that each party to the therapy is involved in whether they know it or not.
"I knew I wanted to write about counter transference which is the therapist's response. There is a fascination about psychotherapy and psychoanalysis, and I wanted to counter the notion that the therapist isn't doing anything."
The intensity of Orbach's imagined experience and response to these invented patients is certainly compelling and, from my perspective, emotionally draining. For once the title is not just a publisher's come-on; sex plays an important part in all but one of Orbach's stories. In the first, that of Adam, a serial philanderer, his determination to seduce the therapist succeeds, at least psychically: "I went into the shower and as I let the water run on my body I felt with pleasure its silkiness, the sensual flow of the water's pulse from the showerhead onto my body. All at once an image of an enormous showerhead in a Claridges bathroom I had glimpsed years before melded into an image of Adam and me making love."
Every so often the narrative breaks off to explain the theory behind a particular situation, and these sections act as emotional breakwaters for the reader in a way that a debriefing supervision with a colleague would for the therapist in real life.
We meet in a Hampstead restaurant for lunch. Although Orbach lives not far away, she understandably has no wish for journalists to cross the threshold that became so famous during the Diana days. Even three years later the memory of her own hounding by the press makes Orbach tense every muscle. ("It was ludicrous. It's one thing to have that kind of publicity when your work comes out but that was completely unacceptable.") And at any mention of Diana's name, even in the most innocent context, Orbach flinches. Her hazel eyes, set close together under a mop of dark springy hair, go dead.
Orbach entered the world of psychotherapy when she was in her late twenties. At university in New York she studied, first, Russian history, then city planning, then the law. But it was as a compulsive overeater that she eventually went into therapy. However, her decision to become a therapist was not simply an emotional response. "It wasn't `God I'm crazy, I've got help, now I've got to help others'," she believes. "There were three hooks. First, it was the late '60s and I was really interested in women's liberation. Secondly, I didn't feel that economic arguments explained sufficiently why women allowed themselves to be so downtrodden. So I needed a theory to understand that. And the third hook was that I had done all this work on women's eating problems, because I'd had a compulsive eating problem myself. Nothing major, but it made me think a lot about women and eating. It was that moment in history when everything was being rethought and there wasn't anybody specifically addressing the issues that women were bringing to therapy, which is what I was interested in, so a lot of us were part of creating a new theory," theories that Orbach has since written about with Luise Eichenbaum with whom she set up the Women's Therapy Centre in north London.
It is easy to see the appeal of this poacher turned gamekeeper for any woman with an eating disorder, princess or no. These days the author of the seminal Fat Is A Female Issue presents a slight and elegant figure and looks younger than her 52 years.
Sandwiching the six case histories are three explanatory chapters (one pre, two post) which provide a supporting framework to the fictional filling. As well as a fascinating look at women's eroticism (or more accurately their lack of it), the closing chapters include a defence against the negative response she anticipates from fellow practitioners who, she believes, will not take kindly to her opening the shutters on their arcane world. Although she insists that her experience of counter transference is shared by many other therapists, her bare-all approach will undoubtedly cause hackles to rise, if only because of the verging-on-purple language.
She is unrepentant. "I suppose in the spirit of what we have in therapy is the possibility of stretching the understanding and thinking and bringing those ideas into the outside world. Therapy is not a spectator sport."
The Impossibility of Sex by Susie Orbach is published by Allen Lane The Penguin Press at £17.99 in the UK