Articles

Please note that these patients have given their prior consent to have these accounts published.


Clinical vignette:
Empathic Resonance Without Words:

In my early years as a therapist I learned a great lesson from a patient suffering post-traumatic stress disorder. It demonstrated the profound difference for her between my initial verbal insights using words, and the eventual experience of  our being together without words.

The patient was a recently widowed Holocaust survivor who I recognized I could not substantially help unless I was able to touch her in a horribly grievous place where she resided yet felt totally alone.  Before me she had worked with a number of experienced therapists, often finding them 'helpful', but ultimately feeling unsubstantially changed. 

I found interpretation to be ineffective, regardless of how potentially accurate or apparently empathic, and my thoughts sometimes even seemed ludicrous in lieu of the profundity of her unanswerable existential questions, such as, “Where will you be at 3 A.M. tonight when I awaken in terror from my nightmares?”  Such repeated interactions led me to feel I had nothing useful to say, and I sometimes feared I might have nothing to offer at all. How could I reach her when she was so far away behind such thick walls? I could never do so from the outside-in. After so many false starts, I could easily become yet another failure to her and even lead her to a deeper despair that help could be possible. 

While imagining this in session  I saw that could not help my patient. Not the way I had been trained. It was a bitter moment of abject humility and defeat.

Something in me let go. What happened next was a spike of horror as I registered in my own body the magnitude of grief  she surely was feeling in hers.

Once I was able to catch all this, I was able to say to her, “ With your permission, I am going to do all I can to meet you as close as I can to that lonely place where you live. But if I do this, I can't be sure I'll be able to  restrain my tears. Neither of us can know beforehand what’s going to happen, but I want to alert you because I sense it's possible. And if I do, I want you to know now that you needn’t be scared, I will be okay. I am choosing to do this with you, in order to be closer with you. I believe I know something of these waters; at times I have been at least very near before. I know how to get in, but I also know how to get back.”  She agreed.
 
The remaining forty minutes of the session were spent without words in complete silence together, sometimes crying, sometimes thinking, sometimes looking at each other, sometimes each being alone in each other’s presence. But opening to each other.
In the next session, according to her, for the first time with other than her deceased husband, she said she felt safe to depend upon another human being. Being in the room was now different together. We were together more.
 
The patient later reported a dream in which she was running towards her mother, who kept rushing ahead of her, always out of reach. She struggled to reach her mother, but could not catch her. She could never see her face, only her back. The patient felt terribly sad and forlorn. She was perplexed, she said, because she could not remember having had any feelings towards her mother in many years, and had not dreamed of her in as long. Why was she suddenly thinking of her now? She despaired that it ended only in the same old story of disappointment and aloneness.
 
I understood the dream as reflecting, however sadly, a great achievement. That somehow, after a lifetime largely spent feeling she was without a mother in the midst of fear, or feeling so forsaken as to have given up any effort to find her, she was now risking rejoining life. She reunited with her dream, to find her mother, her source of protection and comfort, and was struggling to make her way to her. The fact that she does not reach her mother right now is perhaps not as important as the fact that she pursues her and has not given up on her dream. So long as this effort is continued, hope is resurrected and life can have meaning. Hereupon the patient became very moved and said she was aware of how I had not given up on her and that she was grateful for this effort. Perhaps it was an effort we each needed to make.

Thereafter, over many months, she let me closer and became more and more able to turn to me for comfort and soothing. The despair and terrors eased.
 
I am of the opinion that my first feeling, and only then sharing, an experiential state with the patient helped inspire her dream. Once we shared  that place, the interpretation of the dream may help her to KEEP the dream as a guiding light towards it.
 
GIFT TO A PSYCHOTHERAPIST

One of the greatest gifts I've ever been given was from a patient during our final session of psychotherapy at the conclusion of an intensive treatment which occurred over nine years .

A few years into treatment, as she was uncovering many traumatic experiences she had carried from the past, the patient fell into a deep depression. One day she told me had a gun. She refused to give it to me, and refused to agree to call me before ever trying to hurt herself. She said that the pain was so great, she couldn't allow herself to abandon the option of suicide as a way out. She added, "I do not want to go into the hospital. If you involuntarily hospitalize me, I'll get out in 72 hours. But then I'd be in even more danger of killing myself, because I'd be back to the same suffering. And my trust in you would be broken, and I'd never see you again. And then I'd be more alone than ever, and even more likely to kill myself."

At the end of the session she posed to me the question, "So what happens now?"

What could I say?
​At such a dangerous moment something told me I had to answer in the most authentic way I could. "I guess we're each in the same boat, you and I--we have to trust each OTHER. For myself, I have to trust that if I let you exit that door, that tomorrow you'll come back. For you, you have to trust that if you come back, I'll be here for you step-by-step for whatever is ahead.

I didn't sleep well that night. Perhaps most in my position would have hospitalized her in siding with the effort to preserve immediate life. But in this particular instance I had to also weigh that perhaps her greatest hope for a future life lied in preserving our relationship. Because it was the strongest thing she had.

The next day I opened my waiting room door...and she was there!
She reported that that night she'd put the gun towards and away from her head many times. But time and again what kept her from pulling the trigger was the same thought: that I'd put in her my trust.  She couldn't do that to me.

Over the next two years she'd call my message machine and  just listen to the recorded message of my voice up to 15 times per day. Sometimes during the week I would find her sitting in my office when she had no appointment. The first such time she meekly asked, "Would it be ok if, I sometimes come and sit here quietly when things are really hard? It really helps."
I replied, "Of course. I am glad you feel you have somewhere in this world where you can feel at home." She said, "This IS my home! I've never had one before."

After 9 years we jointly agreed she was ready to finish therapy. In that final session she told me,
"The greatest gift you ever gave me came not from anything you had ever actually said. But as a result of all we have gone through together over all this time, for the first time in my life I now know that I EXIST. I couldn't have sought this when I began treatment, because back then I didn't even know it was possible to exist. But now that I know, nobody can ever take this away from me."

​"Since this is our last meeting I feel there's something you deserve to know. Remember the day when I wanted to kill myself and wouldn't give you my gun? Had I told you this then, you would have hospitalized me for sure.

You couldn't have known, but at that time the kids weren't with their father--they were staying with me.
​Back when I was suicidal, in my crazy thinking, knowing that I might have to die, that I couldn't take it anymore-- and knowing what my suicide would do to them-- out of love, in order to spare them--I knew I had to kill them first.
So they will never know this. I will never tell them. But on their behalf, I thank you.
​Because on that day, you saved not only one life. You saved three."