On a bright Thursday morning at 11 a.m. I walked out to greet my new patient, Sophie, only to find the waiting room adjacent to my home office empty. Leaving the door ajar, I returned to my consulting room to wait.
After a few minutes a loud knock came from the front door of my home, some 200 feet away from my office entrance.
Might this be my new patient? This seemed unlikely because in my phone conversation with Sophie I had been careful to explain how to find my office, which is well marked and generally easy to access. Rarely do patients have trouble finding it.
Sophie was an exception.
I ran down my office stairs, across the house, and opened my front door. Greeting Sophie, I gently explained that my office door was to the right of the house. Stepping outside to point her in the right direction, I let her know I would meet her there.
I returned to my office, once again awaiting her arrival -- still no Sophie.
Puzzled, I walked outside to see where she had landed this time. That's when I heard banging coming from somewhere far off. I followed the knocking sound around the back of my house to the patio door. There stood Sophie.
This time I escorted her to my office door, a door that she had passed moments earlier on her way to the backyard.
What did this all mean? Why couldn't Sophie find the way in?
Years of experience as a therapist have taught me to sit patiently with all my questions. I have learned that to do my job well I must allow my interaction with patients, my understanding of them, to unfold without preconceptions. If I leap too quickly to nail down the meaning of any therapeutic interaction I flatten the story, flatten the experience of my patients and flatten my understanding.
My work as a therapist mimics the way I approach my work as a writer of personal essays and memoir. In both, my job is to wait, be patient, listen to the voices within, and find the story.
So it was with Sophie who came to see me seeking relief from a dysthymia -- a lifelong, chronic sadness -- and so it is when I sit down to write -- allowing the story to naturally unfold, not trying to reach a hasty resolution.
As a therapist, how do I help a patient deepen the story?
I do this first by listening. I can't be formulaic. When I hear a patient's history and then leap to think, 'oh, yes, clearly this explains that...or ...that," I am robbing the individual and the treatment of all its richness, complexity and maybe even its truth. While of course theory informs my thinking, once in the consulting room I need to put aside these theories and instead, invite my patients' curiosity and their own exploration of their inner landscape, searching for ways to connect more deeply with their experience--not prematurely imposing my view of the terrain.
Change can only happen if both my patient and I alike are open to the unplanned and unpredictable moment, allowing ourselves to wind up in places we never expected when we began the journey. And like a good story, relishing the many twists and turns along the way.
In both writing and therapy I am working towards a richness of language. I do this by gathering up bits and pieces of memories, fantasies, associations, pains, passions, and dreams -- my own if I am writing, my own and my patients' when I am in the treatment room. It's rarely as simple as naming a feeling. Just like a great sentence, the language of a good interpretation needs to be precise, but also surprising, created in a way that will touch or resonate with the other. Without a meaningful experience in the moment, or a story to accompany the feeling, there is no real contact -- the story goes dead.
A dull story is comprised of sentences like, "Louise walked down the street feeling lonely." We learn nothing of Louise's unique experience--what she sees, feels or remembers as she walks down that particular street.
What if I had said to Sophie that first meeting, "Why do you think you had trouble finding my door?" or "What were you feeling when you couldn't find my door?"
She may have answered, "I was anxious." Or possibly a bit more defensively, "I don't know why. I just couldn't find the right door." Or worse yet, in her distress, she may have felt ashamed and decided not to return, with no opportunity for us to become collaborators or co-writers on a shared journey.
In these imagined exchanges between Sophie and me there is no moment of surprise or true engagement. We don't learn anything new about Sophie, nor do we gain access to the subtlety of her feeling in what had occurred that day. I doubt it would have led to any new memories or fantasies. Rather than bringing us in closer contact, it may only have made our work more difficult.
Sitting with Sophie at our first meeting, I said nothing about why she couldn't find her way in, other than acknowledging that it was an ordeal. I understood that neither of us could yet know what this moment meant. Instead I waited.
Several sessions later, Sophie arrived saying, "I hate walking into the lounge at work. When I went in today there were several people sitting together talking. I felt like an alien." She continued describing her loneliness, despair and isolation.
"An alien?" I asked.
"An alien" she answered repeating the word. "You know it's funny, but I remember being a kid on the playground. I always wanted to join in with the other girls who were playing, but I never knew how. I'd either stand back or barge right in. I could never find the right way in. The more nervous I was, the more awkward I would be. So instead I just went off by myself. In my head I would play this game, where I pretended I was an alien from Mars, that I landed on Earth to observe these humans." She continued, "I acted like I didn't care, or that I didn't want to play. But really I had no idea how to make a connection."
I paused before answering. "The way you describe trying to make friends, but not knowing how to find your way in, feeling like an alien, reminds me of our first meeting when you couldn't find your way in to see me."
Sophie began to cry.
After a few moments she said, "That's exactly right. I was so anxious coming here that day. I can't even tell you how bad it was, I couldn't think straight. It was so awful. I felt so crazy. Even when you showed me the side door, I was confused...you probably thought I was some kind of alien." She laughed without constraint.
Here was a moment of meaning for both Sophie and me: In our interaction we had discovered something previously unformed, not understood, and turned it into something that we could explore together. For Sophie this alien image crystallized her experience and provided a bridge, helping her to express what had been unformed, bringing the story to life.
I invited her to tell me more about these aliens.
She paused a moment and then responded with..., "ET...the movie ET just popped in my head." She shared more about her childhood fantasy that there was another home, far away, where she could return to and feel safe.
In this way Sophie had opened the door, stepped over the threshold and our journey could begin.
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