empathy and the basics yet again

I’ve written a few times about the dangers of thinking you know what’s wrong with you; see this entry, also this one and this one from the main website.  Here’s a fun moment from a session which shows how this very common assumption that you know what’s wrong with you can mess up your life, blinding you to what’s right in front of your face.

Terry had been seeing me for a couple of years when he came in one day saying that he had been feeling more relaxed in recent months, was not so inhibited around other people, was quarreling less with his wife, and had been able to get out and enjoy his financial successes without such obsessing and worry.  But, he continued, for the past couple of weeks he had not been sleeping well and in particular he seemed to be developing restless leg syndrome despite his young age.  As he described all this and began to tell me about a recent experience with his wife, I found myself getting very sleepy and at the same time agitated.  As he started talking about feeling like he wants to “jump out of my skin” during some recent disagreements with his wife I realized that that was what I was feeling as I listened to him.

At this point I interrupted to ask about some details of these arguments and, just as the textbooks would predict, it turns out that there was a lot more agitation and anger lurking under his presentation.  He described in more detail what went on between him and his wife and became clear that, for all of his efforts to be accommodating his wife was being quite impatient with him.

Add to this what I had learned about Terry during our work together.  He always presented with timidity, almost exaggerated deference, and with the complaint of being scared.  He focused particularly over the years on his fear of being fired or disciplined at work.  Yet upon inquiry it always became clear that not only was he in no danger of being fired or disciplined, not only did he receive regular bonuses, verbal praise, referrals for more and more complex work, but in fact he never even behaved at work as if he was so afraid.  Whenever I dug into the stories he told me, it was clear that he was quite assertive on the job, set limits when needed, and even snapped at people on occasion.  So we already have a history of him presenting himself to me – and to himself – as tiptoeing on egg shells, as oh so fearful of being at all assertive, yet underneath quite able to identify when he is being pushed around and to become appropriately angry about it.  Well, that anger at his wife wasn’t so easy to vent and it was keeping him up at night.

As soon as this anger began to emerge in our discussion, Terry lapsed into that refrain of denial that is so common in psychotherapy.  He started to object “I know she’s being irrational and her impatience is unreasonable.  She’s always like that when she’s stressed.   I’m used to it.”  As we talked, however, he noticed that he felt looser, clearer, and freer as we spoke, as well as angrier about his wife’s recent behavior.  He suddenly “remembered” her reaction in the middle of the night when his restlessness awakened them both.  He apologized and moved to the sofa; his wife was irritated, complaining, even accusing.  Expressing some surprise he said “I never noticed it, but she never asks me what’s wrong, never shows any kind of sympathy.  Wow” he added, “That stinks!”  Suddenly he sat up and acknowledged just how pissed off he was.

By the end of the session, Terry felt much better, his speech was not so monotonous, he was looking forward to dinner with his wife, the weekend activities with some friends, and even work.  All of this is in contrast with his tense demeanor and monotonous speech at the start of the session even though the content of his words were at first how things were in general improving.  Moreover, he came in two weeks later and described a new and sustained good mood since that session – shutting down petty objections at work without so much second guessing and worrying, giving himself little pleasures instead of his usual pattern of staying home and fussing, and overall feeling “lighter”.

And as the fringe benefit to me, all of my sleepiness and agitation during the session evaporated as well.  This is always fun in psychotherapy and the phenomenon is called empathy.  A patient tells a story but is not connected to the affect of it.  If patient and therapist are well-connected, the therapist may experience the feelings that the patient is avoiding.  I’ve had sessions where I’ll be listening to a patient and despite the surface calm of the moment find myself enraged, deeply depressed and empty, giddy, hostile and snippy, silly, deeply afraid, and much more.  If the session is successful, and if of course the patient is ready for this kind of work, the therapist can return those feelings to their source – to the patient.  The result is that both of us feel better and the patient is functioning better.

One last thought.  People ask me sometimes “how can you listen to people’s problems all day?”  These moments of empathy are part of what make it fun, rewarding, even exciting.  Don’t forget, Terry told a fairly mild story.  I have moments of empathy with patients describing much more horrific experiences, struggling with much more intense and unwieldy emotion.  It can be quite a ride.

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