The day before my fiftieth birthday, my husband Lou announced to me that he was shopping for a new high-definition, wide screen TV. Since we already had a huge one in our basement, I viewed his need to have another for the family room as silly and redundant. However, I was familiar with his love of technological toys, and appreciative of the fact that he was planning my upcoming party, and so I curtailed my judgments.
On the very next day, the day of the party, a man arrived at our house carrying a huge box. My husband had neglected to mention to me that the TV was coming that day, or that it was way too big to fit on our built-in shelving unit. As they were erecting a makeshift stand in the middle of our family room, I protested that this should be “my day” and suggested that we store this new TV in the basement until after the party. My husband dismissed my aesthetic concerns and proceeded to direct the cable hookup. So, I once again let it go in an effort to hold onto the sweet mood I wanted to be in for my celebration.
Imagine my surprise when six hours later, my husband assembled all of our guests in the family room and proceeded to turn on our new TV to show a video “documentary” of my life! Tributes from my parents, brothers, friends far and wide, and unforgettable interviews with my children and my loving spouse flashed before me. Once I recovered from the shock of it all, I felt that this was the single most wonderful gift I would ever receive. This experience underlined some life lessons about loving that seem to require my ongoing efforts.
I originally decided to become a therapist when, at age eight, I had a knack for understanding relational problems and responding to pain within my family. Fifteen years later, I, along with my peers, studied texts and diagnostic manuals which described a plethora of emotional problems. We absorbed course upon course concerned with treating and ameliorating these problems. Through supervision, we learned that responding to the emotional pain of others required us to address our own expression of difficult emotions including fear, anger, and sadness. However, ultimately, I have found that what is most precious about the treating relationship has to do with our learning to value and pay tribute to the amazing strengths of our patients, so that they can learn to better express their love in their own lives.
When I was 28 years old and beginning to practice, I lost one of my first patients to a deadly case of melanoma. I was a staff psychologist on an eating disorder unit, and Barbara was 25 years old, just three years my junior. When I met her, she first struck me as a mannequin; a beautifully coiffed, redheaded waif with a demure smile. Barbara hated to emote or cry, causing our initial therapy sessions in the hospital to be rather stilted. I have a vague memory of inquiring about her sadness while she stared me down with her fixed half-smile. Once she left the hospital, we worked together for three years. I was still in my neophyte stage of professional private practice; so at that point it was expected that, as a therapist, I would learn at least as much from my patient as she would learn from me.
Well Barbara did not disappoint as my teacher. She first worked toward recovering from her eating disorder at breakneck speed. She exerted an executive decision over her compulsions and yielded to her body’s need to gain over ten pounds in the interest of her long-term recovery. This was no small feat for her since she hated any sign of curviness, and it was also inspirational to the rather vain young woman therapist who was “helping” her.
Although Barbara was watchful of each additional pound, she was able to redirect some of her energy to her relationships with her parents and her boyfriend. Early on Barbara told her mother that she would not be eating at home, since her mother had routinely argued about food choices. When her mother had protested, Barbara announced that her decision was final unless and until her mother could control her dietary commentary; her mother promised to be quiet. I also recall Barbara explaining to her father that, contrary to his expectations, she had decided to transfer to a fashion design school and to discontinue her MBA program. She then had the wherewithal to ask for his reactions to her choice, and allowed him to describe all of his doubts. Not only was Barbara risking difficult conversations and individuating from her parents in ways that I would still need to face over my next decade, but she was also allowing herself to open up in her burgeoning relationship with her boyfriend. I was in awe of her ability to speak her feelings and wishes after spending her first twenty-five years mummified as a supreme “good girl.” I was also impressed by her parents’ tolerant responses. They were allowing her to grow up, even if it meant enduring their own temporarily hurt and disappointed feelings.
Unfortunately, a tumor protruded on Barbara’s thigh with a vengeance, and within 14 months she was gone. But Barbara did not stop her growth in order to prepare for death. In fact, she deepened her involvements, continuing to express both positive and painful feelings; thus allowing herself to become more attached. In our final sessions together, Barbara wept about the failure of her chemotherapy treatment as well as her too brief experiences with falling in love. Outwardly, I concentrated on providing comfort; but secretly, I was unnerved and amazed by her willingness to allow me to see both her anguish and her appreciation of all that she had gained in her life.
Weeks after Barbara’s death, her mother came to see me, and spent some time recounting her daughter’s last days in the hospital. She described Barbara lying peacefully amidst her sisters, cousins and parents; and aided by morphine, dreamily discussing imagined and past journeys with them. In painting a picture of her daughter surrounded and held close by her family for days, Barbara’s mother was in effect giving me an incredible visualization, which I was to tuck away for the distant future.
Months passed and I continued to think of Barbara. I took some time to write a long letter to her parents to enumerate all of the lessons I had learned while working with their daughter. Retrospectively, I gave the parents credit for managing their frustrations with Barbara’s tendency toward stoicism, and I shared my many appreciations of Barbara’s unfolding honesty and risk-taking. Years later, Barbara’s mother would write to me near the anniversary of her daughter’s death to let me know how much she’d valued having this letter.
This experience taught me that I wanted to focus more on expressing positive sentiments as well as negative ones in the course of the treatment relationship. I sensed that as a therapist I was too often embarrassed to feel love and admiration for my patients, and that this had inhibited me from conveying more appreciation to them. So, I was now more primed to learn from my patients and to take opportunities to share my positive feelings toward them throughout the work.
As I have enjoyed a few decades of “practicing,” my patients have continued to help me. Like friends and loved ones, my patients at times teach through negative examples. I liken these lessons to those that the Little Berenstein Bear learns from his Papa Bear in the Berenstein Bear children’s books. Papa Bear for instance teaches his son to ride a bike, and then Papa gets hung up in a tree and stranded in the middle of a lake. The Papa’s refrain goes something like: “This is how I’m teaching you; this is what you must NEVER do!” Because our patients’ stories exist apart from ourselves, and we have the benefit of perspective (and some professional training), we can spot their problematic responses. When we take the opportunity to learn from others’ mistakes and character defects, we can also credit them for teaching us. For example, this week, to an overprotective mother, I stated, “I have been thinking about your calls to your son every night, and it has helped me to realize how insecure that could make me feel if I were your son; and so I have learned something here… I am thinking that I will be less inclined to hover even though I may want to.”
Since I am lucky enough to have a practice filled with many wise patients, more frequently, they teach through positive example. Even when thoroughly bollixed in some areas of their lives, I often glean something about a positive aspect. For instance, also this week, I saw an older man who was enumerating the ways in which he’d felt eclipsed and controlled by his wife for years. He explained that he grew to be emotionally detached and resentful—prior to having the affair which devastated his wife and his marriage. As a therapist, I am well trained to help him to see the destructive impact of his “acting out.” However as I listen, I am also able to witness the articulate manner in which he currently speaks to me, and potentially also to his wife, about his needs and his desire to change their chronic power imbalance. My acknowledgment may encourage him to communicate in more constructive and self-respecting ways. In turn, this encounter serves to remind me that when I am upset by something in my own relationship, I will need to bring up difficult feelings once again, even when it means that I must disturb the peace.
Just as it may be difficult to share negative feelings, it is not always easy for me to find ways of conveying appreciation and admiration in therapeutic relationships. While in my “real” life, I may punctuate phone calls and emails to those close to me by saying “I love you,” I know that it is generally frowned upon for therapists to pronounce their love to their patients. Dick Felder, my first supervisor, used to say that: “Patients enter therapy asking the therapist to tell them that they are lovable (“love” is an adjective), and they leave therapy asking how they can love others better.” In essence “love” becomes a verb, and their realization is that learning to give one’s love in life is of primary signigicance. So, even if I did regularly proclaim my love to my patients, it would not necessarily teach them the importance of investing in being more loving. I accomplish my goal with patients more through creating space for speaking to their strengths and by giving them credit for affecting me. By valuing, appreciating and admiring them, I in effect role-model a loving stance.
In session, if I catch myself in the midst of positive feeling with a patient, and if I sense that this person has the capacity to receive, I may be in a good position to state it plainly: I am touched…, I am amazed…, I am envious… I am impressed. However, my tributes need not be self-referenced or self-revelatory. For instance in a group, I may tell a couple that their way of using humor in the face of their crisis is wonderful. Or I may credit a father with being a great dad when he commiserates with his son who fails to make the soccer team. Or I may label a teenager’s expression of anger as courageous; and I need not explicitly add the reference “to me.” Nor do I need to explicitly add that “you are teaching me by example.” My main focus here is not to shape and reinforce their behaviors; rather I aim to exploit what we therapists call positive counter-transference responses by valuing my patients’ genuine self-expressions in the work.
I reject our profession’s relative inattention toward exploring the pleasurable and admirable and positive aspects of experience. I also reject our profession’s prohibition on the therapist deriving benefit from the treatment. In fact, I believe that as the therapist enjoys and acknowledges learning from the patient, the patient in turn will learn to receive and will also develop a greater capacity for expressing love.
The fact that I “accentuate the positive” does not mean that I wish to “eliminate the negative.” I realize the ways in which disappointments are inextricably connected to love and inevitable in close relationships. As a therapist, I am used to “painting myself a target,” and inviting a fuller expression of complaint toward me when I believe that it is implied or being muffled. But I view these expressions of negative emotions in the context of intimate relationships as ultimately most valuable when they are employed in the conscious service of making a path for a better relationship. In particular, I seek to help people make distinctions between venting—through a tantrum or whine or attack—and more effective articulations of anger and hurt which are aimed at communicating and resolving something with the significant other.
My early contact with Barbara led to work with other cancer patients, family members of cancer patients, and therapists who work with these populations. Through this work, it has become clear to me that facilitating the expression of genuine loving feelings is of the utmost importance in preventing haunting ruminations among family members and therapists alike. In cases involving divorce, termination, and death, I have rarely met someone who regretted not taking the opportunity to elaborate more upon their anger at the point of separation. That is what a good therapist is for after the fact.
I lost a patient to a premature death; but it was impactful to have had this experience in the beginning of my adult life. I have learned to share admiring and appreciative feelings with my patients (and my loved ones) early and often, and to speak of the benefits I have derived during our time together. I no longer view such revelations as breaking with the role of the therapist. And as I have gotten more comfortable with receiving lessons from my patients and expressing the varieties of my appreciation, I have found that I have fewer lingering regrets when patients leave my practice. I try to be current with my tributes toward the people I am with. It is better to know one is loved and admired when one is ten, twenty, thirty, forty, fifty years old than to feel esteemed only at the end of life. This way, when our relationship ends, I find that I have much satisfaction and little to amend.