The couple enters the consulting room. They are my last appointment on Saturday. I am tired having already seen eight patients, and I am ready to start my weekend.
As they sit down, the woman makes a reference to her late husband, who I had treated years ago. I hear the comment, but it doesn’t apparently register.
Then she makes another reference to her late husband. Again I hear the words, but they don’t apparently register.
Except.
Except.
Except…. My body starts to shake and convulse. I have no idea what is going on. I am lost in whatever my body is trying to scream at me. What is going on? What has impacted me? What the hell is going on with me? Is it my tiredness? Is it something going on with me personally that has nothing to do with these patients? I can’t grasp it. I can’t make sense of this shock/surprise. There are no words, images or anything to connect the experience with. I try to listen to what the couple is saying looking for clues as I try and tolerate what is happening to me.
The shaking continues throughout the session.
The session ends and the couple thanks me. They feel it was a good session. But I am still shaking.
The male patient and I have to use the restroom. In the restroom he tells me that he knew the late husband’s family. Again, I hear the words but they don’t register. I just want to go home and maybe the shaking will stop.
It doesn’t.
It stays with me for hours.
Finally as I am trying to go to sleep, half in and half out of this world, the name of the late husband comes to my mind and the shaking stops. I finally got it I think. Now I remember the opening comments of the woman and the closing comments of her male companion.
I am upset with myself because I couldn’t put this together during the session. Apparently I was sensing/feeling/experiencing something connected with the late husband. Something that had not yet been conceived or thought–something unthinkable.
I write my thoughts to the woman. I wonder if she will think I am crazy. She sends a polite response thanking me for being of assistance during the session.
This was an odd experience for me-just an unconnected pure bodily sensation. Odd in the sense that I frequently will sense things in a session-a thought or image of a person. Whatever this is, it does not appear to be connected to what the patient is discussing. I usually muster the courage to inquire of the patient about what I am sensing, and usually it turns out to be accurate. Something that was there in the patient but had not yet been conceived or thought about so it could not be put into words. I have come to trust this “sense” in me, but at times I do wonder if I have gone over the edge and I am just deluding myself. Perhpas I am just tired, seen too many patients, lost my mind? But I don’t think so.
The rational explanation I give myself for this “sensing” is that one of Freud’s great discoveries was the unconscious. Something unknown which could only be inferred yet exists inside each of us and can control our thoughts and actions. Freud wrote ” …one must cast a beam of intense darkness so that something which has hitherto been obscured by the glare of the illumination can glitter all the more in the darkness”. And then W.R. Bion conceptualized what he termed “O”. “O” is unknowable, ineffable and represents the ultimate truth or reality waiting to be experienced, but can never be known.
Recently I was attempting to describe what I do to a friend. I was explaining that I try to not listen to the words that the patient is saying, but to what is not there. She commented, “the empty spaces”. Which is precisely it.
New patients frequently assume that therapy works like going to see a medical doctor. They tell the doctor what their symptoms are, the doctor diagnoses the problem and treats it. But therapy ain’t like that. So after a new patient finishes telling me what their symptoms/problems are and they look at me with that expectant look that I am going to diagnose their malady and fix/cure them, I usually shock/ surprise them and say something like, “That’s what you know/think is the problem. But if you knew what the problem is then you wouldn’t be in my office. The problem wouldn’t exist. I am more interested in what you don’t know about this”.
After the shock has worn off, or perhaps in the midst of it, I attempt to convey that therapy is not like going to see a medical doctor. That we are not dealing with physical ailments. We are dealing with the human mind. And the mind is not sensible. Thoughts, feelings can’t be seen, touched, heard, etc., only sensed and experienced.
Some patients can tolerate this shock and decide to continue working with me in search of the unknown, the unthinkable, the empty spaces.
Others only want my answers to solve their problems. They usually don’t continue with me but find another therapist to diagnose their ailment and tell them how to fix their problem.
I remember another patient. He was an older gentleman. He called me one day and told me he wanted to see me because he was depressed. He came to his sessions in an electric wheelchair having been physically ill for some time. We did some work together and his depression was lessening. His medical state had stabilized. One day, I do not know why, I sensed that I had to discuss dying with him. The issue had never been discussed, and there was no apparent reason for my doing this. We had the discussion, and he felt relieved. He died several days later in the hospital.
Dr. Brody