As therapists, we've all learned that our patients reveal their most painful conflicts during the last thirty seconds of a session, just when they are ready to leave the office. Often they already have their hand on the door knob. Recently I experienced this rather dramatically as I terminated with a woman I had seen for about 25 years.
I first saw this woman, now in her mid-seventies, during some of the darkest hours of her life. I treated her for major depression with a combination of medication and psychodynamic psychotherapy. During more recent years her symptoms remitted, so I saw her only every three or four months for about twenty minutes to renew her medications and to catch up on her life.
At the beginning of her final session with me, she initiated our meeting by saying, "Dr. Olson, I read your book [Finally Out: Letting Go of Living Straight, a Psychiatrist's Own Story]. I learned a lot more about you than I needed to know!" With some anguish in her voice, she asked, "Why did you do that?"
I told her that I felt I needed to reveal some of the most private details of my struggle with my sexual orientation in order for the reader to connect with me. I wanted the reader to know that I understand from the inside what the experience of coming out in mid-life is like. I wanted to convey that I had experienced how difficult it is to let go of an inauthentic life for one that is more true to oneself.
I also told her that I could not have written it earlier in my professional life because I would not have wanted my patients to know me in such a deeply personal way. I now realize that writing Finally Out was my own career door knob revelation.
After spending most of her time processing what her treatment experience with me had been like, in the last thirty seconds she stood up to leave and said, "I've always thought I might be a lesbian." After 25 years and countless hours together, it was only then that she finally felt comfortable enough to reveal to me her long held secret. Then she asked if it would be appropriate to give me a hug, thanked me, and left my office for the final time.
I have practiced psychiatry in central Iowa now for over thirty years. I have been rewarded repeatedly to hear from my patients how I threw them a life-saving buoy when they needed it. I also hear the anxiety in their voices as they say, "I'm happy for you, but. . . I feel like my safety net is gone."
Now, I don't believe that it was me who kept them afloat all these years. I have always approached treatment in a collaborative fashion. I believe in the adage that we don't help people by giving them a fish but by teaching them how to catch a fish. All but a very few of my patients have learned the skills they need to survive on their own. Most could have their maintenance medications managed by a primary care physician. The more complicated ones have been referred to very competent professionals. I feel far less anxious about their futures than they do.
I have practiced psychotherapy with the two primary tenets: Always zero in on the affect, and always explore the resistance. Their friends and family have said, "There, there, don't cry," or admonished them, "Pull yourself together." Instead, I have said, "I see there's a tear in your eye. Tell me what that's all about." It always works. They begin to unload the burdens of their lives in ways they have never before experienced.
But if they say, "I can't talk about it," my response is something like this: "You don't have to tell me anything you don't want to, but I need to understand why you feel you can't tell me. How have others hurt you when you trusted them?" Inevitably, it enhances their capacity to trust me.
I learned in my residency that the healing powers of psychotherapy come from:
1. Genuine warmth
2. Accurate empathy
3. Unconditional positive regard
Being a therapist is a calling, not a career choice. We are drawn to it because we know what the pain of emotional turmoil feels like. Through the years patients have told me that their pain is much worse than difficult childbirths, kidney stones or cancer. Those who don't understand what we do, attempt to diminish us by saying we're all crazier than our patients. But we use that capacity for empathy to connect with our patients. We don't just say, "I feel your pain." We say, "I know how you feel, and I know that some how we'll find a way to help you feel better. Tomorrow will not be the same as today."
Through our supervision and training we have learned that we cannot remain embedded in their pain, but rather we must move away from it again to develop a rational approach to help them deal with their suffering. We give them hope that we will help them find a way to make their lives better.
Genuine warmth, I suspect, is a gift that not everyone has; I don't know that it can be taught. We want to believe that we have "unconditional positive regard" for everyone, but it often requires hard work to get past some of our own prejudices and stereotyping. We don't always love everyone as much as we may wish to.
Everything we know about neurotransmitters, Rorschach tests and systems theory may simply embellish the more spiritual aspects of emotional healing.
How many times through the years have I told my patients who are grieving that love and risk are inseparable? The older we become the more we recognize that life is not about the number of toys we accumulate, but instead it is about the capacity to connect with others on a deeply human level.
As I approach retirement, I have had to say goodbye over and over to people who have revealed to me the most intimate details of their lives. These last few weeks of practicing have been extremely difficult. Every day I say goodbye to people I have come to care deeply about. But what a gift I have been given to have work that I have never stopped loving, and I have never felt like it didn't matter.
As the old woman I mentioned above left my office, I told her that I have become a part of her, and she will continue to have conversations with me inside her head. By now she can almost predict my responses.
Perhaps writing Finally Out was an attempt to leave a legacy, to continue the work I've done after I close my office for the final time. I feel blessed to have had a career that has enriched my life in so many ways and one I continue to care passionately about. How incredibly grateful I am that I responded to being called to being a psychiatrist.