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Key points
- Staying present with a client's anguish is crucial for therapists.
- Most of us weren't taught how to meet suffering.
- Learning to face your pain offers pathways for meeting clients' pain.
Bearing witness to—or meeting—our clients’ suffering is one of the most essential and crucial tasks we therapists face. In a way, it sounds simple: You listen carefully, empathize, inquire as to the nuances, and offer support. But looking back at the moments when genuinely meeting a client’s anguish broke my heart or changed me, I’m stunned by how much this particular clinical task asks of us.
I sit across from a combat veteran who falls silent, eyes brimming with tears, as he recalls failing to save his best friend after a mortar attack:
I ran up to him, lying on the ground, and I knew he wasn’t going to make it. But I tried. I tried. It wasn’t going to work, but I couldn’t stop trying. Even today, I keep thinking, "Was there something else I could have tried?"
The pain and loss are so thorough, so alive for him, he literally can’t speak. Tears fall as he looks at me, unable to voice the anguish pouring through him. Desolation contorts his face as we hold each other’s gaze, willing ourselves toward the stamina we need to face the abyss of his heartbreak.
Therapists have endless ways of thinking about this kind of raw trauma, but if we’re not careful, all the theories can take us away from the most foundational requirement of true witnessing, which lies in our ability (and willingness) to meet the pain with full presence.
“Meeting” the pain means: not trying to make it better and not attempting to give the client perspective; not re-framing it, fixing it, taking it away, or hammering out a brightened-up version of his story.
Just: Meet. The. Anguish.
Demetria is processing the recent stillbirth of a baby she and her husband had tried for several years to conceive. They had already painted the nursery, read the infant-parenting books, and made lists of names for their little girl. Demetria described the torturous moments after her daughter was born—her terror mounting as she watched the doctor and nurses working frantically to get her daughter breathing.
Demetria tried talking to friends about her grief, but no one really understood. She tried a grief group but felt overwhelmed by other mothers’ stories. If I can tolerate sitting with the searing pain she feels, she can describe the years of longing, the pure delight in her pregnancy, the bright hopes and shining dreams for her daughter’s life. And the crushing blow of those hospital moments. Like many who are in anguish, Demetria’s immediate need is to feel met—to abide in the full, unwavering attention her heart-wound needs.
There are remarkably helpful modalities for processing anguish these days (EMDR, AEDP, CBT, and others), but it seems an unyielding sense of presence must be our foundation as therapists.
Were you taught about bearing witness to a client’s suffering in your grad school program or early training? Did you get specific help learning the finer points of presence while encountering deep anguish? Were you trained to look at your resistance, hesitation, fear, or helplessness in the face of oceanic pain? I know I wasn’t.
In my very first session with a client (during my grad school internship), the client began to cry as she faced deeper truths about her predicament, curling forward over her knees and sobbing. I felt unsure how to respond to her heart-wrenching weeping. I offered her comfort and reassurance, and when I debriefed with my supervisor after the session, he seemed pleased with my work. But I drove home through darkened streets, unnerved by my first encounter with raw pain.
After forty years in practice, I’ve had innumerable opportunities to learn how to face and tolerate a sense of utter helplessness—my real powerlessness—in the face of their suffering. At some point, I realized that the helplessness and powerlessness I wanted to avoid in myself were reflective of what they had to face in themselves.
Over the years, I’ve come to see that the way I deal with the pain in my life (even if it wasn’t painful to the degree a client might face) is the greatest tutor for being able to hold presence in the face of their pain. When I face my loss, trauma, and grief honestly, teaching myself to ask for help or vulnerably sharing my struggles with others, my stamina steadily grows.
As I learn how to sit with my pain, my tolerance for others’ anguish increases. I begin to trust that encountering pain fully is not only worthwhile, it’s actually the gateway to true healing.
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