On Sitting Beside Him

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It was three years into our work together when he received the news that his 22-year-old brother was sick again. After surviving once before, it seemed untenable that the cancer would return, and yet, there we sat. Receiving updates in sessions is like being offered a chapter every week; there was one on waiting, on prognosis, on bearing witness to dying, on saying goodbye, and then there was the one that we shared right after his brother’s death–

Among psychologists, we talk extensively about the importance of holding space for our patients. Psychoanalyst Donald Winnicott describes the holding environment as a warm presence that fosters trust and safety. He maintains that the ability to attend to patients tenderly, similar to the way a loving mother would nurture her child, fosters the foundation for psychological health and healing.

In an effort to fulfill this role, we cultivate a physical space that is private and comforting, a relational sense of care and acceptance, and an experience of emotional containment. We may even offer a brief hug on a special occasion. But despite all the parts we carry, I have yet to hear us address the moments where we want to, or even do, hold our patients literally. In the therapeutic relationship, is there room for that?

In the sessions leading up to his loss, I found myself eyeing the spot next to him on the couch, observing my desire to just sit there beside him. It was a strange sensation to want to leave the safety of my own therapy chair. It had never occurred to me before how the therapist’s chair, itself, is a safe space for the clinician. In our chairs, we are elevated, comfortable, poised containers of wisdom—powerful, even.

While sitting there, I envision myself enveloped in my oversized armchair: legs crossed, eyes focused, hair fallen on my shoulders, my head slightly tilted to the right, prepared for the mild nod. My water and coffee cups rest on the small console beside me, my very own secure objects, waiting to be seized. The table between us, with all its accruements, forms a boundary that keeps us at a safe distance.

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As the sensation crept up again, I wracked my brain. In a moment of clinical intuition, I shared my countertransference with my patient.

“For the past several weeks, I have found myself wanting to sit next to you in that spot right over there.” I pointed at the open space on the grey suede to his left. “How would that feel for you?”

He nodded in agreement, pulling his head towards his hands, which rested in his lap. I rose from my chair and crossed the threshold of the coffee table, making my way to the empty spot on the couch. It felt strange for a second to be in a different seat—as if I was encroaching on territory that did not quite belong to me. On the couch, it is the patient who is in charge. I am just a visitor.

We sat there next to each other for a moment just being, and I was keenly aware of how much more being mattered than doing in that moment.

“Would you like a hug?” I offered.

He nodded again, and tears streamed through the cracks of his hands. His part fetal position tightened as I inched closer to his side. I put my arms around him with a gentle squeeze. We breathed together, rocking slowly. Snot dripped down his face directly in front of the tissue box that remained untouched. How powerful it was that he did not feel the need to wipe his pain away.

He was significantly larger than me, and I thought for a second how funny we might have looked to someone on the outside. The irony was that in that moment, my care for him felt so infantile. I imagined the innate inclination that Winnicott describes a mother feels when she coddles her child. I badly wanted to protect him, shield him from all of the painful existential realities that exist, and make the world a safe place just for him.

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Similar to the loss that many mothers experience, it’s a difficult moment as a psychologist when you are confronted with the reality that you cannot eliminate the pain of the world. The patient, too, experiences that same loss, a sudden awareness that the therapist is not all-knowing or all-powerful. Despite our knowledge of this truth, when it arrives, it somehow feels unexpected. Sitting there with him in my arms, I gave way to my own helplessness. I allowed myself permission not to protect but to expand. As we sat together silently for a while, I marveled at how limitless the room on my couch was for us both.

To sit with someone is a powerful gesture. But sitting beside—it’s vulnerable. We simply become two people sharing a moment of humanity. As the therapist, you have to trust that there is meaning in your willingness to put your own armor aside. When we do this well, and with intention, we give our patients freedom. Permission. The ability to sit with pain and still survive. We must never take for granted that the couch is a much braver seat than the chair.

This moment between us is one we would continue to revisit over the coming years and cherish as one of the most powerful sessions we have shared. The beautiful thing about psychotherapy is that in instants like these, we become artists. We discover techniques that cannot be taught, only intuited. Fine lines. Experiments. Pushing limits. Our work is messy and perpetually unfinished. Our patients, too, unlock our creative growth in ways we did not have access to before them.

And just like that, our time is up. All you get is one hour to show up in the way your patient needs you to. He wipes his face, grabs his messenger bag, and heads towards the door.

“See you next week,” my voice cracks.

Perched in the doorway, a deep pang of guilt creeps up on me for letting him go out into the world carrying so much grief. However, as I watched him make his way, I noticed that he walked out with such ease, standing tall with his leather briefcase swinging by his side. I stood there in awe of his resilience, for it was me who hesitated to let go—the patient was perfectly capable of holding himself.

**With gratitude to my patient for granting me permission to share a powerful moment in our story.**