Can a Therapist Know How You Feel? Must He Have Courage? Thinking About Essential Qualities in a Counselor

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Does a therapist “know how you feel?” No. How could he?

But he may still be able to help you even without such knowledge.

Why don’t I know how you feel? I am not you. I am not your age or perhaps your gender. We may not share the same faith. I wasn’t born in the same place under the same circumstances. My parents made more money or less than yours, lived with extravagance or pinched pennies. They survived the Great Depression well or badly or not at all; and so forth.

A counselor is not in your skin, so can’t know the sensations which comprise your life. Yet he can have some idea, perhaps even a good one. What might that idea be based on?

First of all, you are both human and have a certain set of shared, although not identical experiences. Speaking for myself, as a seasoned counselor I talked to thousands of people who told me what they thought, revealed how they reasoned, and explained how events influenced their mood. I therefore became familiar with the range of what is possible in reaction to an enormous number of circumstances. I also read text books, received instruction from teachers, and shared in the richness of emotion, perception, joy, and adversity found in stirring memoirs, novels, plays, and movies.

Despite all of this, I am open to surprise. An example: my father died abruptly in the year 2000 at the age of 88. I’d known he was mortal at least since the time of his heart attack when I was a boy. Prior to his death I counseled many people who were suffering from loss. Still, despite dad’s advanced age, his demise was shocking. Like the flick of a switch — the “here today, gone tomorrow” unreality was too true. Unexpected fatigue lasted for months, as though the life force taken from him had been emptied from me as well. Even now, years after this loss, I can’t say for sure “I know how you feel” if you tell me about the death of your father. Your relationship with him and the circumstances of each of your lives might cause me to rely more on imagination than something closer to your lived experience.

I would argue we cannot even recall how our own pain felt once the distress recedes into the moderate or distant past. Big events do not remain unaltered in the museum of the brain. Rather, they are like a photo faded by the sun. We need painful memories to diminish, which would otherwise leave us in a perpetual state of agony. Even splendid, heavenly recollections, if remembered with their original impact, would compromise our ability to attend to the most crucial elements of each new day. To some degree we must unconsciously forget or transform our life history.

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You might ask me: “How then can you help me grieve my loss if you can neither ‘know how I feel’ nor retain an unaltered remembrance of your own loss?” In several ways. I can listen to you and bear witness to your pain. I can be sympathetic. I can accept the emotions and stories you share: the varied combination of sadness, anger, exhaustion, and sense of separation from the world accompanying the death of a loved one. I can abide with you, acknowledge your suffering, and “be there” until it passes. If you will accept the comfort, our relationship will help to reattach you to life, even while you are grieving something that rends the same cord of attachment.

You will never be what you were before your loss, of course. But, you are more likely to heal if you share your grief. Holding it in or trying to “move on” too quickly — or shedding your tears only in private — can cause your sadness to pass by inches or not at all. Human contact in the aftermath of loss is crucial. A supportive spouse, friend or therapist can help. Time does the rest.

My sympathy for you doesn’t require I first possess knowledge of your internal life any more than enjoying milk requires a prior existence as a cow. Best not to say you know how another experiences his suffering. It is enough to tell him you care. Indeed, were you to fathom every detail of the emotions passing through another without caring, absolute understanding of his pain would count for nothing. Genuine concern — not some magical power to read another’s heart — is what counts. A patient will often forgive a therapist’s momentary failure to grasp his upset, but ought not to accept his indifference even if his knowledge of the patient’s emotional state is exact in every aspect.

The counselor carries an imperfect bag of tricks. Like the wounded soul who comes to treatment, he risks failing at the task he shares with his client, even if the courage demanded of the patient is greater. The therapist also assumes the frightful responsibility of caring for another with no certainty his effort will avoid tragedy, even if his burden and terror are less than the patient’s own.

The practitioner is always practicing. He must work to learn more and attempt to heal you no matter how much knowledge and experience he has. His therapeutic arsenal is never complete. Psychotherapy research is forever making new discoveries. Fortunately, if the therapist has the knowledge, dedication, and experience along with the courage to allow your heart to touch his, what he has tends to be enough.

In accepting you as a client, he risks injury to both you and himself. Why? In short, because you do matter to him. In treatment with the best healers, that is the one thing of which you can be certain, however much your relationship history causes doubt.

The top photo is Misty Morning by flagstaffotos.com.au/ The second image is Cirrus Clouds with 3-D Look by Simon A. Eugster. Both are sourced from Wikimedia Commons.

20 thoughts on “Can a Therapist Know How You Feel? Must He Have Courage? Thinking About Essential Qualities in a Counselor

  1. Dr. Stein, it sure takes courage, caring, and commitment for an individual to embark on such a profession.

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    • One advantage to being a music therapist, is being able to play with patients ‘in the moment’-which gives us a significant access, to being in a feeling moment-with a patient. And in this way-we know how it ‘feels’ -because we work in the rhythm, tone, timbre and nuances. So—yes for music therapists, we experience the range of affect, in the moment of our patients’ occurrence…a unique vantage point-with superior access to feelings.

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      • I wouldn’t doubt that music therapists have a very special point of view and point of contact with a patient. That said, I still wonder if they “know how it feels.” If one attends a concert or listens to a recording with others, the range of responses to the music is very wide. Thanks for your thoughtful and provocative comment. Certainly something to consider. At the very least, both the therapist and the patient are experiencing the same thing in the same moment, even when they “feel it” differently.

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  2. I like the fact that my t is a lot stronger emotionally than me because it gives me confidence that he can handle my wounds. Also it’s a good example of the kind of emotional stability I want to achieve and confidence in myself and maintaining my point of view in the face of differing opinions. I can see that my t has these strengths within himself. I think if he fully understood and experienced my feelings the therapy room would just be to raw for me to get better in. Knowing to that I am genuinely important to him does cover the occasional slips he may have and with all that I am making a lot of progress along the way. Thanks Gerald a very reassuring post.

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  3. This is an ‘intake of breath’ post – a post where there is so much to learn and absorb and be moved by, with every sentence. It is a ‘breath-holding’ post – it gives you pause while breathing, it hurts, but in a good way. So many wonderful points – about concern being more important than mind-reading, about the courage of both parties and the risk the therapist takes with his own heart as well as his patient’s, and as you say, all with no guarantee of success, or even of life, at the end of it. I love this part – “If you will accept the comfort, our relationship will help to reattach you to life, even while you are grieving something that rends the same cord of attachment.” One sentence but so many vital words – comfort, attachment, grief – and the need to accept what another is giving, in order to take part in it and to start to heal. And knowing that they matter, is I think what so many clients want to be able to feel. What strikes me again and again in your writing is the enormous respect with which you approach your patients – or rather, with which you approach ‘patients’ in your writing, and with which I imagine you approached your own patients. So often you speak of their courage, and their suffering, and the compassion that you have is utterly self-evident – it pours out of your writing and I can only imagine how it might have poured out of you in session. It is humbling and evidences a humble spirit. As a ‘patient’, it is validating, and as a human being it makes me thankful to ‘know you’ and to read what you have written. Thank you for sharing this…..

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    • Thank you very much. For me, and I think for most therapists who are respectful, respect comes naturally. It is not something we have to work on. If you could see all of us outside the session, I’d expect we’d rarely cut off others in traffic or use foul language when frustrated in public (privately is another matter!). Thanks, again.

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  4. I imagine that this relationship between therapist and client is complex. I stumble over the notion that one is paying money to another to what? form a relationship that might result in some kind of transformation? Operative word is “might”. And it seems to me that the client invests a great deal in this relationship. Certainly he/she invests money but also time and, perhaps most importantly, exposure or the notion of being vulnerable but without any reciprocity. That’s a tough one for me.

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    • It’s difficult to reconcile the payment for services and the “I care about you” aura from the therapist that is needed by the client in order to trust him/her with the vulnerability you mention. For me it was a constant battle between my head telling me “you’re paying him to listen and empathize” and my heart telling me “forget the payment, that’s for his expertise, and trust that he does truly care and is not just pretending in order to keep the business”. The real heavy price paid ends up being not in dollars but in the intense emotions that come into play, especially should the therapy relationship come to a premature end before these emotions are resolved.

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      • Thank you for this Brewdun. Objectively there is no reason why one cannot care and receive payment, but the dilemma you describe is both understandable and poignant. The emotions that survive a premature end of treatment are echoed by many of the patients I’ve read who have seen therapists retire (as I did), move to another location, die, or (in rare cases) decide to take another vocation. I’m especially grateful that you raised this point, since the pain is reflected much more by blogger-patients than it is answered by therapists. I will be giving it some thought and see if I can eventually address it broadly in a new post. I know there were at least a few of my patients for whom the announcement of my retirement, by itself, was painful.

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    • You have raised questions that echo the thoughts (and complaints) of many others. The best therapists offer more than a relationship. I’d say we try to guide the relationship toward accomplishment of goals the patient has identified, using our knowledge and experience of “what works” to do so. The word “might,” as you suggest, offers no guarantees, but then a knee surgeon (an example I offer because we both have some experience on this body part) offers no guarantees either. I think you are right that there is no one-for-one reciprocity in self-exposure, but patients do “get to know” much about many of their therapists if the therapy is not brief. I’ve written more on the topic elsewhere on this blog, so you might wish to look more at what I (or others) have said. In closing, I’d add this: a therapist needs to be aware of the concern you raise and not dispatch it simply by saying, “Well, I need to make a living just as you do.” And perhaps, by keeping the various imbalances in the relationship in mind, he is more likely to produce an answer that is ultimately satisfactory and an end result that honors the patient’s effort and vulnerability. Thanks for raising the issue, JT.

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      • Although I have the greatest respect for mental health care providers, I don’t understand the process. It’s odd but I always think I need some kind of documentation or script or something in order to fully buy something. I need to grasp the underpinnings of the process. I have known a number of therapists both professionally and personally and, in my professional life, I often made referrals for families for mental health services. I think it’s just such a broad and ever changing field with a fair amount of subjectivity that I have a hard time corralling it. I suspect the only way I would ever be truly satisfied is if I were to go back to school and take on the profession!

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      • As a short-cut, you might want to read about ACT (Acceptance & Commitment Therapy) which has a pretty logical structure and a growing body of research supporting its efficacy. For what it is worth, most of us in the field have our doubts about certain of the various forms of treatment. For me, that particularly includes those therapies that seem to require faith in the process without hard data to back it up.

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  5. I have always wondered if she was being truthful when my t said she could literally feel my pain? I think that she can because she is so intuitive and also a very “in the moment” person.
    Recently, her son passed away under tragic circumstances and I have not seen my t for 2 months now. I know I can feel her pain as I have had the loss of my father…(not nearly the same as losing a child). But I so wanted to console her as she has consoled and counselled me over the past four and a half years. Because of the nature of the client/therapist roles, I am handcuffed to not being able to even really contact her and have no idea when or even if I will have therapy with her again.
    I had written a long message entitled “I release you” where I basically was telling her that I don’t hold her responsible to see me anymore if she feels it would be too taxing…(we are very attached). I kind of feel like I have trapped a butterfly and need to set it free to see if it comes back or stays with me)…kinda stupid I guess. I just don’t want her to feel indebted to me because of a past experience I had with my last therapist who ended our therapy on a very painful/sudden/un-therapeutic (no closure), way. I know she feels that to not see me would be a re-enactment of that ending and probably feels responsible for not adding to that past hurt.
    Regardless, feeling ones’ pain (I feel) is possible and sometimes overwhelming because I am not trying to NOT imagine and feel what she is going through.
    Thanks for the interesting post.

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  6. drgeraldstein

    I’m sorry to hear about the dilemma you’ve described following from the death of your therapist’s child. I don’t doubt that some of us come closer to feeling another’s pain when that particular other is especially well attuned to us and visa versa. I do think, however, that it is usually a risky assumption. One could test it empirically, but it would be hard to do so between a therapist and patient because admission of not “feeling your pain” might complicate the relationship and the treatment. In any case, thanks for your good words and best of luck with your present dilemma. It was brave of you to “release” your therapist and most kind. She may find it therapeutic for herself to return.

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  7. Re: ACT – thanks for that piece of info. I went to a couple of websites just to familiarize myself with the theory. That’s a pretty interesting approach and one that makes sense to me. I see some parallels to ancient Eastern thought.

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  8. Yes, the Eastern angle is certainly there, JT. Glad you found the material of value.

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  9. As someone who has recently been diagnosed with BPD and started therapy, this post really touched me and opened my eyes. I adore my psychologist, and believe I have truly found a gem. I have had her on a pedestal since starting therapy.

    “My sympathy for you doesn’t require I first possess knowledge of your internal life any more than enjoying milk requires a prior existence as a cow. Best not to say you know how another experiences his suffering. It is enough to tell him you care.”

    I love that. I’m having a particularly difficult period at the moment… Both in life and with my therapist. I feel disconnected from her. And it leads me to think she doesn’t really care. She’s leaving for a holiday, and it’s almost 2 weeks until I see her again and it’s driving me crazy. I find myself thinking that she must know how this feels for me. She’s going to forget about me. She won’t even think about me. While I’m here, missing her. Feeling she won’t come back. That I’ll lose her. Surely she must know how torturous this is. Logically, I know that’s irrational thinking. Emotionally however, I can’t seem to stop feeling like this. Like you said… How can a therapist know how we experience/feel about something? This feels like one of those instances.

    All I know is she has a lot of courage. I’m a handful. 😛

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  10. Therapists can’t know exactly how you feel, but those with experience know about feelings of abandonment. I went on lots of vacations, but I always came back with the knowledge of the people in my practice. Indeed, it usually took me several days of being away in order to get to the point of beginning to feel the refreshment that allows counselors to come back with the energy they need to do the best possible job. Although I don’t know you, I wonder if some of your abandonment worries are transference from one or more prior relationships. In any case, you sound like a “handful” worth the effort and time of your therapist. Best of luck.

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  11. Thank you so much for your reply. I think you may just have hit the nail on the head with the whole transference comment. It certainly makes a lot of sense. I’m pretty sure my therapist and I will deal with that sometime.

    And thank you for your last sentence about being worth the effort and time of my therapist. It made me all warm inside. 🙂

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