empathy in therapists

March 19, 2017

How Vulnerable Can We Be? Emotional Openness in Therapists and Performers

We get to see public people expressing private emotions on TV. Allowing themselves to be vulnerable. Not only on dating shows. Politicians do it on occasion, including George W. Bush, whose voice cracked and eyes moistened more often than any U.S. President I can remember.

Still, most of us try to stay in control. We hesitate to let down our guard for fear someone will reach into our chest and rip out our already wounded heart. In my experience, however, some of the most touching public situations occur when a self-possessed person displays the courage to live so much in the unselfconscious moment that the voice breaks or tears flow a bit. Before I tell you about my own challenge with this, I will relate two other public examples, as well as describing a therapist’s hesitancy to feel too much in session.

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Fred Spector, a retired Chicago Symphony Orchestra violinist, told this story in 2001 about an event then three decades old:

We were doing the Verdi Requiem and we knew that the mother of Carlo Maria Giulini, the conductor, died (unexpectedly, while he was in Chicago). He walked on stage (to rehearse with us), starts to conduct the Requiem and stops. He was crying and he said ‘They want me to come home (to Italy). What good is that? My mother is dead. It is more important that I have this experience with you and the Verdi Requiem and think about my mother.’ And now he’s got us all crying, the whole orchestra in tears. ‘That’s more important because then I can experience and think about my mother in this marvelous Requiem. … and those were the greatest performances I’ve ever played of the Verdi Requiem, bar none. … We wanted to get that feeling he wanted for his mother.

Giulini was a private, ever-dignified, old world man (born in 1914) for whom this exposure was uncustomary if not unseemly. Indeed, the orchestra and chorus had been instructed by an administrator not to say anything to him about his loss. Such a direction could only have come from Giulini or his wife.

Of course, it’s one thing to be unguarded in an empty hall and another to “lose it” during performance. Indeed, among the greatest sins of public musical or theatrical presentation is to be so moved by the words you can’t do your job: enable the audience to experience emotion while you remain in control. I am aware of one instance alone when the rule was violated, but the artist succeeded anyway.

A 1947 Edinburgh Festival rendition of Gustav Mahler’s Das Lied von der Erde (The Song of the Earth) was the occasion. This hour-long song-symphony portrays the transient beauties of existence and concludes in a 30-minute Abschied (Farewell) to a friend and to life, based on ancient Chinese poetry.

The work’s last moments are a whisper of exquisite, heart-rending beauty as the singer reflects on the passing away of human life, while the world itself blooms anew every spring, “forever.” The last word — “forever” or “eternally” (“ewig” in German) — recurs several times, ever more muted against the fading, shimmering, ethereal consolation of the orchestra.

According to Neville Cardus, a critic for the Manchester Guardian, Kathleen Ferrier, the contralto soloist, was “unable to enunciate the closing words.” Moved by the music, she broke down.

Ferrier, a 35-year-old woman soon to become an international celebrity, was then new to this composition and in awe of Bruno Walter, the 70-year-old conductor who had been the composer’s disciple and given the work its world première in 1911. Cardus tells the story of his arrival backstage after the curtain calls:

I took courage and forced my way into the artists’ room, where I introduced myself to this beauteous (unselfconsciously beauteous) creature. As though she had known me all her life she said: ‘I have made a fool of myself, breaking down like that.’

When Walter came into the room she went to him, apologizing. He took her hands, saying: ‘My child, if we had all been artists like you, we should every one of us have broken down.’

For Cardus, it was one of the greatest, most life-changing performances he heard in a long career as a music critic.

Where does a therapist fit in our discussion? He is not a public performer, but must empathize with his patient. Unmoved by the human suffering he witnesses, he is of no value. But what if he is moved to the extreme? Were he to experience the same level of emotion as his client, he himself would become the patient. The room would be occupied by two people equally anguished, both needing support and relief with no one available to give it.

Someone must possess a therapeutic (but not unfeeling) distance from the suffering. The therapist must.

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My own challenge with public vulnerability came in toasting my first child’s marriage. Tears interfere with an adoring parent’s speech at many such events. A guest’s attention is then drawn to the speaker’s unraveling, however sympathetic or touching, not his words about the newly married couple. I wanted the assembly to know what I had to say about my daughter and son-in-law, the better to appreciate them. The language, properly spoken, would externalize the internal, convey emotion, and move the audience.

The problem was, in practicing I could not get through the speech. Time after time I tried, time after time I failed, overwhelmed. Were I to tell you the number of rehearsals I attempted, starting months in advance, I suspect you would not believe me.

The day came — the moment came — and I still had not a single run-through without the internal tidal wave overwhelming my words. Once on stage, however, — finally, finally — the elusive control arrived and the toast went well. I was not as emotionally “present” as I could have been, but the cost of unconsciously distancing myself from my sentiments was the price for moving the audience by words and delivery, not becoming overwrought and a bit incoherent.

Why am I reminded of all this? I just completed a course at the University of Chicago’s Graham School in which our instructor, near the class’s end, discovered her voice cracking with emotion. Sometimes this happens in intimate conversation, frequently in counseling, but not so often at the U of C, and not from this confident and expert guide to literature. She said (to someone else) after the session, she “didn’t know where that came from.”

But, you know what? It capped a great class discussion of a moving novel with a flourish. Sometimes one needs to go with the flow, even if the flow is both figurative and literal.

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The painting at the top of the page is called Tightrope Walker by Jean-Louis Forain(1885). The next image is Australian Artistic Gymnast, Lauren Mitchell at the 41st World Artistic Gymnastics Championship in London, UK, October 14, 2009. The photo was taken by Steven Rasmussen, Explorerdk. The following picture is Gymnast Feet on Beam, January 19, 2008, by Raphael Goetter. All are sourced from Wikimedia Commons. Finally comes Tightrope Walker by August Macke (1914), sourced from WikiArt.org/

October 4, 2015

How Therapy Fosters Courage

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You came to the therapy session. Courage was required. You admitted things were too messy, desperate, painful. A brave step was needed. Despite hesitation you took the road less traveled.

The therapist was not a monster. He invited you into his office. Your courage was reinforced.

Now you find he hears your words, watches without blinking. The attention is encouraging. Few ever took you seriously, showed patience, gave you their time — listened with quiet intensity.

You discover the contact has value — the relationship is worth something. Again, the effort didn’t meet with the disaster you expect as a matter of routine. The reinforcement makes future risks more likely. You begin to wonder if perhaps you previously fulfilled some of your own dire prophecies.

The counselor is reliable. At first you think he is a unique example of dependability in an undependable world. What luck! Later you recognize the truth: others as good, or close to it, might exist if only you raise your eyes to look. An intrepid search begins for those who are also decent and caring.

Issues too deep for words are exposed in session. You surprise yourself with your openness. Your vow never to make yourself vulnerable again is set aside. Courage grows.

Perhaps you begin to recognize grit is not always a matter of physical bravery. Indeed, you identify its presence when you look in the mirror. Especially if you face your short comings in the reflection. Change takes more bravery than what is demonstrated on the football field. Your moral muscle increases in size. Your heart becomes toned. You develop something called “therapeutic integrity:” to stick with treatment despite the punishment it inflicts. Your head is held higher. Avoidance is less often your first choice.

Yes, the rose of life is full of thorns, but the scent and beauty are worth an occasional prick. Your bravery makes this revelation possible. You learn to survive such pricks and avoid them when you can. Especially the human kind.

You voice strong opinions to your counselor and the world does not end. He applauds the growth to which he is witness. You begin to internalize his approval and the strength in you he identifies. More and more you come to lead the process — more evidence of therapeutic integrity.

The things you never thought possible — the behaviors others could enact but you didn’t — are done. You explain this not by some sort of therapeutic magic, but by the virtuous qualities inside you of which you had no awareness.

More chances are taken. You learn to say no, to travel alone, speak your mind, grieve, enjoy a restaurant dinner solo, date again (or perhaps, for the first time), recognize the toxic takers, act in spite of fear, dust yourself off when you’re down and come back for more. Your pulse quickens not with fear, but a lust for life.

Your intrepidity manifests itself in “baby steps” at first. Later they are well-placed strides. Eventually you run with joy, recognizing life is in the running, not always the winning of the race. You have discovered you can “take a licking and keep on ticking.” The scars you were ashamed of become badges of honor. The lines in your face are earned. They enhance your beauty to those who recognize the richness in you, not just your sausage casing.

Lord Byron wrote in Prometheus Unbound:

To suffer woes which Hope thinks infinite;
To forgive wrongs darker than death or night;
To defy Power, which seems omnipotent;
To love, and bear; to hope till Hope creates
From its own wreck the thing it contemplates;
Neither to change nor falter nor repent;
This, like thy glory, Titan, is to be
Good, great and joyous, beautiful and free;
This is alone Life, Joy, Empire and Victory.

“Good, great and joyous, beautiful and free …”

Blame and lament are past. Fear is no longer a constant companion.

You are your own self, the maker of your life in so far as we are ever able. Take up your chisel and approach the marble — create the art that is your life.

You’ve learned the sculptor’s hand is never finished with you; and that fate is but one sculptor.

You are the other.

Courage made it possible.

December 6, 2014

How do Therapists Become Empathic? Another Question You were Afraid to Ask Your Therapist

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Several weeks back, Spacefreedomlove sparked my interest by posting questions she’d been afraid to ask her therapist. Though not her counselor, I answered those queries here. I also requested her readers to offer their own. I’ll respond to one such today and more in the future. I don’t promise any other retired therapist would answer as I do.

This question comes from Possibly Penny, with my thanks:

“What is your story? What helps you to appear empathetic toward what can seem like trivial external triggers?”

Several things. I was a sensitive little boy, both sensitive in the way most children are (to their own injuries) and sensitive to the many moods I encountered in my home. As the first born and first grandchild of my mother’s parents, I received lots of attention, especially for the four-plus years before my brother Eddie (and later Jack) arrived. So, I knew love and loving at the start.

I think my family was happier in my first few years than at any other time. No, it wasn’t due to being wonderful, but because a first child who fits the household’s expectations creates parental bliss. A progeny of three active boys (my brothers only one year apart) demands more than a solo flyer. Moreover, Milton Stein and Jeanette Fabian married in 1940 and, not long after, the future-dad found himself in a European war zone. I was conceived in the joyous heat of his return from the defeat of the Nazis. The intensity of their desire to be together is reflected in his Love Letters. Their world was new with promise. The hardship of the time apart got repaid in a metaphorical second honeymoon upon dad’s return. I doubtless benefited.

I think my identification with the underdog derives from several roots. While the extended family held mild prejudices in private, they gave everyone respect in the world of lived public experience. I listened to many stories from my folks about their lives prior to marriage (during the Great Depression). Mom was malnourished and humiliated by her family’s poverty and her father’s alcoholism. I identified with her pain because I loved her.

Both sets of grandparents were secular Jews. Outside I received the occasional anti-Semitic slur, but nothing more. Nonetheless, I intuitively understood discrimination, not only against Jews, could lead to horrors beyond imagining. From dad’s mother came eye-witness stories of Russian pogroms. By high school I’d made friends whose parents had numbered tattoos on their arms, casting indelible shadows on all of their lives.

Uncle Sam, mom’s brother, owned a business in which he employed both black men and women. This was prior to civil rights legislation, a period when lynchings still occurred in the South. During high school — in summers and after class — I worked with them side-by-side.  Experience confirmed my expectations having to do with their basic decency, intelligence, and kindness — neither inferior nor superior to whites. They deserved better than to be “other.” One of my two best friends in first year college was a bright, funny black young man named Lou Sterling. We did things out of school (including at my house) at a time when blacks and whites socializing in public still was uncommon.

I grew from an uninhibited small boy to a smart, but introverted teen with interests I thought few others cared for (like classical music). The sweet child who worshiped my mom was replaced by a stranger (still me) who saw enough of her flaws and unresolved anger to judge her and struggle with her. In other words, I knew the role of the outsider even within the family. Time passed before I understood what was required to work through the psychological after effects. Fortunately, I found a terrific group of high school buddies who reconnected many years after graduation to give college scholarships to disadvantaged teens of varied races and religions. We still maintain contact.

My wife, the finest person ever, is a model of kindness and consideration. I’ve had the boundless good fortune of having two female children of whom I am immensely proud. More pertinent to Possibly Penny’s question, I learned from them, experiencing by osmosis the big and little hurts each suffered when they were small. These three women showed me a side of life I didn’t experience growing up in a home of one female and four males.

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I’ve had a lucky life, but one (from an early time) that permitted me to peer into what it could have been had I been a young man in the Great Depression or a malnourished, ashamed teenaged girl or a Jew caught in the Holocaust or a black person before civil rights reforms. My empathy, to the extent it exists, is due to this and all the lives I’ve been permitted to enter. Whatever compassion I have works to counteract my judgmental tendencies, with less or more success, depending…

One other element of Possibly Penny’s question: she wonders how empathy is possible in response to “what can seem like trivial external triggers.” She is, I believe, referring to a patient’s overreaction to an event that appears small to an outsider, but reminds the client of something associated with trauma.

My answer is simple. It consists in knowing a triggering stimulus, however trivial, can be psychologically powerful. The capacity to be empathic follows from understanding how you (the therapist) overreact in your own life, even if you never were as traumatized as the patient. You must look through your client’s eyes back at yourself to understand his viewpoint.

Therapists are people. Patients often put them on a pedestal and sometimes underneath one! In both spots are flawed human beings. We mental health professionals strive to rise above our limitations, for ourselves and our clients. And we do care about our patients, although not in the same way we relate to spouses, children, siblings, parents, and friends. We endeavor to find whatever is best in them all. We don’t always succeed.

Every one of us in a clinic office is swimming upstream, some with more success. My job in therapy was occasionally to give my patients just a little push against the current. Looking back, I think I got the better of the deal. As I said, call me lucky.

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The first image is the Compassion Logo of Projekts der Schulstiftung der Erdiözere by Schulstiftung. The photo is called Taking Care of the Heart by Enver Rahmanov.