I am inspired by responses to my blog and appreciate each of you who have encouraged me in this endeavor.

You’ve also shared highly relevant personal concerns that I’d like to address here for the benefit of all of us, as you are working with STDP (or elements of it), an emotionally intense, dynamic therapy. My 9/23 blog on the subject of therapist courage, an attribute linked to positive outcome in the research, prompted this poignant comment about one therapist’s uncertainty about working with a dying patient in her 20’s.  “I am not sure I can help her go to her deepest fears since I share the same ones!!”  This therapist’s honest questioning is deeply touching and who has not asked this question of themselves at one time or another. I have something to share with her in a moment.

Another therapist sent me a heart-wrenching article written by forensic psychologist F. Barton Evans III, Bethesda, Maryland and Department of XX George Washington University Medical School who assesses the veracity of the stories told by torture victims seeking asylum in our country. He wrote about the courage it required of him to move outside of the purely neutral stance expected in his profession and immerse himself in the experience of a breathtakingly brave young woman, who was tortured horrifically yet said “with utter conviction that she would never do anything to jeopardize her family and her people. Dr. Evans replied incredulously, ‘Even to save your own life?’  His patient vehemently replied, “What is your life be worth, if you do such a thing?” This extraordinary person, who exhibits courage we can only aspire to, apparently had a transformational effect on Dr. Evan’s. His willingness to enter unknown territory with her apparently changed him and expanded his perspective. He states “I now with uncertain courage call on forensic psychologists to reconsider their notions of neutrality, opening ourselves to the real human experience of those whom we examine.”

I discussed on the IEDTA listserve (email Allen Kalpin <akalpin@aol.com> to subscribe) the doubts of the aforementioned young therapist with fears of working with a dying patient, especially with an intensely emotion-focused approach, and I received this beautiful and enlightening response from a perceptive physician:

“Dr. Evans’ wonderful patient  knew what had happened to her so the only real question as she sat in the room with Dr. Evans is whether he, or anyone else for that matter, could compassionately re-visit her experiences with her, or would she be left alone to confront her terrible trauma.  Somewhat similarly, the dying patients I have attended know what they are facing and sometimes just need someone who is willing to hear them call things for what they are without running out of the room in horror. The imminent death of someone who is dying young and out of turn is just too close for comfort.

The patient has two sorts of traumas, whatever she carries from her past and the unknown aspects she faces regarding her certain future.  The therapist of course carries her own history within her and also shares that certain future herself but seems to be dealing with the knowledge of her own finiteness through phobia and denial. What is the suffering the therapist fears?  The knowledge of death or the pain of death? Perhaps we do not go from zero to 60 mph without going through the intervening steps.  Thus she will have a chance to start and see how it’s going and either she or the patient can verbally or non-verbally take a time-out if needed.  Sometimes just stopping to share a cup of tea can give courage, either to the patient or the therapist or both.  But if along the way she feels that at this time in her life she cannot proceed, it is wiser and kinder to bow out.”

Fears of stepping into new territory with our patients can come up at any time, not only with patients with extreme trauma. Our patient may be struggling with an issue that activates an old wound within us that may be outside of our awareness, and we find ourselves in a pattern of avoidance or compensating by working too hard. I’ve seen a number of therapists who fully comprehend the theory but back off just as they get to the mother lode. When therapists feel the need to “bow out,” which may mean referring a particular patient to someone more appropriate or simply slowing our exploration of a patient’s feelings because we are not prepared to go further without additional help, we not only serve our clients but are also being wiser and kinder to ourselves.

Therapists are subject to affect phobia, or fears of feelings, as certainly as our patients and we may need a “graded approach” to building our own tolerance. Let us remember that gradually stretching ourselves, stepping prudently onto new ground, is an act of courage! Frankly, I don’t think any of us could be practicing psychotherapists without courage inside of us. However, it becomes an issue of whether we are willing to risk a bit more than yesterday, as we broaden our knowledge. That said, we also need to track the “perpetrator” within us, i.e. that part that shames and devalues us for not being someplace other than where we are. It takes its own form of courage to recognize our limitations. When we show kindness and compassion towards ourselves when we need to slow down or stop entirely, it calls forth the healthy force within us that we hope to activate in our patients!

I plan to address soon a therapist’s fears of possibly harming a patient in a vulnerable physical state, such as pregnancy, with deep affective work. I also want to respond to the comment: “My referrals have increased dramatically since doing this so something is going right.  However, I feel drained, exhausted, stressed and more porous to all my patients’ distress.”

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