Hellfire and Brimstone...and so Much More
Richard U. Rosenfield
I read Ed Lundeen’s (2006) most recent column, “How Psychotherapy Works--The Sociopath Who Changed” with great interest and sense of understanding. In terms of impact, It reminded me of my relatively brief work, as a still young psychotherapist 30 years ago, with Tom (not his real name), a severely paranoid man, then in his mid 30s, who was unemployed, gay, and living with his mother amid a swirl of anger and distrust with few productive connections anywhere in his life.
After several months of work that included assessment and attempts at some exploratory psychotherapy to see if there was any basis for connection with which to focus on therapeutic goals, I found myself in the midst of a delicate dilemma. I had made the decision to leave my position as staff psychologist at a community mental health center for full time private practice and needed to tell Tom that I would need to transfer him to another therapist. I was not in a financial position to accept low fee or pro bono patients nor did he have the resources to see me privately.
With a month to go, I saw Tom in our regular weekly session and announced my planned departure. With a great sense of political correctness, I offered him the opportunity to share his feelings with me about this abrupt termination in the remaining time we had together as if handling this transition straightforwardly would be sufficient. I was not prepared for the immediacy or intensity of Tom’s reaction. He rapidly became more and more agitated, virtually rocking back and forth in his chair, as if he were about to explode. Whatever textbook descriptions of abandonment rage might have existed at the time, I am certain they could not have possibly described adequately what I was seeing unfold right in front of me.
Later, my colleagues in adjacent offices told me that the thin walls could not contain Tom’s mounting agitation and they struggled with whether to barge in to check on my safety or even call the police. Fortunately, they did neither but I was face to face with someone whose agitation appeared heading for psychotic proportions. This was no routine matter. I was about the same age as Tom, married, with two young children, a house, two cars and a mortgage, planning the next move in my life while leaving Tom behind with next to nothing.
What happened next has become one of my favorite teaching tales but I certainly did not know the outcome at the time. As therapists, we know we are subject to our patients’ emotional storms but with all of our training, sometimes, as Ed Lundeen’s “honey” remark illustrates, it’s our humanity that can be our best and most real intervention.
“As a therapist it took an intuitive, empathic moment to connect profoundly with another human being’s despair”
Without much conscious awareness, I leaned over, at the height of Tom’s agitation, and asked in my quietest and most gentle voice if he had gone to church a lot as a child. Without exaggeration, Tom’s agitation stopped instantly and he began to sob, at first uncontrollably, and then more softly as he slowly regained some semblance of control. When he was finally calm, I asked him what had just happened. He explained that as a child both his parents were alcoholics and often sent him off to a Pentecostal church in the Deep South on Sunday mornings as they recovered from their stupor. I was stunned! How had I, a nice Jewish boy from New York, been able to sense, intuitively, from Tom’s rhythm of agitation something of the hellfire and brimstone cadence that accompanied his youthful abandonment? I will never know.
I wish I could say this remarkable, unexpected display of therapeutic empathy had resulted in a major breakthrough in Tom’s therapy. It did not or, at least, did not appear to. We all know that progress with anyone with characterelogical disturbance, as Ed Lundeen’s work with his patient demonstrates, takes considerable time, patience and repetition of the most rudimentary gains. This dramatic session with Tom ended and the month ended with little observable effect and we politely parted company.
This, however, is not the end of the story. About two weeks later, I heard a knock on the outer door of my new office. I was not with anyone at the time and curiously opened the unlocked outer door. There stood Tom! I would be less than truthful if I said that I was unafraid. Frankly, I thought I was being stalked and assessed Tom’s demeanor for signs that I was perhaps in some physical danger. I couldn’t have been more wrong. While still standing in the hall, Tom looked me straight in the eye and said “Dr. Rosenfield, I know that I am not able to continue seeing you but I just had to know where you are”. With that, we shook hands, wished each other well and he departed peacefully. I never saw or heard from him again.
This experience has had a profound impact on my career. It has taught me to trust deeply my reactions to my patients and never to assume that someone is unreachable. As a therapist, it took an intuitive, empathic moment to connect profoundly with another human being’s despair. I did not learn this intervention in a classroom, from a textbook or from my training. I learned it from connecting with my patient. While I cannot “prove it”, and certainly not at the .05 level of confidence, I believe that what transpired between Tom and me had something to do with his feeling completely heard and understood, perhaps for the first time in his life, even though he lacked the language to express this connection himself. Like Frank was for Ed Lundeen, Tom was one of my most influential teachers. I only hope he internalized as much of me in our brief time together as I did of him. I remain forever in his debt.
In conclusion, I would like to suggest that the second part of Lundeen’s (2006) title for his column, “the sociopath who changed” may have inadvertently put the emphasis on the wrong point, the validity of the diagnostic label. As therapists, once we begin equating our patients with a diagnostic label, we lose sight of their individuality and what I believe is every person’s inherent capacity for growth.
Perhaps Harry Stack Sullivan said it best. As Mabel Cohen points out in her introduction to Sullivan’s Interpersonal Theory of Psychiatry (1953), Sullivan held to the tenet that “we are all much more simply human than otherwise, be we happy and successful, contented and detached, miserable and mentally disordered…” All of us who have the privilege of being psychotherapists find ourselves treating other human beings who have often endured no end of horrid developmental experiences and survived with whatever protective defenses they could muster. Diagnoses, however helpful in describing characteristic behaviors and beliefs, do not focus on human potential and the importance of connection for facilitating change.
I believe Lundeen is closer to the mark with the first part of his title—“How psychotherapy works”; it is indeed the psychotherapeutic relationship that fosters growth. As I experienced in my work with Tom and sense intensely in Lundeen’s work with Frank, it is through the force of the therapist’s humanity that our patients meet someone who provides them with a chance to safely express parts of themselves that remained far too vulnerable and fragile to reveal and, through the connections forged through this relationship, find what they need to grow and expand their ability to be a more constructive part of society.
References
Lundeen, E. (2006). How psychotherapy works—the sociopath who changed. The Independent Practitioner, 26, 126-128.
Sullivan, H.S. (1953). The interpersonal theory of psychiatry. New York: W.W. Norton & Company, Inc.
Richard U. Rosenfield, Ph.D has been in independent clinical practice in Northern Virginia for over 30 years and frequently uses the power of expressive writing to build bridges of connection with his clients. He can be reached at rurosen@aol.com or at (703) 569-3442.
