Sylvia, a stocky woman in her late 50s, came into my office and sat down. She’d called the clinic just an hour before, apparently from a pay phone in the parking lot below, asking to see a therapist. As a new trainee with a free hour, the receptionist assigned Sylvia to me.
Now, sitting upright on the sofa, she was the picture of matronly determination. Her hands were folded on her lap. Her jaw was set. Only her pale eyes, blinking rapidly behind thick-framed glasses, betrayed any anxiety.
“Hello, Sylvia,” I said, reaching out a hand to shake hers. She ignored it.
“Listen,” she said, her voice laced with feeling, “I’ve made all the financial arrangements. I have the means at home, in my desk. A bottle of pills.” She glanced at her watch. “It’s four o’clock. These sessions are what?–forty-five, fifty minutes?”
She nodded. “Okay then. I plan to kill myself at seven o’clock tonight. So I guess you have fifty minutes to talk me out of it.”
Let me back-step: This initial session occurred many years ago. I was in my late 30s, having just finished graduate school, and working as a therapist trainee at a low fee family clinic. I’d only been there six weeks or so, in which time I’d acquired a total of three regular clients. I’d had two semesters of group supervision as part of my graduate work, and a half-dozen individual sessions with the supervisor assigned to me by the clinic. If I described myself as “green,” I’d be boasting.
Prior to beginning my training as a Marriage and Family Therapist, I’d been a professional screenwriter. More importantly, perhaps, I’d been in group therapy with a Gestalt therapist and trainer. But I think it was the symbiosis of aspects of these two facts that directed me in my work with Sylvia during our initial encounter, and in the months of work that followed.
As a Hollywood writer, I’d worked in both television and film. My job as part of a team of writers on staff at various network sitcoms included the sometimes harrowing, and always challenging, experience of participating in the “writers’ room.” This involved a daily meeting with the other writers in hours-long “pitch” sessions: intense, competitive free-for-alls of jokes, story ideas and comic situations–each writer trying to “top” the other, defending his or her own ideas, while simultaneously criticizing everyone else’s. And this was considered a good thing. And for a very good reason: “pitching” generally elevated that week’s script, increasing the comedy, heightening the levels of conflict, and sharpening the characterizations.
One of the traits acquired after a few years of this experience was the ability to think on your feet, and to go with the first idea that came to mind. There wasn’t time to debate with yourself the merits of the joke or notion. You had to ultimately trust yourself and your innate talent, whatever its limits, and keep throwing out ideas. And yet this could not be an exercise in chaos theory: the jokes or situations being offered had to fit in with, or enhance, or be a springboard for, elements in that week’s script. The spontaneous, free-flowing creative expansiveness that was required to be effective (i.e., improve the script) had to make sense in a particular context.
In other words (illuminating the paradox known to all artists), to be a good staff writer required a combination of freedom and discipline, intuition and structure.
With these concepts in mind, I now want to discuss my experiences as a patient in a Gestalt group. Here, as had never before happened in my life, I was invited to acknowledge and explore very powerful, contradictory feelings. Even more challenging (or, to be honest, terrifying), I was asked to do this without judgment; that regardless of what feeling or impulse I had, I had to risk just being aware of it, even “playing” with it, and learning what it had to teach me. As Robert O. Brown defined it, true awareness was accepting that “this is my experience, whether I like it or not; and my liking or not liking it is also part of my experience.”
In the ensuing years, I’ve added layers to my clinical training–including long-term training in intersubjectivity theory, and other more relational theoretical models–such that I don’t even consider myself a Gestalt therapist anymore. But I can’t over-state the value of those early experiences in the Gestalt group, especially in light of how they combined with my experience as a writer, to intersect in that initial session with Sylvia many years later.
“Okay, then,” she’d said. “I plan to kill myself at seven o’clock tonight. So I guess you have fifty minutes to talk me out of it.”
When I heard these words, I felt a flood of different emotions, in more or less descending order: panic, then disbelief, then despair, then more panic. Even as I sat across from her, struggling to make sense of her words–indeed, struggling against the almost unreal, dream-like quality of the situation–I could feel the blood rushing to my neck. I probably looked white as a paper plate.
Then, as the reality of her challenge coalesced in my mind, I did what my experience as a Gestalt patient and my years as a creative person taught me to do. Or, rather, allowed me to do. Be myself. Whether I liked it or not.
In retrospect, it was probably the most creative, most intuitively attuned act of my clinical career. Because what she said–“I plan to kill myself, and you have fifty minutes to talk me out of it”–alarmed me, challenged my belief in my ability as a therapist, and frightened me in terms of how best to help this poor woman. But, what it mostly did was piss me off.
And so, without a moment’s thought, I blurted out, “Why wait till seven o’clock’ Let’s have you die now.”
Sylvia stared, and pushed her glasses further up the bridge of her nose.
“What did you say?”
Even as I answered her, some part of me was creatively picking and choosing from the swirl of images in my mind. Pitching ideas. Stalling for time. Maybe a little of both.
“I said, why don’t you die now?” She spread her hands, at a loss. Then she looked at me as though I were an idiot. “Are you trying to be funny?”
“No.” I literally did not know what words were going to come out of my mouth, even as I was saying them. “I just think, if you’re planning to do it later tonight, we might as well take advantage of the time we have now. Let’s at least get something out of this session.”
Then I had it. The image. The “pitch.” “Would you be willing to try something?” I asked.
Sylvia paused for a moment, then nodded. More curious than suspicious at this point, I think.
I then suggested that she lie down on the floor, on her back. Grunting from the effort, she complied.
“Okay,” I said. “You’re dead.”
She frowned up at me. “I’m dead?”
I didn’t answer, but instead began taking some chairs from the different corners of the room and arranging them in a vaguely rectangular pattern around her on the floor. “Your coffin,” I informed her.
She let out a long breath. “This is so…”
I interrupted her. “Who’s viewing you in the coffin'”
She snorted. “My family, of course.” A pause. “What’s left of them. My daughter Gail and her husband Ted.”
She said the name “Ted” with emphasis. Sharply.
I waited now, as she took another breath. Without my suggesting it, she closed her eyes. Her breathing slowed. She seemed to be allowing herself to “die.”
“What’s your daughter doing?” I said at last.
Sylvia’s voice was softer than I’d heard it before. “Crying. Those big sobs, like when she was a little girl. As though she couldn’t catch her breath.”
“What about Ted?”
Her eyes still closed, she turned up her lips in a half-smile. “Ted’s looking down at me, not doing anything. But I know what he’s feeling.”
“Guilt. And it’s about time. I had to die before he’d finally feel it, though. The son-of-a-bitch.”
I saw the yearning on her face. And took a chance.
“You’re sure he’s feeling guilty?”
Sylvia’s brow darkened. “Probably not.” There was resignation in her voice.
“Ted’s probably glad I’m dead. That I’m out of their hair. Weepy, neurotic Sylvia. The mother-in-law from hell. Blah, blah.”
She opened her eyes and found mine, watching her from my seat. “There’s no question, he’s glad I’m gone. And Gail, too. I don’t believe those tears for a minute. I want them both to be sorry for how they’ve treated me. I want them to know the hurt that I’ve known. But you know what? I bet they won’t. I bet they’ll just go on, relieved not to have to deal with me anymore.”
Sylvia folded her arms across her chest. A long sigh, as she stared now at the ceiling.
“Goddammit, I’ll probably even die for nothing too!”
We spent the rest of the session this way, Sylvia on her back on the floor, occasionally glancing over to me on my chair as we talked. She gave me some history–her father’s alcoholism, her painful adolescence as a chubby outcast, her marriage to a physically abusive man, her raising Gail alone after the divorce, her daily Mass attendance worshipping a God “who doesn’t give a damn what happens to me.” Alhough she’d never been in therapy before, she’d talked about many of these things with her parish priests. She “knew the issues,” she assured me. Before too long, the session was over.
“Sylvia,” I asked gently, as she reluctantly got to her feet, “would you like to come back on Tuesday, same time, and die again?”
She considered this for a long moment. “Why not?”
With this ringing endorsement of our work together, she turned abruptly and left.
That evening, I called Sylvia to confirm our next appointment, and to assess for suicidal ideation. She seemed irritated that I was concerned, and was insulted that I wanted a contract between us that she would call me if she felt suicidal.
“I said I’d come back, and I will. You’re just trying to cover your ass. You know, in that way you remind me a lot of Ted.”
Great, I thought. Something we could use.
Sylvia did come back on Tuesday, and twice weekly after that. Although she found it relaxing and an invitation to let her thoughts and feelings flow more easily, she only wanted to “die” on the floor a few more times.
By now, I realized, to “die” for Sylvia meant that she could allow her defensive armor to go down, her sharp wit to take a recess. It was a convenient, concrete metaphor for “letting it all go,” thus freeing her to express her moment-to-moment feelings. Soon, though, it became easier for her to do this sitting across from me on the couch, “like a regular client,” she said.
In the ensuing weeks, we explored in fairly traditional fashion her lifelong battle with depression, her self-esteem issues concerning her intelligence and body image, and primarily her disappointing experiences with men. Her religious faith, long a cornerstone of her subjective world, she treated with an almost wry affection, like a mischievous child you couldn’t really get angry at, and yet whose actions always frustrated you. “God and me are still having conversations,” she remarked once, “but lately I don’t think we’re gettin’ anywhere.”
Although a moderately successful real estate agent, she’d never handled money well, and often relied on her daughter’s rich husband when things got tight. Ted was a wealthy investment banker–“a total Republican,” she explained–and quite authoritarian with Gail and their two little girls. “He doesn’t let me see my grandchildren as much as I’d like,” Sylvia reported. “He says my bad moods and health complaints set a bad example for them.”
Sylvia was a difficult, easily distracted client, and the first months of our work together saw little progress in terms of challenging her self-experience as fairly worthless and occasionally pitiable. Under this, of course, was a deep rage, below which dwelt pervasive feelings of shame. I knew, as my confidence level and clinical skills increased, that the more she trusted me, and the more congruent our interactions, the better the chance she’d be willing to bring more of these shameful feelings into the room, and allow us an opportunity to explore their origins and meanings for her.
This exploration ultimately happened, at least to an extent, until a job with another real estate firm made it difficult for her to keep coming to the clinic. I made a referral to a facility close to where she would now be working, and we were able to conclude this phase of her treatment with mutual feelings of affection and gratitude.
During our last session, Sylvia reflected on what had happened during our first one, and said that she’d come away with a particular message.
“I thought you were crazy,” she said, “when you told me to lie down and act dead. No, not crazy. What I really thought was that you didn’t know what you were doing.”
“I didn’t,” I admitted.
She smiled. “Funny, but I got that, even as I was lying there, imagining my funeral. I kept thinking, ‘This guy doesn’t know what the hell he’s doing.’ But somehow, the fact that you were willing to just follow your nose comforted me.”
“Really? I would think you’d feel the reverse.”
“Me, too. That night, at home, I wondered what had felt so good about the session. Then I realized what it was. I’d come in and said I wanted to die, and you’d said, ‘Okay.’ You took me at face value. You didn’t make me wrong, or bad, or crazy, or selfpitying. Plus you also let me see how you really felt.”
She gave me a maternal look. “Honey, you don’t think I knew you were angry? Here comes some crazy lady saying that she’s gonna kill herself, and demanding that you help her. Hell, it would make me mad. I liked that you let me see that. All my life, people haven’t let me really see who they are, or what they’re feeling about me. So I always have to guess, and what I usually come up with is that there’s something about me they don’t like.”
She leaned back on the couch. “Besides, if you didn’t know exactly what you were doing, and could risk it anyway, maybe I could, too. Maybe I could risk something… like trusting you, for example. So that’s why I came back.”
After we’d said good-by, we spoke a few times on the phone, Sylvia filling me in about her new job and her struggles with her new therapist. But it sounded like her treatment was in good hands, and the calls became less frequent. Then they stopped altogether.
I’ve never seen Sylvia again, but I’ll always be grateful for the lessons I learned from her during that first session, even though it presents, in retrospect, more questions than answers. Had it just been the result of a “good fit” between therapist and client’ Maybe even simply “beginner’s luck” (on both our parts).
I can’t help thinking it was something more: the balance between intuition and clinical judgment, however modest and untested; the value of creativity in therapeutic work, of course, but only when wedded with an absolute conviction to meet the client where he or she is right now. And, further, that such creativity only has value in terms of the clinical dyad when the therapist is willing to be where he or she is right now, as well.
“Only connect,” the poet says. Is there a better definition of the therapeutic alliance, and indeed of creativity itself, than that?
Article written by Dennis Palumbo first appeared in the January/February 2006 issue of The Therapist.