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- Herausgeber: Crown House Publishing
- Kategorie: Fachliteratur
- Sprache: Englisch
In Their Finest Hour, therapists, on the cutting edge of their profession, detail their most professionally rewarding cases and share what they learnt from them. These outstanding therapists define achievement in their field, describe how therapy really works and speak frankly about how their cases shaped their ideas. Each interview was recorded and then transcribed and written into narrative prose, including re-created dialogue that was based on case notes and recordings.
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Veröffentlichungsjahr: 2008
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Contents
Chapter One
The Finest Hours
We have each spent our lives doing therapy and trying to make sense of how and why it works. Between us, we have written seventy-five books on the subject, covering almost every facet of this mysterious process imaginable. That is not to say that we can say with confidence that we do know what it is about therapy that is most beneficial, but we can speak with authority about its most salient features.
In our research, we have had the privilege of interviewing hundreds of the greatest therapists who have lived during the past century. We have talked to them about their careers, filmed them demonstrating their theories in action, and interviewed them extensively about what they did in these cases and why they chose those particular paths. We have also had the opportunity to interview dozens of the most famous therapists about the worst session they ever had and what they learned from it (reported in our book, Bad Therapy), as well as the most bizarre or unusual case they have ever seen (reported in The Mummy at the Dining Room Table). During these quite intimate conversations, we became hooked by the drama, the pure magic, the stunning brilliance of these stories that highlight human transformation during times of adversity. We were struck not only by the changes that took place in the clients in these seminal cases, but also how these greatest minds of our profession were also affected by these relationships.
There have been some excellent books in the past about the most interesting and seminal cases of psychotherapy, but never have the greatest successes of the most accomplished theoreticians been assembled in one volume, and told in their own words. Their Finest Hour brings together two dozen of the greatest living therapists, who tell the stories of their best work, however that may be defined. We chose these particular theoreticians not only because of their professional reputations and stature, but also because they are such great storytellers. We wanted to write about those “finest hours” that best lend themselves to a good read, as well as providing important lessons on living life to the fullest.
All of the therapists we interviewed faced the challenge of deciding what constitutes great therapy. If a client improves in a single session, but the therapist had little to do with the improvement, is that one’s finest hour? Likewise, there are times when a clinician engages in some masterful intervention, or builds a fabulous relationship with a client or family, but there is no discernable progress even after months or years of treatment. And then there are those times when you know you have done a fine piece of work that has made a huge difference in a person’s life, but the changes won’t be acknowledged. Another variation on this confusing theme is when a client claims that vast improvement has occurred—thank you very much for your tremendous effort—but neither you nor anyone else can see a whit of difference. This is one reason why it is so difficult for us to research the outcomes of our efforts, much less to choose what we believe are the best examples of our work.
To make matters still more complicated, we are not altogether certain how therapy works in the first place. That is one reason why there are so many schools of thought, many of them represented in the chapters of this book. Each of us has distinct notions of what is most important in a therapeutic relationship and what the ideal role is that a therapist should take in promoting changes. Cognitive therapists (such as Arnold Lazarus and Albert Ellis) believe that the main focus of our efforts should be on changing the ways people think and talk to themselves, and that this will lead to subsequent changes in feelings and behavior. Psychoanalysts (such as David Scharff) believe that the past shapes present issues and that until we resolve those underlying struggles, people are doomed to repeat their dysfunctional actions. Adlerians (such as Jon Carlson) take a more integrative approach, one that looks at family constellations and family-of-origin issues. Existentialists (such as Jeffrey Kottler and Alvin Mahrer) focus on helping people to find greater meaning in their lives. Constructivists (such as Robert Neimeyer, Stephen Madigan, and Michael Mahoney) seek to help people to re-story their lives, creating new narratives that are more self-enhancing and self-empowering. Ericksonians (such as Steve Lankton) downplay theory altogether and instead concentrate on innovative interventions that disrupt current dysfunctional plans and substitute alternatives. And this is just a sampling of the ideas represented in this book and in the profession!
In spite of the incredible diversity in approaches to therapy, there is some consensus about what tends to work best. A solid relationship needs to be developed, one that is trusting and collaborative. Clients are taught new ways of viewing their problems, especially alternatives that create more hope and possibilities. They are further offered the support and guidance they need to try new things and practice them in their lives. Most practitioners spend some amount of time working on developing greater self-awareness and insight, although this type of work takes many different forms (focusing on the past or present, thoughts or feelings, individual or family dynamics, and so on). Hope and faith play a big role in what all therapists do: instilling a strong belief that change is indeed possible. Finally, all therapists do “stuff.” They have their favorite interventions and strategies, and while these may look different and have varied goals, they do essentially the same things, which are to get people to stop doing things that are not working and try other things that work much better.
This is a gross simplification, of course, but one of the things that is so amazing about the therapy profession is the different forms it appears to take and yet still produce positive effects. And make no mistake: therapy does help people most of the time. Some of these individuals might very well have improved anyway, but they would not have done so as quickly, nor would they have learned the lessons that go with this type of growth.
Although you will see many types of therapy described in this book, and cases of miraculous cures, the routes taken on these journeys are as different as the individuals. That is probably no different than the way people approach their work in your own chosen field.
In spite of the variety of approaches represented in this book, as well as the diversity of cases described, all the contributors were asked essentially the same questions, to use as a basic structure. First, we asked them which case came to mind that represents their best piece of work. We encouraged them to tell the story of what happened in this ground-breaking episode, followed by queries about their own understanding of why things unfolded the way they did. This will give you a unique window through which to view the way each prominent therapist thinks about his or her work and makes sense of the world. Finally, we asked about what could be learned from this situation that might be useful to others. We are not just speaking about other therapists, but what anyone can draw from this case that might help him or her to initiate more powerful and lasting changes in his or her own life.
Each of the interviews was recorded and then transcribed, then written by Jeffrey into narrative prose, including re-created dialogue that was based on case notes and recordings. We sent each chapter to the contributor to check for accuracy, and in some cases, to fill in further details. The contributors also worked to disguise further any identifying features of the clients.
We will talk to you again at the end of our journey, after you have had a chance to enjoy these therapeutic tales and the wisdom they contain. At that point, we will revisit the central themes of the stories and what they have to offer us as object lessons for how change best takes place. In the meantime, fasten your seatbelt and be prepared to alter your views of what therapy is all about and how it really works. In the stories that follow, you will have the opportunity to observe the most accomplished therapists in the world work their magic with some of their most challenging and yet rewarding cases.
Chapter Two
The Ball, the Snowflakes, and the Wheelchair
Cases from Jeffrey Kottler
Jeffrey Kottler has been a leader in humanistic and experientially based therapies, devising an approach that is highly pragmatic and integrative, including features of a dozen other models. In his dozens of books about the therapeutic process, and the therapist’s experience, he emphasizes the power of personal contact and caring. He uses creativity and humor to help clients take risks and challenge themselves in new ways. He likens the role of the therapist to that of a “travel agent,” whose main jobs are to help structure and guide transformative journeys.
Some of his most highly regarded works include On Being a Therapist; Divine Madness: Ten Stories of Creative Struggle; and Making Changes Last. Jeffrey has collaborated with Jon Carlson on a number of other projects: Bad Therapy; The Mummy at the Dining Room Table; The Client who Changed Me; Moved by the Spirit; and An American Shaman.
Jeffrey has been an educator for thirty years. He has worked as a teacher, counselor, and therapist in preschool, middle school, mental health center, crisis center, university, community college, and private practice settings. He has served as a Fulbright Scholar and Senior Lecturer in Peru (1980) and Iceland (2000), as well as worked as a Visiting Professor in New Zealand, Australia, Hong Kong, Singapore, and Nepal. Jeffrey is Professor of Counseling at California State University, Fullerton. He is also the co-founder of the Madhav Ghimire Foundation which provides educational opportunities for lower caste girls in Nepal who would otherwise be unable to attend school.
A Dying Breath
It has been said that when people are about to take their last, dying breaths, they see their lives pass before their eyes. I imagine that such a stream of images would include snapshots of faces more than flashes of landscape or objects, but perhaps that reflects my own priorities. I would also guess that many therapists would see the faces of their clients among their loved ones as their last memories on this earth. I know that would be true for me.
Like most of the contributors to this book, I have seen and helped thousands of people over the years. If I add to this list those I reached through the media and writings, it is staggering to consider that the potential audience is well into the millions. Of course, I have never met most of these people, nor will I ever hear any indication, one way or the other, about how I was helpful to them. It was my clients, however, whom I will most remember. And if I am granted moments of reflection before I take my last breath, I’m certain some of their faces will pass before my eyes.
Breaking the Cardinal Rule
It is interesting to consider which clients we most remember and others we have long forgotten. I remember some of my finest hours, but also some of my most trying sessions and challenging cases (but that was the story of another book). Foremost, I will never forget the single session of therapy I did with a couple from India.
“How might I help you both?” I addressed the couple in my most earnest voice. The husband, an immaculately dressed physician, spoke in clipped, regal sentences, emphasizing his British accent. The wife, dressed in a traditional sari, remained quiet while he did all of the talking.
“My wife,” he said, gesturing toward his wife who sat placidly, “she wants to work.”
“I see,” I said, not seeing at all.
“We do not do this sort of thing in my family. Women are supposed to stay home and raise a family.”
“And how do you feel about this?” I addressed the wife.
Before she could answer, the husband chimed in on her behalf and said that she would like to work but he still felt this would dishonor his family. “It would tell all our people back home that I am not capable of taking care of her.”
I understand that there were some complex cultural dimensions to this story. Apart from my own biases in favor of greater equality among men and women, and the cultural norms of our community, I understood that they had been raised in a very different milieu. Still, I was annoyed by his controlling behavior, and perhaps that was revealed in the impatience of my next question.
“So, what do you want from me?” I asked.
The good doctor nodded, pleased that we had gotten to the heart of the matter. He looked very busy and preoccupied, ready to get back to the hospital and continue his work. “Well,” he said, “we are now living in a different country, a place where you have very different rules for this sort of thing.” He said this distastefully, clearly indicating that he did not agree with these lax standards.
“That is true,” I agreed with him. I was still uncomfortable that we were talking about his wife as if she was invisible. So I turned to her again: “I’d like to hear from you, Mrs Vejay. How do you feel about this?”
She looked at her husband for permission to answer me, but he just stared straight ahead. She presumed this was a sort of tacit permission. “It is true,” she said, “I would like to work. As yet, we have no children. I am so far away from my family and my parents and my friends back in India. I do not like staying at home all day. I want to do something else. I see all the women here, in this country, have jobs. I would like to work as well.”
I was nodding my head in agreement all throughout her brief statement, then caught myself. “Thank you, Mrs Vejay. So if I understand this situation, the main problem that you would like assistance with is related to whether you should be able to work or not. Doctor, you would rather she didn’t, and Mrs Vejay, you would very much like to do so.”
“That is correct,” the husband agreed.
“Okay,” I said, still confused about what they wanted from me. “How can I help?”
The doctor looked at me as if the answer to that question was rather obvious. “Well, we would like you to tell us what to do.”
“You want me to tell you whether your wife should be allowed to work or not?”
He nodded solemnly.
“So, if I tell you that your wife should work, then you’d agree to let her do so?”
Again he nodded.
“And if I say no, then she doesn’t work?” This time I looked toward the wife, who also nodded her head.
I could feel the panic start to well up in me. I knew that giving such advice was absolutely the worst thing I could do. I rehearsed in my head just how I would tell them that I—or any therapist—does not give advice in this way or make decisions for people. Instead I would help them sort things out for themselves, explore the relevant issues, and negotiate a mutually acceptable solution. That’s what I was thinking. But it certainly was not what I actually did. And even now I don’t know whether to feel proud, or ashamed, of my intervention.
Maybe I responded as I did because people rarely listen to me, even when they do ask my advice. Perhaps I was just appalled at the doctor’s sexist, controlling attitude and I wanted to annoy him. I’d like to think I was responding in a culturally appropriate way when I chose to do exactly what they asked of me: “Okay then, if what you want me to do is to tell you whether your wife should work or not, I think that decision should be left up to her. That is the way we often do things in this country. But still, I understand that in your …”
“So,” he interrupted, “you are saying that she should work?”
I was visibly sweating now. I’d just broken a cardinal rule and I was trying to figure out how to get myself out of this advice-giving fix. “Well, I was trying…” Then I just stopped. I looked him right in the eyes and nodded my head firmly, definitely. “Yes,” I said, “if that is what you are asking me, then I think that is perfectly okay.”
“Thank you,” he answered. “Well then, I think we are done here.” He looked at his wife, indicating it was now time to leave.
“That’s it?”
“Yes sir,” he said in a calm voice. I was pleased he didn’t seem visibly angry. “That is all we wanted to know.”
Indeed the couple left the office, and unless it was my imagination, they seemed quite affectionate and relieved. Because I was concerned about what damage I might have done unwittingly, giving in to my impatience rather than taking the time to help them figure out things for themselves, I followed up with the couple a few weeks later. The husband answered the phone and reported that his wife had found a job and was now working 20 hours per week. He seemed fine with that, thanked me politely for all my help, and promised to contact me again if they ever needed more help.
Well, this was hardly my finest hour of therapy, even if the outcome was so spectacularly positive from the point of view of the couple. But I cite this as one example of faces I will never forget. There are others of course—many other successful cases that turned out quite well as a direct or indirect result of my interventions. But I would rather not talk about any of these.
Successes and Failures
It is curious to me that it is a lot easier to remember the worst representatives of my work rather than the best examples. It is not that I’ve rarely helped anyone—just that once a case is completed, I tend to move on to the next challenge rather than dwell on what happened. For me, therapy often feels like magic, beyond my comprehension. Whenever someone makes a dramatic breakthrough, I sit in awe at what transpired yet feel reluctant to analyze what happened lest the illusion fall apart. I also wonder if whatever role I played in the transformation will desert me next time. Maybe I’ve lost my healing magic. Maybe what I have, or whatever I can do, won’t last.
This is not good science. Everything that I’ve learned (or at least been trained in) has encouraged me to measure the impact of my work, assess the outcomes, analyze what happened and why, so that I might more reliably work skillfully in the future. If I don’t know what I do, and what effects such actions have on others, how can I duplicate my actions next time?
Although I know that I am supposed to spend considerable reflective time deconstructing the successes of the work (notice the absence of the possessive pronoun, “my,” since they don’t feel like they were mine), there are always another half-dozen people around who appear to be stuck no matter what I do to try and help. There is precious little time to think about the glorious victories (and it does somehow feel like a war at times) when the battlefield is littered with failures. And make no mistake; while I am reluctant to accept much responsibility for the major breakthroughs that take place, that is certainly not the case with respect to the failures.
I should know better by now. I teach my students and supervisees to process negative outcomes in more constructive ways than I handle them. But the fact remains that I can name at least a dozen things I did wrong before I list something I did right. And this isn’t at all because I’m a bumbling, ineffectual idiot, but because I seem to learn more from my mistakes than I do when things go according to plan.
It is not that I can’t think of many people I helped, because I am darn good at what I do. I listen well. I hear and see and sense things that are beyond the awareness of most other folks. I am good at explaining complex things in comprehensible language. I know how to confront people sensitively, and bring their attention to things they’d rather ignore or avoid. I feel a lot of love and compassion toward others—I care a lot—and I seem to be effective at communicating this consistently. I’m a genuinely nice person and I work hard at treating others with respect. I’m a good talker (and writer)—persuasive, clear, and honest. I’m flexible, creative, inventive, curious; I’m playful too and like to have fun. For all these reasons, I help people—whether students, clients, supervisees, or colleagues—most of the time. And after each happy customer who leaves my office, I immediately turn my attention to the next dissatisfied soul who requires assistance.
The Ball
It was the giggling that hooked me. I looked up from my comfortable seat, my feet propped up on the table, and creaked up into my standing position. My muscles ached and I was almost certain I had pulled something. I could breathe only with difficulty since the altitude was well over 13,000 feet. I was trekking in the Himalayas, in the Langtang region that straddles the Tibetan border. I had already spent a week on the trail, climbing steadily higher, but this was the toughest day so far. There were vertical peaks on all sides, snow-capped mountains that were covered in spring wildflowers. I was racing to beat the monsoon, covering distances that were probably beyond what was reasonable. That’s why I was winded and weary (that and the fact that I’m getting old).
I had given a lot of thought to planning this trip. I had not only plotted my itinerary but had given considerable thought to each item I had brought with me; I wanted to keep the weight down.
Having spent a lot of time in remote places, I like to bring gifts with me when I travel. I’m careful about my choices, wanting to be culturally sensitive and yet true to my own convictions. For instance, when visiting a hunting village in East Greenland, I was told to bring cigarettes to show appreciation to people who were nice to me. I couldn’t quite bring myself to do that, instead bringing a few Frisbees for the children. But I wondered if I had actually changed the culture of these people by introducing this foreign flying object to their play; prior to my arrival the kids seemed to delight in throwing snowballs at one another; now they had Frisbees to fight over. So I’ve learned to be careful about such things.
Friends who had visited Nepal warned me not to take gifts at all. They said that the people in the mountains were gracious and hospitable without any external rewards, and it was best not to “ruin” them with material temptations that might encourage them to beg from others. This made sense, but nevertheless, I stuck one thing in my pack. More about that later.
There was something irresistible in the children’s laughter. As I said, I was resting at a stop for travelers, a modest stone dwelling with thatched roof and a fire to heat up tea and yak milk. The plot of land was no bigger than a football field, and it was the only level ground for miles in any direction; the drop-offs were steep and endless. So this family of a husband, wife, and two kids had settled themselves on this habitable horizontal space in a totally vertical universe.
The kids looked to be about 4 and 6 years old and they were positively adorable. They were playing soccer with a deflated ball, their only toy, it seemed. In between kicks and giggles, they flirted shyly with me, glancing at me only when they thought I was not noticing. Their father was pounding rock into smaller stones, which he would later smash into gravel that could then be mixed into concrete. Their mother was standing over the clay oven, baking fresh bread to serve with my tea. And the kids were thoroughly entertained by their deflated ball, delighting in the idea that they had an audience to watch their play. Soon, their crowd was about to join them in the game.
I stood up on creaky legs and immediately the youngest boy, the 4-year-old, kicked it my way before falling on his butt. His brother giggled and ran over to help the little guy up; he started laughing too.
So for the next few minutes we had a little game of international soccer, Nepal against the United States. The score may have been tied, or perhaps one of us was winning—it was hard to tell since we didn’t have any goals, we didn’t keep score, and the little boy kept changing sides when he felt like it. Their parents watched us while baking and pounding rocks, grins on their faces. I can’t recall ever having so much fun playing soccer (but then, I never liked the game much).
As things proceeded, the 4-year-old became more competitive with his older brother. He took a mighty kick at the ball, this time managing to remain on his feet. But to our collective horror, the ball took flight off to one side and sailed over the edge into the abyss. I must say the kick was quite a powerful effort, even if it was in a wayward direction.
The two boys ran to the edge of the world, staring off into the clouds below where the ball had now vanished. For all I know, it may still be falling.
We all just stared off into the edge, motionless. I don’t know what we were waiting for. Maybe expecting that someone “down there” would kick the ball back up to us on the top of the world? Maybe that the ball had landed on a ledge below so that we might retrieve it? It was not to be; the ball was gone forever.
Both boys turned around in absolute dejection. This was their only toy in the world, their most cherished object. They lived in a place so remote that it took 4 days’ walk just to get to a road, where a bus might take 12 hours to take them to the nearest city. The children had no friends on this mountain except one another. They had only the ball to play with, even if it had been deflated and worn.
The smallest boy looked up at me helplessly and started crying. Then his brother started in; they were both heartbroken. Even their parents looked as deflated as the ball had been.
I signaled to both boys and called them over to me. They ignored me first, lost in their own grief, but when I repeatedly gestured for them to join me, they inched a bit closer. They had been doing just fine before I arrived; maybe they held me responsible for their misfortune.
The 4-year-old came over to me cautiously, then learned against me for comfort. I pointed to my bag and gestured for him to watch what I was doing. Now curious, his brother joined us. I reached inside my bag and felt all around along the bottom, searching for something that I had stored away. I now had the kids’ full attention. Then I pulled out my hand and out came a ball, the only thing that I had brought with me as a gift. I formally presented it to the youngest boy, nodded thanks to the parents for the meal, and then turned and started to walk down the mountain. When I looked back over my shoulder, I saw both boys peering over the edge of the cliff, watching me descend toward the valley floor. I waved to them, but they seemed spellbound that this stranger should appear out of nowhere, offer them the one thing they needed most, and then disappear into the clouds.
Feeling Useful
I’ve been doing therapy for 25 years and have seen thousands of people in my office. As I mentioned, because I’m pretty good at what I do, most of them left my services far better off than when they first came in. So then: why are the examples that come most vividly to mind those that involved children on the street? In another case that follows, you will see that these children were not clients of mine, nor did I ever learn their names or see them after a single encounter. Yet I am still haunted by our interactions. And I have never felt more useful in my life.
Feeling useful is an important theme for me. I grew up feeling pretty powerless as a kid. In baseball I was always stuck in right field, bored out of my mind because nothing ever happened out there, and yet terrified that someone might hit a ball to me which I would promptly drop. It wasn’t until years later that I learned that I needed glasses, that the world always looked blurry to me, but for some reason I still cannot understand, my parents never had my eyes checked. I remember memorizing the eye chart in the school nurse’s office because not being able to see was just another way that I felt inadequate. It also explained why I didn’t do so well in school, since I could never see what the teachers would write on the board. Whenever I was called up to point out the object of a sentence or to balance both sides of an equation (tasks that still seem pointless to me), I would stand up there just as lost and clueless as when I had wandered right field. It was as if I was seeing those scribblings on the board for the first time—which was true!
Since I was neither a good student nor a good athlete, one would think I might find solace in some other pursuit, but truthfully, I wasn’t very good at anything except building model airplanes (and even then I don’t think I was so much good as persistent).
To make matters worse, my home life sucked. My mother and father hated one another, or at least they didn’t like spending time together. My mother was often drunk and my father was often gone somewhere gambling, playing golf, or chasing women. Needless to say, I didn’t feel very useful to anyone, least of all myself.
Ever since I can remember, I wanted to do something with my life that might be useful to others. Maybe I wouldn’t feel so helpless. Maybe all the pain and anguish I went through might have been for some purpose, even if that was only to help me to understand what others live through. Anyway, I walk through life looking for opportunities to be helpful to others.
I used to have an office at the university along a hallway that became congested during class changes. My neighbors on both sides were always complaining about the interruptions when lost students would peek in the door and ask directions to a particular part of the building. They would close their doors and pretend they weren’t in, so they could get their important work done. Me? I liked being asked directions; it made me feel useful. So much of what I do as a therapist and a teacher results in ambiguous outcomes—I’m not often sure if I’ve helped someone, if I was useful, if I made some kind of difference. I’ve learned over time that the ones I think I’ve helped may only be faking, or their changes may be intermittent and impermanent. And it sometimes takes so darn long to have a significant impact.
But giving directions? I loved it! I took great pride in giving precise instructions to people in need. First I would invite them into my office in the most reassuring way possible. “No problem,” I would say, “that’s a hard room to find. Most people have trouble locating it.” Then, after validating their experience, letting them know they were not alone in their struggle, I might reflect a few of their feelings, just to let them know that I fully understood the depth of confusion. “It’s pretty frustrating,” I’d say in my most empathic tone, “not being able to find your way.”
The students would look at me suspiciously and start to edge toward the door. They were not used to this kind of solicitude and attention—and besides, this was taking far too long.
Once I let them know they’d been heard and understood, then I would give them quite detailed directions to their destinations.
“Room 313 is a little tricky,” I’d reassure them. “When you get to the end of the hall, you make a left—it’s the only way you can go. By the way, you’ll notice a particularly attractive bulletin board on that corner that you might want to check out—another professor on the floor designed it and it’s one of the best.”
The student’s eyes would start to glaze over and he might begin to head off, but I’d quickly finish, being so sensitive to his needs.
“Okay then, you make a left at the end of the hall, pass the drinking fountain—very cold water by the way and excellent vertical lift of the stream of water—then you get to the tricky part because the room numbers are not actually in sequence.”
And so it would go, and I would spend the better part of 5 minutes helping the student when it would have been just as easy to point impatiently to the left as my colleagues would do. But I felt so useful under these circumstances. It felt like I was really helping someone. With my clients, I can never be certain if I am getting them to their destinations, but when giving directions I can be pretty sure that I am effective in my job. I even used to like to do follow-up if I ever saw the student again. I’d yell out to him, “By the way, did you get to your room okay?” Of course, the student would tuck his head and move away from me. But that was probably because he was so grateful for my assistance. He probably didn’t want to take up any more of my valuable time.
Where was I? Oh yeah, I was telling you about why it’s important that I feel useful. And why the instances of helping that most stand out for me are those that took place with strangers rather than clients. As you’ll see, both of these cases have similar features in that, just like giving someone directions, it was an instance of a single-session intervention that had clear, constructive outcomes—the problem was solved.
An Angel on the Curb
I was walking along the street, not far from my home, when a blur of movement caught my attention. Then I heard sounds, loud cries actually.
“Baby, baby, …, Baby.”
It was some kind of chant. A girl’s high-pitched voice. I lost the part in the middle, but she seemed to be saying “baby” in that familiar, teasing tone common to children who sense they have gotten underneath someone else’s skin.
Sure enough, I looked down the block to see a taller girl standing over a smaller boy who was sitting on the curb crying. The boy’s head was tucked between his knees and his hands covered the back of his neck, as if he was protecting himself from a further assault. The girl just stood over him, repeating her chant, “Baby. Baby.” With no response from him, except for a few pitiful sobs, she kicked his foot in disgust and walked a few feet away.
As I hurried closer to the scene, I noticed there were papers scattered all over the sidewalk and street like huge snowflakes. There was a backpack lying open in the street; it had been run over a few times by some passing cars.
Just as I reached the boy, a bus pulled up to what I now realized was a school bus stop. The girl climbed on the bus without even a glance backward, and the vehicle pulled away. The boy still sat on the curb, his head buried in his lap. He was crying even louder now that his nemesis was no longer around.
“Hey there,” I said to the boy, sitting down on the curb next to him. He jerked in a startle response, looked up at me from underneath his arm, and then continued crying.
“You had a bit of trouble, huh?” I said.
The little head nodded.
“That girl looked pretty tough,” I ventured. “Big too. I guess she was giving you a hard time.”
Nod of the head, more pronounced this time.
“Come on,” I said in a cheerful voice, as if I came upon scenes like this all the time. “Let’s pick up your papers before they blow away.”
The boy looked up at me and presented the most beautiful smile I had ever seen, and perhaps ever will see again. It felt like I was an angel who had been sent to right this wrong.
We spent a few minutes retrieving his schoolwork and stuffing it back into his bag. The boy got a special kick out of our joint effort when I went out into the street and stopped traffic so he could collect the papers that were lying in harm’s way.
“So, when’s the next bus?” I asked him as we resettled ourselves on the curb.
“I don’t know,” he shrugged. “Maybe a few minutes.”
“Mind if I wait with you until it comes? Just to keep you company?”
The boy looked at me shyly and smiled. So we sat on the curb together and chatted. He told me that the girl was a bully who was constantly bothering the little kids. Usually she picked on someone else, but that person must have gotten a ride that day, because the boy was the only victim available.
I never learned the boy’s name, never saw him again. But I’ll never forget watching the bus pull away and seeing his face through the window. He was still looking at me with awe, uncertain if I was real, or just an angel who had swooped down out of the clouds.
A Kiss on the Forehead
Now, why do I think of this as my finest hour as a helper? It was such a simple interaction. Someone in need. I was at the right place at the right time. I listened a little, offered some reassurance and support. I helped pick up his papers. I sat with him on the curb. Anyone could have done the same thing. No special training needed. But it still got me thinking a lot about why I do the work I do, and what I get out of it. It is all about that smile.
It was not too long after that, another place and another time, that I was driving down the street and caught some movement out of my peripheral vision. I don’t know why I noticed the motion, perhaps it was a flash of light, or something odd that didn’t seem to fit with the surroundings. For some reason, I sensed trouble even though, driving by at 45 miles per hour, I only caught the barest glance of something out of place.
I pulled over on to the gravel at the side of the road and started to back the car up to the spot where I thought I had seen the erratic movement. This was in a rural area, and there was a large field with knee-high grass or weeds or even alfalfa or something (I wouldn’t know the difference). I looked out the window, and sure enough, there was someone out there, someone sitting in a chair. But it was the strangest thing—the chair seemed to be moving back and forth. I had to get out to investigate.
Once I opened the door and stood up, I could see that there was someone sitting in a wheelchair, moving back and forth, jerking sporadically. What was he or she doing in the middle of the field, I wondered? Probably none of my business, I thought and started to duck back into the car. But what if the person was in trouble? What if he or she needed help? I thought about that little boy on the curb and wondered if this was another opportunity to be of some use.
I waded through the brush to approach the person and could see immediately that it was a child, a girl actually. She was in one of those motorized wheelchairs that are operated with a toggle switch at the controls.
“Can I help you?” I called out.
“Grrrrrrr. Mnnnnnno.”
“Excuse me?” I tried again. “I was wondering if you needed any help? I was just…”
“Frnnnnn. Mnnnnnno.”
Was this some kind of joke? Was she putting me on? Why was she talking in nonsense?
I approached a little closer and the girl started to make this unearthly, gutteral wail. I could see now that she was severely disabled. Her body was small for the size of her head, the feet and hands curled in. The features on her face were contorted as well, as if she had no control to direct any aspect of herself. Then I noticed that two of the fingers on her left hand seemed to be trying to work the control on the wheelchair, but it seemed bogged down in the weeds and mud.
I looked around for help but there was nobody else around. Then I looked to see where she had come from, or where she was going to, but there appeared nothing else in sight; it was as if she had dropped out of the sky.
I started to panic because the sounds the girl was making were so disturbing, so unlike a human voice. The electric wheelchair was still rocking back and forth, just like a car stuck in a snowbank. Her two fingers were moving back and forth. And she was still making that high-pitched growling sound. There was a part of me that wanted to run away.
I moved in front of the girl and kneeled down in the weeds. “I want to help you,” I said in a voice louder than necessary, but it was hard to talk over the whirring of the chair’s motor. “Could you stop doing that for a moment?” I gently touched her fingers with my hand and she pulled them away as if scalded. At least the noise stopped.
“Can you tell me where you came from?” I asked her. “Or where you want to go?”
The girl started making sounds but they resembled no language I could understand. Apparently she was trying to talk to me, but I had no idea what she was saying.
“Where do you live?” I said, more slowly this time. I felt like an idiot because the problem was not my making myself understood but trying to figure out what she was saying.
We just stared at one another for a minute, just looked into one another’s eyes. I don’t know about the girl, but it felt like we were willing ourselves to communicate. Then she started wailing again. And this time she was scared, really, really scared.
I looked around again for help. How could this girl be alone like this? How could she be stuck in the middle of a field? How the hell did she get here?
I sat down on the ground at her feet and tried to calm her down. No, that’s not quite right. I was trying to calm myself down. I felt on the verge of panic. I can’t recall ever feeling so helpless. This girl desperately needed help. She was in serious trouble. I wanted to do something, but we could not communicate in even the most rudimentary way—she couldn’t tell me what she needed or even tell me what to do to help her.
“Is there someone I can call?” I asked her. “We need to get some help. Who can I call?” My voice was rising in panic, and I think she sensed that I was as scared as she was.
The girl started making sounds again, incomprehensible sounds that did not make any sense to me. I had been hoping that somehow, magically, I would begin to understand her if we spent enough time together. That may have been true, but it would take a lot longer than either of us wanted.
“I need to call for help,” I told her, and started inching away. “I’ll go call for help.”
The wheelchair started to jerk back and forth again. There was no way I could leave her like this. But I had to do something.
Then I realized that she had reactivated her wheelchair in order to get my attention. I looked down at her two fingers, her only working parts, and noticed that she was moving them around. I came closer and she started to make louder noises. It was as if we were playing hot and cold and I was getting warmer. I moved over to the left side of her wheelchair so I could see what she was doing with her fingers. She seemed to be moving them in circles. I stared and stared but could make no further sense out of her movements. When she started to reactivate the wheelchair, jerking it back and forth again, I sat down on the ground at her feet and started to cry.
I have never felt more helpless in my life. And I think part of this is that somehow, some way, it was as if I was inside her. Talk about feeling someone else’s pain—it was as if all her fear and frustration and anger, all of it was inside me. Maybe she couldn’t cry, or even speak the same language that I do, but I could definitely feel what she was going through. Or maybe that’s not it at all. Maybe I was crying for myself, not for her. This was my worst nightmare: a person who needs my help and I can do nothing to be of service. This is what it often feels like to me when I do therapy—it feels like I have so little to offer. Compared to the depth of someone’s pain, the severity of their struggles, my helping efforts seem so feeble.
I think I startled the girl when I looked to be in worse shape than she was. Here I was supposed to be the rescuing angel and I had lost it. One of us had to get our shit together, and I’m a little embarrassed to say it was her first.
I had all but given up, deciding I had no choice but to leave her and go call for emergency help when she started tapping her two fingers on the armrest of the chair. I looked up. Her head was jerking, but so was the rest of her; it was only her two fingers that seemed to speak the same language that I do, and those fingers started making those circles again. Two circles, one above the other.
An eight, I thought. She’s drawing an eight, a number! She’s telling me something!
Okay, great, she’s 8 years old? Gee, that’s nice to know, but how does that help? Besides, she looked older than that, probably 10 or 12 at least.
Her fingers were moving again, this time up and down. They were repeatedly moving vertically in the same rhythm with which she had been making circles earlier.
“Are you making numbers?” I asked her. “Is that what you are doing?”
Her head jerks seemed to change direction and speed. Maybe that was a “yes.”
“Is this a phone number you are giving me? Is this the person you want to call?”
The girl’s eyes looked down at her fingers and she was forming another shape, possibly another number, maybe another 8, or a 3.
We spent the next few minutes in this way, trying to read the numbers that she was writing on the arm of her wheelchair. This wasn’t like a movie where the breakthrough happens all at once, and immediately I am able to “hear” the hidden message; in fact, it took us the better part of 15 minutes—maybe longer—to agree on seven numbers. I made her send the message over and over again because her finger movements were hardly precise and consistent. Finally, we both seemed to agree that what I repeated back was the number she had in mind.
“Okay now,” I said to the girl, finally calm again. “I’m just going to go away for a few minutes. I have to find a phone. Then I am going to come right back here and wait with you until someone comes to get you. Do you understand?”
I may have been imagining this—after all, I still held the image of that other little boy’s smile in my head—but I’m almost positive the girl smiled at me. It could have been a smile; at the very least, I think she was reassuring me that she’d be okay until I returned. It was strange, but in this hour (or was it only a half hour?) that we’d been together, I think I was getting a lot better at reading her thoughts or feelings. Then again, maybe that was wishful thinking.
In any case, I rushed off to make the call. I dialed the numbers slowly, willing that each one was correct. Frankly, it would be a miracle if this worked, not only because I was still not sure I had “heard” the numbers correctly, but also because I wasn’t sure that I remembered them.
“Hello.” I heard on the other end of the line.
“Hi,” I said. “I don’t know if this is the right number, or if this is the right person, but I found this girl in a field…” The words were rushing out of me as if I needed help as much as the girl did. I needed to tell someone about what had happened, about how hard I was trying to understand and be understood.
“Oh my God!” the voice said. “Is she okay? We’ve been looking everywhere for her.”
“So,” I interrupted, “this is the right number?”
“Oh yes, of course! Thank you so much for calling. Where is she? We’ll be right there.”
“Um,” I hesitated. “Uh, I don’t know where she is. I mean, she’s in a field. It’s off a street.” I started to panic again. Take a deep breath.
I was eventually able to describe the location, and as it turns out, the girl had wandered away from the school grounds that were just on the other side of the field. This was a school for disabled children, many of them wheelchair-bound. As best we figured out, the girl had “escaped,” or perhaps gotten lost, or maybe tried to find her way home during recess.
I went back to the field, tromped through the weeds, and called out to the girl that help was on the way. She was breathing slowly now. And so was I. I reached out my hand toward her and her two fingers grabbed onto mine. I sat down next to her wheelchair and we held on to one another until help arrived. The last thing I did before I left was to plant a soft kiss on her forehead. Then I wiped away my tears.
So, why am I crying now as I write these words? Why have these three helping experiences, outside my office, had such a profound effect on my life? Why do I think of them as my finest hour?
So Hard to Choose
All three of these helping experiences had similar features. First, they were chance encounters for which I was unprepared. I seemed to delight in the serendipitous (might I say fateful?) nature of the events. Because I was not in a helping role—I was just a civilian—a pedestrian, a driver, a hiker—I felt no obligation to offer assistance; it was a choice. I reached out to someone because I felt like it. And for me, money issues have always gotten in the way. There is something about being paid for helping others that pollutes the purity of the experience. The greatest pleasure (for me) involves making a difference in someone’s life when there is only intrinsic satisfaction.
Second, these were all children. Although most of my career as a therapist has been spent working primarily with adults, I have always been drawn to helping kids. My first job as a helper was as a preschool teacher. Although the subsequent opportunities led me toward working with adults (and later adolescents), I’ve longed to be with young children. At social gatherings and religious events, I am the first one to head to the room with the kids.
Third, as I mentioned earlier, it is important to me to feel useful. Even with my clients, I sometimes think that any other therapist could do basically the same thing—I am replaceable. But with these three fateful encounters, I was the only help available—it was me or nobody. Probably dozens of people walked right by the boy crying on the curb, dozens of cars zipped by the girl in the wheelchair. And how many trekkers in Nepal had a spare ball in their bags?
Fourth, the outcome of each of these interventions was immediate and dramatic. I did something constructive even though so much of my work involves situations where I can’t necessarily see the results, or they don’t last. Indeed, I hardly resolved any of the basic issues in any of these people’s lives—the boy was probably bullied again the next day, the girl still had to contend with the challenges of a debilitating disease, and the other two children still had to face chronic poverty. Do any of them remember me now as I remember them? I think not, although I hope that somehow my modest gestures helped them to feel a little safer in the world.
So far, all of these explanations sound like they are part of the picture, but I’d be lying if I implied this is what they were all about. There was no ongoing commitment to any of these relationships, no hard work, no continued responsibility—just brief actions that actually required minimal effort.
So why am I diminishing my work with the thousands of clients and tens of thousands of students (or even millions of readers) I’ve touched over the years? I think I just find it hard to select one finest hour. I don’t honestly know what my best work is. I don’t trust my judgment about that, and I also don’t trust reports of consumers. I’m suspicious about whether the effects will really last.
On Not Knowing and Not Understanding
Perhaps my finest hour was the last one in which I helped someone. I spend a few months each year working abroad, often in Australia, but also in South Asia. I teach and supervise doctoral students from the region. Just yesterday I spent a “finest hour” in a car with a doctoral student from Nepal. She is a physician who wants to change the health care system in her country, one of the poorest nations on Earth and with very high infant and maternal mortality. The outcome of her studies will not be just a dissertation on a shelf but real-world expertise that will allow her to shape and influence medical care to make it more responsive to the needs of sick women and children. In the hour we spent together, we talked about things like “grounded theory” and “qualitative design” and “constructivist orientation” related to exploring why Nepalese women will not seek medical services, even in life-threatening situations. But most of what I did for this doctor was offer her support. I honored her valiant efforts. I provided some degree of validation. Sure, I know stuff that she wants to know, but that was a small part of the conversation compared to the connection we shared.
So, in these days of brief therapy, miracle cures, solution-focused interventions, what is it that I am saying about what is most important in my work? Am I a dinosaur because I still value relationships over symptom resolution? Nah. Because in each of the three previous stories, I “cured” the presenting problems—the loneliness on the curb, the stuck wheelchair, the ball-less existence.
There are so many layers to the story of my finest hour that I fear readers will have a field day analyzing my deeper motives. I feel ashamed that I don’t know my finest hour—I don’t even know what is my best work. I’m just walking around in the world looking for opportunities to be helpful.
