Focusing as Therapy for the Therapist
By: Greg Madison Ph.D.
Click here to contact Greg and/or see his GoodTherapy.org Profile
(Published in The Focusing Connection, 2003)
*Focusing is a natural way of being with our own experience, patiently, until it becomes
more clear. Information on Focusing can be found at www.focusing.org
Unbeknownst to most clients, psychotherapy remains governed by many theories and
boundary ‘rules’, the actual purpose of which may be to protect the therapist from his or
her own anxiety . In this short piece, an existential therapist uses Focusing to attempt to
remain open to the difficult experience of being with a dying client. Through this example
of his work in an acute hospital setting, Greg suggests that Focusing can be a crucial
aspect of redefining therapy as a human relationship rather than an expert one.
The medical and nursing team called me to meet Loyola, a patient who was refusing to
accept her terminal diagnosis and return home. Walking onto the ward I became aware of
a nervous feeling in my stomach. Although feeling nervous is not unusual for me, I
decided to focus on this particular ‘nervousness’ and it soon became clear that it was
about carrying the staff’s expectation that I would convince Loyola that she had to go
home. The nervousness was that she might see my ulterior motive and realise that she
could not trust me to hear her experience. But finding the meaning of my nervousness at
that moment felt exciting and it suddenly became easy to set aside the staff’s expectation.
I approached Loyola feeling open to her and much freer to really meet this new person.
When I entered her room, she was sitting up in bed and her short hair and slim figure
gave her the appearance of a young boy rather than the 54-year-old grandmother that she
was. She responded to my openness and with a broad smile indicated that she was happy
to talk with me.
The senior charge nurse offered us his private office for our session. As I closed the door,
Loyola asked simply and directly, ‘What can you do to help me?’ Somewhat taken aback,
I took a seat and replied with the usual banality ‘Sometimes talking about your feelings
can help’. This sounded trite in the circumstances and I was aware that I spoke from
some sort of ‘therapist script’ rather than from a deeper sense of our situation – it alerted
me again to the presence I needed to maintain in order not to retreat into a therapist role.
As Loyola began to speak of her current ‘trouble’ and her mastectomy three years ago, a
look of pain crossed her face. She tapped her remaining breast saying ‘Now this one’s
gone all hard. They are giving me medicine to fix it like they did the last time’.
Although she was insisting on more treatment, Loyola seemed somewhat unconvinced
about the possibility of a cure. She concluded our session with the statement ‘I know this
is not my time to die. Medicine and God will cure me’. I asked Loyola how she felt about
talking to me and she paused to check her feeling (yes, a natural Focuser!), then
announced ‘I like you, can we meet again?’ I left feeling excited and looking forward to
our next meeting. I hoped that the next session might present the opportunity to naturally
introduce Focusing to Loyola, but not as a technique that I could hide behind.
In traditional therapy, often the therapist remains more or less anonymous, a friendly face
showing little sign of struggling to live a life of his or her own. Some theories of therapy
insist that certain practices are crucial in order to elicit and interpret the client’s
‘unconscious’ defences and anxieties. If Loyola and I were to truly meet, it was evident
from the outset that our therapy would be based upon a shared ‘unknowing’ rather than
an ‘expert’ analysing a ‘client’. I was also aware that a large part of our therapy would
depend on my ability to remain aware of my felt experience and ‘that part of me’ which
was terrified of witnessing Loyola’s struggle to live. I also knew that ‘something in me’
wanted more than anything to remain fully present to this person, almost as an ethical call
to acknowledge her as a legitimate person, not a problem to be solved. In doing so, it
became increasingly clear that I was being challenged to open to my own mortality.
As I arrived on the ward the next week, the medical team stopped me and reiterated that
they could do nothing for Loyola and they were anxious to discharge her to community
care. She was resisting this as leaving the hospital would amount to accepting that she
was dying. There was talk they would have to call security to escort her from the ward if
she continued to refuse to cooperate. Could I ‘help’? I said I would check whether she
fully understood the situation, that’s all I could do. This time as I approached Loyola, our
relationship brought that old nervousness together with a tinge of responsibility. The
feeling needed some kind of action.
Loyola smiled from beneath her oxygen mask when she saw me. Her breathing now
made even a short walk to the nurse’s office difficult, so I pulled a curtain around her bed
and sat down next to her. I asked if the doctors had spoken to her about her condition.
She confirmed that they had, but she didn’t understand why they wouldn’t help her like
they did three years ago. ‘If it’s all they can do, then I want them to just chop it off’ she
said, motioning to her remaining breast, ‘I don’t want to die, it’s not my time.’
I became aware of something in me that wanted to recoil from all this and comfort itself.
I wondered if there was a part like that in Loyola and I felt a surge of gentleness towards
her. While acknowledging this, the image of Loyola, terrified and uncomprehending,
being wheeled from the ward against her will, guided me to pay attention to the nervous
responsibility, which now had words. I asked gently, ‘Loyola, how do you know it is not
your time now?’ ‘I’m certain of it, God would not want to take me now’. ‘So it’s up to
God?’ I asked. ‘Oh yes, He made me and He’ll save me’. I heard a pregnant open place in
me say, ‘Yes, I guess it’s only up to God now since the doctors can’t help any more’.
Loyola stopped pulling at her bedclothes and stared at me. Her eyes were fixed steadily
on mine and after a long pause, she asked ‘You mean they can’t stop me from dying?’
We were silent. Her expression drained from her face. My body felt totally alive, every
detail of the moment, the moment many of us dread, was vibrant. I had a felt sense of life
that encompassed not only Loyola and myself, but everything. After a long silence, she
slowly looked up, right into my eyes, and said ‘Then it’s up to God. I will pray for a
miracle. It’s not my time yet, I know that’. Her faith allowed us to retreat from that
apparition of non-being and paradoxically I felt a little dulled, though relieved.
In our following sessions, as Loyola’s life began to shrink around us, we became
increasingly connected to each other. On a Thursday afternoon, I arrived at her bedside as
usual. She was now very weak and removed her oxygen mask to whisper something to
the relatives gathered at the foot of her bed. They nodded, looked at me and left us alone.
I pulled the curtain and sat down with Loyola. Again, the silence descended around us
and I felt a deep love for this woman I had known less than three weeks. I know it was
my Focusing awareness that enabled me to feel this, rather than the usual ‘professional
relationship’ of therapist and client. After a few minutes, I said ‘You’ve not been well the
past few days so I haven’t been staying very long’. She nodded. There was nothing more
to say. She struggled to remain conscious and every few moments managed to stare hard
into my eyes, as if to say, ‘please look at me’, which was the hardest thing for me to do.
But I did not look away, or analyse, or diminish her with platitudes. I had spent time after
each of our sessions Focusing on my response to her situation, learning and preparing
myself to be as open as I could to any eventuality. Now this was her dying, unexpected
and unwanted. During those silent minutes I imagined my head on that pillow, struggling
to breathe. It felt like we were children who had accidentally strayed too far into the
woods, and only one of us would make it back. Perhaps we are all children in the face of
death.
The following morning a doctor called to say that Loyola had died shortly after I left.
How should I refer to that time Loyola and I spent together? Was it therapy? I did not
diagnose her with a mental illness, pathologise her ‘denial’, give her advice or
homework, or interpret her behaviour. I did not fight with her defence mechanisms,
encourage her to think positively, or to realise her full potential. Instead I used a Focusing
awareness to try to remain open in myself to the mystery of what was happening to her
and between us. Perhaps it was only when Loyola saw my readiness to grapple with my
own death that she felt our therapy, and her life, could come to an end. Perhaps it was
really my therapy after all?
©Copyright 2008 by Greg Madison. All Rights Reserved. Permission to publish granted to GoodTherapy.org. The following article was solely written and edited by the author named above. The views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the following article can be directed to the author or posted as a comment to this blog entry.
Click here to contact Greg and/or see his GoodTherapy.org Profile
http://www.goodtherapy.org/Sacramento-therapy.htm Sacramento Therapy