Suggested Tips for Clinicians: 

• Practice methods for strengthening your therapeutic presence.
• Ask yourself if you are or are not empathically attuned with each client.
• Explore barriers to full presence and empathy with more challenging clients.

 

A capacity crowd in the large conference hall rose to its feet in applause. Daniel Siegel, renowned author, clinical professor of psychiatry at the UCLA School of Medicine and Executive Director of the Mindsight Institute, had finished his presentation. I too stood with enthusiastic appreciation, not only for this lecture, featuring the clinical significance of therapists’ mindfulness, but for all the ways his research and writing about developmentally informed parenting, neuroplasticity, and the incorporation of science into the practice of psychotherapy. All of these had influenced my thinking and work over the past ten years.   
 

Dan had begun to move away from the podium when he seemed to catch himself and walked back to centerstage. He stood, fully facing the hall, hands clasped in front, nodded his head and bowed. For our part, the applause of several thousand therapist attendees showed no sign of relenting. Then an event unfolded I have carried with me since. 

It began with the simplest of gestures. Dan took and held Tadasana, a standing yoga pose. His feet parallel and facing forward, Dan released his fingers, opening his hands which moved to the sides of his legs, palms open, shoulders relaxed as he appeared to empty himself and stand receptive before the crowd.  
 

The audience responded with delight and gratitude at this embodied receptivity. The volume of the applause rose, and Dan, smiling gently, took a deep breath. The crowd responded again. Waves of mindful presence, enthusiasm and gratitude rolled through the large hall back and forth, until Dan took a final bow and joined the crowd he had just helped to unify.  
 

Gratitude is amplified by its reception. Reception is its own expression of gratitude. A feedback loop, formed by gratitude and receptivity, generates a mindful, compassionate field that feels very much like love.  
 

Tears rolled down my professional cheeks. I quickly brushed them away hoping the strangers around me noticed neither my intense emotion nor its expression. Unleashed by the power of that loving field, my tears flowed freely and powerfully, apparently straining for release. I felt seen, heard, and appreciated. I was included, a true part of this collegial, communal event. There was a transcendent quality in which this loving field was not so much being created but being acknowledged as existing before this moment. All of us stumbled into an awareness of a much larger and enduring field of love.   
 

I was awed by the immediacy and goodness of the human family. But it was an ecstasy undifferentiated from loss and longing. My tears expressed my grief at how seldom I had been aware of my presence in such a space. Having often felt unseen, unheard, and unappreciated, I suddenly experienced a sense of loneliness and despair of enduring connection. The pangs of longing and the shame of my dissatisfactions with self and others were ignited by my embrace of this mass symbiosis. Yet, there was also relief at the quenching of my childhood thirst for an uninhibited expression of mutual affirmation and solidarity.   
 

In the religious experiences of my young adulthood as a youth minister, a shared faith and religious ritual turned what might have been merely an experience of communal intimacy into an encounter with the metaphysical. My peers and I tasted, not merely the immediate experience, but elements of a universal interconnectedness: with one another, with the Church, and even, it seemed, with God.     

As I grew older and my religiosity subsided, the felt importance of that faith and my need to participate in a loving field never waned. If Dan Siegel had continued off stage to privately appreciate the applause, he may very well have experienced a profound sense of what his work meant to us, he may have been moved to tears and even been motivated to write another great text, but his personal experience of appreciation and inspiration would not have generated the mindful, compassionate field of love we all shared. To generate such a field, he had to turn around and move back to the edge of the stage, putting himself on display. He needed to make the mindful choice to allow his body to express his emotional state, ultimately taking a posture of reception easily understood by the community before him.  
 

As an audience member, I too had a role in creating the moment. While Dan closed his presentation, I might have remained seated, turned to a neighboring attendee and, in a relatively hushed tone, remarked upon an outstanding insight or application. My neighbor may have responded with her own insight and drawn my attention to aspects of the presented theories elucidating my thinking. This might all have had a positive impact on my practice, but none of it would have generated the field of love.   
 

 All of us that day physically manifested our emotional reaction by standing, applauding loudly, and maintaining focus on Dan. We allowed his gestures to carry meaning and translated that meaning into action with vocalizations of delight and even louder applause.  
 

After any professional conference I strive to identify the clinical application of what I have learned, knowing that for me to retain information I need to utilize it. While I came away from that conference with much information, it was this personal, emotional experience that I most wanted to incorporate into my life and work.  
 

But where would this powerful manifestation of gratitude and receptivity play out in the consultation room? Although, as a psychotherapist I am sometimes the recipient of heartfelt expressions of appreciation, I have never received a standing ovation. Nor do I often feel deserving or desirous of one! The emotional waves of gratitude between therapist and client are smaller and quieter and, as a possible result, the loving field we generate is more easily dismissed or completely overlooked.  
 

It is a process that unfolds in many sessions. It unfolds with the subtlety of a raised brow, a silence, the slightest of gestures. It is carried by a word, a smile, a tear. We know it as empathic attunement and the creation of a therapeutic space. It is enacted when a client experiences acceptance in response to long held shame. I wonder how open my stance is in receiving such gratitude. Does the client feel my reception and the gratitude I feel for their gracious expression?  
 

Recently, in a relational-process group I co-facilitate with my colleague Aisha Mabarak, a field of love made a surprising appearance. Sheila* arrived late due to complications at her job that held her past the end of her shift. She reported being exhausted and ill-prepared to share her feelings with the group. 

“I’m in a fog,” Sheila said with an uncharacteristically flat tone. I responded by thanking her for making it to the session and affirming her inclination to take a restful, though present, pose. Aisha, however, had a different approach. Not wasting any time, she asked: “Sheila, why don’t you share with the group a little more about this fog you feel stuck in?”  
 

Sheila proceeded to describe, with increasing emotional range, how deadened she felt by a sense of invisibility in multiple facets of her life. Examples spilled forth of her efforts to meet the needs of others only to be met with thoughtlessness and a glaring absence of gratitude from family members, friends, colleagues, and bosses.  
 

Other group members expressed empathy and support. One member voiced these sentiments succinctly, saying that she felt Sheila’s pain and she was, at that moment, imagining how hurtful and difficult it must be to feel so unappreciated by people who care for you. In approximately fifteen minutes Sheila had gone from a depression-based brain fog to expressing her anger and upset assertively, leading to smiling and expressions of appreciation for her fellow group members.  
 

My inclination to support Sheila by giving her space was intended to express, both to her and to the group, that it was acceptable to feel your pain in session and to choose to set self-protective boundaries. This intervention may have been simply wrongheaded, or it may have, by reminding members of their autonomy, laid the foundation for co-facilitator Aisha’s fruitful follow-up. While I had responded to Sheila’s verbal communication and her depressed presentation, Aisha responded to another expressed impulse—this one non-verbal.  

Sheila expressed her impulse to participate in the group by showing up and letting us know how bad she felt. Rather than disappearing off stage, a space she was also entitled to occupy, she had moved her body to a visible place. Rather than closing herself off, she showed us how she felt, as Daniel Siegel had opened his hands and exposed his palms.  

Aisha’s response might be analogous to the convention applause. This applause was an essential welcoming saying: “Sheila, your sadness, hurt, embarrassment and anger are all welcomed here!” Group members said: “This is your group! Take the time you need. We are here for you. We see you. We hear you.”  

Hearing and feeling this welcoming presence, Sheila responded at first with tears, then with expressions of anger and ultimately with smiles and the laughter of gratitude for the group’s support. The faces of the other members lit up with warmth and solidarity.  
 

*** 

Facilitating such moments of conscious gratitude and receptivity is something I try to bring to all my sessions. Of critical importance is my understanding that my role in this regard is that of facilitator, not creator. It is a powerful, organic experience that can only be had within the context of a collaborative effort. Daniel Siegel, for all his talents and wisdom, could not create that field of love by himself. Nor could the audience of thousands of therapists, even if they were consciously working in unison to do so!  

As a therapist, my receptivity to gratitude only increases the availability to the client of a mindful, compassionate field. A field, that I argue, has the healing qualities of love.  
 

While love is not “all we need” in the consultation room, it is a quality of human experience necessary to both healing and health.  

 

*This client’s name has been changed.  

File under: A Day in the Life of a Therapist, Musings and Reflections