Psychotherapy.net Team, Author at Psychotherapy.net

Narrative Therapy in a Cross-Cultural Conversation with Someone Approaching Death

Posted on September 12, 2023February 11, 2026 by Psychotherapy.net Team

Acknowledgements

T?na koutou, t?na koutou, t?na koutou k?toa

Ko Ben Lomond t?ku maunga

Ko Loch Lomond t?ku moana

Ko McAllum t?ku iwi

No Kotorana ?ku t?puna, engari I haere mai ?ku t?puna ki Aotearoa nei

No reira ka mihi hoki au ki te iwi M?ori

Ko James Copeland t?ku t?puna

Ko Hamish McAllum t?ku p?pa

Ko Jan Hutchison t?ku m?ma

Ko Gavin Pilkington t?ku tane purotu

E rua ?ku tamariki ko Tim r?ua ko Ella

Ko Sasha McAllum Pilkington t?ku ingoa

No reira t?na koutou, t?na koutou

Kia ora t?tou k?toa

Thank you, Huia Swann, for your encouragement and feedback through the many iterations of this story.

An Unexpected Beginning (1)

It was a busy morning at the hospice. I made my way into the community team’s office and was greeted with a buzz of activity. One of the nurses called me and I turned to greet her. In her hand was a referral letter.

“Sasha, I was wondering if you would see this woman for counselling? Her name is Louise, and she has advanced lung cancer. (2) Louise is refusing all treatment. It seems someone thought she was ‘in denial’ but I saw Louise yesterday and she told me she’s ‘not having any chemo’ because she doesn’t think she’s worth it. Louise is M?ori, but she’s refused cultural support. Could you see her?” she repeated, as she handed me the letter (3).

“Of course,” I replied, disturbed by the thought that Louise didn’t feel she was worth treatment, but grateful the nurse had looked beyond the judgement that Louise was “in denial.” Before I could say any more, the nurse was summoned to the phone and with a smile, I left to call Louise.

A few days later I pulled up in a beautiful driveway. Plants nourished by an attentive hand surrounded the house in front of me. As I got out of the car, I saw a slight woman emerge into the sunlight. Her dark hair gleamed as the rays of sun caught it and, as I came closer, I saw she was smiling. Louise welcomed me warmly and, after I had removed my shoes, guided me into the house. We sat down at the kitchen table. Nearby stood a large kete (4) filled with driftwood, each piece carefully placed to reveal a story. Woven mats hung on the walls and outside I could see clusters of red berries hanging below the fronds of a nikau palm. Artistry was evident in creating this home and I looked around with admiration.

After some further introductions, Louise eased herself back in her chair and looked at me expectantly. Tentatively I responded to her silent invitation with, “People are so much more than the illness they are living with and their current situation. Would it be OK to begin, maybe, with me asking you a bit about yourself…so that I might learn a little about who and what matters to you?” (5) I didn’t name the illness as I didn’t know what language she preferred to use or how she might wish to speak about her experience.

Louise responded immediately. “Sure! I’m married to Pete and we have three children. They’re all really supportive, in and out of the house every day…”

Louise continued to share stories of her day-to-day life and I listened attentively, occasionally asking her questions so that I could learn more of what was important to her. I quickly learnt Louise was a hard worker and a committed parent. She made no mention of where she was from or her t?puna (6).

After a time, Louise paused and reached across the table to pick up a piece of paper. “Well, it’s lucky you’ve come to see me on your own.

I don’t like groups because I lie in them. I’m a liar,” she stated in a forthright tone, waving what I now realised was a support-group invitation from the hospice.

Struck by her honesty and trust in me, a stranger, I replied, “Would it be OK to ask what you mean when you say you lie?” (7) In my mind was an awareness that some truths are more easily spoken than others, and for some people it was unsafe to voice or live their truth.

Louise responded, speaking in rapid buoyant tones, “Oh, I say what I think I should in groups…but then later I discover it would have been all right if I’d said what I really thought.”

With all the respect I could convey, I replied, “What is your understanding of why you say what you think you should?”

Immediately Louise explained, “Oh, I tell a story to fit in.”

I reflected that people usually have good reasons for what they do. “What is important to you about fitting in, do you think?”

Louise sat back in her chair looking thoughtful. “I like to fit in. When I’m in a community I’m proud of it. I like belonging to clubs. I wasn’t brought up to do any sport or anything, so it means I can choose. I’m not tied to one thing.”

Curious, I responded, “Would you mind me asking… how do you go about this fitting in?”

Louise paused. “I don’t know, but I’m really good at it,” she finally said.

“Are you a flexible kind of a person?” I offered.

“Sure am.” Louise nodded.

“Which kinds of communities or clubs do you like to fit in with?” I continued.

“I take the best of what’s around. People are good to me, kind,” Louise answered, as if she couldn’t quite believe her good fortune.

“Would you say you are someone who both accepts and appreciates the generosity and care of others?” I asked, noticing her gratitude. (8)

Louise began to tell me how she appreciated homemade gifts as opposed to bought ones. She elaborated on the care and effort in the presents people made and gave to her. Homemade fudge was so much better than a box of chocolates, she explained.

“Do you see the intention behind the gift, the love maybe?” I asked. Louise nodded as if this was obvious to her.

“What do you give to people in return when you accept their gifts, noticing the care and effort that has gone into making them?” I asked, highlighting the reciprocity in the way she received gifts. (9)

“They must feel the magic, because I do,” Louise answered matter-of-factly. “People are kind,” she reiterated. “I have lung cancer. It’s an ugly cancer. I was so happy when they included me in the make-up day for women with cancer. I didn’t think they would, what with me having a dirty cancer and them all having the pretty pink kind.”

Taken aback, I responded, “Would it be OK to ask what you mean when you talk about your cancer as being dirty and theirs as a pretty pink kind?”

Louise lowered her head as she answered me. “My cancer is dirty because it’s a smoker’s cancer. It’s my own fault.”

Infusing as much respect into my voice as I could, I asked her in a quieter tone, “Would you mind me asking you some questions about how you began to smoke?” I reflected on how hard it would be to be a smoker with cancer and not afforded the support that other people living with cancer are offered. I tried to imagine being shamed at one of the worst moments in life, not allowed to feel sad or angry but being repeatedly blamed both vocally and silently.

“It was the ‘in thing’ to smoke,” Louise explained. I nodded. Louise and I both came from a time when many people smoked.

“When I was 10, 11, 12 years old, I pinched my mother’s cigarettes for a naughty puff,” she told me with a mischievous glint in her eye, evoking glimpses of childhood fun away from the surveillance of adult eyes.

“When you were 10, 11, 12 years old, do you think it was possible for you to realise the full implications of the naughty puffs?” I inquired, hoping to lessen the harsh judgement she extended towards herself alone.

“No. I didn’t realise in my teens either. It wasn’t ‘till much later when I came to live around people who didn’t smoke,” she told me.

“How do 10-, 11-, 12-year-olds come to smoke, do you think? How do they come to think it’s a good thing?” I responded.

“It’s the way I was brought up. It was a hard life. It wasn’t ‘till I started playing sport that I realised there were different ways of living, that some kids had a bed each and enough to eat. (10) My parents were hard people. They smoked and drank,” Louise conveyed with a frown.

In my head I did a few calculations. Louise would have been growing up after the Second World War when many M?ori were living in poverty. I thought about her family and wondered if Louise had a grandfather who fought in World War One. I knew of P?keh? returning servicemen who had been allocated a farm in the ballot after fighting in World War One, while my friend’s t?puna (11) who fought in the M?ori Battalion returned to discover his ancestral lands had been confiscated. There were many possible reasons for why Louise’s family experienced hardship.

“What is your understanding of how they came to be like that?” I asked.

“Maybe it’s ’cos they grew up in the Depression. (12) It was a hard life, and they worked hard and partied hard. Yeah, they were hard people,” she repeated.

“Hard lives can have people turning to cigarettes and drink to ease things, especially when there is trauma and hurt that comes with it,” I commented. “What do you make of there being cigarettes for sale when we all know they kill people?”

We pursued this line of questioning for a bit longer, with me seeking to broaden the responsibility for smoking into our societal context so that Louise wasn’t left to shoulder it entirely on her own.

However, I noticed myself beginning to labour a little in the conversation and started to wonder if I might be more interested in taking such a direction than Louise was.

So, I listened harder for what was important to her.

“Yeah, well…” Louise pondered. “I left home at 13 to get away from it all. I knew I had to get out. The beatings, the life… My fault I smoked… Miracle I survived this far. The shame of it has been with me since I’ve had children.”

“What was important to you that you knew you had to get out?” I wondered.

“I wanted to get away from the cigarettes and the booze…” Louise elaborated.

“Do you know what it was that was important to you that you wanted more from life, that you didn’t just accept the cigarettes and booze?”

“I wanted a better life and to live it,” Louise explained.

“May I ask, what sort of better life did you want?” (13)

Louise told me how she wanted a home and security. “I wanted a bed of my own and to know where I was sleeping each night,” she explained.

“What steps did you take towards getting a better life?” I inquired.

“I went white.”

The words hung in the air, heightening my awareness that I, a privileged P?keh?, sat at her table. I wondered how I was selling her short.

Louise continued, “I knew I had to leave if I was to survive, so I hung around with my white friends. When I left, I got away from a lot. Not just the cigarettes. I made sure I fitted in, and it was my ticket out.”

“Would you say fitting in saved your life?” I asked her.

“Definitely, I had to get away from the other lot.”

She watched me, seeming to wait to see how I would respond. I reflected on Louise calling her own people “the other lot.” I could hear the racist discourse ringing in my ears, inviting the harshness to be because they were M?ori, rather than taking into account the devastating effects of colonisation on generations of M?ori people.

“Could you help me understand a little more of what you mean when you say ‘the other lot?’” I inquired. (14)

“M?ori,” she replied, sounding like she was repeating something rather than truly believing it.

Louise waited, her body tense and alert.

“Colonisation has been very hard on the M?ori people,” I ventured, thinking of the decades of injustices M?ori had endured. “Do you think that the drinking and smoking and what you went through was because they were M?ori, or do you think it could have been because of the hardness of life and what it did to the family?” (15)

Louise’s shoulders dropped and she was quiet for a moment. “I’ve forgotten who I am,” she rasped sadly. (16)

Before I could respond, she ploughed on, seeming to contradict herself with what could have been growing pride in her voice. “I do all the old stuff: knitting, cooking, sewing, carpet-making. I paint.”

“Are you a creative person?” I asked her, smiling. “And the garden?”

Louise enthused about her garden.

“Are there threads of who you are in the old arts?” I asked her.

Louise considered. “Yes, I think there are.” She seemed to meditate on this for a moment, then looked me in the eye. The corners of her mouth crinkled up as a smile formed briefly. “But then I forget,” she added, looking shamefaced again.

“Colonisation can do that to people…get in the way of being connected to who you are… Not surprising when there were laws trying to do just that,” I said sadly. (17) I reflected on the children who had been beaten in school because of laws that forbade them to speak Te Reo M?ori and the efforts to suppress M?ori cultural practices. “There can be a heavy cost when you are forced to turn ‘white’ to survive. Would it be OK to ask if there has been a cost for you?” (18) I thought about what it might be like to forget who I was. Emotion stirred in my belly.

“I don’t have a belonging,” Louise confided. “I feel I’m a betrayer.”

Deep sadness leaked into the air around us. It hovered, seeming to draw us together. We sat in silence.

After a time, Louise gradually seemed to recover, and in a bright voice she said, “You know I’m Scottish. I identify as Scottish.” I looked into her beautiful brown face, with its broad nose and dark brown eyes, framed by the sweep of almost-black hair.

I responded then, not as I would to a P?keh? with a question, but in the way of M?ori who connect through the people and the land they come from, whanaungatanga (19). I adjusted my phrasing according to shades of tikanga M?ori (20) and said, “The people I come from are Scottish. They belong to the clan of Callum. They come from the highlands of Scotland.” My intention was to tell her we were connected, and in telling her this and in the way I phrased it, I wanted to say, “I also acknowledge your M?ori side and it is beautiful,” though this was implicit.

My disclosure resonated with Louise immediately. Laughing, she jumped out of her chair and rushed off to gather photos of all her grandparents who had died long ago. She introduced me to her Scottish grandmother, whom she loved dearly. “She taught me the old arts,” Louise explained.

“Were you a willing learner?” I asked her.

“Yes, I took in what I wanted and spat out what I didn’t.”

“May I ask what you value about your M?ori side?” I inquired, appreciating that the photos were of both sides of her family.

“M?ori love fully and unconditionally, no questions asked, no grudges.”

“How do you love?” (21) I asked, hoping to make visible a thread of whakapapa. (22)

Louise proudly announced, “I love like a M?ori!”

Warmly, I responded, “Can you tell me some stories of how you show that knowledge of loving?” I wanted to strengthen Louise’s description of herself as having the ability to love fully. It stood out in contrast to her sense of not being worth chemotherapy.

Louise was off, taking centre stage. I listened, grinning, delighted by her rich and lengthy stories of such loving. I then asked her questions of how she came to learn such loving and we tracked knowledge of love through the generations in some long-overlooked stories.

“Who in your life knows that you have this knowledge and way of expressing yourself?” I asked.

“All my friends!” Louise responded enthusiastically.

“Could it be that you have captured aspects you value from both worlds with your fitting-in ability?” I asked, after a moment’s reflection. Louise embraced this possibility seemingly for the first time. Her enthusiasm bubbled. We went over her mothering and loving of her children, with Louise adding details such as “…but the car is warranted.”

“Could it be you are not a betrayer if you’ve made the best of both your M?ori and P?keh? sides?” I slipped in the word P?keh?, the M?ori word for non-M?ori, to give weight to M?ori knowledge. “You’re right, I’m not,” she told me. Then, as she thought about it, her voice firmed. “No. I have been clever; I haven’t got off-side with anyone. I have danced on both sides of the fence.” Louise smiled fully at me. It was a beautiful sight.

Smiling back, I continued, “If you were to think of yourself as a person who can dance on both sides of the fence, what difference might that make to how you are living your life?”

“Well, just everything,” she exclaimed exuberantly. Idea after idea quickly followed.

“If this ability you have to dance in two worlds was one that you kept in your mind, what might it keep you in touch with that is important to you?”

“That I’m OK. Sasha, it’s going to change my life!” Louise’s joy once again spilled over. I was overwhelmed. How generous she is, I thought.

“Do you think it will make a difference to how you live with cancer?” I asked.

A little later, I started to draw the conversation to an end, mindful that we still had more to talk about.

“Sasha, I like this talking,” Louise exclaimed, with bouncing joy. “Today I discovered I’m not a liar!” (23)

I drove back to the hospice with sadness stuck to me rather than her happiness. All I could think of was Louise…a M?ori in a sea of P?keh?. I thought of the times when I have felt apart, out of step, disconnected and the only one. I tried to take myself there, but I knew it was not the same. When I arrived back at the hospice, I wondered what I might have missed, what I didn’t ask. Later, as I reflected with Niwa, my M?ori colleague and friend, I was reminded of the bridges that friendship, love, and respect can provide.

A few days later, I heard from the nurses that Louise had decided to have treatment for her cancer. Louise later explained to me, “I felt worth it after we talked.”

When Niwa and I met with Louise and her family a few weeks later, we heard the good news she was improving. A short time of respite from the cancer beckoned.

Postscript

This story illustrates one way a counsellor might go about such a conversation. It is not the only way to respond. I carry the knowledge that I have many blind spots, especially in conversations that are cross-cultural. I am also aware that I am the recipient of the kindness and generosity of the people with whom I meet. This story does not represent a “right way” to practice but rather is written in response to a question I ask myself: “What does my commitment to the principles of Te Tiriti O Waitangi (24) look like in practice?”

Notes

(1) For those readers interested in the use of stories to learn or teach narrative therapy see Carlson et al (2018) and Heath et al (2022). For additional examples of stories illustrating narrative therapy see Epston, 1989; Heath, 2015; Ingamells, 2014, Ingamells & Epston, 2016; Pilkington, 2014; 2016; 2021; 2022.

(2) This story was written with the permission of the person in it. All identifying information has been changed.

(3) In Aotearoa New Zealand, M?ori have a higher incidence of lung cancer and poorer survival rates than P?keh? (non-M?ori. A number of barriers to early diagnosis and treatment have been identified including access to care, engagement with specialists, communication with specialist services, and lack of culturally appropriate services (Kidd et al, 2021). Even though Louise’s lung cancer was incurable, chemotherapy would offer her the chance of improved quality of life and an extended life span.

When someone responds in ways that others don’t understand, it is common for judgements to be made from a position of “knowing best” what is right for that person. I find it more helpful to be curious about another person’s world and to try and understand what is important to them. I also want to learn what they are taking into consideration that matters to them and is restraining them from taking a particular course of action. For example, what was Louise concerned about or prioritising that she had chosen not to accept chemotherapy? Often, when I have fully inquired into what matters to a person and what they are weighing up, their decision-making process and reasons becomes clear. At other times, the questions I ask can lead them to reconsider their decision and take another path. (See Chochinov, 2022)

(4) A kete is a basket usually woven from flax. M?ori words are in common usage in Aotearoa New Zealand. I have chosen to leave such words in this text out of respect for the person in the story, and to uphold the mana of Te Reo M?ori (the M?ori language).

(5) My intention in asking this question is twofold. I wanted to get to know Louise aside from the difficulties she was living with in ways that dignified her and brought forward her preferred stories of who she was. I also wanted to create space for culturally respectful ways of getting to know each other without assuming how she might wish to go about that. A broad question such as this one creates space for Louise to answer in ways that fit for her. In some instances, I may ask a person if there is a particular way they wish to begin, in order to create space for karakia (a ritual chant or prayer) or any other ritual that may be meaningful to them. Louise’s talk and refusal of cultural support led me to think such an invitation might be uncomfortable for her. I therefore held back on this occasion knowing I could raise it another time.

Building a relationship in ways that honour and create space for possible cultural identities a person may hold is important, especially if that culture has been oppressed. Such respect has effects on what kinds of conversations are made possible and can open areas that are often overlooked. For example, acknowledgement of tikanga M?ori (M?ori cultural processes) can underpin the engagement of M?ori in treatment (Kidd et al, 2021) and can be significant in generating a relationship in which stories of suffering can be told.

It was unusual for me to have this first meeting with Louise on her own. (It was Louise’s decision to do so.) I usually meet with many different constellations of families and most often see someone who is unwell with at least one other member of their family/wh?nau. Louise introduced me to her family after this conversation and later brought different members of her wider wh?nau/family in to see me when they visited from other parts of the country.

(6) The people Louise was descended from. For some M?ori, this is an important part of forming a connection and getting to know each other.

(7) This was a significant deconstructive question in our conversation. Deconstructive questions pull apart the threads of an idea so that a person can examine them. When we take up a stance of curiosity and ask a person about the particular meaning of common words and ideas to them, new therapeutic directions can open up.

(8) As I learn more about Louise’s life, I am listening for how she goes about what is important to her and whether that way of living expresses Aristotelian “virtues” that she values, such as for example; generosity, compassion, kindness, courage and love. I gather more stories of these expressions of goodness that are valued by Louise and these stories make up the backbone of the re-authoring process (White, 2007). I am mindful that ideas of what is important and considered virtuous sit inside cultural frameworks. Such themes of what people are engaged with in their life, and the virtuous ways they go about what engages them, are called “narrative values” by the philosopher Todd May (p. 73, 2015). May says it is these stories that can give a person a sense of living meaningfully. Such identity stories that describe valued qualities of a person are very helpful at the end of life. Not only do they lend meaning to a person’s life, but they offer a way of responding to illness, treatment and dying that is not reliant on a well body. They can give a person a sense of agency at a time when they may be experiencing a lack of influence over their life (see also Pilkington, 2022).

(9) Ideas that position a person who is unwell as “only receiving” can lead them to feel a burden on others. I often inquire in detail into how a person receives the care of others and the experience they generate in the carer with the intention of highlighting the reciprocity in the relationship. The way we receive can give another person an experience of themselves as generous, kind, significant, and worthy for example.

(10) Moana Jackson vividly describes the processes of how colonisation robbed M?ori of a sense of home in their own land and what was lost. “When you take away the whenua from a people who regard themselves as tangata whenua; when you take away their ability literally to touch the mountains; if you limit their ability to dream their own dreams; if you take away the earth upon which they stood with love; then you render them homeless in the most complete sense (Jackson, 2022, para 25).” (Whenua means land and tangata whenua means people of the land.)

(11) T?puna means ancestor in the M?ori language.

(12) During the depression M?ori were harder hit than P?keh?. M?ori were often the first to lose work and were paid lower unemployment benefits than P?keh?. The situation with benefits was only rectified in 1936 (Waitangi Tribunal, 2004, p. 659).

(13) I cannot assume I know what “a better life” means to another person.

(14) My intention in asking this question was to make the racist discourse visible so that we could examine it together.

(15) Note the way I scaffold my question with a statement. Louise immediately recognised how I was positioning myself and responded. Consider the harmful impact if I had let the moment pass without addressing such an idea and one that included Louise in its judgements. We could ask, what was made possible in the conversation following these moments when I sided with her and her wh?nau against racist discourses?

(16) This is an example of how meaning can be lost in translation (Mutu, 2004). When Louise referred to who she was, she was not speaking of an individual internal construct of self but a relational self. Included in who she understood herself to be were her connections to her t?puna, her wh?nau, the whenua (land), and moana (sea). In this conversation, Louise is considering the elements of whanaungatanga that she wishes to be connected to and that have been disrupted by colonisation. I, in turn, am referring to a relational self when I reflect on what has gotten in the way of her connecting to who she is. When I asked my colleague Barbara O’Loughlin of Marut??hu and Ng?ti Hau?, to describe her understanding of who she was, she answered me, “I whakapapa to the maunga (mountains), to the moana (sea), the awa (river), to my t?puna, to my whanau and to te ao M?ori (the M?oriworld), (personal communication, November 24th, 2022)”. There is no “I” or “self” t

Brief Therapy with Single Mothers: The Transformational Alchemy of Metaphor

Posted on September 6, 2023March 3, 2026 by Psychotherapy.net Team

Psychic Schemas and the Phenomenology of Being a Single Mother

There are over 9 million single mothers in the USA. Therapists working with these women hear stories of abandonment, disempowerment, loneliness, hopelessness, victimization, rage, and unrelenting stress.

Disturbing perceptions and emotions such as these, and the distorted interpretations that result, may, but more likely and typically, solidify into psychic schemas characterized by deeply embedded patterns of distorted thinking, dysfunctional reacting, and compromised coping.

Psychic schemas, themselves free of valence, can be understood as internal vehicles serving as repositories for what the individual notices, perceives, and catalogues — including feelings, thoughts, sensations, actions, experiences, and the ever-changing states of the Self. The way these phenomena of living are perceived — through thought, memory, imagination — and the linguistics of the internal narrative, provides the personal schema with its phenomenology, its valence, and its meanings.

As with any individual, what gets introduced and accepted into a single mother’s schema will affect how she thinks, what she feels, how she continues to live her life, and how she views herself. Her existing schema will influence content that continues to be incorporated. The phenomena that become absorbed will affirm or refute negative cognitions, support or refute distorted thinking, validate or dissipate painful emotions, increase or decrease stress, and affect choices of action, including decisions about the mother’s parenting — and about her sense of self.

Through listening to the single mother’s stories, and recognizing her interpretations about them, the therapist can become aware of and assess the possibilities for creatively crafting metaphors that can elicit cognitive shifts, emotional transformations, and behavioral change.

The Transformational Alchemy of Metaphor

The unconscious mind embodies a powerful potential to transform negatively charged schemas into more positive ones that embody uplifting themes and hopeful interpretations. The quiet mind, combined with the evocative and rhythmic language of hypnosis, can fuel a subconscious shift that can reduce stress, increase ego strength (including parenting skill), transform confusion into clarity, decrease stress, and increase a sense of strength and wellbeing.

Used in conjunction with trance, the mother’s personal metaphors become powerful tools that can reach beyond the didactic to tap the unconscious mind’s potential for reframing and restructuring the phenomenology of the single mother’s psychic schema. This potential to redirect focus, shift internal states and create change in the bio-psychosocial-emotional substance of the patient’s psychic schema constitutes the transformational power of metaphor.

Metaphors (and their cousins, simile, allegory and parable) contain rich sensual imagery that can gently and poetically focus attention to perceptions that can shift self-states and move patients toward changes they desire. When used with techniques of trance, such as tempo and attunement, metaphors drawn from patients’ stories constitute a power-filled therapeutic tool for anchoring change and growth in the body-mind with stability and durability that can successfully lead to increased resilience and coping strength.

Using brief, simple, and effective techniques, therapists can assist the single mother in imaging and identifying with new metaphors drawn from her own personal story. In trance, this “sympathetic identification” with new and transformed metaphors can lead to increased confidence, more solid self-esteem, greater ego strength, and a more integrated core of Self. When this positive enhancement becomes incorporated into the psychic schema, the psychosocial-emotional benefit to the mother can also benefit the health of her children.

In the following narrative, my work with “Queen Esta” demonstrates the way in which a carefully crafted metaphor has the power to shift the meaning of a personal and create a stronger sense of Self.

Queen Esta’s Story

“I just left my husband of 30 years!”

That was how Esta introduced herself, at the age of 83, knowing that she could have a future. Esta wanted to understand why she had spent thirty years with a second husband she did not love. To Esta’s credit, she had the wisdom to realize that at this critical turning point, it was important for her to understand the greater span of her life in order to accept her choice to leave her marriage.

As Esta’s story unfolded, it became clear to both of us that Esta’s acceptance of her current choices had everything to do with looking at a different piece of her story. Long before there were social supports and the stigma had faded, Esta had been a single mother. Esta soon came to realize that understanding the impact and meaning of her single motherhood would hold a key to the answers and comfort that she was seeking.

I discovered that Esta had married her first husband in the early 1940’s, shortly before he went into the service and, “when I was too young to know what love was.” The new husband had come home on leave and had left Esta again, pregnant. Esta’s husband was not pleased with the news. When he told her that he wanted her to have an abortion, she agreed it was a very good idea. “I did have one,” she enjoys saying triumphantly — “and it was him!”

After dismissing and divorcing her husband, Esta found herself a single mother of a very young son. In the mid 1940’s, widows, especially war widows, had some acceptance, but single motherhood was not as socially integrated as it is today. How had Esta coped? What had been her resources? Even so many years later, Esta did not fully comprehend how strong she must have been to grapple with the social context of the day and the great difficulties and isolation that single mothers faced.

As single mothers in every era must, Esta had to deal with her own fears and insecurities and raise her child at the same time. Esta had done both successfully, but she did not see the strengths she had drawn on or realize that they could add to her resilience in the present.

During her son’s early childhood, Esta had called upon her inner and outer resources. She had relied on her parents to take care of her little boy while she worked long hours, often traveling alone overnight. She remained mindful and grateful for the help she was getting from her family, feeling fortunate that she had this support. In this way, Esta did not see herself as a victim, but rather cultivated an attitude of acceptance that gave her strength to keep going.

“Esta,” I asked her, “Wasn’t it terribly hard to be a single mother in those days?”

“Yes, it was.” She assured me. “I did what I had to do, but there were others harder up than I was, with no families to help.

“What is the secret of this positive attitude you had?” (She still has it into her 90s!)

“I believe in God.” she said unhesitatingly. “This was the path he chose for me, and I had to accept that. I felt grateful to have my son. He was so precious, and my mother and father loved him as if he was their own. I accepted my decision to divorce and trusted that this was what God wanted for me. So, you see, I was lucky.”

As Esta continued to examine her life story, she came to realize that more than luck had been at work. She was able to see her courage and the intuitive wisdom that gave her the courage to banish husband number one. Finally, she could entertain the idea that there was also deep wisdom in her choice of husband number two. At a point where she no longer had family support, was weary from her grueling job, and had no financial base, Esta had married a man who could, and would, support her and her son.

Esta was now able to make sense of her past and present choices, comforted by knowing that they had been logical, born from a positive impetus. With this knowledge, she was able to accept the sadness of never having had the romantic union, but Esta was relieved of the stress caused by disappointment and regrets, and feelings of well-being replaced disappointment and regret.

Once again, Esta had “done what I had to do.” Realizing how strong she had been in the past helped Esta to see that her decision to leave her current husband was coming from an authentic core part of her Self which knew what was right for her now as it had in the past. As she achieved this wisdom, Esta’s feelings of sadness and self-doubt were replaced by a sense of well-being and an appreciation for her experience and her maturity.

In the throes of her single motherhood, Esta was too immersed in survival to see what she was accomplishing, and the era of self-help and therapeutic support had not yet dawned. Now, so many years later, ready to look back and see her success as a single mother, Esta embarked upon a review that allowed her to know how inner wisdom had directed her to cope and survive. Esta told me about the love of her life, a young man who had died before they were able to be married, almost 50 years ago.

Esta recounted the depth of that old grief, and how difficult life became then, and again when her parents, on whom she had so depended, died. Through all these losses, Esta had kept her sense of humor, her belief in God, and the persistent effort to give her son a good life. She maintained her dedication to him even to the day when this son, now a man, asked for her blessing to follow his destiny 3000 miles away. “My heart broke.” She told me. “But what could I say? This is what he wanted, and I wanted him to be happy.”

As she reviewed the events that required such pervasive and abiding courage, Esta was able to acknowledge that, indeed, life had been hard for her. She affirmed that trust in the will of her Higher Power had enabled her to embody the healthy attitude that had been with her into her 90s. When Esta started therapy, she was no longer the young mother with a little boy to bring up.

However, it meant the world to Esta to transform her doubts of having wasted her life into a view of herself that affirmed her strength, and the deep abiding soul Wisdom that guided her so many years ago, when she just “Did what I had to do.”

When asked how I should identify her in my book, Esta requested that she be called “Queen Esther.” Partly, she says, because Queen Esther in the Bible was a wise woman and a survivor; and partly because now Esta saw herself as “Esther,” a modern Queen, courageously having raised a boy into a good man.

Esther told me that she knows that the difficulties she faced as a single mother helped to make her into the Queen she is. She knows that she made choices from an inner truth that directed her to do the right thing.

Queen Esther was then, and will always be, truly a Soul Mother.

This story is excerpted and adapted from Soul Mothers’ Wisdom: Seven Insights for the Single Mother, by and with the permission of its author, Bette Jonas Freedson, and that of its publisher, Pearlsong Press.

Providing Culturally Sensitive Narrative Therapy and EMDR to Original Peoples

Posted on August 31, 2023February 11, 2026 by Psychotherapy.net Team

Finding Strength through Connection in Counselling

We hope to help the reader understand one attempt of working in the most non-colonial way possible with the Onkwehonwe. In this story, playing a minor role, is how a settler of Irish heritage, Linda, committed to honouring the Onkwehonwe. Linda was assisted in her understanding of the Kanien'kehá:ka (Mohawk People), and in how to be helpful, by Juliette, playing the major role. Linda was Juliette’s helper/psychologist and Juliette was consulting with her.

Juliette: When I reflect on the beginning of our sessions doing NT/EMDR, I remember feeling that I would always suffer. I was unclear as to what might come of this type of therapy.

Linda: I was trying to integrate EMDR (1) into Narrative Therapy (NT) to work in a non-colonial way. EMDR uses bilateral movements to change the way memories are stored in the brain, allowing one to restructure trauma memories.

(In the work with Juliette, I asked her to reprocess negative memories and how they made her feel while trying to help her realize differences — for example, if she felt unsafe, she could try remembering experiences of feeling safe).

I tried to let you lead the way with EMDR and then answer NT questions to highlight non-problem stories. With NT (2, 3) the ethics provide a non-colonial way of working by flattening the hierarchy and being non-judgemental.

(NT works with the way people make sense of their lives with stories. Narrative therapists help people be other than what the problem stories would describe. These stories determine how we see ourselves. Narrative therapists believe that stories aren’t fixed. Problem stories pretend to be the truth, but they are not, as Maggie Carey, shared with me in a personal communication in 2018).

I am expected to write an evaluation for Kahnawà:ke Shakotiia’takehnhas Community Services-KSCS) when they refer someone to me. I use special knowledges discovered from the Tree of Life or Journey metaphor (4) as my report. People consulting can thus realize that they are not only their negative stories, but that their life stories can be retold in ways to transform their experience of life, understanding there ARE also non-problem stories.

Juliette: This experience with you would be the very foundation to what gave me the strength and encouragement to push through whatever came my way. Your compassion and technique allowed me to open to you. I could feel the beauty of your spirit.

Linda: I appreciate your comment about spirit.

Juliette: Everything happens for reason I believe. I know in my heart that the Great Spirit sent such a loving and gentle person as yourself to me. I honestly think he hand-picked you for me, since I had so much hurt and pain. I needed a sensitive, well experienced human-being.

Linda: I am drawn to NT because it suits MY spirit. It helps me be a sensitive human being for you.

Juliette: I felt very connected to you, considering your background of living off the land. We may be from diverse cultures and generations, but in some sense, we are the same.

Linda: I feel humbled that someone with your capacity to relate to nature, animals, and spirit could feel such a connection with me.

Juliette: I am the product of multi-generational trauma. With that comes many co-existing disorders. I felt no judgments with you. I could speak about my visions, dreams, and animal experiences. You were interested to hear about it. In the past we were not allowed to speak of such things for fear of being arrested or terminated. Blood memory is important in my People. Even though some of us have not directly experienced certain traumas, it is in our DNA.

Linda: I wonder if the words torture or violence might be more fitting than trauma, (inspired by Cathy Richardson’s work, [4]). If torture is in our DNA, are non-torture stories too?

Juliette: I found NT/EMDR to be immensely helpful in lifting the dark cloud that was hanging over me. It helped to open me up to even further healings. Most of all I think the way you did it and gave feedback, writing what came out of the sessions, was helpful. Three years later, I still have these notes to help me look back on how far I came.

Linda: I write notes for you to have nothing hidden. I give everyone my notes.

Juliette: I cherish the letter you gave me when we finished our sessions.

Linda: Therapeutic letters are a huge part of my work. They help consultees notice their revelations (5). I summarize changes noted in therapy. Now I often co-write letters with the person consulting, to co-construct counter-stories (6).

I love that you wrote back. I appreciate you describing me as medicine woman, mentor, and healer.

Juliette: I think what you are trying to do for Indigenous people is honourable. It is not an easy task to take on collaborating with people who have been so greatly affected by colonialism. I wonder if your background of living a simple life had anything to do with the paths you chose to take on helping people like me. I found you educated and knowledgeable in your field. You are hardworking and always striving to help others. That is a commendable characteristic to have. These qualities remind me of the seven grandfather teachings to live by: to have love, respect, truth, wisdom, honesty, bravery, and humility. You have all those qualities in your healing practices.

Linda: Wow! Thank you.

Juliette: Medicine people come in all forms with each bringing something that the client might need at that time. You were the first I had seen.

In June of 2019, three months after our sessions ended, my grandmother passed. I lost my Stepmother in a tragic accident. We lost our family pets. On July 4th, I had a hard delivery with an emergency C-section. I know that without our work, those hardships might have broken me for good.

I continued to see healers and came to terms with the fact that this will be a lifelong endeavour, considering what I have gone through.

Linda: If I could be considered to have contributed to the beginning of such a lifelong healing journey, I would feel fulfilled.

Juliette: I appreciated and found helpful that you shared some of your life story with me. That made me feel a connection. I felt I was not so alone in some life experiences. From the eating disorder I had, one thing stood out in my mind. You said, “bulimia seems a form of self-punishment.” That one sentence made me think twice about ever doing that again. Why punish myself for what others had done to me? Why give them that power? So, I never did it again.

Linda: I felt the unfairness of this.

Juliette: NT/EMDR is powerful. That helped me relook at my traumas in a different light, helping heal the little girl in me. Since then, I’ve been raising my three children. My son is now three. His name is Keenai (meaning black bear) and his Kanien’keha name is Takarihóntie (news travels fast). I was cleansed by a healer as I was under spiritual attack, which helped. I enrolled to become a traditional healer in mental health and Indigenous addictions counseling. We learn different resources and ways to help my people. We do land-based teaching where we take part in sweat ceremonies, singing our songs, making drums, etc. I kept a consistent A+ average. I am learning what was taken from my people.

Knowing who you are and where you belong is medicine. The more I learn and heal the better my confidence gets and the less the anxiety comes. I am no longer on medications.

Occasionally I need to take an anti-anxiety medication as the course can be heavy, speaking about residential schools and the many injustices that led to the situation we are in today. I have come a long way from where I was. I AM immensely proud of myself. I was told I am the medicine for my family and people.

So many people I met through this journey are medicine for the people. I consider you to be one of them. You gave me that encouragement to keep healing and advocating for my people. For that I will be forever grateful.

Linda: What you just said made me remember questions in the letter I sent you. “if we could invite your welcoming ancestors and your Creator here to be with us and we could have a conversation, how do you think they might express their pride in you?"

Juliette: They would give me a great big smile.

Linda: How would they want you to feel about the way that you were an advocate with me and about the way you have turned your life around?

Juliette: I think they would be so proud and hopeful that things are changing.

Linda: Do you think that they would be honoured?

Juliette: I know I am honouring them by healing and acknowledging their hardships, changing whatever I can to bring back what was taken from them/us.

Linda: I wonder if they might have advice about how to be even more of an advocate for your people and the land.

Juliette: I think they would tell me to be a warrior and to keep fighting for the ones who cannot.

Linda: Do you think that if you continue to speak out and be an advocate to those of your people in need, regarding how to transform a life from one of drugs and alcohol and violent partners like you have done, they would be happy to stand by your side?

Juliette: They are always by my side. I know they are happy with what I try to do.

Linda: Do you think they were at your side every day when you kept yourself safe?

Juliette: They guide me always.

Linda: Now, do you think they would be even prouder by your decision to become an Indigenous healer to those having challenges with mental health and addictions?

Juliette: They ARE proud. They guided me. They want me to help others. It is a part of our ways that if we are well, then we help those who are not so well. If I have a full plate of food and see someone with nothing, then I give them half of mine. That is the concept. Don’t let others suffer if you have the means to help; take my struggles and heal so I have that empathy to help others.

Linda: Interesting. My mother taught me with privilege comes responsibility to help those with less privilege.

Juliette: I have questions to ask. What drew your attention to helping my people and other people who have endured a terrible history?

Linda: Perhaps my mother’s teaching. Also, the stories my grandfather told of how the Irish were mistreated as they were colonized. It might be my wonderful experiences as a child and adult living on a farm and receiving community healing. Maybe, the appreciation I have of your culture bringing back community with the passion to get back to your cultural roots.

Juliette: Was there any moment in your work where you just knew you were doing what you needed to do and were in the right place?

Linda: Every day. Especially after this conversation with you. If any of the work we did together played even the smallest part in where you stand today, can you guess how proud I might feel of the work I do? I believe that you will help your people remember their roots, their strong culture, and what they can teach us non-indigenous people. If I played even the smallest part in this journey you have taken, I would know I am in the right place, doing what I need to do.

References

(1) Shapiro, F., Kaslow, F. W., & Maxfield, L. (2007). Handbook of EMDR and family therapy processes. John Wiley & Sons.

(2) White, M., & Epston, D. (1990). Externalizing the Problem In (Eds.). Narrative means to therapeutic ends. W.W. Norton & Company.

(3) Freedman, J., & Combs, G. (1996). Narrative therapy. The social construction of preferred realities. Norton.

(4) Richardson, C. (2021). Facing the Mountain: Indigenous healing in the shadow of colonialism. Charlton Publishing,

(5) Denborough, D. (2014). Retelling the stories of our lives: Everyday narrative therapy to draw inspiration and transform experience. W.W. Norton & Company.

(6) Ingamells, K. (2016). Learning how to counter-story in narrative therapy (with David Epston and Wilbur the warrior. Journal of Systemic Therapies, Vol. 35, No. 4, 58–71.

(7) McAllum Pickington, S., (2018) Writing narrative therapeutic letters: Gathering, recording and performing lost stories. Journal of Narrative Family Therapy: Special Release 20-48.

Critical Tips for Building and Maintaining Your Private Practice: Avoiding Self-Defeat

Posted on August 29, 2023February 11, 2026 by Psychotherapy.net Team

Over my consulting career with mental health professionals at various stages of their development, I have offered critical guidance about the development and maintenance of their private practices. I have also learned a great deal about why so many of them struggle in these efforts.

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All of us who see clients privately have likely heard stories about why some left treatment and came to us, or why they did not return to the former psychotherapist. In the process, we have also hopefully learned why we were chosen to be their therapist as opposed to others with whom they have consulted.

Successfully Managing Telephone Contact with Clients

There are many ways in which clinicians — often unknowingly — defeat their own interests in the course of building and maintaining their private practices. One of these is the difficulty managing and handling telephone contact with prospective clients. New clients who were given several names of therapists have reported to me that one of the reasons they came to see me was that I was the only one who returned their phone call, or that I returned their call on the same day, rather than two, three, or more days later. I am astonished every time I hear this.

Another familiar comment I’ve fielded surround concerns the “phone-side manner” of the therapist who does return the call: “Unfriendly,” “Cold,” “Abrupt,” “I felt like I was bothering them,” “Didn’t really seem to want to answer my questions,” “She sounded to me like I must sound to the salesperson who calls me at dinnertime,” and more. It seems that some therapists are not any more comfortable talking with strangers than prospective clients are comfortable talking with us.

Prospective clients who have been sent to us by a known referral source may simply be calling to make an appointment as instructed. For many others, however, that initial phone call is a fragile moment that may have been delayed for some time. This is a first opportunity to engage the client and establish a positive initial connection. Many prospective clients who feel uncomfortable or even put off during the first call will never make it to the first visit with that clinician. Some potential clients call to arrange an appointment and save their many questions for the first visit.

Other prospective clients, especially those who are ambivalent, fearful, or who are seeking help under duress, require answers to their questions on the phone before ever coming in for a session. How this conversation is handled by the therapist might well make the difference between a new client and a non-client. If a therapist is uncomfortable with a prospective client needing a lot of information during the first contact, it might be evident and affect the quality of the encounter. Some callers ask difficult questions that must be handled sensitively, e.g. “What is your fee?” “What is your orientation?” “How long will it take?” “Should I bring my spouse?” And my favorite: “Now that I’ve told you a little about my problem, do you think you can help me?”

Many therapists seem to struggle in answering questions about their fee. There is probably no really safe or “good” answer — at least on the phone, and especially for clients who have issues or conflicts about paying for psychotherapy. Some therapists try to dodge the question by saying that they do not discuss fees on the phone and attempt to postpone the fee discussion until the client agrees to come in. The caller may find this answer evasive and permanently end the encounter. With a direct answer, arguably a superior response, the therapist runs the risk of an abrupt end to the encounter. The prospective client may be comparison shopping and the stated fee may eliminate a therapist right away or the client may make an appointment and then not show up.

It is important to remember and utilize the “rules of engagement” we all learned many years ago. The first phone contact is, possibly, the beginning of treatment. It is essential that the clinician is attentive, receptive, steady, ready to be of service, and generous so that the person contemplating therapy feels recognized and accepted sympathetically as a person in trouble.

I have always conducted the first session as a courtesy, i.e., no fee. This, I believe, accomplishes a few ends. For one, it conveys that the possible treatment is not all about money — especially helpful to therapy “virgins” who have seen too many Woody Allen movies. Second, if, for whatever reason the relationship is not going forward, there is nothing owed for what will not be an ongoing experience; and third, if I choose not to accept an individual as a new client in my practice, they are relieved of having to pay to hear me decline and explain why.

The Importance of Client-Centered Office Space

Some therapists are not sufficiently mindful of the impact that their office — their physical space — has on their clients and what that space conveys, especially new clients. One client told me that the main reason she elected not to work with someone with whom she had consulted, “There was a large spring protruding from the couch I was invited to sit on. The couch was in terrible disrepair and so was I. I was afraid that the broken couch might be a metaphor of some kind, so I decided not to go back.” Another oft-heard complaint concerns inadequate soundproofing, and, in the case of some home offices, too many personal distractions that interfere with a sense of privacy and optimal concentration.

Some clients have spoken of their confusion and upset about not having been given clear instructions about how to locate the office and, once there, which door to enter, whether to ring the bell, and what to do when the therapist may be running late and does not immediately respond to their arrival. Sometimes the issues that we see as insignificant have a profound impact on our clients. If one agrees that a first session is often a particularly anxiety-arousing event with a more-than-likely vulnerable prospective client, then therapists should do everything possible to ensure that the journey from phone contact to first visit is as smooth and reassuring as possible.

The office bathroom can be another problem area. Client observations have included such things as broken toilets, no toilet paper, general hygienic neglect, and broken locks or no locks at all to ensure privacy. To some clients, some of these things may be hardly noticed, but to others, these moments have significant impact and may influence or determine their feelings about continuing the relationship itself. This is generally more of an issue with new clients. If one agrees that the therapeutic cathexis is likely to be to the office as well as the clinician, then appreciating the importance of an attractive, appealing, “holding (office) environment” is crucial.

Tips for Communicating with Referral Sources

One of the most common complaints I hear from those who consult with me for private practice help is that certain referral sources have stopped sending clients for reasons unclear or unknown. Curiously, some private practitioners resign themselves to the loss and quietly regret it without ever inquiring why.

Referral sources expect to be acknowledged and thanked when they send a client to your practice. They also like to be informed about the disposition of their referral and some appropriate and discreet information about how the person they sent to you is doing. When I was building my practice many years ago, I sent referral sources a one-page statement entitled, “My Treatment Approach,” (see addendum to this article) which enabled them to understand how I conduct the initial evaluation and what the client would be experiencing when they came to see me. Feedback over the years was quite positive. Some referral sources sent work my way citing this document as unlike anything they had ever received from a psychotherapist marketing a practice. I also sent referral sources articles that I had written, kept them abreast of changes to my practice. In this way, I maintained contact with them if they were considering sending a new client my way. When I have not received any referrals from a traditionally active referrer, I inquire why. Sometimes the answer is as simple as, “you just didn’t come to mind,” so my call or e-mail inquiry served to reestablish my presence.

How to Handle Termination

The problem for many clinicians here, it seems, is when a client announces a desire to end the treatment when they are ready, and their therapist is not. This is an unfortunately mishandled moment in many treatment relationships that often sours or ruptures the relationship — at times, irreparably. Some clinicians simply cannot let go and, rather than explore the client’s desire to terminate as the treatment issue it is, they wind up angrily challenging the client and becoming an adversary, rather than remaining a valuable ally. This sometimes leads to an abrupt severing of the relationship and the client will not return. He or she may seek a new therapist or, worse, may be reluctant to seek therapy again.

***

We are all very busy mental health professionals who, at times, run the risk of losing sight of the issues that have impact on our clients. Our interpersonal skills and sensitivity to client needs must go beyond the essence of the therapeutic contract. Attention to the areas of practice discussed above and the ways in which we represent ourselves has significant impact on the treatment and demonstrate respect and appreciation for the people in distress who have chosen to share their lives with us.

Addendum: My Treatment Approach

After making empathic contact, I conduct a mental status examination to arrive at as comprehensive an evaluation as possible in the initial hour. I assess motivation, capacity for insight, flexibility, frustration tolerance along with an understanding of the presenting problem and symptom constellation. I attempt to see how affects are handled, thoughts are presented, what mood is prevalent, and how well or poorly I am related to. Resistances are initially bypassed while attempting to ease the person into the therapeutic encounter.

I arrive at a psychotherapeutic diagnosis and develop a preliminary formulation of the goals of continued work. This formulation includes an understanding of what a person is seeking in his life and what seems to be blocking his or her progress and achievement. An informal “contract” is negotiated which serves as a blueprint for the therapeutic work ahead. There is early interpretation of the transference, where appropriate.

The above is done to determine whether interventive efforts should be directed at nurturing, maintaining, enhancing, or modifying inner capacities; mobilizing, improving, or changing environmental conditions; or improving the fit between inner capacities and external circumstances.

Questions for Thought and Discussion

Which of the author’s suggestions resonates most strongly with you? Not at all?

Which of his observations have you struggled with in your own practice development?

Identify three changes you can make to enhance your practice

Strengthening the Therapy Relationship with Gay Men

Posted on August 24, 2023February 11, 2026 by Psychotherapy.net Team

In general, gay men have grown up feeling diminished in their families and beyond. The way in which they interact in the world is shaped by these experiences and so the stakes are high when they come see you. Comfort and compassion are essential components in successful treatment with gay men, and the immediate goal is to create a positive alliance. Growth takes root in this alliance, regardless of which therapeutic models or specialties you offer.

Because connection takes precedence in this moment, the paperwork that comes with this professional interaction can be put aside in favor of establishing rapport. Paperwork can wait, connection cannot.

When the client shows up to your office for psychotherapy, he will already be in a vulnerable state. His presenting issue, which is often a source of failure or shame, is accompanied by the internalized feeling that being gay is to blame. Thus, the association formed by the two of you must serve as a foundation of ongoing trust in order to explore what inherently feels dangerous to explore.

Sizing You Up

Gay male clients will be sensitive to certain aspects of interaction and particular qualities in you. Gay men are well versed in detecting safety concerns.

Do you understand him?

Are you reassuring?

Do you accept him being gay?

If you do, are you conveying it in a way that feels accepting and loving? (If he is coming to therapy based on issues pertaining to sex, intimate relationships, or compulsive behaviors, this will be especially salient).

If you are gay, do you share enough similar viewpoints for the relationship to feel safe and satisfying?

Is there a way in which the fact that you are gay actually evokes a sense of competition him?

Are you the kind of gay man he feels comfortable with — a therapist who understands his values within the community?

Is your style something he judges you for or reacts to?

If you are not gay, what are your biases, and how or when will they show up?

Are you open enough?

Whatever your orientation, do you offer the right balance of familiarity, professionalism and freshness?

As I said, the first goal at the start of new treatment is to make the connection. Remember the gay male’s history. Your client’s needs may have him looking outside of himself for acceptance, and your job at the beginning is a tough one. It is easy to fool ourselves into thinking we are doing what is right in order to make a connection, but paying attention to subtle interactional qualities is a crucial aspect of creating that necessary sense of trust. Dr. Zeig asks clinicians to imagine themselves in the consulting room: “What postures do you habitually assume? Are you unnecessarily rigid? What flexible postures can you adopt that can enhance your effectiveness?” (1)

If the client has been in therapy before, his explanation, “I wanted something new,” may warrant some exploration. Did he have a sense that his previous therapist disapproved of aspects related to him being gay? Did he come to some kind of therapy impasse? Was he having trouble translating insight into action? Whatever the reason for his having left the previous context, you’re it now, and in order to meet him where he is, you will need to appreciate his dilemma, figure out his relational style and provide the right amount of what he needs.

Keep in mind that most gay men are used to sitting on the sidelines. Showing sincere enthusiasm is inspiring, though it may take some time for him to adjust to the attention. Most clients come to therapy wanting to resolve a problem. Some are clear that it is crucial to have a good connection with the therapist in order to accomplish this, but others may not be aware of how important this aspect of therapy is.

Most gay men have grown up in unempathic environments. Thus, empathic resonance and responsiveness from the therapist are of particular importance. At the same time, the therapist’s empathic responses may fall on deaf ears as the client questions the genuineness of the interaction (2). Gay males suffering from low self-esteem are accustomed to deflecting energy from themselves and may have a knack for not accepting positive feedback. I also attribute the reaction to internalized homophobia. People with low self-esteem are more comfortable with critical feedback than praise, and they elicit values that confirm their negative self-view (3).

A quick story: A client who is not new to therapy but has just joined a group I lead reveals the tenaciousness of his low self-esteem even as he is receiving very positive feedback. This man is upbeat, attractive, articulate, and warm. When it is pointed out by the group that he exhibits these traits, his face becomes flushed, he breaks eye contact, looks down, and his posture transforms into that of a vulnerable child. Exploration of this response only brings out more embarrassment and shame. This is a man who is successful in business and to whom others respond with interest. His mysteriousness — a façade developed to hide behind — only evokes greater interest. In this moment, the uncertainty that lurks just beneath the surface is glaring.

Attunement

As therapists, we always appreciate the significance of the therapeutic relationship or we wouldn’t be working in this field. The topic is endlessly captivating. “The therapy relationship is more than a staging ground for technique, it is the primary factor in successful psychotherapy” (3).Our chief goal is to provide a meaningful experience with our clients. It is that simple. For gay men, this meaningful experience provides the greatest opportunities for change. Remember, using body awareness through experiential work, focusing on clients’ resources, and using the strength of the therapy relationship creates optimal change.

You and your client will simultaneously enjoy the rewards of using this three-prong approach. Attunement refers, in part, to this palpable shared experience. The term attunement has become popularized largely based on remarkable neuroscientific findings. Mutual physiological changes take place when people are attached to, and are in sync with, each other (4).

Your Natural Self

Whether it be your areas of expertise or your reputation that brought a client to you, being appreciative of the dynamic of the relationship is crucial. How you exhibit warmth and interest in him makes a difference. It is your natural strengths that create the greatest comfort and promote closeness. How you interact is far more important than the exact words you use. Techniques that you learn are helpful but perfecting them might be more significant for you than for your client. Your stance is that of a healer, respectful and sacred in your intentions. You are an important figure to your client, perhaps in ways he has never had in his life before.

Literature delights in affirming the significance of this relatedness. Successful therapy depends much more on the connection, empathy, and mutual fondness that develop between a gay client and therapist than any other attribute of the therapist. “What is healing as the client experiences being at one with the therapist.” (5). It is more important that the therapist direct efforts towards appreciating the client’s experience than focusing on what really happened. This perspective centers on the client’s affective experience.

Now, in current work with gay men, we can explore sensory experiences too. This opens up a treasure chest of possibilities because somewhere inside are his resources. Perhaps they have been dormant for years, but with caring guidance they can be elicited from deep inside. Research indicates that within the context of healthy relationships, individuals are able to gain experience of identity, meaning, choice, and love. The combination of these produces hope and resiliency. We discover our value, stretch our limits, gain new abilities, and collaboratively create a meaning for our existence (Short, 2010, pp. 301, 302). Authenticity opens to creativity and collaboration; the powerful mixture leads to success in the therapy.

Attunement in Action:

Create an inviting, informal atmosphere.

Use your eyes to make contact with your clients.

Be aware of your body language and show yourself to be open and welcoming.

Use your intuition to create a relational match by joining the client in his ways of perceiving things and living life.

Trust the unique ways in which information comes to you as you sit with your client. Utilize them.

Use humor with purpose in order to promote closeness or emphasize a point.

Strive to make a powerful connection that is profoundly experienced by both of you.

Focus on experience rather than technique.

Authority Figures

For gay men, positive experiences with authority figures are few and far between. Most gay men have concealed their identity or behaviors, recognizing that there was always the danger that people in positions of authority would be disapproving. I still find that many clients don’t tell their physicians they are gay, despite being sexually active. They are afraid their physician will react negatively, and the need for interpersonal harmony surpasses anything else. Of course, it is of the utmost importance to maintain good physical health, get regular HIV tests and immunizations for hepatitis, and to have safe-sex discussions. If a physician or therapist is perceived as being disapproving, the option of another provider is always a good one, yet secrecy is the default mode for many men. They forget that they have other options. This scenario happens just as often in psychotherapy, especially where sex and use of substances are concerned.

What Does it Mean to be Gay Affirmative?

I have highlighted that gay male clients flourish through your ability to notice and utilize their resources. This is the magic you can easily provide. Although it isn’t difficult, it often is forgotten amidst the therapy protocols and the current emphasis on identifying treatment goals. Clients are the best at self-pathologizing. Gay liberation itself is still fairly young (early 1970s); affirmative therapy for gay males is even younger.

Before 1990, there was ample literature to support the idea that conversion from homosexual to heterosexual was a preferred intervention. Some therapists believed it was in the best interest of their clients to change their sexual orientation, given that it is impossible for a gay man to live a happy life or have a stable relationship (6). There is still conservative religious literature that supports this perspective, but it is less common than before.

There is now consensus that it is damaging to a person to attempt reparative or conversion therapy with him. I am surprised at how often I get referrals of men who were treated with conversion as the goal. However, more common these days than outright suggestions for conversion is the perception of disapproving attitudes from psychotherapists that negatively reinforce a client’s feeling about being gay. Often these therapists are seen as rejecting and uncaring, though I would guess that many of them are actually just unaware of how they are coming across to their clients.

People who grow up with healthy authorities may not recognize that a gay man has tended to the needs of the authority figures (including parents) in his life by keeping quiet and hiding his secrets. Therefore, a client may recreate in therapy a dynamic he had with his parents by remaining hidden. The need to be compliant or good prevails. Therapists need to be on the lookout for such a dynamic and create a tone that implies mutual openness and acceptance.

The bottom line is that accepting your client for being gay is essential. A wonderful description of gay-affirmative therapy states: “Psychotherapy can result in change, although this is the secondary goal to creating an experience of empathic contact for the patient, whether or not change takes place” (2). Right on. Making this connection will be as useful as anything else.

Perhaps the best way to provide affirming therapy is to accept and affirm that you care for your client. Then you find a way to join him in his views and sensibilities. The therapist’s ability to be reliable provides a milieu that aids the patient in experiencing “twinship.” Sensitivity and empathy affirm that patient’s sense of self (2). Internalization of these interactions can lead to significant internal structural expansion and cohesion.

A Gay Affirmative Perspective in Action

You want your client to feel comfortable, valuable, proud about being gay, and for him to know that you are in accord with his true self. You can do this by finding avenues of connection with him, as a person, not just as a client.

Allow yourself to appreciate how you respect him, where your commonalities intersect, and how your differences are intriguing to each other. This way of relating is not didactic, but rather it is intuitive and emotional. Either you both will feel it, or you won’t. There is no need to try too hard to win him over, the way that you effortlessly relate is the win.

Script: Seeing and Knowing You

This script was inspired by a client sharing his difficult experiences of coming out in college. Because these struggles were having an effect on his coursework, his professor asked to meet to offer him support. His memory of receiving nurturance all those years ago was so profound that he describes it as a turning point in his life. Ironically, he remembers nothing about what was said. Instead, he vividly recalls the feeling of being cared for in this special relationship. The lamp that was shining on his professor’s desk figures prominently in his memory. The visual representation of this lamp still captivates him and represents the richness of this experience, even 30 years later.

I am struck by how other clients report similar types of childhood or young adult memories, often with neighbors, grandparents, aunts, uncles, or other people who shared their love.

This script can be used as a reminder that there were people in the past whose nurturance made a lifetime of difference. In addition, I use this script at conferences and with therapists to remind them about having had significant moments like this in their own past.

For traumatized clients who cannot conjure up anybody who provided this type of experience, a family pet or a childhood toy can be used.

“Allow a time in your past to come to you when you may have felt awkward, just a little bit different from others, or perhaps you felt alone. It might have been as a child or as a teenager, and you can look back and appreciate what it was like for you then, remembering the ways that you may have held yourself back, or constrained yourself. You can even assume that position in your body right now.

You can also appreciate how time has shifted for you now, since you are no longer at that place anymore.

Now, remember a person back then who could see you and know you for who you really were, and for what you needed at that moment in time. You can appreciate how it feels that you knew that he or she cared about you, how lucky you were and are to know that he or she cared. This caring person may not have even verbalized the ways that he or she could appreciate you, or the ways that you mattered, but you just knew this was so. You simply knew this by the way the person looked at you, spoke to you, or did something special, just for you. Appreciate the way it feels inside.

It may have been a teacher, a doctor, an aunt or uncle, or perhaps a neighbor who noticed you and took care of you in just the right ways. In your mind, you can see what this person looks like, where you were back then, and what the surroundings looked like back then. You might even remember the sounds or smells back then. That is right.

This person could see you for who you really were and really are, and was able to offer you love and support, and it felt so very special. It was just what you needed. Appreciate how it feels now and assume that position in your body. That is right.”

“If I Can, So Can You”

I provide experiences that help my clients feel alive through my own interactive stance. Near the start of treatment I say: “What you see is what you get.” In addition, I am mindful of my posture, movements, tone of voice and use of eye contact, all to imply an available informal stance that encourages the same of them. This mindset provides gay men with new opportunities. It is met with great relief, especially for clients who have had more aloof therapists in the past.

Clients are grateful to experience this positive energy and it elicits a new way of being: My informal use of self serves as a role model with its intrinsic message of acceptance of being gay. Just being myself has proven to be the most successful therapeutic tool in the room. Again, behind the curtain of any therapy technique should be authenticity: this is what allows for the power of any given technique to come through.

A quick story about my client Thomas: He was raised Mormon and says he envies the confidence of his Jewish friends. Turns out, his therapist, me, is Jewish and gay. I was excited from the start that he was willing to use the energy between us as a part of therapy; it is just how I love to work.

While exploring career stagnation, he describes a scene in hypnosis that suggests a dynamic between us. It hadn’t occurred to me until months later when I re-read my notes that the person he described might be me. It reflects how powerfully the relationship in therapy is experienced, even when it isn’t in full conscious awareness.

“There is a man in the foreground, standing in water. It is some kind of a pond or a lake. There is a reflection of a forest behind him, and the background is green and black. The sun is focused on this man. He is smiling with his head tilted, looking friendly, but strong and inviting.”

Perhaps the sun that focuses on me symbolizes the success he perceives in me, or me in him. I often am inviting him to leap into the depths of the water, either with me, or for himself.

The next excerpt brings Brad back. Here you get a glimpse of what the weave of therapeutic alliance, experiential work, and calling forth the client’s resources looks like in session.

Brad

Thinking about his growth in therapy, Brad is very clear: “Love is wanting someone who truly wants me, rather than my settling for his approval of me. I have been waiting too much for permission from men. I deserve to have a man offer me what it is that I want, and it is exciting that I am beginning to be self- directed now. I am going against the old voices I have lived with for years.”

In exploring ongoing themes, he describes, “When I am faggy, I am faggy by choice, no more editing of myself!”

Knowing how much he enjoys being creative in hypnosis, I decide to embrace his “faggy” stance in a way that symbolizes resourcefulness. I ask him to describe a memory when feeling this way was wonderful. (This was all with his eyes closed, in hypnosis, where he could let himself go more than usual.) He recalls going to the disco in the late 1970s: “Everybody was happy, celebrating their gayness and having a ball on the dance floor, uninhibited and free.”

When I ask which “faggy” song was playing — reflecting back his use of the word “faggy” in a light and easy way — he answers: “‘I Feel Love’ by Donna Summer.” Since we grew up in the same era, we spend a few moments mutually sharing our enjoyment of these times. I continue with this theme.

I ask him to bring this feeling of being free to a time in his past when he would have liked or needed more of it.

“I am in the way back of my parents’ station wagon. This was a place where I would go to in order to escape from them and try my best to feel free from them.” Knowing that he is a wonderful singer, and assuming that his singing will be a powerful experiential moment, I then ask him to sing the song out loud. I am right. It is a powerful and intimate moment. I push him to push himself further than he usually does, and I also participate in enjoying the depths of this intimate moment, one of the more intimate moments in my career.

He begins meekly:

“Ooh

It's so good, it's so good It's so good, it's so good It's so good

Ooh

You and me, you and me

You and me, you and me You and me

Ooh

It's so good, it's so good It's so good, it's so good It's so good

I feel love, love, love, love, I feel love.”

He is very self-conscious, but he continues. It is incredible. I ask him to describe what happens next. “You are driving the car, the music is blaring, I am in the way back and the lights are blinking, like the lights in the disco. We are now at a red light, where the people in other cars watch us.”

He is emphatic: “Turn up the volume, Rick!”

I had turned up the volume by asking him to sing, and gladly turn up the volume again in this important moment.

With tears, he says, “This is so incredibly hard. I want to be somewhere where all of this is okay, and it is right here.”

Experiences Unite

The success you achieve with your clients comes from your ability to join your client in his world. This often feels like a trance state or state of flow where everything else goes away and it is just the two of you. This ability to join involves the challenging task of putting your own perceptions and experiences aside.

However, in a trance state it can feel effortless. Martha Stark describes the tension between decentering in order to lose herself in the client’s experience, while recentering in order to give her authentic self to her client. Though she does not do hypnosis, it certainly is hypnotic.

A client sitting with his eyes closed and allowing the therapist to guide his experience is in a vulnerable position. In these moments, the client is no longer able to reference the therapist’s facial expressions to judge how the emotional interaction is proceeding. Trust is paramount and should be well established before embarking on this type of work, and one should only proceed with the client’s full permission.

The payoff for those who can establish comfort with vulnerability is that therapist and client together have greater access to the richness of the client’s internal world. This happens through joint exploration and joint experience. Clinician and client follow each other’s leads, and at the same time, each takes the lead.

The experience is mutual: a deep state that is creatively assembled and experienced with and for each other. This is interpersonal trance. The therapist’s unconscious mind tunes into the client’s unconscious messages, feelings, and needs. The therapist involved in this trance activity is better able to resonate empathetically with the client, and to meet his unconscious needs. As both experience a receptive trance, the client is also experiencing an interactive, interpersonal state of high resonance. The internal resources of therapist become available to him.

Even though this is done experientially, the experience is processed consciously, and the client not only has the benefit of what came up while doing this work, but also has the benefit of expanding on the respectful and loving experiences within him.

Often, while doing hypnosis, I am aware that I am talking to the child, and that he is responding to me both as child and as adult. Thus, I exaggerate the softness or the kindness in my voice during these moments. The client is often nodding his head, receiving my voice — its cadence and tone — as though listening to a lullaby. Inevitably the experience of being understood and appreciated moves clients to tears. Milton Erickson believed the therapist’s role to be a surrogate parent, and I concur.

The brief excerpt that follows provides a snippet from a much longer hypnosis in which I placed emphasis on being relational and tailoring the session to build on the solidity of my connection with the client.

Bud

Bud was having difficulty moving out of his parents’ home and establishing an independent life. Together we go on a journey, traveling by car.

Me: “And even though I am driving the car, I wouldn’t know where to go unless you gave me directions, because you are the navigator and all I am doing is following your directions.”

Bud: “We are still in the car; you are continuing to drive me past all the dark places. And you know exactly where to go, you know where to take me, I can’t do this alone. Please don’t leave.”

Me: “And you can trust, Bud, that I am here for you, that I am not going to drive away. And I wonder if you can appreciate moments when you sit here with me during a session, and moments when you leave a session, and I am not with you anymore, and yet I am with you at the same time.”

Bud: (Nodding his head) “That feels very manageable, very reassuring. Not so scary. Manageable. It doesn’t feel as scary, or lonely. I can hear you in the back of my mind telling me I can do this; I can manage this. It feels good. It makes me feel like I can do this. I can hear you saying, ‘You can do this; you can get through this.’”

“I Am Here for You”

Earlier I talked about the significance of maintaining a “You can” position for our clients. Another important stance is “I am here for you.”

I say or imply this often, and with great sincerity. It cuts through many protective layers when offered at the right moments. Sometimes I directly say this in hypnosis. If a client is struggling with pain, I want him to know that he doesn’t have to hold it by himself. This is a hard allowance for men who have been denied and have denied themselves the availability of others and of love.

Jason

Jason is a client with a painful history of sexual abuse, alcoholism, physical abuse and emotional neglect. He has learned to quietly excel in his own private world. Although it appears that he is successful and gregarious, and has many close friends, he is actually a loner and keeps himself well hidden from others.

Over the course of his sessions, it is clear that he is doing with me what he does with others, deflecting and hiding. One day I decide to take a big risk.

I ask him if he knows that I am really there for him. Tears come to his eyes. “I am here for you, Jason. And I will continue to be here for you.” These words are magic to him. He continues to weep, relieved and moved.

Later he expressed many times that this was a pivotal moment in his life. “It was the first time I could believe the truth of this: Rick is and was there for me.”

Going Deeper into the Relationship: Dealing with Conflict

When you sense that your client is having a struggle with you, do you encourage him to speak about it?

Do you ask him to describe what he needs from you?

Are there times that you avoid these kinds of conversations?

Do you find yourself giving in to your fear about pushing your client?

How many times has your client had struggles with an authority figure and not been able to discuss it?

Many of us simply prefer to avoid these kinds of discussions and instead stay focused solely on the client’s symptoms and presenting problems. In doing this, we miss out on rich moments. We hope that the connections with our clients provide lasting changes, and that our relationship provides the love of a parental figure. It does, and yet there needs to be more: working through the resolution of conflict is a crucial piece. It adds richness to the therapeutic experience, particularly with clients who stay for longer treatment.

Dealing and working through conflict in the context of the therapy relationship is a must because a gay client’s history with conflict may simply consist of avoidance. But in life conflict is inevitable; now is his chance to move through it in a different way. The question is, will you meet him there?

Whose Fault Is This Anyway?

Apologies and countertransference disclosers are crucial to successful therapy with gay men. The shame that gay clients feel is often manifested in accepting responsibility for painful experiences that are externally prompted. An empathic lapse by the therapist often becomes a source of self-criticism for the client.

I recall once in a group I was leading that I made a joke that turned out to be at one of the participant’s expense. As soon as I blurted out the joke, the group came to Todd’s rescue making clear that my comment was too gruff. It would have been tempting to rush to my own defense, “explaining” what I really meant, in order to save face. Of course, this would have also further isolated the participant and put the group in a dilemma.

Instead, I contacted him immediately following the meeting and apologized. And in the next meeting I took responsibility by reiterating to the group what Todd and I had talked about. It was important for the group, and Todd verified how important it was for him to have me apologize.

Martha Stark discusses “The New Good –The Old Bad;” The unconscious wish on the client’s part to engage the therapist in a reenactment of his internal dramas, with the therapist assigned the position of the powerful parent, and at times the po

The Costs and Benefits of Virtual Reality in Psychotherapy

Posted on August 22, 2023February 11, 2026 by Psychotherapy.net Team

Learning to Weather a Patient’s Emotional Storms

Edith typically experienced a fire-hose intensity in the flow of her emotions. She would dye her hair in bright colors, and these colors changed almost as often as her moods. She could be washed over by waves of anger or sadness. She frequently stormed in rage at her caregivers in the nursing home, or on the phone with her son. During psychotherapy conversations, her anger often dissolved into tears. The symptomatic features of her Bipolar I disorder were like a flashing neon sign on her forehead.

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Part of the therapeutic work with Edith’s case was to educate the staff that her dramatic and unpredictable swings of mood from manic to depressed and her sometimes rapid speaking were elements of her illness. Edith would also verbalize sharply critical comments to her caregivers: “You don’t even care, you don’t listen, what do you get paid for, anyway!” I thought it was important to help the staff to appreciate how reacting with strong personal emotions to her symptomatic behaviors might provoke even greater instability. They were taught to maintain a sense of role boundaries, avoid personalizing her actions or comments, establish clear expectations for daily care, set limits on unreasonable or unacceptable behaviors, and see how those steps would add to the effectiveness of their care and to their professional satisfaction.

The Pain of Virtual Rejection

One morning upon greeting Edith, I was assailed with, “My fiancé dumped me!” As I sat down, I thought, “what fiancé?” She’d not been in a relationship. Edith had a tablet computer and spent many hours playing a virtual reality game. Her avatar was a slim and pretty lady who owned a florist shop and was a personal fitness trainer. As she was interacting that morning with the male fiancé avatar, another female avatar approached and claimed that he was her boyfriend, and the male character “virtually” walked away with the other female character.

In response to our conversation, Edith was able to acknowledge that she had designed her avatar as an entertainment, and a partial fulfillment of things desired yet not available in her present life. But she was unable, at that moment, to realistically distinguish between herself and her fantasy avatar, or to distinguish her emotions from those she projected onto the avatar. The stress of the situation triggered a psychotic episode for Edith. She experienced a loss of ego-boundaries.

I consulted with team members at the facility about ways to manage Edith’s care and treatment. Psychiatric hospital care was not indicated because she made no threats to herself or to others, and an involuntary admission might add to her sense of rejection from persons and supports available to her at the home. Safety checks every 15 minutes were unobtrusively put in place, and staff would make frequent, brief contacts to help her regain her sense of self and her composure. Privately, I wondered if one day I might need to develop a therapy avatar and enter virtual reality settings to conduct therapy interventions.

Four years later, I worked again with Edith at a different nursing home. She had been living in an apartment and was helped by home-based care providers. She’d become ill with an infection, went to the hospital, then to the nursing home for further care prior to discharge home. Since I last worked with her, Edith had experienced significant diminishments in her eyesight, her memory, her mobility, and her overall functioning. She did not remember having worked with me in the past. As we sat for therapy one morning, Edith said that she’d been trying to compose and memorize a poem, because she could not write due to visual loss.

She dictated the poem, and I wrote it down so she could bring it home with her. In her poem, Edith was confronting the many losses she’d experienced, and additional ones she anticipated. Her poetic reflections were sorrowful yet realistic and reasonable given her situation. She showed no indications of psychotic symptoms and was no longer using a virtual reality game. “I know it’s getting darker for me,” she said, “But I just have to face it.” Her medical condition had worsened over time, yet she showed an improved psychological ability to deal with her circumstances. Edith was also more comfortably willing to rely on people in her life who provided helpful services.

***

Postscript: Virtual reality systems are playing an increasingly prominent role in entertainment, education, business, and in the treatment of mental illnesses. Will the use of virtual reality be a positive influence in all cases, or might it be risky or possibly harmful for some? Might virtual reality headsets be a sort of psychosis-induction device for some vulnerable people? How will we as psychotherapists better understand how risks and benefits of virtual reality might vary for different people? Time, experience, and research findings will help guide our future steps. But we can at least proceed with a sense of caution, as well as curiosity about potential new and helpful approaches.

Questions for Thought and Discussion

How might you have clinically addressed the situation with Edith and her virtual fiancé?

What are your thoughts about the use of AI in psychotherapy?

Would you like to gain familiarity with AI in therapy? If so, what kind and for what purpose(s)?

Stealing a Passage Home: Narrative Therapy to Re-claim Honesty

Posted on August 17, 2023March 13, 2026 by Psychotherapy.net Team

First Meeting: Dignity and Grace

What I most remember about my first meeting with 12-year-old Dilip were his deep brown eyes which spoke to me of a tenderness and sadness that I am not used to witnessing in boys of his age. He was accompanied by his mother, Sangita, who entered my room with the grace and dignity that came to characterize her in every one of our meetings. I didn’t know then how much suffering that dignity and grace had survived.

Sangita had explained to me on the phone that she was desperately worried about her son who had been stealing for some years from family members and shopkeepers. More recently the stealing and lying had spread to friends’ houses and to school, sites that had previously been exempt. Dilip’s intelligence was clear in everything he did. He had recently helped draw up plans for his mother’s projects on her architectural design course, including 3D movies and elevations. Sangita proudly told me how he had set up his own business repairing electrical items he had found on the roadside in “inorganic rubbish collections” and then successfully selling them online to help raise money for his family when times had been hard.

She told me how she and her husband, Kulwinder, would lie awake at night contemplating how Dilip’s entrepreneurial abilities might take him in the “wrong” direction in life and how his prodigious intelligence might be put to ill use. Sangita confided in me that they were worried that one day they might “see him behind bars.” I marvelled as I looked into this young man’s eyes. He seemed like a vulnerable innocent — not an enterprising entrepreneur with a dubious life ahead of him.

Sangita’s voice quietened, and her face became strained as she began to relate to me how Dilip’s brother, Harman, had been diagnosed with leukaemia five years previously and was now in remission. She spoke carefully and softly with the matter-of-fact-ness of someone for whom devastating events have become routine. She told me how they had only been told of the diagnosis shortly after they had left India and arrived to start a new life in New Zealand.

Kulwinder and Sangita had taken Harman with them, ahead of the other children who were to remain in India until their parents had found a home and work and had applied to become New Zealand residents. Dilip was to remain with Sangita’s in-laws and, because they had room for only one child, Dilip’s younger sister Ravi went to live with family friends nearby. Kulwinder and Sangita had adopted Ravi after the Indian earthquake of 2001 when she was four months old. She required special and tender care as she had not only been orphaned by the earthquake but also suffered from Autism and Dyspraxia.

Sangita leaned forward as if her shoulders were struggling to hold the weight of her story. She told me how she had returned to India to visit Dilip and Ravi. No sooner had her feet touched Indian soil when Kulwinder phoned her from New Zealand and broke the desperate news that Harman had a severe form of Leukaemia which had already spread to 98% of his body. He had immediately been admitted to hospital where he had begun radical treatment.

She told me how the doctors broke the news that he would be starting intensive chemotherapy and would “need his mother.” Faced with the knowledge that Harman was unable to receive the treatment that he desperately required in India, Sangita and Kulwinder made the difficult choice that they should remain in New Zealand with him. Torn between her children, Sangita was given a visa to return whilst their residency application, already delayed for a year, was being processed. She returned to New Zealand, little knowing that it would be more than two painful years before the family would be reunited.

As they had yet to become New Zealand residents, they were not covered by New Zealand medical care and had to meet the expenses themselves. To do this, they had to draw upon their savings and that of many of their family back home, running up bills of half a million dollars for their son’s radical treatment.

Somewhat shaken by Sangita’s story, I silently held her eyes to acknowledge the pain which she had conveyed with such dignity. Together, we then turned to look at Dilip. Dilip’s eyes had remained downcast throughout his mother’s tale. Collecting myself, I realised that I must turn my attention to him and the impact of his mother’s account. In his eyes, if not in my own, the stealing problem would have centre stage. Only too aware of Dilip’s nervousness and the likely embarrassment that a stealing problem might have brought upon him, I was quick to externalise the apparent problem and to add lightness to the tone of my voice. I said, “Dilip, your mum tells me that she has been worried because she thinks that there is a stealing problem that has been trying to take over your life and that is why she has asked us to meet. Is that what you thought too?”

Dilip uttered a barely audible “yes.”

I gently enquired when the stealing problem had first come along and how it had made its presence felt in his life. He informed me that it had begun when he was five, during the time he had been left behind with family in India, anticipating his reunion with his family in New Zealand.

Speaking through her tears, Sangita, told me, “He was not sure we would call him back. He was so angry that twice we had to cancel his return because of Harman’s illness and problems with the visa. He told us that he would only believe that he was coming to us when he was sitting on the plane. Many times, Kulwinder called him because our relatives said that he was bullying other kids. Even the bus driver was not willing to take him on his school bus. When Kulwinder called him, Dilip was not saying anything. He was just silent. His father was angry that every day we were counting each dollar because Harman’s treatment was so expensive, and Dilip didn’t speak when we called. Kulwinder said that it was not worth phoning him anymore. We had been telling Dilip that he would be coming soon, but in the last few months, he lost patience and said ‘every time I pack my bags nothing happens. I will only believe I am coming to New Zealand when I am on the plane.’ Our family in India had a servant who had known Dilip from birth. One day he called me and ordered me to ‘come here and take this child or pack up and come back to India.’ It was a very bad time for all of us.”

“Did he have some idea of what was going on in Dilip’s heart?” I asked.

“Yes,” she replied.

“Would he have said that his heart was breaking?” Sangita nodded, tears on her cheeks. “Dilip, was your five-, six- or seven-year-old heart breaking?” I asked.

“Yes,” he replied. “Was it heart-breaking for your mum and dad that your heart was breaking?” Sangita began to sob. “Have you talked about these matters like this before?” I enquired.

“Never,” she choked out through her tears.

“Had your family’s heart been breaking in that time? Not just your heart and Dilip’s heart but your husband’s heart and perhaps your daughter’s heart?”

“Yes,” Sangita replied.

I noticed that Dilip was sitting uncomfortably on the edge of his seat. I thought to ask him whether he would prefer it if we were to speak alone. Before I did so, Sangita swiftly looked at her son and said, “He wants me to sit outside.” Dilip nodded and she discreetly left the room.

To lighten the sadness that had fallen upon the room, I wondered aloud, “Is this stealing problem an international stealing problem that has followed you across continents?” The corners of Dilip’s mouth rose slightly.

“Did you know,” I enquired, “that, in all the time that I have talked with young people about the problems that have bothered them, I have discovered that sometimes problems start out trying to be helpful and only later become troublesome? Might that possibly be true of the stealing? Did the stealing try to help in any way with the sadness of being left behind in India and the sadness for your brother in his illness?”

Dilip replied, “Yes, maybe it took the sadness away a bit. It did help to start with!” Dilip’s body seemed to relax, and his eyes focussed intently upon me. Alarm crossed his face and tears filled his eyes as he said, “I wasn’t sure they would call me back.”

I said, “Call you back? Do you mean that you didn’t know whether or not you would ever be called back to live with your family again in New Zealand?” Dilip nodded. “Dilip, does anybody know just how sad you have been?” Dilip shook his head slowly and thoughtfully.

“No one knows. I don’t want my mum and my family to be sad.”

Realising that this sadness was at the heart of the problem but also knowing that I must tread carefully, I gently asked, “Dilip, would you mind if I try to understand a little more about this sadness?” He hesitated but then nodded his approval. “Could I start by asking you how big the sadness has been?” He looked a little confused. “If we could measure the sadness [a concept of David Epston’s creation], and let’s say the most sadness there could ever be is the width of this room which is, oh, about three metres, how much sadness was there in India when you feared they wouldn’t call you to live with them in New Zealand?”

“Two and a half metres,” Dilip replied with considerable certainty.

“And how much sadness is there now here in New Zealand?” It turned out that now there was between one and one and a half metres of sadness remaining. When I enquired, Dilip told me that the remaining sadness came from missing the family he had left behind in India.

“They keep coming to visit but they can’t stay because of their visas. I don’t want them to be sad either.”

I asked, “Are you worried that they will be sad if they know of your sadness in the same way that you are worried that your mother and your family might be saddened by your sadness?” Dilip held my gaze intently as he nodded in agreement. I gently asked if he thought that talking about their shared sadness would bring about more sadness for everyone.

Timidly he said, “Talking will make them more sad. I don’t want them to know.”

Sensing that our conversation might be on the verge of being overwhelming for him, I asked him if he thought it was time to welcome his mother back into the room. He nodded, adding, “But I don’t want to talk about what happened.”

Aware that the sadness was key if Dilip and his family were to be rescued from the effects of his stealing reputation, but also mindful of the need to honour Dilip’s tenderness, I asked him if I could briefly mention that we had talked about his life in India and how the stealing had come about. He nodded.

“Could I also mention the sadness and how it had become less since he had been reunited with his family?”

Dilip nodded hesitantly but went himself to invite his mother to return.

Sangita came into the room hesitantly. I pondered how much hope she had pinned on the time I had spent alone with Dilip.

“Sangita, Dilip and I have been talking about his time away from you all in India and how the stealing began. He felt very sad whilst he was without you but, since returning to be with you, the sadness is very much less.”

I saw Sangita’s tears begin. Mother and son glanced at each other. The sadness was palpable.

“Sangita,” I ventured, “have you talked together as a family about all that has happened to Harman and to each of you?” Dilip’s eyes widened in what suggested to me renewed alarm. “No, not even Kulwinder and I have talked.”

I asked, “Has the strength that this ordeal required of you left little room or time for really feeling or really talking?”

“Yes,” she replied. “Every year something big is happening. When I was saying goodbye to my brother-in-law at the airport last week, he said, ‘In your life it is always headlines, not small news.’ There are always big things happening. When Harman got sick there was no one. We were here alone. There has been no time to talk.”

I realised that for the previous few years, the family had been just surviving all that had happened and had not had the opportunity to reflect. I was also aware of the need to honour the tenderness of this family who had lived through so much with grace and dignity. Contemplating the way forwards, I felt unable to venture further into the territory of their sadness. To do so would have been to trespass unnecessarily into their pain when surely there were other routes available. With this in mind, I asked, “If we were to find a way to try to put the sadness to rest without talking about it directly, would that seem helpful?” Sangita and Dilip, without reference to each other, nodded in unison.

“How are you hoping that our conversations together might help Dilip and your family?” I enquired.

Sangita gazed at me for a moment and then said, as if uttering a prayer, “we want to know him better again. I would like to try to help the sadness not to come into his life again. I would like him to be happy.”

Second Meeting: Honesty as a Way through Sadness

A week later, Kulwinder was the first to put his head around my door. I had hoped that he might join us. Dilip and Sangita followed. With Dilip’s and Sangita’s permission, I summarized for Kulwinder our conversation of the week before. Kulwinder quietly took in my words. I proposed that whilst talking might be one way, there are other ways to tend to wounds. Turning to Dilip, I asked, “Am I right in thinking that your family’s suffering make you suffer?” He nodded without hesitation. “May I speak a little about your suffering as I understand it?” The family nodded their consent.

“This family has endured much. Many people have told me that when there is too much suffering, they come to believe it is better not to talk about it. Instead, they decide to get on as best they can with their lives. And they say that has worked for them for a while. But then they tell me that the suffering and sadness catch up with them; it can reach them in the strangest ways. I am not sure about this, but could the stealing have been a way to draw others to the suffering that you have all gone through? It is a measure of this family’s wonderful dignity, endurance, and perseverance that you have not cracked under the pressure of so much suffering and sadness.

“Dilip, you are a very young man and I think you can help your family out of their sadness. I know it is odd to turn for help to one of the very youngest as usually we turn to the eldest. But you are different. You have talents which show that you are a very quick learner. What you can do — and we all will help you with it — is to prove once and for all, beyond a shadow of doubt, that you are an honest boy, son, and man to be. When you do, I will ask your family to show you their happiness and, when you think people are happy enough, then, and only then, we will talk about the sadness from the past. Then we will see how everyone can be together in sickness and in health as a wonderful family who suffers and has suffered. And, Dilip, you will always know when you grow up that it was you who led the way from sadness to happiness for a family who has had more sorrow than almost any other I have known. But yours is also one of the strongest families I have met, and I am proud to know you all.”

Turning to Dilip, I addressed him alone.

“Dilip, I am going to suggest a way of restoring your reputation as an honest person. You won’t need to talk about your feelings right now. Would you be interested in such a way, even if I were to tell you that for it to work I cannot reveal to you exactly what it involves, and you will only discover this over time?”

Surprised, Dilip looked towards me, a shy enthusiasm for the project I had outlined beginning to light up his face. He nodded and then looked to his parents who nodded their assent. I said, “This is an idea that has worked many, many times before. Do you trust me that I have a way to prove beyond a shadow of a doubt that you are either a stealer or an honest boy?” Dilip’s eyes grew wider, this time with intrigue. He mouthed a silent “Yes.” I added, “I cannot give you all the details now, but next week I can meet with you all and we can begin. Today, could you help me understand more about the stealing and the reputation it has left you with?” Dilip, Sangita, and Kulwinder nodded in agreement.

I said, “Now, to begin, I need to know who in your life cares whether you are an honest boy or a stealer [Family members and friends are recruited as members of the young person’s community for the restoration of honesty].”

Dilip looked for assistance from his mother, who replied, “Well, his grandmother. She cares for him very much.” Then directing herself to Dilip added, “And your uncle, my sister, your brother, and your teacher. She is very much worried about you.”

I asked, “Is there anyone else in India who particularly cares about Dilip’s reputation as a stealer?”

“His grandparents and my father in particular” ventured Kulwinder. “Not everyone in our family knows but my parents are worried about his future and about what will happen if the stealing and lying grow with him.”

“And Arthur and Julie and Daniel,” added Sangita.

“Who are Arthur and Julie and Daniel?” I enquired.

“Arthur,” Sangita replied, “is an elderly man who is a friend of the family. He is very fond of Dilip and Dilip is very fond of him. Arthur lets Dilip spend time with him in his workshop, he shows him how to use tools and make all sorts of things. Daniel is Dilip’s school friend and Julie is his mother. Julie was the first person who talked to us about the stealing in New Zealand. She carries a loving heart. She didn’t want to punish him. She just talked kindly to Dilip. After that I told Dilip not to go to anyone’s house anymore.”

I ask, “Dilip, how has the stealing affected these people who care about you? [The effects of relationships of the stealing reputation are established] Let’s take your grandfather for example.” Dilip remained silent until Kulwinder rushed to his rescue.

“His Granddad — Sangita’s father — is worried about what will happen to his life. My parents love him very much and you know what it is like when a loved one is not on the right path. It is very hurtful. It breaks your heart.”

I ask, “And Dilip, what do you think the effects will be upon these people who care about you when they find out that, beyond a shadow of a doubt, you are now an honest boy and honest son? Can we start with your Granddad?”

Dilip looked surprised by my question but seemed to be sticking with it. I offered a question to scaffold his response.

“When he finds out, will he call on the phone or send you an email? What will he say?”

“He will be happy,” Dilip said shyly. I asked him a question closer to home.

“Do you have any idea what a reputation for honesty would mean to your parents?”

Dilip replied, “It would bring peace and happiness to their hearts.” Sangita, tears in her eyes, looked to her son and replied to my question.

“We love him very much. Knowing that Dilip is an honest boy would be the biggest gift to us. The stealing has weighed on our hearts. We have come to feel that we cannot believe in what he says. It will take time for us to know if he becomes honest again. We have to be sure his honesty is real.”

Third Meeting: The Idea is Revealed

“Dilip, as I said, this is a tried and tested way for you to prove that you have regained your honesty. Are you sure you want to go ahead?” Dilip nodded hard. “Okay, I am going to propose that you are honesty tested.” The family looked at me quizzically. “Dilip, as these are tests, I cannot tell you the details because if I did it would mean you were not being tested. The honesty tests will take place over a period of time. Your parents will decide how long the tests will take — it could be weeks or months — to satisfy them that you are honest. When the time comes, when you have proven beyond a shadow of a doubt that you have redeemed your reputation as an honest young man, we will hold an honesty party to celebrate. Now, if you are sure you wish to go ahead with the honesty testing, let us shake hands to confirm our trust in one another.”

Dilip dutifully placed his hand in mine and the deal was sealed with a firm handshake [Consent is given for honesty testing to restore an honest reputation].

“Dilip, now I am going to meet privately with your parents to let them know what this challenge to restore your honesty involves. Then you and I have a letter to write.”

After Dilip had left the room, I outlined for his parents how we might set the honesty tests [Setting up the process of honesty testing].

“Over the next few weeks or months, you will set Dilip tests which will confirm him as either an honest boy or a stealer. These must be carefully planned so that he has no idea they are tests. Just to give you some idea of what other families have done in the past, I can tell you that some parents have left change where it is visible when they have left their child briefly alone in the car. Others have left money on the hall table, etc. The tests should vary in location and be as unpredictable as possible. It would be a good idea to involve Dilip’s supporters. For example, you may want to ask Arthur or Julie to set some of the tests in their homes. It is up to you to decide how long you continue to set more honesty tests. It is all a matter of how much time and how many successful tests you think you need to be convinced that your son is truly honest. After that you might like to consider a further period of probation without tests until you are both sure that he has restored his honesty.”

Kulwinder and Sangita decided on a period of three to four months during which Dilip would have to face the challenge of six tests followed by a probation period of three to four weeks. After they had asked a few questions, I explained that it is vital to the success of the tests that others who care for their son are enrolled as witnesses. To that end, I would assist Dilip to write a letter in which he would formally disavow his stealing habit and declare in writing how he wished to renew his honesty. Dilip would be expected to post or email this letter to the concerned parties or read it to them over the phone. Immediately after each test had been completed Dilip would be required to call or contact each person on his “honesty team” to declare the result revealed to him by his parents.

Dilip returned, and we slowly and carefully crafted the following letter to send to his honesty supporters. In collaboration, we composed the letter by way of an extended enquiry which was continually interrupted so I could write down his answers [Co-crafting of letters].

Dear Granddad, Grandma, Uncle Sanu, Uncle Achyuta, Auntie Amrita, Auntie Pavani, Arthur, Julie, Daniel,

I would like to ask you for your help in changing my reputation. As you may well know, I have developed a reputation as a stealer. This reputation has grown over the last five years or so even although it has come and gone several times.

This stealing reputation has caused me and the people who care about me a lot of worry. It has been hard for me to change this reputation on my own because a reputation like this is very powerful. It is so powerful that it has followed me all the way from India to New Zealand.

I know that the people who care about me are worried about my future because they fear that this reputation could grow even bigger.

The stealing reputation has meant that lately I haven’t been able to stay at friends’ houses. This makes me sad.

I want to be able to prove to you all that I am now on the right path. I want to bring peace and happiness to your hearts and to reassure you that I will have an honest future.

I don’t expect you to believe me if I say there will be no more stealing. Kay, a counsellor, has told me that it is possible for me to prove that I can be. To prove to you that I am honest I am willing to go through some honesty tests that my parents will set for me with Kay’s help. I and my parents will call you after each honesty test to tell you the result. When I have passed all my tests and enough ‘honesty time’ has passed to prove to you that I now deserve a reputation as an honest boy, I will invite you to my ‘honesty party’. If you cannot come, then I will invite you to write me a letter or send me an email that can be read aloud at the party.

Love,

Dilip

I read the letter to Dilip, waiting for him to signal his approval after each paragraph. He looked at me thoughtfully before commenting, “I think they will trust me to get the better of the stealing.” Together we agreed that all the letters would all be delivered the following week. A last-minute amnesty was offered to Dilip so that he could admit to any stealing that might have been worrying him because it was undiscovered or not proven [The opportunity for eleventh-hour admissions].

Fourth Meeting: Eleventh Hour Confessions

We met again in a week. Kulwinder was eager to tell me of a very recent development: between meetings, perhaps because of the amnesty, Dilip had confessed to having stolen and eaten a box of chocolates bought as a present for a family friend. Although upset that the chocolates had been stolen, they were relieved that he had confessed, especially as this was his inaugural confession. He had never admitted to a theft before despite at times very lengthy interrogations to establish his wrongdoing.

Both parents had taken heart at his confession, as did I. This event seemed like a timely departure from the path that Dilip had been travelling. I hoped that it would spur their confidence in Dilip’s commitment to honesty and decided to make the most of it.

“Does this confession speak of anything that you are proud of in your son?” I enquired. Sangita eagerly responded.

“It shows he wants to be truthful; it shows the purity of his heart.”

I asked, “Have there been any other ways that Dilip has shown you the purity of his heart lately?” Kulwinder spoke of how Dilip had been listening to his mother more and contributing to the care of his sister.

“I believe he has more strengths than he can see!”

“And how did you get on with the letters, Sangita?” I asked.

“There was only one problem. He didn’t want to give the letter to Arthur. He actually cried the night before Arthur was due to come with a pet rabbit for him. I said, ‘You have to tell him, or you won’t be going to his house.’ The next morning, he said that he would give him the letter. He gave it as Arthur was leaving; it was hard for him, but he did it.”

I asked, “And how did the other people whose support Dilip called upon respond?”

Sangita was quick to reply that, when Dilip had bravely read his letter to them on the phone, her father and mother had said they would be very happy if the stealing went away, and they would show their happiness in the form of a large gift for him when he passed all the honesty tests. She said that they had already begun the honesty tests and so far, Dilip had passed two tests with flying colours. Their confidence in him was palpable.

I flung out my hand to meet Dilip’s in a “high five.”

“Great. Great, fantastic!” Seizing the moment, I asked, “Are you feeling the effects of having a more honest reputation?” The restoration of an honest reputation is proposed in place of the refutation of stealing.

“Yes,” he replied confidently.

“And tell me, how would you say having a more honest reputation has affected you?” Dilip’s reply surprised me.

“Well, I am allowed in the garage now. I haven’t been allowed in there for a while which was really hard because that’s where I make things. My parents said I couldn’t go in there because of the stealing. Now I am making a steamboat out of oil cans. Arthur has lent me a soldering iron.”

I said, “Okay, would it be fair to say that your honest reputation is winning back your parents’ trust in you?” Dilip’s expression said it all as he shot a shy smile at his parents whose faces were already alight with pleasure.

I asked, “What’s it like for you to know that your parents’ trust in you is growing as your reputation for honesty is growing?”

Dilip replied that it was good. Eager to capitalise on the growing trust by naming the pride on all their faces, I asked “Are you feeling a little bit more proud of yourself?”

“YEAH.”

Comparing the present pride with the sadness of our first meeting, I

Using the Filipino Practice of Shared Inner Perception in Psychotherapy

Posted on August 14, 2023February 11, 2026 by Psychotherapy.net Team

Pakikiramdam (Shared Inner Perception)

Shared Inner Perception is the essence of the Filipino core value of Pakikiramdam. It is the sensing and attunement that occurs when people interact. Although I speak of it within a Filipino cultural context, many other collectivistic cultures share a similar value. And from an ancestral anthropological viewpoint, we were all collectivistic at one point in our histories.

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Pakikiramdam is a Filipino core value that is antithetical to the Western philosophy of directly stating what one feels or needs. The word “stating,” makes all the difference. Through Pakikiramdam, the Filipino — usually the immigrant or in the first-wave generation — is able to state or communicate far more without words than is typical or even comfortable for those solely dependent on the literal word for communicaion.

In mixed-generational or mixed-racial families, these two styles of communication often clash, leading to instances where the intent of the speaker becomes lost on the listener, while the listener feels out of touch with the speaker. In my clinical experience, this scenario often plays out in therapy with Filipino clients, leaving members of the family feeling unheard, mis-heard, or unvalued. If the therapist is not keenly attuned to the client, whether Filipino or not, the potential for miscommunication multiplies.

Shared inner perception in the therapy room starts with deep listening. It is using the therapist’s gift of intuition, attunement, collaborative projection, and co-transference. When the intuition channel of the therapist is clear, it’s like a light shone on a map that the client possesses. When the intuitive channels are unclear, ridden with ideologies and blind spots that belong to the therapist, intuition is instead like a broken compass, taking the client somewhere he intends not to be.

Pakikiramdam’s language relies on watching, listening for, and sensing non-verbal cues; paying attention to what is not said as much as to what is said. This includes paying attention to changes in vocal inflections, subtle facial and bodily movement, breathing patterns, and subvocal sounds, such as tsk, tsk, tsk.

This is not an uncommon scenario:

Ricky, a Filipino American son asked his elderly mother, “Do you want me to pass by your house before I head straight to work?” “His mother replied, “Oh no, just go right ahead.” And so the son did. A few days later, he realized that his mother experienced Tampo (having her feelings hurt, although not completely angry or upset, by someone they care about). Why?

Here’s the other part of the conversation from the mother’s perspective:

“No, just go right ahead. Oh, by the way, I remembered I have to call the plumber because I can’t flush my toilet. I had a stomachache yesterday, I guess I used too many toilet papers. Now, I don’t have a single roll. Gosh, I need to go because my neck is starting to ache holding onto the phone. Bye.”

It would’ve been more useful for the son if the mother had clearly and directly articulated her needs, even though he did repeat his request to her to stop by. Let’s explore this scenario.

Self-Soothing Versus Collective Coregulation

The “rules” for communication in individualistic and collectivistic cultures differ widely. Individuals and family members in cross-generational, or mixed cultural/racial families often experience scenarios similar to that of Ricky and his mother.

Systems of care in a particular culture are influenced, in large part, by the self-soothing strategies that are part of that culture’s value system. In America, grandparents can babysit their grandchildren but more formal out-of-home, out-of-family care, like daycare or school, provides American families with the stability and consistency of care that the parents need to manage their livelihood and parenting responsibilities.

In non-Western, collectivistic societies, cooperative care is the social norm, through which children are raised by non-family “trusted-others.” These informal resources allow primary caregivers to pursue much of the same goals parents have across cultures, that is, to pursue economic opportunities and navigate parenting with ease. In these collectivistic cultures, Filipino included, parents emphasize the importance of being part of a system, which includes relying on others and being someone to rely on.

In the Filipino culture (in the Philippines), preparing and rehearsing children to read non-verbal cues are taught almost instinctively by adults from birth. The words, iyak-iyakan (pretend crying), galit-galitan (pretend being mad), sakit-sakitan (pretend being hurt), may be used in a playful, teasing way with young children so they can read real situations when they arise.

I had the interesting experience of a being a kindergarten teacher both in the Philippines and in America. The stark difference in the use of teasing as part of the group dynamics with children and the adults was notable.

Teasing is defined as making fun of someone in the English language. While I am neither proposing or advocating for teasing, I am referring to a type of teasing where someone who is teased can tease back. In fact, this is not an uncommon strategy of parents in the Philippines to teach their children to tease back playfully when teased. In this instance, the teasing becomes a communal act, as does the soothing.

It’s also not uncommon that such teasing can be used to lighten up an embarrassing moment. For example, if a child trips in front of his friends, his friends might start laughing, not as a way to ridicule him entirely but to elicit laughter so that child does not feel embarassed. Again, rather than burdening the fallen child with soothing themself, that burden is shared by the group and soothing becomes an act of community based on that groups ability to sense or intuit that child’s distress.

Shared Inner Perception in Parenting

In the following illustration, I contrast the Filipino and American orientations to the goals of parenting.

The American parent’s goal is to teach their child to self-regulate, to be independent, and to be self-sufficient. In the individualistic, nuclear family system, there simply aren’t as many helpers that can assist in informally raising the child. A good child is one that can self-soothe, articulate their needs, and do things on their own.

The Filipino parent’s goal is to teach their child to enter group settings successfully. This means teaching children to read non-verbal cues, including watching for subtle changes in facial and bodily movement, as well as tone of breathing and voice. A good child is one who can collectively receive and give coregulation, can share their space, and do things with others.

To contrast self-regulation, coregulation, and collective coregulation (a term I made up to explain this phenomenon), I’ll use the umbrella metaphor:

In individualistic culture, it’s essential that an individual learns to build and toughen their own umbrella so that when rain comes, they won’t be drenched. This is self-regulation. When the rain turns into a storm that surpasses the umbrella’s protective capacity, the individual may seek the company of other umbrellas. After all, two umbrellas are better than one. This is coregulation.

In the therapy room, when trauma, or a client’s deepest hurt, is akin to the rain that turns to storm, deep attunement to that client’s need for the protective umbrella, so to speak, of the therapist becomes crucial. Self-regulation yields to coregulation.

Shared Inner Perception in the Therapy Room

Returning to Pakikiramdam, shared inner perception values the following for the purpose of connecting with others: Pangangapa (to grope), Pagtatantiya (to estimate), Tiyempuhan (to wait for the right time), Tiyakin (to ascertain), Pagsusuri (to investigate), Pakikibagay (to deal with), Pakikisakay (to catch/ride on), Timplahin (to blend or season to the right taste), Singhot (to smell or sniff).

It would be daunting to rely on the therapist’s intuition as a treatment plan. Intuition without a framework can put that therapist in a position of a guru who must rationalize that they were only following their intuition when they have led a client to themselves.

A useful tool is a sense of wonderment which gives way to collaborative projection. In that, the therapist’s projection is likened to a doctor who is giving an intravenous injection. The doctor has seen many veins, good and unsuitable candidates for a shot; they project based on their professional experience. When they finally choose a vein, that projection is essential, and yet they watch for a slight twitch and nuance because only the client can tell that a good vein is actually good.

The therapist who diligently engages in the practice of observing their clients can begin to wonder about the subtle unspoken reactions and changes in their client that serve as guiding cues for therapeutic involvement and intervention. This process of wonderment is not the same as interpreting, since the therapist must constantly check that their projections are in agreement with the client’s and not the other way around.

Shared inner perception is an openness to co-suffering, not just as a mere strategy for treatment but as a human experience that the suffering and the witness (therapist) are both touched by what was shared in the therapeutic relationship. As the client grows in therapy, so does the therapist and vice versa. It is a thread where the beginning and the end are indistinguishable.

It is a dance to take the experience of the client at face value, leaving space that there may or may not be more. In other words, that a no response from a client may be a camouflaged yes and a yes, a polite way of saying no. The therapist who hones their shared inner perception skills doesn’t read their clients like an x-ray, but understands that the x-ray may reveal very different results depending on how it is held.

Final Thoughts

Marco Iacaboni’s research on mirror neurons and the process of co-internalization distinguishes between the self and the other, suggesting that our neurobiology puts us “within each other.” In this vein, interpreting facial expressions and social exchanges becomes a mirroring process, a thread that connects both the therapists and the client, and not merely a strategy “done to” a client.

Although the concept of Pakikiramdam in this article was introduced through the Filipino cultural lens, its tenets are not exclusive to this culture. In addition, its therapeutic use is not reserved for this population. There are modalities in the Western culture that purport a similar framework to healing.

For example, J.L.Moreno’s work on psychodrama encourages therapist spontaneity and flexibility. The other characters in the drama can utter words that the protagonist (client) dare not speak, giving timely voice and necessary silence when appropriate.

Various other modalities rely on creative expression — the sand tray, movement, art, and music — all become powerful mediums through which to explore healing without tripping into the trappings of language that often mean different things to different people. Language in all its forms, spoken and otherwise, is at the heart of the therapeutic communication.

****

The therapist, therefore, listens deeply like a dancer listening to the rhythm of a tune for the first time, aligning her moves to the serenade of the music. Every beat counts and every beat missed becomes an opportunity to recalibrate the dancer to waltz back to the therapeutic relationship.

The Symbolic Healing Power of Traditional Coping Strategies

Posted on August 10, 2023February 11, 2026 by Psychotherapy.net Team

Why do coping strategies help to resolve psychological symptoms? I once assumed that this question had a simple answer, but I have found over the years that the answer is much more complicated. There is a hidden depth to this question that is both mysterious and life-altering.

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As a therapist, I regularly offer an assortment of coping strategies to help my clients cultivate symptom reduction. The empirically grounded strategies that I most commonly provide include breathing exercises, grounding techniques, mindfulness practices, and/or distress tolerance skills. My clients typically report these techniques to be effective physically and psychologically. Despite their positive impact, I often wonder how exactly these coping strategies work — beyond the obvious, that is!

How Coping Strategies Work

The apparent reason for the success or failure of any coping strategy is its potential to effect visible or discernable change in behavior, thought, and/or feeling. However, I have often found both in my personal life and clinical work, that there is a deeper symbolic process contributing to these outcomes.

For example, I love to run simply because it makes me feel better. While the science suggests that running promotes neural growth, creates a reduction in inflammation, stimulates new activity patterns in the brain, and releases endorphins which help to regulate mood, sleep and energy levels, these are not the reason why I run.

I run because it “carries me to a new place,” beyond the literal, that is. Symbolically, this seemingly simple, mechanical activity “opens me” to new paths and possibilities within my own internal experience. It reorients and centers those parts of myself that have gone astray. I return to who I truly am when I’m running, and I am never the same once finished. If, once I begin running, I’m angry, my feet can stomp out my frustration. If I’m anxious, my body can unwind, working through its tension. Beyond the positive, physical outcome, these symbolic gains are what keep me going, so to speak.

Along similar symbolic lines, I often de-clutter my home when my thoughts feel cluttered or chaotic. Sometimes, however, I forget to attend to this symbolic process, getting lost in the physicality of de-cluttering. In those moments when I should be focused on the symbolic, I feel too distracted by the misguided pressure of the physical act. In instances like this, and in retrospect, I often wonder how much more benefit I would gain if I were to better recognize and then enter more intentionally into these symbolic processes.

Transforming Act into Symbol

In a similar way, I often wonder if my clients are missing out on the full benefits of their coping strategies by not paying attention to their symbolic healing potential. For example, one of my client’s daily practice of journaling became much more effective when he began to intentionally symbolize the words he wrote as thoughts that were finally “leaving his mind.”

This particular client initially presented with “stress” related primarily to his inability to let go of the future-oriented worries that regularly “pulled at” his attention. These thoughts typically intensified in the quiet of the night as he obsessed over the demands and possibilities of the next day. These thoughts made it impossible for him to fall asleep, which left him fatigued and even more worried the next day. Over time, this cycle solidified into a holding pattern that dominated his life, making it impossible to freely move forward.

I asked him to write down his worrisome thoughts before bedtime to externalize them. Initially, he found it difficult to banish these thoughts to paper, so he stopped trying. The action didn’t seem powerful enough to help. The full benefits of writing down his worries made sense only when he intentionally embraced the symbolic process by truly experiencing his worries leaving him through the embodied process of writing.

He also expressed the need to add a symbolic ending to the process by crumbling and tossing away the worry-laden paper into a small trash can that he set up in his nearby hallway. While he considered other symbolic acts including storing the paper in a designated box, shredding it, or setting it on fire, the act of tossing it away made the most sense to him. Over time, the journaling practice extended beyond the original act and into his everyday activities so he could experience a more complete sense of separation from the worries that had previously dominated his life.

Bridging the Gap Between the Physical and Symbolic

My clients and I find that the physical and symbolic need to be explicitly paired in order for the coping strategy to work most effectively. For example, I had another client who was struggling to experience the full advantages of diaphragmatic breathing. Despite the research suggesting the many neurophysiological benefits of this activity, she wasn’t experiencing them.

As it turns out, this client had struggled with anxiety for most of her life, incessantly shopping for and trying on coping strategies in search of “the one” that would finally “fit” and bring her relief — hobbies, relationships, etc. Over time, we realized together that the “real” cause of her unrelenting distress was the fear that she would not be able to endure “standing still” and being in the moment. Searching for, trying on, and then discarding technique after technique was an illusory quest, denying her peace in the moment.

Together, we discussed this disconnect, and I suggested that she take a small step towards stillness by intentionally pairing a pleasant feeling (one she wanted to bring into herself) with every inbreath, and an unpleasant feeling (one she wanted to release from herself) with every outbreath. She chose to breathe in peace and breathe out anxiety. She came to the following appointment excitedly celebrating the positive effects of this modification to her breathing practice. The simplicity of the assignment, and her willingness to literally and symbolically “breath into it,” helped to override her deeper fears of being fully present, reduced her anxiety, and freed her to more fully and deeply engage with life.

Both clients provide striking examples of the transformative power of symbolic acts for enhancing the efficacy of otherwise traditional and mechanical coping strategies. One of the major benefits of the symbolic process is how easily accessible it can be for clients. The benefits await clients willing to engage with the limitless possibilities that symbolism provides.

For example, taking a shower may help me to wash away the shame that is held in the body. Pulling weeds can help to eradicate negative thoughts that keep “popping up.” Simply locking the front door to one’s house is a symbolic gesture that offers a sense of safety. Every moment, every act, every thought contains the possibility of actualization. The quest for symbolism, whether in or outside of clinical space, is an endless call to adventure.

This call is also a call to more fully enter into the mystery of this human experience, and to participate in the world with a fuller sense of awareness and being. Personally, these symbolic processes enrich and transform me on my own personal journey to feeling fully human. They help me to not only cope with my own day-to-day challenges, but more importantly, they pull me into a much deeper participation of healing that continually restores my own love and appreciation for life.

Professionally, I remain eager to deepen my engagement with the symbolic so that I can help guide my clients toward transformative experiences, regardless of the troubles they present. Whether they “write out” their distressing thoughts or “breath away” their anxiety, I admire their willingness to entertain and benefit from venturing into the symbolic with me. I am also amazed by and find beauty in their commitment to do so. I am fully committed to offering all my clients these symbolic pathways they can use in and outside of my office and consider this a fundamental aspect of the therapeutic process.

Questions for Thought and Discussion

What are your reactions to the author’s premise of the importance of symbolism in healing?

How have you used this process with your own clients?

Which clients with whom you currently work might benefit from this strategy?

How have, or might you use this symbolic process in your own personal life?

Katja-Writing: Being Author and Audience to Fictionalized Stories of Trauma- Part II

Posted on August 8, 2023February 11, 2026 by Psychotherapy.net Team

Irene wrote this story in August 2017, based on a recurring nightmare. Parenthesized comments are Christoffer’s responses.

Freedom — A Dream Story by Irene

Kate got up early that morning. She could not sleep. This night had been particularly ugly, and Kate had not dared to fall asleep after dad had gone.

(I am at a loss for words to connect to this. Even though it calls for something to be said. Somehow these words are powerful, even though it is short and describes so little.)

Kate lay there for a long time, observing her sister’s alarm clock that she had forgotten to set yesterday evening. It did not matter that much, for Kate would make sure that sister got up on time. Although the sound of sister snoring was calming, Kate also had a particular unrest and tension in her body. She lay scolding herself in her head: “Kate, get up now! Sister is safe now. You can go back to your own bed!”

(Dearest Kate. You protected your sister in this ugly night. That is what you were doing. Your love is so great that I have difficulty imagining it. And the injustice is so great.)

Although she could hardly stand to leave her sister, Kate forced herself out of the bed. She knew the danger was past and that they should be getting to school soon.

(It seems to have two meanings, this word [In Danish, the words “the danger” and “the father” are spelled exactly the same.])

Kate picked sister up from the floor and tucked her in bed.

(This is beautiful. It glows in the darkness.)

Then she set the alarm clock to ring in half an hour.

(No sleep for Kate. She must be exhausted.)

Kate walked through the dark attic and down the big staircase. She took out oatmeal and two plates. Just as she had just about set the table for sister and herself, dad came in the door.

(Stay away!)

Dad smiled with a look in his eye and said, “Good morning. Did you sleep well?”

(Are you insane?! What the **** kind of question is that?! Are you absolutely insane?)

Although Kate had not slept, she said that she had indeed. It was a good morning, for Kate knew that sister had slept all through the night.

(Your heart always belongs to your sister. I wish someone’s heart was yours in the same way. You too should be safe so that you could sleep all through the night in safety)

That was good. Dad asked if she wanted a “super-sandwich” or “sloppy-sandwich.”

(Does he not get anything? It is like he does not have any awareness that he has given his daughter “a particularly ugly night,” which I am sure is the world’s biggest understatement!)

Kate wanted a super-sandwich. She knew that the sandwich only consisted of a slice of rye bread and a slice of white bread put together with liver pâté between them. Dad believed that if the rye bread was on top when you ate it, it was a super-sandwich, while white bread on top was a sloppy-sandwich, while in the eyes of the children it was reversed. Dad and Kate used to laugh about it in the morning, but on this morning, she did not think it was very funny. The sandwich had no superpowers, no matter how she turned it. She did not feel very strong.

(Kate, you must be absolutely exhausted. And violated and degraded.)

Sister came bumping down the stairs. Kate had taught her to sit on her bum and take one step at a time.

(I bet you have taught her a thousand good things, Kate.)

Sister smiled and had slept well.

(Because Kate protects her and makes her safe. Is there a better gift to give to a child than that?)

Dad teased her by putting half a “super-sandwich” (rye bread on top) on her plate. Sister made a sound of joy and seemed as surprised about it as she did every single morning.

(This tells me that Kate succeeds in protecting her sister. Because sister seems like she feels safe.)

Sister’s happy laugh always got Kate in a better mood. They ate their bread with some oatmeal that they knew was not mouldy like the bread often was.

(I never feed my children mouldy food. Why do they have to eat mouldy food? Does Kate’s mom and dad not care? Do they eat mouldy food themselves too?)

Kate took sister along to the school bus. It was Wednesday so Kate did not have to look after her sister so much during the ride. The big kids were not riding along on Wednesdays. While sister was being silly with the boy from next door, who got on just down the road, Kate sat looking out the window. She liked to look at how the road, the trees, houses, and people disappeared.

(Is that because it feels like escaping?)

That made her calm. The further away from home that they got, the worse Kate felt. She knew it was not because she would rather stay at home, but it was like her body began to wake up.

(Does this say something about what Kate does to survive? Does it reveal how she prevents her body from being awake so that she does not feel what it is subjected to? Is that necessary to survive? Her body ought to be honoured as the way in which she is present here in the world. That body is sacred and should be protected and caressed. True caressing that stems from caring and loving from people you love and with whom you feel safe and are safe.)

It began to hum and hurt, and she felt nauseous. Sister and the boy were playing energetically with their bags, and one bag hit Kate on the face by accident. Kate scolded and told them to sit and be nice. When Kate turned to the window again, she felt how the pain increased on her cheek. It was nice. Her cheek went all warm, and everything else disappeared.

(Is this also a way to escape? A way to slip away? A way in which Kate protects and upholds herself?)

It was as if Kate’s brain no longer focussed on the nausea, but only on Kate’s cheek. It was a nice feeling, because strangely it somehow made her clean. It was as if it sucked up (like a vacuum cleaner) all the bad so that it only existed on the cheek.

(I think I understand what it says here, but I am not sure I properly understand what this is and why it works this way.)

Kate knew what she had to do!

The bus arrived, and Kate hurried sister along. Sister did not understand why they were in such a rush this morning.

(It is because you have something you need to do, is it not, Kate?)

The bus always arrived 10 minutes before the call to attend class. Sister was being difficult and did not want to come along, and so Kate spoke to her in an excited tone of voice:

“Look!” Kate pointed into the empty air in the direction of sister’s classroom and said, “Do you see the giant ice palace?! It’s made of ice cream!!” Sister looked around with big eyes but did not see anything.

(You are amazing at this, Kate. I think you really understand a lot about how your sister thinks and what is fun for her. And I think it is a significant accomplishment to be so imaginative and convincing while there is at the same time a seriousness in this situation. I bet there is a history of how Kate and her sister found this imaginativeness together. Kate, I know this is something you do to lure your sister along and get her to do what you need her to do. One might say that you manipulate her a bit. I know that. But I do not think it is evil. I am impressed at your skill in making life a little easier for your little sister, and that is loving.)

That did not matter, though, because Kate’s voice assured her that if you imagined something strongly enough, there was a real possibility that it could become real. And who would want to miss an ice cream palace?!

“I’ll get there first!” Kate yelled, picking up sister’s backpack and started running.

“Wait for me!” sister yelled and dashed after her. When they arrived, Kate took out some paper from her backpack, folded it and gave it to sister.

“You mustn’t eat it all at once. It’ll give you tummy ache.” Sister skipped over to the boy from next door in excitement and showed him the “ice cream”. They immediately started playing with it, while Kate put sister’s backpack in its place.

(Sister is having fun. You are giving something good to your sister’s life, Kate. That is true, even though I know that it also has a different purpose. But that does not make what you give to your sister any less real.)

After Kate had said goodbye to sister, she ran to the restrooms in the building for the middle age group. It was right next to Kate’s classroom, so she had time if she was quick. Kate locked herself in the toilet and put down her backpack and pulled out a small razor. She had stolen it from dad’s toiletries once. Kate knew stealing was wrong, but she was going to give it back – someday.

(He he. I bet that when Kate grows up you will still be able to recognize her by things like this here. This particular way of phrasing it. I like it. There is life and self-determination in it.)

Kate got everything ready like she had done so many times before — rolled up her sleeves, unrolled most of a roll of toilet paper to form a little blanket that she placed in her lap and got ready with the razor. It was important that no blood got on her clothes, because then the grownups would get angry at her — or the other children would see confirmation that she was weird. Kate stretched out her arm, pressed the razor into the skin and pulled. What a relief. She was liberated!

(Does that not hurt? In biology class we once had to cut ourselves in the finger to measure our own blood sugar. I couldn’t do it. The thought of it made me nauseous and I refused. Not because I can’t stand the sight of blood. I am fine with that. But cutting myself deliberately. I can’t. Here is something that is different from what I am familiar with. What is this? Kate, you call it liberation? When you cut yourself, is it like cutting a rope that had you tied? Or is it because it is like something being able to come out of the body?)

The first cut opened her and let out her ugly thoughts and feelings.

(So it lets something out. Something that was trapped inside?)

The next cut wiped away her personality.

(Is it a particular version of you that is wiped away, Kate? Something you precisely do not want to be?)

The third cut gave her a feeling of strength and courage.

(Does something else step in when ugly thoughts are let out and personality wiped away? I wonder where that strength and courage comes from?)

And the last many cuts made her invincible.

(Wow! This is powerful stuff. Is this a big contrast for you, Kate? Compared to what you are otherwise made into by humiliation and violation?)

She always tried to cut around the bruises on her skin, but that was not possible this time. Kate had been very bad all summer, so dad had had to punish her.

(Did your father himself teach you that this is something he has to do, Kate? He does not have to do anything. It is a choice. And what must a little girl do, I wonder, to deserve so much “punishment” that she is covered in bruises? I cannot think of anything to justify it. And by the way, it is illegal. And Kate’s dad, will you stop making your daughter believe that you have to beat her up because she has been bad? Would you like to know who I think is bad? Kate’s dad: Keep your hands off your daughter. She is a most beautiful human being and you do not even grasp it. You treat her as if she were a thing that exists only for you.)

The bruises covered almost all her body. But it didn’t really matter. She could not feel the bruises at all when she cut in herself. Kate always did it quick, so it did not hurt. The pain began to make itself felt after a little while. It warmed, removed the nausea, cleansed the filthy body and made her alive.

(It cleanses? And makes alive? How does this transformation work? And perhaps more importantly: Where does it take you, Kate? I am fascinated with this Kate that appears when the body has been cleansed and a personality has been wiped away. This strong, courageous, invincible, alive person. Do you know where that comes from? What are you capable of when you have become that person? Would you like to always be that person?)

For a moment, she rested her head against the wall. Her arm fell into her lap. She went all limp. It was as if all bad that had ever happened to her disappeared. Like a wet sponge erasing all traces of chalk on a dirty blackboard. Kate had become clean. She made a new cut every time the blood coagulated. It was beautiful to behold how the blood first streamed down over her arm and coagulated in big lumps. Observing how the blood coagulated, she knew that she was normal. Her blood coagulated as it should. No one could prevent it from coagulating. She knew that in this, she did not differ from other people.

(Does the blood make you part of humanity? I am sorry that your skin must be cut and that you must bleed to know that. But I am also glad that it is possible for you to know that, even as I wish you had a different road to that knowledge.)

It told her that she was more than a kind of object only to be taken out for the pleasure of others.

(I think we see the same in how your parents treat you, Kate: They treat you as a thing that exists for their sake. You are truly more than that. You are a living human being. I believe that when you treat a human being as a thing, then you are practicing a form of evil.)

She was a human whose blood coagulated as it should. Kate also knew that NO ONE had touched her blood and thereby spoiled it. It was all clean and now it covered her filthy body.

(Kate, does this tell you that some of you is out of reach of others? That there is something in you that is clean regardless of all the filth they throw on you? I am sorry that it takes blood to know that, but I am so happy that it is possible for you to know. I imagine that the knowledge that there is something that nobody has touched and that is clean and proof that you are a real human being – I imagine that that knowledge is quite significant for you! Has that knowledge contributed to Kate’s survival?)

While Kate sat there on the floor, her eyes closed and enjoying being in a sort of parallel reality that protected her from the evil world she otherwise inhabited, it suddenly called in for class. Kate returned to reality. Now she was busy.

She panicked while she wrapped her arm with the remaining toilet paper. Kate only now realized she had cut herself much deeper than she usually did. The blood under her arm had not yet coagulated, as it should! Kate wrapped more paper around it, but it kept seeping through. If she put more paper around the arm, the thickness of it would give her away. That must not happen! Kate had to think fast while she pulled her sleeves in place. She concluded that luckily it was only the lower arm and therefore easier to hide it, as long as she took care to turn it away from others. She flushed the bloody paper in the toilet and made sure there was no blood on the floor or anywhere else.

When Kate tried to get on her legs, it was as if she should faint. She had not felt that way before.

(Has she bled too much? Is it so serious that she has suffered significant blood loss?)

Kate thought it was probably because she had been running with her sister and hoped that sister was okay.

(It is always your sister that you have in mind, Kate. I wish someone had you in mind as much as that.)

Kate struggled to her legs and supported herself into class. The others were running around and were too engaged in their own activities to notice that Kate was not feeling well. She sat down on the chair, even though she knew the teacher had not given permission for that yet. Kate probably got on her feet as she ought to when the teacher came in, but she was too unwell to remember if she had.

(Kate is usually quite sharp, even in extreme conditions. And it is not usually like this? So, it is not because she is still in a rapture or in another world?)

It was not until she saw the teacher explaining a lot of things to the class up by the blackboard that Kate registered that class had begun. Kate could feel the vessels in her arm pumping blood into her body. It was almost as if she could see the arm rising every time her heart made a beat. Kate could not focus on what the teacher was saying at all. It was as if the teacher’s mouth was just moving without any words coming out. The teacher moved from side to side; and Kate felt almost car sick from watching her.

(This sounds bad, Kate, are you alright? You don’t sound at all alright!)

Kate saw how the other children opened their math books and started solving problems. She tried to do the same but got so dizzy when she bowed her head that she was close to falling off her chair.

(!)

Kate tried to focus on the math problems, but her eyes kept wanting to close, and the fingers could not manage to lift the heavy pencil. The teacher came over to her table, while she supported her head with her arm. Astrid, that was her name, sat down and asked her in a friendly voice:

“Do you need help?” When Kate did not answer, Astrid asked, “Let me see. Which problem are you at?” Kate would usually turn the numbers the wrong way, hoping to be sent over to the special education teacher. It was nice to get away from class and get help from the special education teacher.

(Does that feel more like caring than most other things that happen to you, Kate?)

Kate liked Astrid, but Astrid always paid so much attention to her.

(This is a form of caring from Astrid.)

She did not like that. It was hard to hide anything from Astrid.

(A dangerous care? Is it because this attention could unravel the masks and the acting? And then what? Would the consequences be overwhelming for Kate, even though she would like someone to be nice to her? It must be a terrible dilemma; Having to participate in maintaining one’s own prison and cover for one’s own executioner while a kind person is standing right there and wants something good for you. How do you survive that? Because you know nothing else?)

Kate always succeeded to do so, but it was difficult. Perhaps because secretly, Kate wanted to tell Astrid everything, but she could not do that. The special education teacher was very pedagogical and would end up doing the problems for you if you pretended to be really bad at it. That was nice, because then you did not have to think. It was not like that on this day, though. Kate had not written anything wrong, so she could not be sent to the special education teacher. She had not written anything right either.

(She has not written anything because she can barely stay conscious. There is something really wrong, Kate!)

Astrid moved closer to Kate and put her hand on Kate’s arm. Kate was startled and pulled in her arm in a sudden movement. She did not really intend to respond like that. It was not like it hurt or anything, but Kate was just startled that someone was suddenly nice to her.

(I suspect your body is used to responding to violence. That is its first response. Is that right?)

People around Kate usually never touched her. Perhaps they thought that it was best for Kate when you did not show her kindness or attention.

(Oh no. What may that give Kate reason to conclude? Does that not fit in all too well with the idea of being filthy and wrong and not a real human being?)

At least then she would not tell any crazy stories. Maybe they were right?! Kate sort of woke up a little when she caught sight of Astrid’s hand. Astrid had gotten blood on her fingers but did not seem to have noticed it yet.

“You look pale. Are you alright, Kate?” asked Astrid, now in a worried voice. Kate replied that she was just a little tired, but then it happened! Astrid discovered that there was a fresh drop of blood on Kate’s sleeve. It was just a little blood off of Astrid’s finger. Fortunately, she had not seen how much Kate had bled through her jumper.

(!!)

Astrid again put her hand on Kate’s arm and asked if she was okay? While Astrid repeated the question in different versions, the shame grew within Kate; “Why are you so STUPID to bleed through?! You do not deserve Astrid being this nice to you at all!”

(Dear Kate. I want to tell you that you are never stupid. And you are not at all in control of what your body is doing here. Your body has suffered injury and it cannot close the injury. Someone being nice to you is exactly what you deserve. That is precisely what you deserve, for you are a beautiful and good human being, doing all that you can to solve all problems under completely awful, hellish conditions.)

Astrid pulled up a chair next to Kate. This time she must have noticed the blood because she twisted Kate’s arm around forcefully so that she could see the lower arm. Kate knew that the forbidden thing happened and that she should resist, but she just did not have the energy.

(!!! She does not have the energy. This is bad.)

Astrid lifted Kate’s sleeve a bit and looked positively shocked when she saw the blood soaked paper that had tried to hold back the blood in vain. Kate came quickly to her own defence:

“I won’t do it again! It was just one time!” Kate knew that was not true, but she was willing to say anything to get rid of Astrid.

(Is this the dilemma again? Being forced to cover over your own imprisonment just when a kind person wants to help and has seen something right. Is it not terribly destructive for a person’s perception of oneself to be put in that situation?)

In a firm and serious tone of voice, she asked Kate to accompany her out of the room. Kate, ashamed and fearing that her classmates would see how weak she was, tried to get up, but her legs would not carry her. Kate sent Astrid a look that told Astrid that the legs refused to lift Kate off the chair. Astrid told Kate to wait there and bolted out of the classroom. Kate was ashamed and knew that it was all wrong with her.

(No, you do need help, Kate. You are allowed to. It is right.)

It was not nice of her to make Astrid so worried.

(Astrid’s worry is not your creation, Kate. It is not a pain that you have inflicted on her. Astrid’s worry (and I think that word is an understatement) is a result of Astrid’s moral character and her responsibilities and duties to other people in general and to children and pupils in particular. In fact, she must feel that way as a moral being and a responsible schoolteacher. That is not something you have created, Kate. You are entitled to Astrid’s worry, Kate. You are entitled in being the occasion for the activation of Astrid’s moral character and duties to other people)

Kate found it more difficult to stay awake and again supported her head on her arm.

Kate suddenly awoke at someone pulling at her. It was Astrid and some other teachers. Kate could not quite figure out what had happened — or where she was.

(It makes me silent inside to read this, Kate. Because I think you lost consciousness just now. I think you are in very serious danger, Kate. Will you please let the adults do what it takes to help you? These people wish you no harm. I know that is probably difficult for you to believe, but will you try please?)

She was not in the classroom any longer but was lying on the floor in another room. A bunch of teachers stood around her. They looked uneasy and talked amongst each other in serious voices. Astrid had put Kate’s head in her lap, while someone else was in the process of cutting open Kate’s sleeve.

(I value the care that Astrid shows by doing like this. That is caring in a fundamental human way with no professional distance. I am drawn to the fact that the dream allows Astrid to do this.)

“You mustn’t!” Kate burst out. Kate panicked and tried to free herself. One of the teachers yelled, “She’s trying to grab the scissors!”

(Do they think Kate can be a danger to herself?)

But that was all wrong. Kate just wanted to get free and look after her jumper.

(Dear Kate. You always look after everything so well, and also other people. But right now, you are more important than the jumper. You yourself are precious. The jumper is just a thing. You are a human being.)

Astrid stroked Kate on the forehead and assured her that nothing would happen to her, that she was in safe hands and that they just wanted to put a band-aid on it.

(Thank you, Astrid. I think that is the right thing to do. And thank you to the dream for letting Astrid do this.)

Thinking a band-aid would be nice enough, Kate calmed down.

(Good!)

When they lifted up her sleeve entirely, they could clearly see the many bruises and the blood seeping from the toilet paper. They exchanged serious looks along with some sign that Kate did not understand.

(I think they realize something of what Kate is subjected to. I think that they think it is horrible that a child has been treated in such a way. And I think they may understand something about why Kate has done as she has. That she suffers and tries desperately to do something about the pain and the fear and the humiliations she is subject to.)

The school nurse removed the paper. When the paper was all gone, the blood flowed onto the floor. Panic shone in their eyes and they got busy.

(It is really serious. I hope Kate makes it.)

Kate felt that she was all wrong because the blood had not coagulated by itself.

(That is for the blood to decide. You cannot decide that, Kate. It is not about whether you are wrong. If I were to point out who was wrong in all this, you would not even make the list. You would make the top of the opposite list.)

A teacher passed some more towels to the school nurse and they put them on her arm and pressed hard. The school nurse looked at one of the teachers and asked, “Will you make the call?” The teacher confirmed the order and ran. She tied the towel tightly and pointed further up.

“Look!” They began to evaluate Kate’s bruises, but Kate was too tired to fight against it and could not keep her eyes open. While they shook her, she only managed to feel how the blood in her veins pounded against the tight bandage. Everything was hazy and confusing, but it was quite nice to be unable to think.

(This sounds so desperate. So utterly desperate. That the reality in which you live is so horrible that you just want to not think, and that to be able to escape thinking, you have to not be able to.)

When Kate woke up again, they were taking off her jumper. Kate resisted and Astrid asked them to stop. They did.

(I think they understand something here. I think they become aware of Kate’s dignity and the inviolability of her body — especially in light of how others have transgressed against that inviolability.)

As Astrid lifted her arm, Kate noticed that Astrid had goose bumps. “Oh, I have hurt her!”

(Dear Kate, you have not hurt Astrid. It is true that what is happening here is painful for Astrid. But it is not an evil you have inflicted on her. Astrid’s pain is a consequence of her morality and humanity and her care for others – including you, Kate. Astrid’s pain is testament to her moral character and human qualities. It is not your fault, Kate. You deserve Astrid’s worry. You desperately need people who are intensely worried for you, or else I think you may die. And it would not be best to die. That would be a loss for the world and for those who care about you, and a loss of what your life might turn into. Your fate is not sealed. Your life is so young. You are still all new. Life is not only this.)

Kate felt bad and felt tears coming. “1-2-3-4-5-6-7…..” That helped Kate regain control.

When Kate woke up again, more footsteps could be heard, and a panicky voice shouting, “It’s in here!” More people came in. Four of them were paramedics. “I don’t like men,” Kate thought and was reminded of her dad.

(That is understandable.)

“He will get SO angry when he finds out I have caused so much attention… and they haven’t even seen the bruises.”

(HE will be angry about what YOU have done? That pathetic excuse for a man who with such vile and cowardice blames his daughter for the consequences of his own actions. He should be ashamed! What kind of thing is this to do against another human being, and even a child this loyal?! May you choke on it, Kate’s “dad.”)

One of the paramedics pushed hard on Kate’s collarbone, so she opened her eyes again.

(Then they are worried. This is done to see if a person has cardiac arrest)

“Am I sleeping?” asked Kate. “Why am I sleeping?” she mumbled. Said Astrid calmingly:

“You must be tired.” Kate smiled inside — they knew nothing!

(Oh, Kate. You are far away. But I am glad that you don’t feel fear. That way you suffer less right now.)

One of the ambulance people said something to Kate about staying awake and staying with them. Kate did not understand, because she was right there?! Another asked where she got the bruises? Kate knew they wanted her to say something bad about mom and dad, and that would give them an excuse to send her to the orphanage,

(Have your parents made threats about this to you, Kate? Have they frightened you with such tales to silence you and not reveal the horrors that they inflict on you? Remorseless cowards! To think to scare a child into being one’s own prison keeper.)

but Kate didn’t want to leave her sister.

(Yes. Y

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An Unexpected Beginning (1)

Postscript

Notes

Psychic Schemas and the Phenomenology of Being a Single Mother

The Transformational Alchemy of Metaphor

Queen Esta’s Story

Finding Strength through Connection in Counselling

References

Successfully Managing Telephone Contact with Clients

The Importance of Client-Centered Office Space

Tips for Communicating with Referral Sources

How to Handle Termination

Addendum: My Treatment Approach

Sizing You Up

Attunement

What Does it Mean to be Gay Affirmative?

“If I Can, So Can You”

Experiences Unite

Going Deeper into the Relationship: Dealing with Conflict

Learning to Weather a Patient’s Emotional Storms

The Pain of Virtual Rejection

First Meeting: Dignity and Grace

Second Meeting: Honesty as a Way through Sadness

Third Meeting: The Idea is Revealed

Fourth Meeting: Eleventh Hour Confessions

Pakikiramdam (Shared Inner Perception)

Self-Soothing Versus Collective Coregulation

Shared Inner Perception in Parenting

Shared Inner Perception in the Therapy Room

Final Thoughts

How Coping Strategies Work

Transforming Act into Symbol

Bridging the Gap Between the Physical and Symbolic

Freedom — A Dream Story by Irene