Trust in the Process: Sitting with Not Knowing in Therapy

Young woman in forest, sitting on wooden staircase, looking upwardOne aspect of psychotherapy is that the person in therapy and the therapist participate in a process larger than what either or both can directly observe. Something can be happening in plain sight, but we might not see it because it doesn’t fit into our way of looking at things. But sometimes we fit into its.

Tom—not his real name—was in his early thirties. He was dealing with a number of opportunistic infections that had him confined to a hospital bed in a back bedroom of his family’s house and changed his once-handsome appearance. I saw him through an AIDS service organization that put services into people’s homes, and one of those services was therapy. Tom presented with symptoms supporting a major depression diagnosis, which he wore with a decidedly gloomy air—with anger beneath the gloom.

I’ve never felt as flattened as a therapist as when working with Tom. “What the eff good is this supposed to do me? Pardon my French,” he drawled halfway through our second session. He was always polite, and deeply weary.

He had a point. The infections which had affected his appearance and made movement out of bed virtually impossible had interrupted a life that had always been characterized by independence, a successful career, and enjoyment. I tried bereavement work and adjustment interventions, but Tom only withdrew from dialogue, observing me from across an ironic distance. He also made it clear that he didn’t want to address his health (“I live with this all day, every day. You think I want to spend another hour talking about it?”).

What he was willing to talk about were his teenage years. He’d been born and raised in the Midwest, and his narrative, once he got going, was vibrant with details. Not just of what he’d done and the people he’d known, but about the landscape, the wildlife, and even the weather.

Tom had a highly developed extroverted sensation function. In depth psychology, this is a way of saying that a person is interested in the physical details of the world, and that these details are a source of deep pleasure. Issues of insight and meaning or even feelings weren’t high on Tom’s agenda. But he could describe the particular quality of the snow the night he and his cousin decided to walk to the corner store half a mile from the house for cigarettes (the flakes were slightly wet, so they tended to stick together, coming down in a spin because the wind kept changing direction, which was why he and his cousin lost their way on the street they’d both grown up on).

To me, this level of detail seemed like concrete thinking. I was someone driven by insight and deeply rewarded by it. It’s also how I gauged progress in the work. I couldn’t see anything happening in our sessions, which naturally made me think that nothing was. Early on, I asked him, tentatively, if he would prefer to work with someone else. To my surprise, he told me, “This is working OK. I don’t have any complaints.” I didn’t get it. Gradually, I learned to set aside my own expectations—one of which was that I was supposed to get it, was supposed to get something—and just be available to sit with him.

I was someone driven by insight and deeply rewarded by it. It’s also how I gauged progress in the work. I couldn’t see anything happening in our sessions, which naturally made me think that nothing was.

And so, without leaving the back bedroom of the little house in Los Angeles, I went on walks in the Midwest woods with Tom. I learned that the trees were mostly hickory, with a few spruces here and there. They never grew much over 12 feet and weren’t thick-growing, but they had plenty of walking space between them. It was a wet country, and you could usually hear at least one creek, often more, and the katydids. Birds sang around us, warblers and bluebirds, chickadees whistling like they wanted to get our attention. And of course the mosquitos were murder in spring and summer, and that’s one of the reasons he smoked Kools nonstop as we walked, because skeeters don’t like the smoke.

Sometimes we’d go down to his uncle’s for the Fourth of July barbecue. Everybody was there. His uncle used a cut-open water heater for a grill, and there was never any barbecue sauce, just salt and plenty of smoke. It was the best barbecue we ever tasted, and just one of the things lacking in L.A.

Other times, in the season, we’d go chasing storms up on the flatlands with his cousin—when she could be convinced, anyway, and by ourselves when she couldn’t. Yes, it was a pretty stupid thing to do, but when you saw those big, purple storm heads, bigger than anything you see here, and all that lightning, you forgot about everything else. And the tornadoes, when they came, were the best thing in the world. You never forgot those. And when you were stuck laying in a bed all the time, you dreamed about them and wished one would come out this way and take you back home.

Tom’s health went up and down—down most often. Eventually, he was hospitalized. Part of what I did was to follow people and keep meeting with them when they went into the hospital or nursing facility or hospice. The first week, Tom was in the ICU and not receiving visitors except family. When his mother told me it was OK, I went to sit with him.

“I haven’t slept in days,” he grated miserably. “I can’t sleep here. It’s too noisy, and they’re always coming into the room for something.”

I asked him to close his eyes. We went on a guided imagery walk out in the Midwest countryside. I knew the way. The hum of the air conditioner was the breeze through the tops of the hickory trees. That beep of the IV monitor—was that a grebe calling out on the pond or maybe a thrasher? The air circulating in the special mattress that reduced the chance of bedsores was the sound of the creek that ran along beside us. In this familiar landscape, we walked on and on, in no hurry, until the end of our visit. The last time I saw Tom, he was sleeping peacefully.

When Tom visits me in my thoughts, he reminds me not to judge the work because it’s not mine to judge. Its fruits might not show up anywhere that I ever see or know about. He reminds me to trust in a process that’s larger than I am, that I’m only part of.

© Copyright 2015 GoodTherapy.org. All rights reserved. Permission to publish granted by Peter Cashorali, LMFT, therapist in Pasadena, California

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Gerri

    Gerri

    July 22nd, 2015 at 9:09 AM

    Hardest part sometimes trusting the process…

  • Joanna

    Joanna

    July 22nd, 2015 at 1:17 PM

    Nice article. Very inspiring.

  • Dianna

    Dianna

    July 22nd, 2015 at 2:17 PM

    I agree Gerri. It is hard to trust that process, and I think that a lot of that is because most of us, myself included, like being in control and that is what makes us feel safe.

    When we attempt to give that control over to a process like psychotherapy or even to another person, we begin to feel a little not grounded, unsteady, and that can be pretty disconcerting.

  • Kaylee

    Kaylee

    July 23rd, 2015 at 8:07 AM

    Beautiful writing, I love all of the imagery

  • Blake

    Blake

    July 25th, 2015 at 7:19 AM

    When we have such a dramatically changed life experience the way that this person had, it can be hard to feel like there can ever be any happiness in your life again. Even if you are working with the very best professional around, sometimes once you have dug yourself so deeply into that depression it can feel next to impossible to bring yourself up from that ever again.

  • Paula G

    Paula G

    July 25th, 2015 at 7:58 AM

    Wow. Brings me to tears. It’s amazing how every person has their own unique path. This helps me as the road is foggy to trust that we are still on the path and each seeming roadblock and obstacle serves a purpose. Other times, just noticing the surroundings is really enough. I’m so glad you were there for Tom.

  • elaine

    elaine

    July 26th, 2015 at 4:31 PM

    You might not think that you are making a difference in someone’s life but then you read something like this and you come to realize that everyone has their own way of dealing with things, and if they like you being around, even if it doesn’t seem like the way that you would pursue it, try to continue to be for them . You could be making a huge difference in their life without even knowing it.

  • Kelly

    Kelly

    July 27th, 2015 at 12:24 PM

    I’m a therapist as well and have only been working independently with clients for a little over a year. This article brought me to tears, too, just like it did for another reader. I have a client similar to “Tom” and I’ve had to check myself many times on my thinking because his needs in terms of coping with his life-threatening illness are so different from the work I was prepared to do with him. I had to take a step back and process the “process,” if you will, with him to realize that, per his report, he needed space to simply let out all of his thoughts and emotions about what he was going through without having to maintain the cheerful, optimistic attitude he sustained around his family and friends who seemingly took cues from him and, albeit with good intentions, invalidated his realistic concerns through telling him to only focus on the positive. If I had continued to force my agenda on him, I think it would have further invalidated his concerns and reinforced his feelings of isolation and frustration. I learned more from him than he could have ever learned from me and I’m lucky to have had this lesson so early in my career. Thank you for the piece– you’ve made me process my experience with this client better.

  • Tate

    Tate

    July 28th, 2015 at 10:20 AM

    If there is no trust in the whole process then there is no true reason why you should even pursue it.

  • Audri

    Audri

    July 29th, 2015 at 12:20 PM

    you know, until reading this I never gave too much thought as to how defeating it must be to work with certain people when you are doing everything that you can to help them and you are having to sit with your own processes too.

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