Each year we open submissions for our Annual Wise Therapy Spotlight, where we ask a question of particular importance to our wider therapist community. We are always moved by the depth and generosity of our community voices.
This year, we asked our community, What Is the Soul of Therapy? Read more about our inspiration for this, our 5th edition, in the letter from the editors and Academy of Therapy Wisdom founders, Brian and Ian.
Continue here to read the submission by Erika Tsoukanelis, MS, MFA, LCSW. We hope you enjoy it as much as we all did.
Resting in the Soul of Therapy
In my second year of graduate school, Bill Clinton was the president of the United States, no one I knew had an email account, and I was living in my first apartment, with stacks of textbooks balanced on egg crates throughout. I was assigned to intern at a mental health clinic in Yonkers, New York, and I was terrified. I showed for work in my best purple blazer and sat queasy in my new supervisor’s office. His eyes were kind, and his voice was gentle as he handed me the file of my first psychotherapy client. Her name was Bella. She had called the clinic seeking therapy for the first time in her life. She was 84. She had just endured and survived open-heart surgery, and since returning home from the hospital, she said the whole world had turned gray.
I was young. Bella was old. I had grown up wealthy. She was born in Italy on a small farm that grew oranges and lemons, and emigrated to this country at age 15 with nothing but a thin coat and a few American dollars in her sock. She had worked as a seamstress until just a few years ago. She had been married, raised children, became widowed, lost one child to drug addiction. I was just teetering on the brink of new adulthood, looking to forge this career as a psychotherapist for no better reason than I wanted to help. I felt driven to rescue. I had no real idea what that might entail. I certainly had no idea how I was to help the wisp of a woman who showed up at the clinic for her appointment on a late fall afternoon.
Bella had been raised to be polite and respect authority, so if she had any feelings about a woman her granddaughter’s age coming to collect her from the sparse waiting area, she did not betray them. Her sadness was in her skin and the way she moved. It was in the way she held her head low, and the way she curled around the surgical wound at her sternum. She sat down in the office chair wincing, then looked up at me. We met eye to eye, and she waited for me to speak.
I was like so many therapists. While I had been privileged in childhood, I had also been hurt. I had been wounded in ways I had yet to fully understand when I met Bella, and I carried those wounds of the heart along with that internal mandate to rescue. Focusing on and soothing others, being the balm for my family’s hurt, had carried me through the twisting of childhood, and now I was caught between my mandate and my own sense of abject powerlessness as I sat across from the woman who was frozen before me.
My supervisor had advised me to ask her lots of questions, reflect back her answers, offer validation. “Where should we begin?” I asked Bella, and she shrugged. Then she said, “I don’t know. I don’t seem to know anything anymore.” I nodded. I leaned forward. “Just tell me about where you grew up, I guess.” I nodded again, and she began to share.
She talked of her past. She spoke of the lake near her childhood home, of picking lemons, of her first love. Remarkably, she returned after that day, and she kept talking. Of the decision to leave her country, of meeting her husband, of their apartment near Getty Square where they moved in 1932. As the weeks went on, she kept coming back, and I learned about her grown children who were still alive, her grandchildren who lived far away, her favorite tomato sauce recipe. I listened to her story unfolding over the weeks, and I let myself feel honored to be hearing her words, but while my supervisor at the clinic assured me that I was doing a fine job, I did not see her brightening. She told me only happy stories, but her voice was dull. Her face remained an icy mask. At the end of each session, she pulled herself up, sighed and moved out of the room without looking back. Sometimes I would watch her from my window as she went to the bus stop, slouching against the increasing cold of the season. In the dim light of my office, I was tormented by the notion that I was being no help at all. I could not fathom why she kept showing up. What I offered was not enough. I was not enough.
Sometimes during those darkening days, I would be struck by something even more dismal. As I thought of Bella, I felt dread. I thought of her wrinkled hands and her loneliness, the deep scar I imagined down the center of her chest. I felt her despair in my own body, and I shuddered. She deserved a more experienced clinician, didn’t she? I thought of her poverty, of the electric tape that held the soles of her shoes in place. I could keep listening. I could. But did I want to? The dismal thing I felt was the desire to gather my things and walk out. Perhaps I did not want to be a therapist after all.
One morning in early January I sat in my office nursing a cold, a small space heater blowing warmth on the front of my body, my back facing the drafty window. I was expecting Bella for our regular appointment, and I felt the familiar anxiousness in my stomach. I rose to meet her in the waiting area, but her usual chair sat empty. The anxiousness melted into relief, then as the minutes passed that relief turned into concern. Was she ok? Had she finally noticed that I was a fraud?
Then I heard footsteps in the hallway, and the waiting room door opened, and she was standing before me. I knew right away something was different. She looked at me, and her face had changed. It had gone from stiff to soft. She followed me into the office, and before she had even sat down, she began to weep.
I was alarmed. I felt an urge to soothe her, but before I could find the words, she extended her hand to show me a Polaroid. I took the photo. It was of a black and white cat on a couch by a potted pink geranium.
“He died this morning,” she managed to say through her tears. “His name is Tux. I found him next me. His little body. He was dead.”
As Bella told me about the cat she had loved for the past decade, something unfamiliar happened inside me. I forgot myself. Or, I should say, I forgot about my fretting. I forgot about helping. Instead, the trueness of Bella’s tears pulled me in, and I began to listen to the human before me with my whole body. I felt a steadiness through my core, and while I knew she was grieving her pet, I knew that this was all of her grief as well. I did not say this. I was too busy being with her, and then she started to tell me of watching her husband lose his breath to emphysema and her son lose his spirit to heroin. It was all too much for her heart to bear, and it had given way. It had broken.
Bella did not seem to want anything of me at all. She only wanted me to be with her. Not to make it better or make her better. In my realization of this, I lost track of my own inexperience and found myself holding her pain—not for her, but with her. We held it together. Yes, there was an unmistakable “we.” This was her grief, and it was my grief, and also it was universal grief. The human experience of loss upon loss. Instead of wanting to pull away, I found myself wanting to stay with her, and while I could have fallen into a pit of despair or let my fear blend with hers, nether thing seemed to happen. The “we” that contained us grew larger than us, and it cradled us. I did not have to be enough, and I did not need to fix her. I did not need to fix anything, nor could I. With that, I felt my entire being soften.
At the end of the session, Bella turned her head smoothly toward the window. I sensed in her body and mind something flexible and new to me. “I used to pretend I didn’t care about that old cat,” she said. “I would shoo him away when the neighbors were watching. But I loved him, I did.”
There came from some place within me a pull to tell her to get another cat, to assure her that she would get through this, that she was so strong. But to follow that pull would have been to dishonor the wonderful resonance that I had felt: this thing that was not me, nor her, but both of us and more, so I tried something else, and I said, “You did. You loved him. I am so sorry he’s gone.”
Before Bella left my office that day, she looked back over her shoulder and offered a tentative smile, and I smiled back.
I knew virtually nothing about the body of therapy—the limbs and organs and skin of technique and theory and modality—but on that day I learned about the soul of therapy. It is in this connection, human to human. It is in the holding of the sacred container of the “we” that is me and the other and the relationship, and the greater “we” of humanity and beyond. Without this soul, there is no transformation. When it infuses the work, when the body of therapy is lit from within, true change becomes possible.
Thirty years later, Bella has more assuredly passed. I hope she felt heard in our time together. It would be dishonest to deny that I wish I could have given her a more sophisticated and potent treatment, but I did what I could. We do what we can. I continue to stretch and learn, as a therapist and teacher and human. That is my responsibility in the work that I do. I tend to my own wounds, and I improve my capacity to show up for others. Not because I should or because I need to prove I am enough or because I need to save anyone, but because in the moments of connection I shared with Bella and so many clients since, I have come to believe in the possibility of individual evolution being a part of universal evolution, and if my suspicions are right, I would like to participate actively as one small part of that great change.
We are told that the world is lonelier and more divided today than it was when I sat with Bella in the clinic three decades ago, and perhaps that is true. If so, we are living in that same world as our clients. We are facing the same desolation and separateness. The mechanism of healing is still the same. We just have to be and be with, and trust. We are not here to rescue anyone. We only need to meet the other and rest in the soul of therapy.
The views expressed in this essay are not necessarily the opinions of Academy of Therapy Wisdom, its presenters or its staff. This is part of a series featuring the unedited voices of our community in conversation. All content is used with permission and is copyright 2024 by Academy of Therapy Wisdom. Only the author may reproduce their content.
To read more articles or download a free copy of the final publication visit Wise Therapy Spotlight.
