Within 10 minutes I had this man crying. This big, strong, tough, no nonsense military commander had cried only 3 times that he can remember in his whole life. The death of a sibling and the birth of his children. Otherwise he has never shed a tear. And I had him sobbing like a little child. It was about as powerful as therapy gets.
He came to me to feel better. Since discovering a serious heart condition less than two months prior, he was told to quit drinking alcohol completely or his heart might fail him before he could get a transplant. Alcohol was his medication. It was his way to cope and distract himself from all the pain inside that he never addressed since returning from war. But now, having immediately quit (this tough guy has the will of a bull), without his self-prescribed medication, he was forced to face up to what was going on inside. And it was destroying him and his relationships.
The session started with my asking about his symptoms. Anger. That was the big one. Uncontrollable anger over just about any little thing. He was not violent, but would ‘snap’ for any reason. And snapping meant yelling, kicking, throwing, breaking, screaming, but fortunately he would not harm anyone. He was a great leader in the combat setting, but at his new position as manager, the employees probably wanted to quit or kill him. So I watched and waited for the anger to arise.
Fortunately, healing was in the cards that day. Normally I follow my agenda and ask all the pertinent questions about history, social circumstances, symptoms and so on. But intuitively realizing that he was seeking an answer – that he was ready for profound change – I abandoned the psychiatric interview agenda and went ahead with my instinct. It was time for therapy. So I awaited the anger…
It’s quite uncommon for anyone to interrupt my sessions, but just a few minutes in there was a knock on the door. I observed his behavior. His fists tightened. His jaw clenched. He was in mid-sentence when the knock came and he abruptly became silent. He looked away and tried to compose himself. It appeared that he was angered by the interruption.
I asked him to excuse me and I briefly attended to the nurse’s question. It only took a moment. When I returned, it was on.
“So, did that upset you, the interruption?” I asked.
“Yeah, she should have more respect than that. People ought to know when to keep their place. The door’s shut. Doesn’t everyone know what that means? I am sure she knows better than to interrupt your sessions…” He went on for a while – and it probably would have been a long while – until I stopped him.
“Hang on, sorry to interrupt, so you were angered by her, right? What would you like to have done?”
“I’d have brought her in, closed the door, and, well, I wouldn’t have been physical, but, I would have told her something to make sure she never makes that mistake again with me, ever!”
I explained to him that I appreciate his allowing me to make the decision about how to deal with her and I apologized for the interruption. After all, it is my office and I set the rules. Then I explained to him that the nature of my position here is that of a walk-in clinic with some scheduled appointments, where interruptions are entirely acceptable. After all, this is primarily a medication management job for me, not a therapy job. He replied and told me that he understood and respected that it is my office and my rules, but he was not happy about the interruption.
I asked him if he was still feeling angry. “Yes.” And what does anger feel like? “She should know better. That’s rude for her to just barge in like no one matters but her.” Etcetera.
I interrupted him. And when I did I saw the anger flare again. “You didn’t answer my question. Please answer my question. What does anger feel like?”
He tolerated me. He was very angry. This large, muscular, very angry military combat veteran who saw more battle than most was angry with me. I admit I did this on purpose. He again replied that he would love to tell her what he thinks of her. She ought to this and that. It’s wrong for her to blah, blah, blah.
I stopped him again, “You aren’t answering my question.” I said this gently, of course. In therapy, all challenges must be gentle.
This stopped him short. He was controlling his anger as best he could and now I had it definitely directed at me and not the nurse. He looked at me. So I switched gears. I had pushed him just enough.
“You look angry. Are you angry now?” Yes.
“How does angry feel?”
“I’m pissed off.”
“Yeah, but what does it feel like?” I asked.
“I’m mad. It’s rude to keep interrupting me. I am answering your questions and you’re telling me I’m not.”
It was quite apparent now. He was completely disconnected from his deeper emotions.
“I apologize for interrupting and upsetting you, but you aren’t answering my questions. Don’t you see? I ask you ‘what does anger feel like?’ and you respond by talking about her. Or me.”
“You see? I asked what does anger feel like, and instead of telling me the feeling – your emotional experience of anger – you tell me about me or the nurse. If you want this therapy to help you, you have to explore the feelings you are experiencing, and tell me about that.”
He understood. He was defensive and mentioned how he has never been good at expressing his feelings. I accepted this and encouraged him to explore the feelings. He was ready to try again.
“Are you still feeling angry?” Yes.
“How does angry feel?”
He looked at me. “I’m pissed.”
“What does pissed feel like?”
“I feel like I could snap and scream or break something.”
I decided it was time to bring his attention to his physical aspect. This would get him. “Okay, what does anger feel like physically? In your body, what are you feeling?”
“You mean physically?” Yes. Physically. What’s happening with your body?
“Well… I keep wringing my hands tight. And I feel pressure in my chest, at my heart.”
“Hmmm. Ok. Very good. What else?”
“I don’t know.” Okay, so I would gently guide him.
“What about your muscles?” They’re tight.
“How about your breathing?” It’s fast.
“What else do you notice now that you are feeling angry?” He tells me his jaw is clenched.
“How does it feel? Good? Do you like this feeling?” No. He sighed. (A sigh. A good sign of release. That’s good!)
“I just noticed you sighed. What does that mean?”
He laughed, but I saw a spark in it. Anger, maybe? A little bit of relaxation too? “I don’t know,” he said. “You keep asking me the same thing over and over.” He sighed again. He is relaxing further.
“You aren’t wringing your hands as much now. Do you notice that? It appears that you are a little less tense now than you were a moment ago,” I tell him.
He laughs. “I guess I’m a little less angry.”
“What does less angry feel like?”
“Physically?” Yes, I reply. He sighs again.
“My breathing is a little better and I’m not wringing my hands as much.”
“What about the muscles and your jaw?” They’re still just as tight.
“Okay, Now tell me again. Back to our rude nurse, when she knocked, what happened to you at that very moment?” I knocked on the desk to remind the senses.
“I got angry. She shouldn’t…” I cut him off quick. “Stop. Don’t talk about her. We are only here to talk about you.” I took this moment to educate him about the nature of anger.
I told him that whether she is rude or not is irrelevant. I told him a favorite quote I live by. “He who angers you controls you.” I believe it was Plato who gets credit for that. I asked him if he preferred that this stupid, obnoxious nurse has control over him and his emotions. Of course not. I explained that he is never going to change her. Perhaps he can, by reprimanding her, manipulate her behavior so that she is more careful to avoid interrupting or angering him, but he will never change her. He understood.
I went on and explained how spending our valuable therapy time discussing her stupidity is a total waste. If he wants to heal, which is why he is here, then he needs to put his opinions and ideas aside and address the emotions that he is experiencing.
He heard me. I told him it’s not easy, but it’s why he’s here, and then I told him something crucial for any therapy to work.
“If you don’t want to do this, it is fine by me. It’s your choice. This is how you can feel better in the long run. If you don’t want to do this now, today, with me, just let me know. But if you do, then let’s move on and get back to helping you experience your emotions. After all, this is what you came here for today, isn’t it?”
He wanted to go on. He was ready to do what I was asking.
I paused. I looked him in the eyes and he looked away.
I waited just another moment longer before I asked him, “So, how are you feeling now?”
That was it. The moment we had been building up to. The moment we had been working toward. He broke down. The magical moment of healing had arrived. He cried.
He cried and cried.
He wept and I did not interrupt him. In a few moments he spoke again.
“I feel lost,” he replied, crying heavily.
I gave him a moment. It lasted maybe another minute or two. Then I asked again, “How does lost feel?”
He felt like a failure. Inadequate. You know, the way we all feel deep inside. “Weak,” he said. Yes, weak. That’s right. The biggest and the baddest among us in the world are weak inside, if only they have the courage to admit it to themselves and see it for what it is. This is therapy. This will help him to grow and feel better for the rest of his life. This is healing.
I let him have a few minutes to be with these unfamiliar emotions. To explore the yet unexplored inside him. It was beautiful. I had to keep from crying myself. I felt the tears welling up, but as the leader and presence in the session I had to be strong, as he surely was on the battlefield leading his comrades, often to death. Only where I led this man was scarier than death to most. I would later shed my tears at home.
When the emotions subsided, he was able to look at me again. And I proceeded with the expected… go ahead, you can laugh. You know what I asked.
“How do you feel now?” He chuckled, and laughingly gave me a threatening look.
He was getting better at this. It took him a moment to reflect, but he answered directly. “Relaxed. Better. I don’t have the tightness anymore and I’m not wringing my hands.” More important than his verbal response to me was his internal review of his experience.
I asked him how frequently he feels this way and he said never. I explained to him that he was, at that moment, in a place of peace and relaxation – the place he should be all the time. He expressed his fear that the second he leaves the room he’ll have to go on and again pretend he’s tough and not show any emotion.
I told him that the goal is for him to maintain this mental and emotional state. To just be. Be at peace with himself. And then to watch for the moment when it changes. The goal is now to observe his physical aspect and watch for when something triggers the onset of the tight, anxious and angry state where he was living before. It came sooner than expected.
He expressed that once he walks out the door, he won’t be all right. Maybe he’ll cry it out a little more on his own in the car on the ride home, which I encouraged. But what about later? What about when something pisses him off, then what? I addressed his fear and asked him to give me an example. He complied and began talking about tomorrow, when he’s at work, and some stupid employee starts to blah, blah, blah, and …”
I cut him off. “Stop.” He looked at me. Again, impressed at how I was able to be so straight and commanding toward him, yet in a way gentle enough that he knows I mean no harm. This is a man not used to being cut off by anyone, ever, but he was getting used to me. He waited.
“How do you feel now? What has happened to you since you started talking about work? I noticed your jaw clenched. You look like you’re about to start wringing your hands.” He let out a single laugh. “Heh.” He saw it. He recognized it.
I asked him, “Does talking about work make you feel any better or is it making you worse again?” He laughed and said it’s making him worse. Just like that, not 10 seconds into talking about work and he’s getting all the anger back again.
“Stop it. Don’t go there. Don’t talk about work. It will upset you. Just be at peace right now. Part of your healing means your learning to think and say things that are in line with your peaceful, happy, tolerant nature. Don’t talk about what only aggravates you. After all, I know how stupid your employees are and so do you, and that’s not going to change. So just stop it. That is something you can change, and it will help you feel better.”
We both knew that the powerful moment came, saw and conquered. It was past now. He learned a great deal and at a profound level. He had what is called the “corrective emotional experience.” He experienced emotions that he had been suppressing for a long time. I provided him the opportunity to experience the unexplorable emotions, thereby releasing the energy tied up inside him. None of his other relationships in life had ever allowed him to come so close to himself.
Throughout the interview I had mentioned his body language a number of times and often it visibly angered or upset him. He didn’t like that I would comment on his posture and movements, but it brought his physical aspect to his attention, which helped to bring his attention to his emotional state.
It was time to end our session. I sat up in my chair and put my crossed-legged foot from my knee to the floor as I shifted my weight in the chair in the direction of the computer. As I did this, I said, “Now I am adjusting my posture and performing my non-verbal cues to let you know that it is about time for us to wrap this up.” He laughed heartily. So did I. He really appreciated that I am a victim of body language too. He was again reminded that he had not been judged.
A moment later when he went to leave he stood and thanked me and shook my hand. As I put my hand on the door handle he said, “I just feel so weak. I’m such a pussy. I should be able to handle this. I feel like I’m not a man.”
Aha! This was not over yet. He needed one more intervention. I stopped him in his tracks by blocking the door and turning to face him. I addressed him by name. “Mr. ____. You are not weak! Nothing is further from the truth! You are absolutely a man.” I told him firmly.
“To come here today and open up, risking everything, exploring the scariest part of yourself for the first time in your life – that takes incredible courage! You are courageous! Don’t you see? A real man stares down his fears and faces what he has coming, without hiding in alcohol or distraction. You are not a pussy at all! You are the opposite. It is the rare, true men among us who do what you have done here today. Don’t you see who you are? You have had the unique opportunity, provided by an unfortunate heart disease to make you get sober, so that you must address your true courageous nature inside. So that you must face these painful and fear-inspiring emotions. Do not ever doubt that you are a man, because you are more man than anyone out there, based on what you demonstrated here today!”
I put out my hand to shake again.
He hugged me.
This technique of gently pushing a person against his defenses is a deliberate attempt to help the patient connect with the unknown internal experience of his emotions. Asking repeatedly what anger feels like is not meant to elicit a good verbal explanation of what it feels like. It is an attempt to get the patient to look inward for something he has not seen before. Guiding his attention to the physical aspects helps put his mind in touch with the physical body, which until that moment are disconnected. Becoming in tune with the physical opens a window to a deeper understanding of what is going on inside at the emotional level.
The emotional level is frequently untouched. If I ask, what emotion are you experiencing, the answer is usually, “I don’t know.” And it’s true that he does not know. That is why he came in the first place. To help him know, I push him to explore the essence of the emotions that he is aware of, which in this case is the anger. Anger takes many forms and is present in varying degrees from irritability, annoyed, frustration, anger, fury and rage. That’s all anger. Between guiding the patient’s thoughts to his own experience and commenting on my observations of his physical aspect, I am able to gently push him to see what is there inside. This is always met with resistance. The resistance is then always met with a challenge to the patient to either go forward with why he came in the first place, or to quit. Until he is brought past his defenses and takes the challenge to see the unknown emotions, those emotions remain hidden from his awareness. In this case, as is very common, it was a profound sense of feeling lost and inadequate.
There are a great number of types of therapy, some of which work because they are based on these same principles, whether this is understood or not. Always necessary are a humble attitude and clear evidence that there is no judgment coming from the therapist. And like anything in life, some therapists are good and some are bad, and a kind heart and desire to help are not always enough to help a patient accomplish what is truly necessary for healing.
Although this case demonstrates the big bad wolf being faced with the most fearful aspects within himself, I find that my experience was at least as profound as his. This was just as beautiful, intense and powerful for my spirit as it was for his, and for that I shall always be grateful. Having one good case where I can help a person to heal and grow makes all the paperwork and administrative nonsense worthwhile. Psychiatry is the outlet I have chosen to help others, sometimes through medicine, sometimes through diet, and sometimes by being in tune with another’s spirit in the deepest type of relationship one can ever share. Even if it only lasts 40 minutes and we never meet again.
Thank you for sharing your life with me, Mr. _____. You are loved.