Clinical Excerpt: The Patient's Meanings

Providing the occasion for the patient's discovery of aspects of himself is an essential feature of therapy. This can be accomplished when the doctor does not intrude himself too frequently or at an untimely moment. However, the doctor remains quiet and uninvolved in the flow of the patient's productions, some gems of potentially useful material may flow by him. The patient needs to know that the therapist accompanies him at every step of his journey in treatment. When the doctor wishes to intervene, so that the patient can pause with himself, this can be accomplished by speaking very briefly; more than ten words at any single intervention is probably too many. Most therapists become aware of this, sooner or later; but it must be said with regard to our ever-present limitations, that some therapists are totally incapable of practicing such restraint.

The effectiveness of this intervention depends upon the doctor's helping his patient to pause at the very moment that they are sharing. This moment is free of the burden, responsibility or distraction of the next moment to come, and of the preceding one — or, in broader terms, of the future and of the past. To the extent that such a pause may occur during the analytic hour, it is possible that it may occur again, perhaps to a lesser degree, outside of the analytic hour, where its effect upon the patient's appreciation and ability to participate may make itself felt.

This paper is a description of an example of attending to the moment with a fifty-five-year-old, financially and professionally successful lawyer, who was born and reared in comfortable circumstances in a small Southern town. He attended schools in the Middle West and then made his way East to settle down to marriage and a career with an established, conservative, highly respected law firm. His life had been an orderly and productive one. His first wife had died after a long illness about five years before he entered treatment, and he had married a remedial te