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First, I want to thank Dr. Fowler for giving such a careful reading of my book. That's very flattering. I found his comments interesting and illuminating.
I'm especially gratified that he's engaging so well with the problems of the Treatment Resistant patient such as myself. He seems very well read in the literature, which I am not.
However, I disagree with the way forward. As I read it, Dr. Fowler thinks the therapist, in addition to the regular talk, should communicate non-verbally, through sounds, facial expressions, and gestures, attuned to the patient's hypervigilance and sensitivity.
While this may be fruitful and powerful, I believe that even the most well-attuned gestures of compassion and empathy are secondary to direct therapeutic engagement. Rather than a new way forward, I think therapy needs to rediscover its old lessons that have been somewhat forgotten.
Speaking from my own experience, working with Dr. Kayatekin was a successful therapy. Yet even he made a basic therapeutic error, which I discuss in my book. Despite the extraordinary amount of anger, I threw at him, over many sessions, I do not ever recall him asking me about that anger. This was such a surprising omission that a friend of mine—a layman like me who read my book—was very surprised.
In addition, Dr. T who I worked with for 5 years after Dr. Kayatekin, never asked me about the manifest signs of anxiety I displayed in therapy, such as asking every 5 minutes how much time was left in the session.
These are striking omissions: the basic tenet of talk therapy is analyzing the emotions in the session itself. If that is missing, the well-attuned and sympathetic noises and other expressions of compassion, miss the basic raw material of therapeutic engagement and exploration.