Epilogue: Saying Goodbye: Are We Really?

Pia comes to her therapy session late. First, Pia goes to the bathroom to wash her hands and face. She carries with her a very heavy backpack. She sits down, wipes her forehead, scratches her arms, takes her water bottle out of her backpack, and then puts the water bottle back in the backpack after she chugs some water. Often, she asks for air conditioning to be put on. She just cannot get settled. Also, she sweats profusely and wipes her face, and her shirt often is drenched from sweat.

All of these behaviors were worse in this session. In addition, the noise connected to all of these activities that she needs to perform in order to get settled in, bothered me more than ever before. In the past, I had noted my observations to her regarding how it takes a long time for her to settle in, and that there are many steps that she needs to take in order to get more comfortable. However, I was unable in the past to bring to her attention another aspect of these rituals. That is, the hostility that was so palpable. In this session, I was able to let her know that she started the session trying to get settled, kind of like a baby that needed to be swaddled, contained and comforted all at the same time. Furthermore, I was able to now add her hostility to my interpretation by letting her know that all of the noise and motion kept me from being able to think. As soon as I pointed out both of these aspects, my patient stopped moving and became quiet for the rest of the session. That is, she could begin to focus on the work of the therapy session and not feel bothered, and at the same time not bother me. We were both finally comfortable.

I felt very proud of my ability to point out these observations to Pia. I thought of Joe Lichtenberg right then and there. I had this visual image of Joe sitting next to me and that we were smiling at each other in the same moment I was able to let my patient know about some disruptions in her infancy that she carried forward to this day. I thought