I’m at lunch with my colleague Caroline.
We’re catching up, talking about our practices, when Caroline asks if the Wendell referral she gave me a while back ever worked out for my friend. As an aside, she says that our call brought back memories from when she and Wendell were in graduate school together. A classmate of theirs had a massive crush on him, but it wasn’t reciprocated, and Wendell actually started dating another—
Whoa! I stop her. I can’t hear this. The referral, I admit, was for me.
Caroline looks shocked for a second, and then she laughs and iced tea begins spurting from her nose. “Sorry,” she says, wiping her face with a napkin. “I thought I was referring a married guy to him. I just can’t imagine you with Wendell.” I understand what she means. It’s hard to envision somebody you know as the patient of somebody else you know, especially if you knew that person back in graduate school. You know too much about both of them.
I tell her I was ashamed back then—about my breakup, my book fiasco, my health issues—and she shares her own struggles with trying to conceive a second child. Near the end of our lunch, she also tells me about a difficult patient and how she had no idea during the initial consultation how difficult this patient would be—how abrasive, demanding . . . entitled.
“I have one too,” I say, thinking about John, “but over time, I’ve come to like him quite a bit—to care about him deeply.”
“I hope mine works out that way,” Caroline says. Then, an afterthought: “But if not, could I send her to you? Do you have the time?” I can tell from her tone that she’s kidding—mostly. I remember talking to my consultation group early on about John and his enormous ego and constant put-downs. Ian had quipped: “Well, if it doesn’t work out, just make sure you refer him to somebody you dislike.”
“Oh, no,” I say now, shaking my head. “Don’t send her to me.”
“Then I’ll refer her to Wendell!” Caroline says. And we laugh.
“So,” I say to Wendell the following Wednesday morning. “I had lunch with Caroline last week.”
He’s silent, but his magnet eyes are on me. I start telling him how Caroline felt about her patient and how sometimes I feel that way about patients, how every therapist does, but still, I say, it bothers me. Are we judging people too harshly? Do we not have enough empathy?
“I can’t pinpoint why,” I continue, “but I’ve felt strange about that conversation all week. It makes me uncomfortable in a way it hadn’t at lunch, and—”
Wendell’s brow is furrowed, as though he’s trying to follow my train of thought.
“I think as a profession,” I say, attempting to clarify, “we can’t keep it all inside, but at the same time—”
“Do you have a question for me?” Wendell asks, interrupting.
I realize I do. I have many: Does Wendell talk about me with his colleagues at lunch? Do I still feel to him like my patient Becca felt to me before I stopped seeing her?
Wendell had used the singular, though—not “Do you have questions for me?” but “Do you have a question for me?” He did that, I recognize, because all of my questions boil down to an essential one, a question so loaded that I don’t know how to say it aloud. Is there anything that makes us feel more vulnerable than asking someone, Do you like me?
It seems that being a therapist hasn’t made me immune to responding to Wendell in the ways that patients respond to me. I get frustrated with him. I resent being charged for a cancellation when I’m sick (even though I have the same cancellation policy). I don’t always tell him everything I should, and I unwittingly (or wittingly) distort what he says. I’ve always assumed that when Wendell closed his eyes in our sessions, it was to give him space to think something through. But now I wonder if it’s more of a reset button. Perhaps he’s saying to himself, Have compassion, have compassion, have compassion, the way I used to do with John.
Like most patients, I want my therapist to enjoy my company and have respect for me, but, ultimately, I want to matter to him. Feeling deep in your cells that you matter is part of the alchemy that takes place in good therapy.
The humanistic psychologist Carl Rogers practiced what he called client-centered therapy, a central tenet of which was unconditional positive regard. His switch from using the term patient to client was representative of his attitude toward the people he worked with. Rogers believed that a positive therapist-client relationship was an essential part of the cure, not just a means to an end—a groundbreaking concept when he introduced it in the mid-twentieth century.
But unconditional positive regard doesn’t mean the therapist necessarily likes the client. It means that the therapist is warm and nonjudgmental and, most of all, genuinely believes in the client’s ability to grow if nurtured in an encouraging and accepting environment. It’s a framework for valuing and respecting the person’s “right to determination” even if her choices are at odds with yours. Unconditional positive regard is an attitude, not a feeling.
I want more than Wendell’s unconditional positive regard—I want him to like me. My question, it turns out, isn’t only about discovering whether I matter to Wendell. It’s also about acknowledging how much he matters to me.
“Do you like me?” I squeak out, feeling pathetic and awkward. I mean, what can he possibly say? He’s not going to say no. Even if he doesn’t like me, he could throw it back to me by asking, “What do you think?” or “I wonder why you’re asking this now?” Or he could say what I might have said to John if he’d asked me this question early on. I would have told him the truth of my experience, which might have been less about whether I liked him and more about how hard it was to get to know him when he kept me at arm’s length.
But Wendell does none of that.
“I do like you,” he says in a way that makes me feel he means it. It sounds neither rote nor gushy. It’s so simple—and so unexpectedly moving in its simplicity. Yes, I like you.
“I like you too,” I say, and Wendell smiles.
Wendell says that while I want to be liked for being smart or funny, he was talking about liking my neshama, which is the Hebrew word for “spirit” or “soul.” The concept registers instantly.
I tell Wendell about a recent college graduate who, considering a career as a therapist, asked if I liked my patients, because, after all, that’s who therapists spend their time with each day. I said that sometimes patients seem one way on the outside, but that’s often because they’re confusing me with others from their past who may not have seen them the way I do. Even so, I told this young woman, I feel genuine affection for my patients all the time—their tender places, their bravery, their souls. For, as Wendell is saying, their neshamot.
“But in a professional way, right?” the young woman persisted, and I knew that she didn’t quite understand, because before I met my patients, I didn’t understand either. And as a patient myself, it was hard to remember. But Wendell has just reminded me.