[Disclaimer: I have used aliases to protect the confidentiality and identity of clients or patients. No other names have been changed.]

One of the great experiences I had as a therapist, including during my role at Brynn Marr Psychiatric Hospital, was supervising an intern. I mean imagine the situation and everything that has come before in my life. I started college as someone lacking social skills and lacking communication skills. Yet here I was working in the field successfully where those specific skills are required, and I am supervising someone else who is looking to me for guidance.

This is a testament to the passion and dedication that I had. I felt a sense of amazement at these many accomplishments and my success. Not only did patients look to me for guidance, insight, , and direction but I had a student in the same field as me looking to me for education, guidance, and insights in a manner not so different than the way I looked to Chris Hauge, my mentor.

Granted Chris had many more years of experience than I did, but this was still amazing. Mary was her name. She could have asked to work under the supervision of my colleague, Leslie, the other therapist on the unit but she observed us both and asked to work with me.

There wasn't anything wrong with Leslie. The situation described in the last chapter about how a hostile environment existed for Victoria was not something Leslie had done herself.

Mary sat in on group sessions, met with new patients to gather information for the intake assessments, and sat in on individual therapy sessions with patients sometimes. This was helpful because I was finding that occasionally some patients would ask me to be their therapist instead of Leslie - I can't say that happened many times, but occasionally someone asked to switch.

I do not know why anyone was asking for me as their therapist.

For what it's worth, and to me, it was worth a lot, no one had asked to switch therapists to work with Leslie instead of working with me. I may have had greater eagerness because I was new, but I've never lost that passion for trying to be the best I can be... to earn the respect and admiration of those I was serving.

As I was saying in the last chapter, I did think that empathy is a quality that must be demonstrated. You can't just tell yourself that you are doing a good job and that you care about the welfare of others. You have to observe how people respond to you.

So, did the patients continue to meet with me after an initial session? Yes. I mean, if you didn't accomplish anything with the patient, why would they return and/or ask to see you whenever they can? I could tell as I walked around the unit that people looked up and to me for my attention.

Consider this, some people might be there involuntarily and waiting to get out as soon as possible. So, they would be going to group sessions to demonstrate that they are participating and to earn points with the staff who would decide they are ready to be discharged as soon as possible.

In addition, while there are differences in the roles and there are boundary issues that differentiate patients and staff, there are still ways in which those boundaries and differences do not have to be so great that a patient doesn't feel comfortable wanting to interact with you and seek your help.

Carl Rogers was a psychologist who pioneered the humanistic approach to psychology or psychotherapy which was also called client-centered therapy. He is known for his ideas about unconditional positive regard that a therapist should convey to a client or patient. This to me seemed like a basis for all other techniques.

In a way, empathy develops by conveying the idea that the person is accepted and acceptable as they are and not based on some conditions about what they must be.

Here is another example of how natural things seemed for me and how empathy, therapeutic technique, and skills were useful in helping a patient named Karen.

I had noticed Karen in my group session one day and she seemed barely alive. Karen was a medium complexion African American young woman in her mid-20s. She was somewhat thin and was about five foot five or six.

Mary brought her in to see me in the afternoon and said that she had interviewed Karen to gather information for the routine intake assessment that we were required to complete for the chart and to create a treatment plan.

We sat down in my office and Mary tried to help Karen talk about some of the things that had happened to her. I was concerned and said, "You have been hurt."

In a very soft voice, she answered "yes."... adding "it wasn't the first time. My father and my brother did things to me when I was younger."

"I'm so sorry," I answered. "It's so sad that something like that should happen to someone so special."

Some professionals worry about being authentic or genuine and complimenting others, but I had learned from Chris that there was a more natural way to be. Chris had been in the field for decades and was well respected in the field. He had introduced the idea of offering positive feedback to others in therapy groups because you can think of something to say even after only a brief encounter with a person and that resonated with me.

Karen looked so fragile, thin, sweet, and gentle. I was aware of counter-transference issues, so I kept some of those thoughts to myself but overall, it seemed hard to imagine not seeing her as a special person, so it just seemed so natural to say.

It seemed like a look of sorrow came over her face which actually looked like it was a relief for her to be able to talk about what happened.

She added, "I was raped" in a very feeble voice that was just barely audible and seemed to convey with it both a sense of relief in saying the words and a sense of shame as she looked away.

"I am so sorry that happened to you. That is such a horrifying thing to happen to a woman," I said.

I then added, "there are ways to process or work through the memory of the experience so that you can find some relief. I can help you to do this in a way that is safe while you are here... with me... with us."

I wanted to do something. This was the setting for that. I had a sense that this didn't just happen last week. If she was shut down like this now, that meant that it must have been a weight that she had been unable to share with anyone... she must have felt a need to keep it to herself. Mary had been providing some insights from her earlier conversation.

Karen seemed a bit curious and maybe confused about what we were going to do. I said, "there are experiential therapy techniques that are helpful in creating an experience of mastery over a traumatic event. Our imagination holds memories like this as snapshots that we are afraid to see. You won't be alone."

"You are safe now, right?"

"Yes," she answered looking at me. I had studied some information about hypnosis and I was using only enough of those insights to try to resonate with her and to meet her experience - her breathing rate and such.

While I was learning about experiential techniques with Chris, I had studied Fritz Perls and Milton Erickson as well as Bandler and Grinder, who developed Neuro-Linguistic Programming, where they drew upon the skills and techniques of geniuses in the field like Fritz Perls and Milton Erickson to model what the essence of what they were doing was.

It seemed to me that this technique of matching the breathing rate, pulse, and vocal patterns was helpful in developing and demonstrating empathy because we had to tune into what the other person is experiencing.

"I can stay with you too," said Mary.

"No, I don't want you to see," answered Karen.

I had registered this as a need that I could understand because of the sense of shame that we sometimes feel at inappropriate times. I also recognized the need to be aware of transference and countertransference issues. Even if one doesn't specialize in Freudian or post-Freudian psychoanalysis, it is valuable to be aware of how a client or patient is reacting to us, how they are projecting their feelings unto us, and how we are reacting to them.

Mary left and I said, "I am going to sit next to you and we can imagine a screen in front of you. This will allow you to review what happened like it was a movie instead of being overwhelmed by the pain and other negative emotions."

She asked, "you will be with me?"

"My voice will go with you."

"You don't have to say out loud everything that is happening... and you can stop any moment you want."

"I want to say what happened - it was bad," she said.

"Yes, it was bad what happened to you... but it's not happening now."

I knew that later we would also need to address the fact that what happened to her had nothing to do with her but I didn't want to give her too much information to think about until it was necessary to add more insights to help her.

I suggested she take few deep breaths, close her eyes and picture a screen in front of her. I had been thinking about the gestalt therapy techniques that Chris used in the therapy groups. I had also been to individual therapy to work on some of my own past traumatic experiences to get a feel for how to do certain gestalt techniques. Chris and I briefly discussed the Neuro-Linguistic Programming Technique that I had read about as well...

I also had taken a post-graduate continuing education course on related treatment techniques and ideas that relate to these experiential therapy approaches.

Anyway, Karen was well-grounded with appropriate reality testing to benefit from this technique. Some visualization techniques can be problematic for someone who is having a psychotic break.

I continued, "let's go back to when it happened. Imagine the scene in front of you if you can."

I added, "You can squeeze my hand to know you are not alone and to help with your feelings when it gets scary or when you get mad..." placing my hand near hers on the arm of the chair.

She grabbed and squeezed, and I said, "It's okay, that doesn't hurt me and you are okay."

"Let your body do what it wants to do, like kicking your feet in front or whatever."

I knew from the techniques of Fritz Perls that to find the closure needed for relief we have to stop stifling our reactions and working to keep everything inside.

She began to relax a bit as if the scene had faded from her.

She opened her eyes and her face brightened and her posture looked different. She had a slight smile on her face.

"Thank you," she said.

"No, thank you," I answered. "I mean for trusting me and for having a chance to see this look of relief on your face."

"I feel... different," she said.

I didn't say that I thought that more work would need to be done. Other things had happened to her and the impact of the rape was going to take more therapy to overcome.

It seemed that what matters is that some sense of mastery can be found, and this can change a person's mindset and create a sense of possibilities... possibilities for healing from trauma.

As always, I reflected upon the actions taken in the therapy session. It's always important to be aware of what is happening especially when you are close to another person - within the distance of human contact.

I've had contact with a therapist myself though in a different way than squeezing someone's hand. Boundary issues are important. At the end of my counseling time in college, after five years working with the same psychologist, we hugged as guys do.

During hypnosis with Chris and another hypnotherapist, I have had them tap my hand or knee first announcing that they are going to do that. There is even a technique where a hypnotherapist tries to verify with the client the phenomena of hypnotic trance by gently raising the hand and letting it hang in mid-air without awareness until attention returns to the arm and hand to allow it to slowly drop down to the person's lap.

The point is that we do need to be aware of boundary issues, but it is possible to remain aware of what is happening. I had a wife at home, and I knew that nothing I had done was shameful in any way that I would hide it from Lynn.

We were working on keeping her grounded in the here and now and in a safe place, so nothing romantic was creeping into the sessions.

These were things that I considered, and much insight could be gained by going through psychoanalysis. I knew someone who was a psychoanalyst as a matter of fact. Her name was Marjorie Israel.

Regardless of what different people think about psychoanalysis, there is a great deal of insight that can be gained by spending time free-associating and reflecting upon our reactions in different situations.

The thoughts that I had when I approached her for analysis were that I wanted to find out about myself and what hidden or unrecognized motives and desires might exist within me that could have an impact on my work in the field with clients. I believe that there is common sense to the notion of transference and countertransference.