In the May/June 2016 issue of the Psychotherapy Networker, Marian Sandmaier asks several therapists:

“What’s Your Most Memorable Therapeutic Moment?:
Six Master Clinicians Share Their Reflections”

In his piece, “The Found and the Lost,” Terry Real describes his work with a couple in difficulties. In the following excerpt, he recounts a tragic event during his ongoing work with them:

Driving her daughter Carrie home from a friend’s house, it was Sylvie’s goodness that compelled her out of her car one snowy New England night to help another car that had skidded on an icy curve and got stuck on the shoulder of the road, caught in a snow bank. That’s when a second car skidded in exactly the same spot, careening into the first car, and then careening into Sylvie and Carrie. Sylvie had multiple fractures in an arm and both of her legs. Carrie died within minutes.

When her husband Ben called me the next morning, he was weeping, grief-stricken for the loss of his daughter. But he was also worried sick about Sylvie. She was in the hospital on a high dose of morphine, and “between the drugs and the shock, she’s pretty much out of her mind,” he said. “She keeps waking up and asking for Carrie: ‘Where is she? Where is she?’”

And no matter how many times Ben tried to tell her, and no matter how he put it, she would not let in that her daughter was gone. “She turns her head, changes the subject, acts like I haven’t even spoken,” Ben said. “You’ve got to help,” he said urgently. “She’ll listen to you. She always listens to you.”

When I walked into Sylvie’s hospital room, the profusion of flowers and gifts had the opposite effect of cheering me. It looked like a funeral home. While I’d tried to prepare myself, the sight of her was shocking—tubes everywhere, both legs and one arm in traction, her face swollen almost beyond recognition. I sat next to Ben and took her good hand. “Sylvie,” I said, “Something terrible has happened.” She closed her eyes. We went round and round for 5 minutes, 10 minutes. I felt cruel, sadistic.

At one point, Sylvie looked at me, really looked at me. Her eyes grew wide. Then she swung her head away from us and sobbed, letting out raw, heart-wrenching sounds.”

After many minutes, she turned to Ben. “Go home and get Carrie’s old fisherman’s sweater.” Her voice was trembling, urgent. “It’s in her bottom drawer.” Then she turned to me. “You’ve got to make sure she gets it,” she told me. “She’ll need it. She’s cold. She’s dead.”

Carrie was buried in that sweater three days later. It seemed like half the town had come out. Friends and family squeezed into every church pew, a sea of kids spilling out the steps and into the street. I sat close to the family—Sylvie propped up in a portable hospital bed, Ben standing next to her, holding her hand, straight and stiff in his handsome new suit.

Over the next several months, I went to their home as often as I could. About three months into it, Ben pulled me aside and confessed that since the accident—and unbeknownst to Sylvie—he’d been keeping a blog. He’d been pouring his anguish out into the internet, garnering thousands of followers from all over the world. I read the posts; they were shattering. Later on, I asked his permission to excerpt an early entry, entitled “Holding My Breath.”

People ask me if I miss her. Actually I don’t, not yet anyway. Maybe I’m in shock or some kind of denial, but I actually feel close to her. I feel her in the air, the sky. She’s with me now as I write. What I miss isn’t her, but us, the two of us together. The back and forth, teasing—what she called, “talking smack.”

Everything froze the minute they told me. My heart stopped, my world stopped. Since then, I’ve hovered somewhere between here and god knows where. I’m the ghost. I don’t think I’ve taken a full breath since. I don’t really want to. If the whole thing started up again—if I begin to live again—it would mean that the world will go on without her, and that’s just not thinkable. I can’t imagine accepting that. There can be no world without her in it, laughing and alive.

Ben told me he was keeping his blog secret from Sylvie because he was afraid it would hurt her too much. But shortly after our meeting, a friend spilled the beans to her. She went right to her laptop and read every entry. “It was amazing,” she told me at our next visit. “Here was my poet’s heart—the man I loved. I fell for him all over again.” She took his hand. “It’s not just the blog,” she explained. “It’s Ben. The way he’s showing up for his own feelings. And the way he’s showing up for mine.”

Ben squeezed his wife’s hand. “We’re holding each other up, best we can,” he said. He was looking at her, not me. “We’re in this together.”

About six months after the accident, we sat together, each of us locked into what felt a heavy, interminable silence. Three people breathing, each of us thinking what Sylvie finally spoke out loud. “I lost my daughter,” she said, “and found my husband.”

You hear that the greatest single predictor of divorce is the death of a child. You hear that no force on earth is more capable of ripping apart a loving union.

But not always.

Steve Andreas comments:

Is this a dramatic, heart-rending and touching account? Absolutely!

Is it a “Most Memorable Therapeutic Moment?” No.

If that statement seems surprising to you, pause to review Terry’s account, and consider why I would say that. . . .

Firstly, though it’s not explicit, the “therapeutic moment” apparently refers to Sylvie’s reading Ben’s blog entries, and being deeply touched by them. However, it was a friend who “spilled the beans to her,” (not Terry, despite the fact that Terry had earlier knowledge of the blog). Ben’s blogging healed the gulf between this couple, without any therapeutic intervention by Terry, so it wasn’t a “therapeutic moment,” no matter how wonderful the result.

Secondly, Terry made a gigantic blunder when he insisted that Sylvie realize that her daughter was dead, and he shows not the slightest recognition of this mistake. Sylvie had already made it abundantly clear, both verbally and nonverbally, that she didn’t want to know that her daughter was dead. “She turns her head, changes the subject, acts like I haven’t even spoken,” These facts alone should have been sufficient reason for respecting her wish. But apparently driven by some idea that Sylvie should “face reality,” Terry continues to confront her, until she finally gives in. “Sylvie,” I said, “Something terrible has happened.” She closed her eyes. We went round and round for 5 minutes, 10 minutes. I felt cruel, sadistic. At one point, Sylvie looked at me, really looked at me. Her eyes grew wide. Then she swung her head away from us and sobbed, letting out raw, heart-wrenching sounds.”

In addition to Sylvie’s clearly expressed desires, there are plenty of objective reasons for waiting until later for her to “face reality.” With Sylvie “in the hospital on a high dose of morphine, and between the drugs and the shock, she’s pretty much out of her mind,” clearly she’s in a severely diminished mental state, not able to think clearly, or process the news of her daughter’s death well. With “tubes everywhere, both legs and one arm in traction, her face swollen almost beyond recognition,” she has quite enough to contend with already, without the added mental and physical stress of accepting her daughter’s death. “Then she swung her head away from us and sobbed, letting out raw, heart-wrenching sounds.”

So what would I have done in response to her urgent asking for Carrie, “Where is she? Where is she?” while at the same time honoring her need not to know? Utterly simple. A soft, “Carrie can’t be with us” is truthful, and to the point. Then I’d quickly follow with questions designed to elicit fond memories, which will give Sylvie an experience of Carrie’s presence, which is what she wants and needs. “What’s one of the things you most enjoy about Carrie? Is it her humor, her honesty, the way she walks in the door after school? The way she tilts her head? What’s special about her?” If Sylvie returned to her urgent question, “Where is she?” I’d simply repeat, “Carrie can’t be with us,” and again immediately follow with additional questions, “What subjects in school does Carrie enjoy most? Can you think of a recent special memory? Did she ever have a crush on one of her teachers?” continuing as long as necessary until Sylvie relaxes into a pleasant memory, so that she can concentrate on the immediate task, recovering from her injuries.

Eventually, of course, Sylvie will need to be told that Carrie is dead—or she may come to that realization on her own. Depending on Sylvie’s condition and readiness, and other circumstances such as the scheduling of the funeral, this could be as little as a few hours, or as much as a few days.

Later Terry reports, “Ben squeezed his wife’s hand. ‘We’re holding each other up, best we can,’ he said. He was looking at her, not me. ‘We’re in this together.’ About six months after the accident, we sat together, each of us locked into what felt a heavy, interminable silence.”

This is a pretty good indication that they are both still grieving, and could benefit greatly from experiencing the NLP grief process, which could have resolved their grief in a session or two, saving them six months of therapy. However, since most mainstream therapists aren’t trained in this method, that’s too much to expect.

I have listened to a number of Terry’s webinars, and found them far more useful than most, particularly when he demonstrates what he would actually say to a client in a particular circumstance. I have also read his book, The New Rules of Marriage, and found it useful in the same way — though I think “guidelines,” “tips,” or some other gentler word would have been better than “rules,” which inevitably sets up a rigid “should” to be followed. Perhaps the publisher “overruled” Terry on the title.

I sent the post above to Terry, inviting him to respond. Here is his reply:

I am delighted with Steve Andreas’ serious consideration of my work and I welcome him as a colleague. I must say, though, that moments taken out of context can be a bit misleading. 

Had he been present, Steve would have witnessed the repeated torment of Sylvie waking from stupor, frantically insisting on knowing the whereabouts of her child, being told her child had been killed, howling, slipping back into torpor, only to have the same cycle repeat every 20-30 minutes. A Groundhog Day in hell. 

Of course the husband and medical staff had tried a softer approach: as in, “She can’t be with us now,” followed by attempting to distract. Sylvie was having none of it. She wanted her daughter and she wanted her now. Vagueness, distraction, or superficial bromides were useless. The husband asked me to do what I could to end this repeated torment and I did what I could.

Sylvie wasn’t happy after the news got through to her, but she did begin to find peace. 

I would not infer that the heavy silence that fell on this family six months after the death of the daughter indicated anything other than normal grief, which I’d be in no rush to take from them. It is a sacred part of the relationship to their daughter that remains, and in my mind, utterly appropriate. 

Steve Andreas responds:

Terry is quite right that I wasn’t present; I had only Terry’s written account to go on. There was no mention in that original account that the “. . . medical staff had tried a softer approach: as in, ‘She can’t be with us now,’ followed by attempting to distract.” And I’m sure that “Vagueness, distraction, or superficial bromides were useless.” Although my suggested response could also be described as a “distraction,” it was very specifically designed to elicit in Sylvie a felt sense of her daughter’s presence, which is what Sylvie wanted and needed.

Of course my suggested intervention might not have succeeded, even if sustained. However, even though the medical staff may have started with “a softer approach,” apparently they quickly defaulted to direct confrontation. “. . . Sylvie waking from stupor, frantically insisting on knowing the whereabouts of her child, being told her child had been killed, howling, slipping back into torpor.” With that unfortunate background, it would have been very difficult for Terry to shift direction and do something more useful.

Finally, many people share the view expressed in Terry’s closing paragraph on what appropriate grief is, and that “grief work” is a lengthy process of “saying goodbye.” If they could witness the transformation from tears of loss to tears of joy that results from reunion with the lost experience based on the opposite principle of “saying hello,” they might change their minds — but that is another discussion.

I sent all the above to Terry, in case he wanted like to add anything further, and have the last word. He replied, “It’s fine, thanks.”