Part 18 (2/2)

_Example_

The previous time I was at the hospital Alice had not come to the unit.

I was told that she felt too depressed to come down. I went to see her.

She had looked surprised and impressed by my visit. She talked on at some length about her suicidal thoughts. I supported this on the basis that {118} verbal expression might make active expression unnecessary if she experienced empathy regarding how dreadful she felt. Then with little encouragement she had come down to the unit with me. Today, Alice was always near me, but nonverbal except for concise responses to questions that were offered with effort. I verbalized my reflections on her behavior and said that I was wondering about it. She said, ”I like having you around; it takes me away from my thoughts.” ”How are your thoughts?” ”The same, I wonder if I'll ever get better?” ”You've gotten better before. I wonder if you're not more concerned about whether you can stay well.” Alice, eyes watery, agreed with a nod. Irene, another patient, interrupted, ”Don't expect too much from me, I've been here twelve years.” I responded to them both, ”But, I do expect a lot of you; things don't always have to be the same.”

10. I verified my intuitive grasp of how patients were experiencing events by questions and comments, and being alert to their responses.

_Example_

Vincent's ritualistic behavior is a.s.sociated in my mind with his exaggerated conscious expression of only the true, the good, and the beautiful. On this occasion we had just had a long talk about his weekend at home, his concerns about his family, and his food likes and dislikes. As we left a room he took his usual long step over the threshold. I noted this aloud and asked him if he knew why he did this.

His expression became wide-eyed and smiling which indicates to me he consciously or unconsciously is selecting what he is going to say. We came to the next threshold. He stopped me by touching my arm and said, ”Josephine, I almost grabbed you to prevent your b.u.mping into that patient.” In relation to my last question I focused on the ”grabbed you”

and said, ”Vincent, to think about grabbing me is a pretty natural thought, and no reason to take a wide step over a threshold.” He put his foot very deliberately if rather testily, right in the middle of this threshold. He stopped, looked at me with his hands together and giggled.

Then he had to go to the bathroom.

11. I attempted to encourage hope realistically through discussing individual therapeutic gains that could be derived from patients' investment in therapeutic opportunities available to them.

_Example_

My impression of Arthur, a thirty-two year old, is that he works at responding to me agreeably as he thinks I want him to, he frequently goes out of his way to make cutting comments to me about middle-aged men patients, and he responds with anger or teasing to a female patient his age. Arthur has a mother, father, and two older sisters. He obviously let me win at Ping-pong several times. I discussed this with him and asked if {119} he had ever talked with anyone about his responses to older women, people in general, or if he understood them. He said, ”No, I have not been able to exactly figure this out yet.” I repeated the talking it over. He said, ”I haven't had much chance for that.” Then staring at me he asked seriously, ”Do you think talking it over would help?” I said, ”I think that it would take a great deal of effort on your part, but I believe that it could help.”

12. I supported appropriate patient self-images with as many concrete ”hard to denies” as possible.

_Example_

Alice, a middle-aged woman, in the midst of a discussion of the difficulties of living outside the hospital, past relations.h.i.+ps with nursing personnel, and her past practical nurse jobs suddenly said, ”I worry about being s.e.xually OK.” This was kind of blurted out and she observed me closely. I said, ”I thought that you had some concerns about this in relation to how you responded to my cutting the hairs on your face. I guess everyone worries at times about their adequacy in this area.” She said, ”I've never been able to have intercourse; I can just go as far as heavy petting. People say you can get a lot expressed if you have intercourse.” I said, ”Some people can, but if you have other standards that you've grown up with, (I suspect a rather religious, rigid Jewish background) it might cause difficulties to go against those standards.” (Alice first became ill at sixteen, left school, and had some treatment in the community.) ”It's pretty responsible not to be willing to bring a fatherless baby into the world, and I'm sure you'd have feelings about how your family might have responded to this sort of thing.” Alice nodded and said ”It's just that I don't know how womanly I am.” I said with gestures and emphatically, ”Well, Alice, if you have two things up here and no thing down here, then the fact is that you are a woman.” Discussion pursued about her further talking about this topic with her therapist and the value of her working through her feelings in this area. This was a lengthy discussion and the first talking I had experienced Alice doing since her depression. {120} {121}

GLOSSARY

~angular view.~ An individual's unique vision of reality necessarily restricted by the angle of his particular here and now.

~authenticity.~ Genuineness; congruence with the self.

~(the) between.~ The realm of the intersubjective.

~bracket.~ Hold in abeyance.

~community.~ Two or more persons struggling together toward a center.

~existential.~ Of, relating to, or affirming existence; grounded in existence or the experience of living.

~existential dialogue.~ A unique individual person with the wholeness of his being is present, open to, and relates to the other seen in his unique individual wholeness; an exchange in which two persons transcend themselves and partic.i.p.ate in the other's being; an interior unification; a mutual common union in being.

~existential experience.~ Contact with reality with the whole of one's being; involves all that a man _is_ as opposed to experiencing through one or several faculties.

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