John Kalafat, Ph.D.
Associate Professor, Rutgers Graduate School of Applied and Professional Psychology
Past President, American Association of Suicidology
One can react to this book on emotional and intellectual levels, and I would ask anyone who does not have an emotional response to please turn in their license to practice. In the initial crisis phase of their work together, this account clearly captures what we mean when we say that we must be able to hold our client’s pain—if we cannot tolerate their pain and anxiety, we cannot help. If we pull back or run for the door, our clients will know and will wisely pull back themselves. This therapist also embodied the mix of support and structure—caring/compassionate and absolute dictator—that are the active antidotes to the anxiety and despair of suicidal crises.
As the interaction became more therapy than crisis work, the patience and tenacity of the therapist became evident in the relentless repetition until the client has enough faith in the therapist’s conviction and commitment to lower her defenses a little at a time. And then to repeat this many times throughout the journey. Above all, this illustrates how therapists must enter into a very personal relationship with their clients at levels that their clients can tolerate. All of our research indicates that the quality of the relationship overshadows all else, including technical competence, in predicting therapy outcomes.
This book illustrates so much about the therapy process—such as why we have to deal with feelings or how the client moves to what Fritz Perls calls the impasse or death layer (beyond the surface, defended, b.s., social layers). This is the point where the client can no longer maintain the self-defeating behavior or defense they have been using, but have not yet incorporated the new coping behaviors. Perls says the client has to stay at the impasse or death layer, rather than fleeing, and they will find that it is not nothingness—something will emerge. Adler calls this countering the client’s “private logic” or “spitting in their soup”—they can go on eating it, but it will never be the same. The therapist spit in Terry’s soup many times (and she had more spit than Terry had soup).
I guess I am saying that I see this book on many levels: a courageous personal account of a long journey in response to a very bad hand that this client was dealt; a major and important account of the therapy process through the eyes of a client (again research shows that clients’ perceptions of their progress, of the therapy relationship, of their suicide risk are more accurate than their therapist’s); a priceless description of a therapist’s commitment, compassion, tenacity, and willingness to connect; a tremendous teaching resource (why deal with feelings, why not tell clients “the answer,” what is the difference between an intimate therapy relationship and other relationships, etc.). Finally, it illustrates the reality of the therapeutic journey in stark contrast to the procrustean, abortive model of managed care, or substitution of pharmacology for competence.
John Kalafat, Ph.D.
Associate Professor, Rutgers Graduate School of Applied and Professional Psychology
Past President, American Association of Suicidology
