Sunday, June 1, 2008

Friendship

Every Sunday morning I have breakfast with a friend. I first met this friend when I was 19. We generally talk about the challenges of being human. We implicitly look to each other for help.

Sometimes help comes in the form of an insight. Sometimes it comes as a personal anecdote. And sometimes it arrives as a question from the dark, a flash of lightening for an instant illumining the sky. Whatever the form, the help has been valuable. At least in my case, it has shed needed light.

One day, however, I had a new experience. I had been feeling alone, and I described this to my friend. Rather than attempt to make me feel better, my friend replied that this seemed about right. He didn't try to take my experience away. He acknowledged it. He normalized it. He stood by me while I had it.

Just after this exchange we got up to leave and walked a half block in the direction of my car. I found myself filled with gratitude and love. A powerful image seized hold of my mind. I felt like I was standing at the edge of an abyss, looking at a red sky that signified death, and right next to me, simply present, was my friend. I told him the image, and he immediately grasped it. Then we quickly parted for yet another week.

Soon after this experience I came to understand that I now had a new definition of a friend -- someone who stands by you whatever you feel. The paradox in my case was that I'd been feeling alone. And while I was feeling alone my friend was with me. He was a witness to my aloneness and yet not an antidote. Like a loved one at one's deathbed. Present but distinct.

Eventually I recognized that what my friend did for me is very much what I try to do for my patients. To be with them while they share their most painful feelings. To do nothing to try to take these feelings away. To acknowledge them. To normalize them. To stand by them while they have them. In this way, I realized, I try to approach them as a friend.

To my surprise, this led to the unorthodox conclusion that friendship forms the cornerstone of good psychotherapy. Not the friendship of broken boundaries and needless self-disclosure in which therapists use the treatment for their own gratification. That is exploitation masquerading as friendship. But the friendship of emotional courage and unbroken presence in which therapists stand by their patients whatever they feel.

Of course, this is easier to say than to do. And no one is always so skillful a therapist. But knowing what it feels like to experience such friendship certainly makes it less difficult to achieve. And for this I am deeply grateful to my friends.

2 comments:

Alexis said...

I just found this blog. As a psychology major, I am curious as to how you develop a friendship with a patient or how you “approach them as a friend”. I have yet to take a class where therapy and friendship are linked.

Dr Raphael Gunner said...

Hi Alexis. Thank you for your comment. In my view, approaching a patient as a friend is very different from developing a friendship with a patient. Approaching a patient as a friend means cultivating the intention to witness their experience without doing anything to take it away. Developing a friendship with a patient seems inappropriate to me because of the structural asymmetry of the relationship and the therapist's responsibility to maintain healthy boundaries. This doesn't mean therapists shouldn't care for their patients. But it does mean that their affection must remain within limits. Limits that make it safe to explore emotional pain. Limits that make it possible to facilitate growth.