“Do you have a question for me?” Wendell asks, interrupting.
I realize I do. I have many: Does Wendell talk about me with his colleagues at lunch? Do I still feel to him like my patient Becca felt to me before I stopped seeing her?
Wendell had used the singular, though—not “Do you have questions for me?” but “Do you have a question for me?” He did that, I recognize, because all of my questions boil down to an essential one, a question so loaded that I don’t know how to say it aloud. Is there anything that makes us feel more vulnerable than asking someone, Do you like me?
It seems that being a therapist hasn’t made me immune to responding to Wendell in the ways that patients respond to me. I get frustrated with him. I resent being charged for a cancellation when I’m sick (even though I have the same cancellation policy). I don’t always tell him everything I should, and I unwittingly (or wittingly) distort what he says. I’ve always assumed that when Wendell closed his eyes in our sessions, it was to give him space to think something through. But now I wonder if it’s more of a reset button. Perhaps he’s saying to himself, Have compassion, have compassion, have compassion, the way I used to do with John.
Like most patients, I want my therapist to enjoy my company and have respect for me, but, ultimately, I want to matter to him. Feeling deep in your cells that you matter is part of the alchemy that takes place in good therapy.
The humanistic psychologist Carl Rogers practiced what he called client-centered therapy, a central tenet of which was unconditional positive regard. His switch from using the term patient to client was representative of his attitude toward the people he worked with. Rogers believed that a positive therapist-client relationship was an essential part of the cure, not just a means to an end—a groundbreaking concept when he introduced it in the mid-twentieth century.
But unconditional positive regard doesn’t mean the therapist necessarily likes the client. It means that the therapist is warm and nonjudgmental and, most of all, genuinely believes in the client’s ability to grow if nurtured in an encouraging and accepting environment. It’s a framework for valuing and respecting the person’s “right to determination” even if her choices are at odds with yours. Unconditional positive regard is an attitude, not a feeling.
I want more than Wendell’s unconditional positive regard—I want him to like me. My question, it turns out, isn’t only about discovering whether I matter to Wendell. It’s also about acknowledging how much he matters to me.
“Do you like me?” I squeak out, feeling pathetic and awkward. I mean, what can he possibly say? He’s not going to say no. Even if he doesn’t like me, he could throw it back to me by asking, “What do you think?” or “I wonder why you’re asking this now?” Or he could say what I might have said to John if he’d asked me this question early on. I would have told him the truth of my experience, which might have been less about whether I liked him and more about how hard it was to get to know him when he kept me at arm’s length.
But Wendell does none of that.
“I do like you,” he says in a way that makes me feel he means it. It sounds neither rote nor gushy. It’s so simple—and so unexpectedly moving in its simplicity. Yes, I like you.
“I like you too,” I say, and Wendell smiles.
Wendell says that while I want to be liked for being smart or funny, he was talking about liking my neshama, which is the Hebrew word for “spirit” or “soul.” The concept registers instantly.
I tell Wendell about a recent college graduate who, considering a career as a therapist, asked if I liked my patients, because, after all, that’s who therapists spend their time with each day. I said that sometimes patients seem one way on the outside, but that’s often because they’re confusing me with others from their past who may not have seen them the way I do. Even so, I told this young woman, I feel genuine affection for my patients all the time—their tender places, their bravery, their souls. For, as Wendell is saying, their neshamot.
“But in a professional way, right?” the young woman persisted, and I knew that she didn’t quite understand, because before I met my patients, I didn’t understand either. And as a patient myself, it was hard to remember. But Wendell has just reminded me.
43
What Not to Say to a Dying Person
“That’s not a thing!” Julie says. She’s talking about a coworker who had a miscarriage—a fellow cashier at Trader Joe’s—and how another coworker, trying to console her, said, “Everything happens for a reason. This one just wasn’t meant to be.”
“‘Everything happens for a reason’ is not a thing!” Julie repeats. “There’s no divine plan if you miscarry or have cancer or your child is murdered by a lunatic!” I know what she means. People make misguided comments about all kinds of misfortune, and Julie has been toying with the idea of writing a book she plans to call What Not to Say to a Dying Person: A Guide for the Well-Meaning but Clueless.
According to Julie, here are a few things not to say: Are you sure you’re dying? Have you gotten a second opinion? Be strong. What are your odds? You need to be less stressed. It’s all about attitude. You can beat this! I know somebody who took vitamin K and was cured. I read about this new therapy that shrinks tumors—in mice, but still. You really have no family history of this? (If Julie did, the person asking would feel safer; it could be explained by genetics.) The other day, someone told Julie, “I knew a woman who had the same kind of cancer as you.” “Knew?” Julie said. “Um, yes,” the person replied sheepishly. “She, uh, died.”
As Julie goes through her list of things not to say, I think about other patients who’ve complained about comments people make at various difficult times: You can still have another child. At least he lived a long life. She’s in a better place now. When you’re ready, you can always get another dog. It’s been a year; maybe it’s time to move on.
To be sure, these comments are meant to comfort, but they’re also a way of protecting the speakers from the uncomfortable feelings that somebody else’s bad situation stirs up. Platitudes like these make a terrible circumstance more palatable for the person saying the words but leave the person experiencing the adversity feeling angry and alone.
“People think that if they talk about me dying, it’ll become a reality when it already is a reality,” Julie says, shaking her head. I’ve seen this to be true too, and not just about death. Not speaking about something doesn’t make it less real. It makes it scarier. For Julie, the worst thing is the silence, people who avoid her so that they don’t have to get into a conversation and say those awkward things in the first place. She’d choose awkward over ignored.
“What do you wish people would say?” I ask.
Julie thinks about this. “They can say, ‘I’m so sorry.’ They can say, ‘How can I be helpful?’ Or ‘I feel so helpless but I care about you.’”
She shifts on the couch, her thinner frame not quite filling out her clothes. “They can be honest,” she continues. “One person blurted out, ‘I have no idea how to say the right thing here,’ and I was so relieved! I told her that before I got sick, I wouldn’t have known what to say either. At work when my grad students first heard, they all said, ‘What will we do without you?’ and that felt good, because it was an expression of how they feel about me. People have said, ‘Noooooo!’ and ‘I’m always a phone call away if you want to talk or just go do something fun.’ They remember that I’m still me—that I’m still their friend and not just a cancer patient, and they can talk to me about their relationships and work and the latest episode of Game of Thrones.”