Infants are amazing to watch and be with. My daughter has a home daycare in Los Angeles. She is short of help so I agree to help this day. I get to hold the babies and I’m in wonder at how they are. The little boy I’m holding has a bottle that pours milk too fast. He is gulping and struggling, crying, upset by his dilemma. I ask for a change. We change it so he can drink comfortably. He looks so grateful and content, enjoying his milk, and he settles in. He puts his small hands to my face, seemingly curious trying to figure out who I am. When he’s finished, he sits up and turns to watch another little boy who is twirling around and falling down to catch the attention of this baby who is watching intently and laughs with a belly laugh so loud that all the other children come over to see what’s happening. They keep at it, playing this way, over and over, one twirling and falling down, the other one laughing uproariously. It’s a joy to see such aliveness.

I’m at work in the hospital. I care for a woman with an orthopedic surgery. While I attend to her physical needs, I’m learning about what happened, how she was injured, about her life, about who she is, her story. We make a connection . . . then I give her space for rest . . and standby . . . she introduces me to her husband. We are all connected with the same theme…her well being. I notice how happy she appears…and as she does what she needs to do with physical therapy, practicing her walking…she calls out to me to watch her…she is beaming at her progress. She transfers to another unit on the hospital which is less intensive in care, but she comes back to show me how she is. She is happy as is her husband, as they both proudly demonstrate her improvement.

It occurs to me that, likewise, as therapists, when we are lucky enough to have an understanding of what is needed and to provide that, what occurs in our patients is a reaching out in their lives with and aliveness and enthusiasm for life.

Reading Hayuth Gurevich (June “08, International Journal of Psychoanalysis) on the “The Language of Absence”, it brings to mind the reality that many of our patients have not internalized a very basic experience of being understood and connection not only at an early age but ongoing throughout their lives. “When the infant meets with the absence of what he was expecting and does not yet have the ability to know that he is suffering, the psychological pain of absence, he cannot but go on living the absence of (in this example, the smile of mother) in a state of shock. His mother’s no smile causes both his face and no smile to freeze……” she continues, “..this is what Shegold called soul murder- an act of non-violent killing what lives into a death.”

As mothers, we have a responsibility for recognizing our child’s language of tenderness that allows for the development of its self, so too, as therapists we need to recognize, understand, and acknowledge what is there and what is absent for our patients. By this and only this, can we hope to help patients reach out in their lives with an aliveness and an enthusiasm such as we can be privileged to witness.

Sometimes, I have been discouraged when what I think is helpful behavior on my part does not elicit gratitude, but instead angry, destructive behavior on the part of the patient. Melanie Klein viewed envy as an early defense on the part of the baby who feels deprived and wants all the goodness of the mother for itself. Anger and destructive behavior result from the baby’s feeling that its needs are not being met. So, in these instances, the cure for the patient who exhibits destructive behavior is to encourage gratitude. “Its hard to feel small and helpless and grateful for what you are getting here, when you feel angry about not having me there when you want me. Its hard to realize that when I am not there, I will be back soon to help you.”

I was tired toward the end of my shift. My patient called me to say that “you never do anything but paperwork!”. I was offended and walked away, but upon reflection, I noticed I was feeling angry and discounted, and came back to say, “I wonder if what you are really saying is that you would like to have more opportunities to talk with me.” This patient was then able to communicate that he was feeling like he was falling through the cracks. It opened much in our communication.

If we are able to tolerate our own uncomfortable feelings (which in this instance I almost wasn’t I was so annoyed), our patients then can do the same and we can better understand what they are really trying to communicate.

As it was in these instances, so it is in the therapeutic setting. When we are able to provide basic therapeutic needs, we notice the aliveness of our patients and their movement toward us and then toward their environment. It may not be instantaneously gratifying, but it does and will happen, as we have all seen in time.

Sue Ford is a member of the SB CAMFT Board – acting as CEU Chair – you can say hello next time you meet at one of our monthly luncheons. You can reach her by email at suefordinsb@cox.net.