When we began our work, my patient was a full-time martial arts instructor. Something drove him to therapy. He wasn’t sure what. A first-generation immigrant, he was raised in an ostensibly close-knit family in a working-class neighborhood in New Jersey. He spoke to his mother every day and lived down the street from her. He seemed engaged and open, but also unreachable. He agreed to my observations but sat with his arms crossed in the chair. I couldn’t read his expressions. The approaches I often use to initially connect to my patients, from using metaphors and visuals to mindfulness strategies, fell flat. I suspected we were missing something, and I didn’t know how to get there. I felt sleepy during our sessions, shifting in my chair to keep alert. I had the sense we were swimming on the surface of something deep, dark, and unwieldy. Perhaps it was this frustration with our work that drove me to try something new. Uncharacteristically, one day I had the impulse to share a poem with him. An English minor in college, I love poetry but had never brought my worlds of poetry and therapy together. A line from the poem “A Luxury,” by Yehuda Amichai, an Israeli poet, had kept coming to me in our sessions: “So many tombstones are scattered in the past of my life, engraved names like the names of stations where the train doesn’t stop anymore.” I sat very still waiting for his response. Something felt different in the room: an alertness that had been absent. He read the poem and asked me what it meant. “Is this about family? About choices?” He seemed puzzled. But something changed. The poem hadn’t spoken to him that day, but later he reread it. Then he bought a book of Amichai’s poetry and began reading poems between training sessions. He described the bustle of people training around him in a large gym, the noise and sweat and visceral physicality of the place and how it contrasted with the inner silence he felt when reading his poems. He came in the next week and said that he now understood what I meant when I had told him weeks earlier that you can love your family but also hate them. At the time he had nodded politely but said it hadn’t resonated. Now, it did. Despite all my training, traditional talk therapy didn’t work with him. But poetry did. Other people’s words began to carry us, like a raft, into new seas. I brought a poem in every week and he associated to it, as if it was a dream. I looked for poems that were evocative, dark, and rich. We read Sharon Olds, Mary Oliver, Ellen Bass, Lee Rossi, and more Amichai. Consistent themes of life and death made each poem feel important and high stakes. We took turns reading the poems out loud. I was aware of my breath as I listened, in a way that felt new. At first, we didn’t make any interpretations. Shyly at first, and then with more confidence, he began bringing in poems he had found himself, and also making connections between the poems and his inner world. Six months into our work he brought in the poem “The Perch'' by Galway Kinnnel. “What does it mean to you, this poem?” I asked him. “It’s slippery, I can’t quite reach it yet, but I know it was wrong,” he said. The room suddenly felt thick and murky. I resisted the urge to ask him to elaborate and began to read aloud a line that had struck me. “The tree trunk contorted by the terrible struggle...” I looked up to see him hunched over. “I didn’t want to do those things. I really didn’t want to.” We sat in charged silence, our eyes locked. Then, he began to weep. There wasn’t a language to talk about his trauma history until we discovered poetry, and then that history became the focus of our work. The introduction of poetry changed our work entirely. For the next seven years, our sessions felt productive and alive. Little by little we did the work of untangling the impact of the incest he experienced with his mother. She had seduced him as a young child and they had sexual relations until he was a teenager. Early on he asked me, “Are you sure that’s not normal?” about his mother’s request to have him touch her. “I’m positive,” I answered, tasting metal in my mouth as my heart raced. One day, a year into our work, he read a poem aloud. It was beautiful: nuanced, layered and strangely familiar. I noticed the absence of an author. “Who is this?” I asked him. “It’s me, I wrote it.“ He pointed to himself with a wide, warm smile. It’s not often that I am surprised in my work, but that moment shook me. Tears pricked my eyes. I couldn’t speak. Revelations are rarely sudden; they generally have an arc and a momentum, and change happens incrementally. But he shocked me that day. From that day on he brought in his own poetry, and we began meeting twice a week. Our patients know us in vulnerable ways: they sense when we feel stretched or pushed; they notice when we keep our balance and when we don’t. It’s intimate work. They observe how we bring levity to heaviness and watch how we tolerate the heaviness when it threatens to engulf. The fact that we can’t share any details of our work with our family and friends means those closest to us never see us at our most professionally competent. Only our patients do. They might even know us at our best and most vulnerable, because the work requires our full emotional attention. There are definitely weeks in my life that my patients get that on a more consistent basis from me than my own daughters. Using the raw medium of poetry as a vehicle made me have to reveal more than I usually do. At the beginning of treatment when my patient witnessed my emotion it was with surprise. “Sarah, why is your voice trembling?” I explained that I was moved. Poetry demands honesty. Without ever knowing many concrete details of my life, he came to know me very well. There were no professional lines crossed, our work was boundaried and safe, but it also felt like a wildly different version of therapy. I had to throw out most of what I was trained to do; he had to trust me that he was safe. It took immense courage for him to start writing poetry because it forced him to reckon with the sexual abuse he suffered; it took courage for me to break out of my known lane. The last line of that first poem I shared by Amichai is “How will I cover all the distances on my own route, how will I make connections among them all?” I recently returned to that poem and realized that was the theme of our work: being brave enough to make new connections. Those connections also involved significant loss, as he got in touch with his anger and began to limit contact with his family. Therapy is about breaking out of negative, frozen cycles. Effective treatment is built on the premise that you extend the therapy relationship’s challenges to one’s relationships outside of the consulting room. It’s supposed to be that way for the patient, but what I found significant about this work was how much we both benefitted. The challenges made me question other patterns in my life and in my practice that had grown stale. Being up close to his process of reinventing a life with meaning, purpose, and intention made me ask myself in what ways I was getting in my own way of creating that. As clinicians, we ask so much of our patients, but I had stopped asking much of myself. Our work forced me to ask myself hard questions, like the role that fear played in my decision making. I’m certain that my decision to have another child at the age of 45, something that I had wanted but not been brave enough to do, was a result of the soul-searching our work engendered in me. Galway Kinnell wrote, ” I climbed up to the perch, and this time looked not into the distance but at the tree itself.” Our work enabled us to look internally at our own trees.
Dr. Sarah Gundle
3 Questions for Dr. Gundle
What was your process for creating this work?
I was trying to process the termination with this patient, who meant a great deal to me. Writing helped me work it out.
What is the significance of the form/genre you chose for this work?
This was a narrative piece that was deeply personal for me.
What is the significance of this work to you?
I think most patients don’t necessarily think about how important and intimate this work is for therapists. He impacted me in ways that were truly significant. I am grateful for our work together. This piece was trying to capture that gratitude.
Dr. Sarah Gundle holds a doctorate in Clinical Psychology from the Wright Institute and a master’s degree in International Affairs from Columbia University. She teaches courses on trauma and international mental health at Mount Sinai West. A member of Physicians for Human Rights (PHR) she works in their Asylum network, where she evaluates the mental health of torture and persecution survivors seeking asylum.