Witnessing Is a Skill

Can we tolerate it, or teach it?

This is Part 2 of a 12-Part Series: The Hardest Things in Psychotherapy

I saw a patient who, at the behest of her husband went for a routine facelift. There was a major error made while initiating anesthesia which left her quadriplegic. I had seen her for six months prior to her surgery for panic attacks and during a time when she was contemplating divorce.

I went to see her in the hospital three week after this catastrophe. I walked into her hospital room and she was propped up while lying in bed. She burst into tears when she saw me. I was not far behind with my own tears. I pulled up a chair, sat next to her, and reflexively said, “How are you?” A ridiculous question. She said “What if I never can move?” My reflex was to reassure, do something, say something, some how fix this. I was at a total loss. I was silent.

Thereafter, I saw her in the hospital weekly, sometime twice a month over the next year as she partially recovered. I treated her panic attacks with medications. This was my first immersion into witnessing.

My training had equipped me with empathy, deep listening, offering reflective comments. True witnessing is different.

The Importance of Presence

True witnessing is the capacity to remain fully present to another person’s pain without needing to convert it into something more manageable. Simply: I am here, I see what this is, and I am not going to look away.

Patient’s also witness their therapist, our failures, mini breaks in our alliance. This patient also witnessed my own failures, mini-breaks, and many mistakes in my less than perfect responses.

Our field—that of the mental health professionals—treats witnessing as a given, but I have found it an ability that is hard to develop. I am still not sure I can do this very well.

The Capacity to Witness

I think the capacity to be a true witness develops through something else: repeated exposure to a patient’s suffering that you can’t manage away.

I think the capacity to be a true witness develops through something else: repeated exposure to a patient’s suffering that you can’t manage away.

My patient came to me with something truly unbearable. I often moved too quickly toward creating meaning or a resolution. I was communicating, without words, that this unbearable event could be overcome.

Overcoming this trauma would never be possible. Living with it maybe. Some traumas are forever

I braced myself when she cried and looked at my watch when the session felt unbearable. My usual moves ran out. What remained was I could show up…Just try to just be present. I was physically there. I am pretty sure I wasn’t fully present. At times, maybe.

Witnessing is one of the hardest things to do.

How Does One Teach “Witnessing?”

It’s not something you can teach a therapist. As an educator, I think we should encourage therapists to experience what it feels like to be a witness and to be witnessed. You can talk about it, you can describe it, but you have to truly experience it in real time with a patient to fully understand. This is a deeply human experience.

Presence is not the absence of technique. It is a disciplined act of remaining.

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Other essays in this 12-part series

• Part 1: Some Traumas Are Forever Some traumas are forever
• Robert E. Feinstein, MD
  
  Professor of Clinical Psychiatry, Zucker School of Medicine at Hofstra/Northwell
  
  Psychiatrist, Psychoanalyst, Educator, and Supervisor Contact: Feinster@RobFeinsteinMD.com

Owner & Founder Empathian LLC ( An Online Mental Health Education Company) Empathian.com

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