SARA ~ An Unforgivable Mistake

by Martha Stark, MD / Faculty, Harvard Medical School

I have been seeing Sara, an extremely gifted 55-year-old therapist, four times a week for the past five years.


Five years ago, at the very beginning of our work together, I said something to Sara that made her feel I did not want to work with her.  (I apologize for not being able to share with you the specifics of what I actually said, but Sara asked me, please, not to.  She did, however, give me permission to share with you what follows.) 


Sara considers what I said to her in our third session those five years ago to have been a mistake for which she will never be able to forgive me, although she wishes desperately that she could. 


At the time, I was horrified that Sara would have so misunderstood what I was saying; but, given what I have since come to know about her, I can now appreciate why what I said was indeed deeply hurtful to her. 


Over the course of our years together, Sara has spent much time trying to decide whether or not she feels safe enough to continue our work.  But, because of the unforgivable mistake that I made those five years ago, she fears she may never be able to trust me.


Although periodically I have attempted to clarify (rather defensively I'm sure) what I had thought I was trying to say in our third session those five years ago, understandably Sara has not been all that interested in listening and has held fast to her experience of me as untrustworthy and of the therapy as a place that is not safe – certainly not safe enough to bring her despair, her heartbreak, her loneliness, or her tears. 


Over time, what Sara and I have come to understand about our dynamic is that we have unwittingly recreated, between us, the mutually torturing relationship that she had with her toxic mother.  At times, Sara is her bad mother and I am Sara who, as a little girl, was tormented by her double-binding mother.  At other times, it is I who am her bad mother and Sara who is tormented by me as she was once tormented by her mother. 


In my work with Sara, it has been extremely important to her that I be able to confirm her experience of things – not just that I validate her perceptions as plausible constructions of reality (Hoffman 1983) but that I actually confirm them.  In other words, Sara needs me to agree that her reality is the truth.  Otherwise, she begins to feel crazy. 


Almost without fail I have been able to confirm Sara's perceptions, most of which have seemed to me to be uncannily on target. 


Unfortunately, some of her uncannily accurate perceptions have been about me.  Although it is more difficult when the focus is on me and my vulnerabilities, ultimately (with the one exception to which I have already made reference) I have been able – and willing – to confirm these perceptions as well. 


As an example of how Sara will zero in on me:  When recently she came to a session and asked to schedule a number of extra sessions, I was obviously very pleased (I actually said something to the effect of "Yes!  Yes!  Yes!").  Indeed, it meant a great deal to me that she would want the extra time, particularly in light of her experience of me as having failed her so unforgivably early-on in our relationship.


So we scheduled the extra sessions and then I said, gently, "You know that I am so pleased to be scheduling the additional appointments, but it occurs to me that I should be asking you how you feel about having these extra sessions." 


Sara did not answer for a long time.  After what seemed like an eternity to me, she said finally, and with much sadness, that she was now not sure the extra sessions were such a good idea after all, because she was suddenly feeling that maybe I did not really want her to be coming for the additional appointments.


Although I was initially stunned by her response, in time she helped me to understand something that I had not previously understood, namely, that by asking Sara to share with me how she felt about having the extra sessions, I was, in a way, humiliating her.  Obviously she would not have asked for this extra time if a part of her had not wanted the additional contact with me.  So for me to now ask of her that she admit to wanting more time with me was to shame her for having desire in relation to me.  Indeed, had I, in advance, thought more about my somewhat formulaic question, then I would probably have known not to ask it. 


What I now understood was that in asking of her that she tell me how she was feeling about getting the extra time, I really was more going by the book than coming from my heart.  You see, I had been taught that it is always important to explore whatever underlying expectations, hopes, and fears the patient might be having whenever she asks for something from her therapist.  So I really was more going by the book than by what I did – deep inside of me – know, namely, that despite Sara's deep reservations about me, a part of her was beginning to trust me a little more and was wanting me to know this without her having to say it right out.


Indeed, I came to see that Sara's experience of me as having shamed her was not just a story about her but also a story about me.  I was able to understand that I really was shaming her by asking of her that she acknowledge wanting to have the extra time with me. 


Sara has been a wonderful teacher – she has devoted considerable time and energy to teaching me to be a better therapist to her and, in all honesty, a better therapist period.  I am so much wiser for my time with her.  I am increasingly coming to see how often I will unconsciously fall back on going by the book instead of coming from my heart – not always in big ways, but in little ways (some of the rituals, some of the routines that I will find myself doing, without really thinking them through).  


Over the course of our five years together (four times a week), we have accomplished a lot – and, in Sara’s life on the outside, she has been able to make some fairly dramatic, and impressive, changes.


But there has been between us this ongoing issue that we have not yet been able to resolve, namely, what to do with respect to the unforgivable mistake I made those numbers of years ago – about which I feel absolutely terrible and for which I have apologized many times over from the bottom of my soul. 


Periodically Sara will turn to me and ask, point-blank, that I confirm her perception of me as having failed her unforgivably in that third session those five years ago.  And, over the years, she has made it very clear that were I to confirm that perception, she would have no choice but to terminate her treatment with me.  On the other hand, when I do not confirm that perception, she feels she has no choice but to continue to feel unsafe, desperately disappointed, and angry.


When Sara and I get into this place, as we have so many times over the course of our years together, my mind almost snaps from the pressure of how crazy-making the whole thing is.  Sara, by asking of me that I confirm her perception of me as untrustworthy and of my early-on mistake as unforgivable, puts me in an untenable position.  But by the same token, I, by wishing deep within myself that Sara would someday both trust me and forgive me, put Sara in an untenable position.  Sara asks of me something that I cannot possibly do; but then I ask of her something that she cannot possibly do. 


It is indeed agony for us both, yes – but it is also telling, telling us a great deal about the toxic relationship that she had with her mother.  And I believe we are doing the work that needs to be done, namely, attempting to negotiate our way through and out of this convoluted, mutually torturing, hopelessly enmeshed relationship that is, in actual fact, a recreation of the double-binding, no-win relationship that she had with her mother.  It is a mutual enactment – in which both of us are participating. 


But by way of the drama that is being re-enacted between us, Sara is enabling me to experience, firsthand, what the experience must have been like for her in relation to her mother.  We will need someday to find our way out of this Catch-22 situation – but, for now, we must both sit with the uncertainty of not knowing what will ultimately unfold. 


The other day, however, something different did happen.  Sara was once again begging me to admit that what I had said to her those numbers of years earlier was unforgivable.  As I listened, I found myself feeling so sad, so trapped, so anguished, and so tormented that I suddenly burst into tears.  I rested my head in my hands and just sobbed.  Sara sat there very still, barely breathing, watching, waiting.  Eventually I stopped, and we continued our talking.  This time I knew not to ask her the pat question, "How was it for you, my crying?"


Later in the session, however, I think Sara did show me what it must have been like for her.  She herself began to cry – she put her head in her hands and wept.  Now it was I who sat there, very still, barely breathing, watching, waiting.  But what made it particularly poignant for me was my knowing that she – as an adult – had never before cried in front of anyone. 


Our work continues.