by Martha Stark, MD / Faculty, Harvard Medical School


Several years into my work with a patient whom I was seeing three times a week, the following occurred.  One Saturday morning around 9 am, Melinda (who had never before called me between sessions) left a message on my machine, in which she said that she really wanted to speak with me – if I could get back to her at some point within the next three hours. 


As it happens, I did not pick up her message until Saturday afternoon.  I tried then, and numerous other times over the course of the weekend, to reach her at the number she had given me (as well as at her home number) – but to no avail. 


When I saw her for our regularly scheduled appointment on Monday, she told me that she had called me because something important had come up for her that she had wanted very much to talk to me about – but that she had intentionally placed the time limit (of 12 noon on Saturday) because if I could not get back to her by then, she did not want to bother me during my weekend. 


These years later, I do not remember the specifics of what prompted her to call, but what I do still remember was my upset and my anger that she would have made it so difficult for me to come through for her – which had been the story of our three-year relationship to that point.  When I had received her urgent call, I had been deeply touched that she would have let herself reach out to me – and I found myself wanting very much to be there for her.  Indeed, she had been very much on my mind the entire weekend. 


And, yes, of course I knew that, with respect to the time limit she had imposed, she had done the best that she could – that it was very deeply a part of who she was that she would have needed not to presume upon anyone.


Even so, I was upset and angry that she had made it so hard for me to reach her.  During our session on Monday, I remember pounding my fist on the arm of my chair and, in my frustration, practically shouting at her, "How could you not know that of course I would have wanted to be able to respond to your call?" 


She looked at me in surprise – partly, I’m sure, because of my somewhat uncharacteristic outburst and, partly, I believe, because I had caught her attention with what I was saying.  Her response to my little meltdown was that she was truly amazed that it would have mattered to me that I be able to get back to her.  She then began to cry softly because now, she said, she understood – in a way that she had never before understood – that I really did care about her.


I offer the above in order to demonstrate the power of the therapist's willingness to go out on a limb in order to make contact, even if it involves letting the patient see that the therapist is vulnerable and that something the patient has done has had an impact.  Yes, and even if it involves making a bit of a fool of yourself.


More generally, letting a patient see that she has had an impact empowers the patient; it enables her to know that she can affect someone.


I think that my reaction (particularly the pounding of my fist and my raised voice) was somewhat inappropriate for the occasion; but it was heartfelt and it was authentic.  And I think my patient understood that.  Furthermore, I think that it both enabled my patient to experience just how deeply committed I was to her and highlighted the extent to which she had never really been able to register, internally, the fact of my love for her.