I’d just finished a family session one October morning when my emergency line rang. The faint voice of one of my long-term patients croaked, “Dr. Deitz. Please. I need help.”
It was Lauren, a 43-year old woman I had been treating for years with medication and psychotherapy. Stable for several years, she and I met monthly to monitor her medication and discuss her marriage and children. She rarely called between sessions.
“Lauren? I can barely hear you,” I said. “What is it?”
“Can you fit me in today?” she asked.
Lauren and I had been through difficult times: her first depressive episode as a 28-year-old, which led to the diagnosis of bipolar disorder; a disabling postpartum depression two years later when her first child Sarah was born; Sarah’s leukemia at age 5, when Lauren spent her nights maniacally scouring the Internet for experimental treatments.
“What’s happening?” I asked.
“Remember that my sister and I are rowing the big race in Boston this weekend? I can barely get out of bed. If I back out now, she’ll never speak to me again.” Rigorous exercise and a strong attachment to her sisters were Lauren’s major coping strategies. “Maybe you can adjust my medicine.”
Lauren arrived that afternoon looking like a ghost in a white sweatsuit, her face as taut as a clothesline. “I don’t know what happened,” she began when I asked what happened. “I felt fine when I left here two weeks ago. And now this,” she said dejectedly. “I got depressed for no reason.”
“No reason?” I questioned, remembering times when Lauren’s moods fluctuated viciously in reaction to stresses of which she was unaware.
“Nothing I can think of,” she said.
“Are you sure?” She shook her head.
“Really sure?” I pressed hard.
“Well, there was this one thing,” Lauren said, and related a conversation the previous weekend where a pushy woman she barely knew lectured her about raising teenagers. The more Lauren talked about that encounter, the more energized she became. She literally perked up in front of me, like a drooping plant that’s been wilting without water.
“This is what she said,” Lauren mimicked the woman’s fire-and-brimstone preachiness and fingerpointing. “‘You’ll see what a handful Sarah will be once she hits puberty. My daughter didn’t want anything to do with me for years. She still treats me like a stranger.’”
“So, something did happen,” I said. “How did that woman’s statement affect you?”
Lauren began to weep, then sob, as if Sarah had died. “I can’t bear the thought of losing her. We’re so close. The idea Sarah won’t want anything to do with me is overwhelming.”
“Did the woman have a degree in child development?” I asked, somewhat indignantly.
“I don’t know.” Lauren’s forehead relaxed a smidgen.
“She didn’t evaluate Sarah formally, did she?”
“No.” Lauren’s cheeks colored and her eyes began to twinkle like they did when something got through to her. “She wasn’t a therapist.”
“She couldn’t be,” I said stridently. “Besides, what kind of person dumps such a load of garbage on someone she hardly knows? Imagine being that woman’s child. I wouldn’t talk with her either!”
Lauren started to laugh.
“As for Sarah,” I said. “Let’s not jump to conclusions. I’ve seen you two lots of times in the waiting room. Not that adolescence is a Sunday stroll, but I think the two of you will do just fine.”
“You really think so?” Lauren asked.
“I never looked at it that way,” Lauren grinned, the tension in her neck and shoulders melting away.
“Do you still think we should change your medication?” I asked.
“No. I’m going to Boston. I’ll let you know how it went.”
Lauren called the following Monday. “It was great,” she said. “Until we talked, I had no idea how much that woman upset me.”
In retrospect, all I did was use humor, empathy and conviction to present Lauren with a different perspective. I helped Lauren become aware of her powerful, unconscious reaction to the pushy woman, which I reframed while playfully confronting Lauren’s tendency to idealize authority figures, an aspect of her personality I had come to appreciate over the years.
Lauren’s brisk response confirms how social interactions, including psychotherapy, turn on brain circuits instantaneously. Humans are wired to connect. Neurons in the premotor cortex and the somatosensory cortex — mirror neurons, as they’re known –fire in synchrony with others’ behavior and feelings. Think of how refreshing it feels for the depressed person, whose negativism colors their thoughts to be with an optimistic, yet not Pollyanna-ish therapist who says something that immediately enhances one’s mood.
Unlike medications for depression, which take weeks to become effective and work at the level of synapses between nerve cells, psychotherapy activates mirror neurons and brain circuits directly.
Of course no one would argue that therapy alone is the cure-all for bipolar disorder, or that one single psychotherapeutic encounter permanently alters brain chemistry; however, since I had known Lauren for years, I could reach her in a way no medicine could. Let’s never forget that psychotherapy is powerful medicine.
Therapy session photo available from Shutterstock