Relationship important part of effective therapy

She tells her story, and it's my job to listen to the telling. It's an awful story. Betrayal, injustice, abuse of power, exploitation -- it's not easy to listen.

Listening trips alarm systems in my body. My brain begins dumping chemicals into my bloodstream, changing the way I breathe. There's a pre-emptive readiness in my musculature that I experience as tension. I feel anger and sadness, both vying for center stage of my attention. Competing fantasies include weeping, stepping outside to scream, sending her perpetrator a letter bomb and pouring us both shots of expensive bourbon. Right here in the office. Right here in session.

The latter fantasy explains why I don't keep expensive hooch in my office.

She finishes the ugly tale. I lean forward with my most sincere Father Flannigan face and say in soothing intonations, "Take the deepest breath you can." She looks up, smiles a tender, peaceful, beautiful smile and says, "I'm really OK." To which I -- Steven Kalas, Caped Crusader, Action Counselor, Man of the Hour -- respond spontaneously and without a moment's thought, "You're right, it's me who needs to take a deep breath."

In the next moment, we both erupt in gales of laughter, both buffeted by the physical force of the irony ricocheting off the walls. It's a cleansing irony. She ceremoniously hands me the Kleenex box and says, in caricature, "Would you like to talk about it?" I shrug and say: "I don't know. How much do you charge?" And we laugh some more.

It doesn't get any more real and honest than that. When I'm old and long-retired, I will remember that moment in my career. I will never stop sharing that story with interns and practicum students whose desire it is to learn this craft called Talk Therapy.

News flash for aspiring therapists: The idea that quality therapy is delivered to people in sheer objectivity and muted detachment is ... well ... absolute crap. Blank slate? Yeah, right. Run away screaming from any therapist who tells you they have no opinions, no prejudices and who seems deliberately wooden and removed from the interaction. It is not my job to be free of bias (as if that were possible), rather, to know my biases to the end that my bias does not intrude, interfere, countermand or impede.

Quality therapy is delivered in the context of a therapeutic relationship! Key word: relationship! Therapeutic benefit emerges -- literally -- in and proceeding out of the relationship. It is not a relationship of unilateral trust, rather, of mutual trust. It is a deep-seated sense of partnership. Even very sick people bring strengths to the table that have seen them through rough times. I notice these things, admire them and even learn from them.

A veteran therapist friend tells a simple yet powerful story about working with a patient who'd been sexually abused by several males in her family:

"She wailed, 'Why Me?!' It was voiced as a demand. She wanted an answer. And, of course, she feared she did something to deserve it. I simply answered, 'The luck of the draw.' She stared at me a moment, then shrieked: 'The luck of the draw? That's your answer?' I nodded and said: 'Yup. You did nothing to deserve it and, as far as I know, God doesn't get pissed off at little kids and decide to punish them by giving them evil relatives who abuse them. To me that means it's just the luck of the draw.' After staring at me several seconds, she burst out laughing and I joined her. She left that session, smiling, shaking her head and marveling, 'The luck of the draw.' I might say that I'd come to this conclusion some time before about my own experiences."

See, a therapist focused on textbooks and technique might have answered, all sincere and philosophical: "I don't know. Why do you think this happened to you?" But patients deserve more than a Human Echo Chamber. They deserve more than nodding, staring and "Mmm." They need human reparative interaction.

Another veteran therapist tells this story:

"I once treated a developmentally disabled teen, hospitalized for childhood schizophrenia. He did very, very well, and at the time we terminated therapy asked me, 'You know why this worked so well, doctor?' I said, 'No, why?' He smiled and said, 'Because you respected me and I respected you.' "

Well, yeah. Of course.

With all respect to the practitioner's training and expertise, maybe the heartbeat of effective therapy is 50 minutes of acutely focused, directed, authentically present and respectful human relationship.

Steven Kalas is a behavioral health consultant and counselor at Las Vegas Psychiatry and the author of "Human Matters: Wise and Witty Counsel on Relationships, Parenting, Grief and Doing the Right Thing" (Stephens Press). His columns appear on Sundays. Contact him at 227-4165 or skalas@ reviewjournal.com.