Keys to the Work in Therapy

A beautiful sunrise

What makes a difference in therapy will often come as a surprise.


From time to precious time, I am startled to discover that something simple I have said to a patient, perhaps even in passing, has had a memorable and helpful impact.

Recalling my own personal psychoanalysis, one most meaningful experience was not a carefully crafted insight, but a comment that my analyst made early in our work together. He could not have known at the time all that it meant to me when he said, simply, “I’ll see it through with you.”

I, who believed that I was too much for my parents, had found a grownup, kind, and intelligent helper for whom I was not too much. That he could imagine that the deep misery of my life could be seen to its end; that he was committed to seeing it through with me; and that he could foresee that we would work it out together. What more could I possibly wish for?

When such a fortuitous event occurs in therapy, it presents a particularly useful opportunity to identify and to explore the patient’s focused difficulties. The instance of “I’ll see it through with you” was the first opening into the complex matter of my belief that I was too much for my parents.

In my work with my patients, occasionally one will describe an experience of meeting a particular life challenge with the sense of me sitting on his or her shoulder — an ally in whatever may be at hand. To earn such a place, I will have had to prove the safety of being let in. Such safety is the consequence of demonstrating respect for the self of the person. Such respect is, in turn, the consequence of listening carefully to the patient … and of being a source of true reflection of the patient’s experience.

By knowing my patient’s experience, I help the patient to know him/herself — to believe the truth of his/her experience. This is the foundation for all of our work — the truth of one’s experience.

Being there for my patient parallels the relationship I had with my mentor, Dr. Elvin Semrad — who sits figuratively on many shoulders, helping us to help our patients to bear the thoughts and feelings that are too much to bear alone.


Rako, S, & Mazer, H. (2003). Semrad: The Heart of a Therapist. iUniverse.