Oftentimes patients wonder what their therapist is thinking about during their session. Presumably it is not about what they need to pick up from the grocery on the way home. A therapist attends to several different kinds of information, or “data,” that a patient presents during the therapy hour. Broadly, there are two categories of such data. One is called the “content,” or what a person actually talks about, such as how incredible the latest episode of Game of Thrones was, or how they almost applied for a new job, how nervous they felt during the past week, or how they just can’t quit smoking. But the other category is much harder to discern, and a trained therapist does his or her best to be sensitive to things in this category, known as the “process.” By process, I mean the way a person brings things up, what they decide to tell the therapist and what they decide to keep to themselves. Or maybe it’s the unarticulated connection between topics, or the common theme that emerges from the various stories a patient tells. Oftentimes, the most significant work takes place in a session where a therapist accurately perceives the “process” that a patient is bringing into the session and then interacts with the patient from within that process. And that “process” usually holds the key to what is really bothering the patient and what would be most helpful to discuss.

For example, a patient who came late to the session after being held up late at work and then stuck in terrible traffic was exceedingly apologetic when she arrived. She then recounted three seemingly unrelated stories of how bad her day was: in one, an ex-boyfriend calls her to ask about a rumor that she hadn’t heard before that was being spread about their breakup which makes him look very bad, in another she describes a very abrasive person she works with who was complaining incessantly to her about a different co-worker’s mistakes, and in the third, she tells me about her sister “freaking out” to her about their brother-in-law badly scheduling an event which inconveniences his spouse, their other sister. She ties the three together by saying simply that it was a very hard hearing all these things, she actually became nauseous, and it was very frustrating day. However, when paying attention to the “process” as well, I take notice of a common theme amongst the stories: that she became panicked in listening to these people, feeling responsible to quickly quell and fix their emotional distress, and felt at a loss to do so. She couldn’t let the other person’s problems remain their own. This further tied into how nervous and apologetic she was in coming late and was worried how inconvenienced I might be as a result. This is actually a core issue for her: her feeling responsible for everyone else’s troubles. She carries the weight of the world on her shoulders, and it overwhelms her. In a future session, perhaps I would further comment on another part of the process: is she also subliminally telling me that she wishes that I, likewise, would jump in and fix her problems when she tells me about them. And what wonderful growth would occur when, together, we observe the complex truth about life, that we are all ultimately responsible for our own problems. That is both frightening, but also liberating at the same time.

These three ordinary stories would express to a casual listener that one’s day was rough. But in therapy, these stories, unique in at least one common respect and brought together in a specific context, can launch an impactful exploration of the way a person wants, but cannot afford, to go on being… and lead the way to change.