I admit it. I once spent an hour holding hands with a 26-year-old female client, sitting alone in her room. Actually, the appointment ran over; closer to two hours. We spent most of the time looking into each other's eyes, exchanging hushed words every few minutes. I struggled internally and uncomfortably for part of the time, wondering if this interaction constituted a professional relationship. Finally, I stopped fretting and decided that being there just felt right.

Karen had cystic fibrosis (CF), with severe pulmonary disease. The self-referral surprised me. I'd consulted to the CF treatment team for almost a decade and knew about her through case-review presentations at clinic rounds, but she'd never wanted to chat with the "psych consultant" before. When I knocked at the door of her private hospital room, she sat propped up in bed with the ceiling lights dimmed and window shades drawn. I introduced myself, while pulling a chair up to her bedside and asked, "How can I help?"

'Don't let go'

As I sat down, she gripped my left hand tightly and tensely blurted out, "Don't let go!"

Karen's 5-foot-6-inch frame had shrunk to 85 pounds, a consequence of the malabsorption that accompanied her condition. A transparent mask held against her face by a thin green strap provided the maximum permissible flow of oxygen to her severely damaged lungs, but could not fully satisfy her body's urgent need.

Every 15 to 20 minutes she broke into a bout of raspy coughing that usually ended with hemoptysis, spitting a few teaspoons of bright red blood in a bedside basin. She needed several breaths of oxygen amid the frequent coughing to give voice to each sentence. The high levels of carbon dioxide in her blood created a frightening sense of air hunger and anxiety bordering on panic.

No evidence-based treatment manuals could have prepared me for that encounter. Karen had no psychopathology. Relaxation training, hypnosis, CBT, EMDR, forget about it! Lonely and terrified by the symptoms modern medicine could no longer keep at bay, Karen wanted human contact. In a moment of intense emotional intimacy, she asked me, a relative stranger, how she could tell her parents that she no longer had the will to keep fighting for her life.

The power of empathy

Solid advances in psychological science have given us powerful tools to treat all manner of psychopathology and human distress. Considerable recent professional debate has focused on the importance of investigating, teaching and applying empirically based techniques. Such debate has directed us to rely chiefly on well-validated evidence as we assess and intervene professionally with our clients.

I agree these are worthy activities and important aspirations. At the same time, I often find myself considering the distinction between performing psychotherapy and engaging in behaviors that seem likely to have psychologically beneficial effects. Many studies have taught us that empathy, the ability to form an emotional connection, and forging an alliance with the client will create a far stronger foundation for change and quality of life than any treatment manual validated by a plethora of randomized clinical trials.

I hope that in the constant quest to improve our science and validate our techniques we do not lose our understanding of just how important fundamental human connections become in advancing the quality of our clients' lives and our own.

A five-word note that spoke volumes

Karen and I passed the time talking about how she could best communicate several important things she wanted to say to her parents about the 26 years they'd shared together. She had an intravenous line in place, and told me that she planned to ask her pulmonologist to start a "morphine drip," knowing that it would both reduce her discomfort and suppress her respirations, quietly ending her life in the course of a few hours. She hoped her parents would understand. I held her hand until her parents arrived. She died later that evening.

At her funeral a few days later, Karen's parents handed me a note she had written on a strip of cardboard she had torn from a bedside tissue box after I'd left. It read simply, "Thank you for being there."