Cover Story

Many therapists aim to elicit revelations from their clients-moments of clarity with the power to transform clients' lives by illuminating the thoughts, feelings and experiences that shape their behavior. But what happens when the revelation is the therapist's own? Sometimes, interactions with clients-dramatic and profound, or small but meaningful-change the way psychologists practice.

The practitioners below have all had moments like these. Some epiphanies inspired them to incorporate new methods into their practices, other moments provided insight that they have used and expanded on ever since.

Picture this

Alan Entin, PhD, has always enjoyed photography, but it never occurred to him to use it in his practice until he was faced with a particularly difficult case of marital discord about 20 years ago. The couple was in their late 20s and had been married a year.

"They were experiencing severe marital conflicts resulting in distance and a lack of intimacy, and headed toward a divorce," he recalls. Interestingly, this was the second marriage for both, though they were former college sweethearts. Entin wondered how that first relationship and subsequent break up might be related to a recurrent theme in their present day relationship-their lack of emotional involvement with each other. Had their relationship always been this distant? As an experiment, Entin asked them to bring in some wedding photos and some photos from their college days. The couple provided a photo from a college dance, showing them dressed up and posed-looking not at each other, but away.

"Their expressions were bland and emotionless," says Entin. "They did not look like they were connecting with each other-perhaps regretting they were there."

The wedding photos revealed even more detail about the couple's relationship. In a series taken of the newlyweds proceeding up a set of stairs to start their honeymoon, the couple smiled eagerly on the bottom step, explains Entin. But as they drew closer to the top the groom started to pull away, leaving the wife to, in effect, drag him upstairs. The photos-combined with his conversations with the couple-gave Entin an important insight. The wife wanted closeness and intimacy, and her husband responded by pulling away, he explains. As the therapist talked more with the couple, it became clear that this was a persistent pattern in the relationship.

This particular case showed Entin how powerful photos can be in therapy, both as a tool to spark interpersonal interactions, but also as a method for revealing the past. He went on to develop an approach for looking at family photos using the Bowen family system theory, and uses photos in his practice to this day.

Mirror, mirror

While photos can provide a mirror, Bonnie Markham, PhD, PsyD, attempted to be one herself.

"My training is largely psychodynamic. In my interactions with patients, I believed that I should function as a mirror, a blank screen," she says. However, about 10 years ago, Markham was working with a graduate student who was having trouble with his thesis due to debilitating writer's block-so debilitating that he sometimes had suicidal thoughts.

"One day he was talking about his struggles and I spontaneously mentioned that when I was writing my dissertation in social psychology I had a period of depression and I could hardly get out of bed for the good part of one summer," continues Markham. After the session, Markham panicked, thinking that she'd somehow come across as inappropriate or unprofessional. However, in her next session with the client, he thanked her for sharing her experience. Realizing that Markham-someone who completed two doctoral degrees-had also struggled with depression and was not ashamed to admit it helped him deal with his own depression. He had even made some progress on his thesis.

Markham recently was visited by her former patient. He told her that a major turning point for him was when she had revealed her own depression. As a result of this experience, Markham has brought more of herself to her practice, she says.

"My experiences have allowed me to use my assessment of the patient and my clinical judgment to decide when, what and how much to reveal, rather than assuming that blankness across-the-board is a helpful stance."

A matter of perspective

Learning when not to let experience color her assessment of a patient is something Jana Martin, PhD, learned early in her career.

She worked in the adolescent unit of a state psychiatric hospital with severely disturbed youth, including some who had committed terrible crimes.

It was a hard place to practice, she acknowledges, because the outlook for many of the patients was so bleak.

After about 18 months on the job, she began practicing in a community health center on the weekends. "My first session was with parents who were concerned about their son," she remembers. "They talked about how the son wouldn't make up the bed, wouldn't take his plates to the sink, didn't listen and just wasn't motivated in school."

Martin is not proud to admit what her immediate inner response was. "I thought-what are you doing here? You don't have any problems!" Horrified by her initial response, she realized that her benchmark for adolescent problems had become skewed.

"Sometimes when we deal with the extremes of human difficulties, we can become immune to the impact of other behaviors," she explains. "It's important to see presenting problems in the context of a continuum." It was a powerful lesson for Martin, one that she tries to keep foremost in her mind and practice: "Every client's needs are unique and warrant an understanding of that client's perspective and experience."