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A few prefaces before we get into this conversation.
As macabre and strange as it is to say, some of my favorite work, or maybe better, the work I find most meaningful and most representative of why I got into this field (and I suspect that’s true for many of us who chose it), is sitting with people who have lived through traumatic loss, violence, and tragedy. It never gets easier to sit in those rooms. But it is some of the most honest and fundamental work I know.
By honest I mean that in these rooms it is very hard to sugarcoat anything. The strategies are all there, and they are rampant: the distancing, the avoiding, the denying, the rejecting, in the client and in us. But none of them can change the floor. The bottom of the case is as deep as a case can possibly go. There is no reframe for these things. There is no interweave for a day that happened. So whatever the two of you manage to build in that room, you are building it on the actual ground, and that is a rarer condition in therapy than we like to admit. Most of our work has somewhere to hide. This work doesn’t.
Back in the second essay, we named something we haven’t come back to in a while. In that essay, we talked about how the person of the therapist is the instrument of the work, and that presencing is the practice that makes the instrument usable. From that point on, we’ve talked about turning toward our craft: how presencing is cultivated, how it collapses under the therapist’s own not enough, and how it gets restored in the middle of a hard session, when it matters most. The third essay said the collapse is readable in the body, that a voice thinning as the client nears the unspeakable thing is information about the field. Jen wrote about the ghosts of supervisors that arrive the moment a therapist becomes visible. The Second Mirror ended on the discipline of staying when the kind-looking thing would be to dim.
But in every one of those is a collapse toward absence. The still face. The flinch. The quiet retreat into procedure. They are the failures our training warned us about, and we can at least recognize them when they come.
There is another collapse, and I suspect it is the more common one among people who read essays like this. It doesn’t look like absence. It looks like competence. The therapist, uncertain, reaches for an understanding, and the understanding is good, and it is even true, and somewhere in the reaching the person has been quietly replaced by the map of them. This is a common shortsightedness of those of us who obsess over case conceptualization (perhaps we’re guilty of this more than most here at Beyond Healing). This is the collapse the rest of the essay is about. The example is my own, from the kind of work where I think it happens most.
Why grief
If I had to name the one place where the relational thread matters most and is often hardest to keep hold of, I would name traumatic loss.
Most of what this series has argued rests on a mechanism: an old prediction gets reactivated, meets a lived experience that contradicts it, and rewrites. The room is well suited for supplying the contradiction. Someone braces for withdrawal and finds you still there, and something learns. But grief has a property that makes that whole account harder to hold onto. The obvious and most central aspect of the trauma does not have a contradiction. In traumatic loss, the person is dead. There is no experience you can supply, in any room, on any Tuesday, that violates the prediction they are gone, because the prediction is correct.
So the thing we were trained to do with a target, bring it online and let it meet something new, runs into a wall that is not a stuck point and not a feeder memory and not a question of preparation. It is the actual shape of the loss. And I think that wall does something specific to the therapist. It makes the feeling of not enough structural. In most trauma work you can at least believe, on a good day, that the work is working. In the first weeks or even months of a traumatic loss, there is nothing to work. There is a person, and an absence, and you.
That is exactly the condition under which the therapeutic relationship is the only thing we have to offer, which is why I think this is where the thread matters most. Grief, as far as I can tell, is relational learning: a person has to learn, across thousands of ordinary moments, that the world no longer contains someone it was built around. The learning cannot be taught. It can only be accompanied. And accompaniment is the thing we are, or are not, able to be.
It is also, I think, where the thread is hardest to hold, and the reasons are sometimes hard to look at. Grief theory is rich. The literature on attachment and loss, on meaning reconstruction, on continuing bonds, on the phenomenology of a world that has stopped making sense, is some of the most beautiful writing our field has produced. It gives a therapist a great deal to understand. And understanding is a very comfortable place to stand when you are sitting across from something you cannot fix.
So the collapse I’m describing has a natural habitat. The therapist who would never go still, who would never retreat into a protocol, who has read everything and feels all of it, has one more place to go when the room becomes unbearable. They can go into what they know.
A disclaimer on the content before the case, because it is one of the most dreadful scenes in human experience: what follows concerns a parent’s loss of a child to suicide. I’ve sat with several families through this over the years, so take it at your own pace. This is a composite case made up of the experiences I’ve had sitting in those rooms and it contains aspects of all of them. While each is unbearably unique, there are common mechanisms and functions that I’ve noticed, and I’m going to describe them in this essay.
The binder
Cicely brought a binder to the first session, about eight years ago now.
Not a folder. A binder, the three-inch kind, with tabbed dividers and a label on the spine, and she carried it into my office the way you carry something that could spill. It held the day her son died. The timeline. The school’s sign-out log, the text messages printed, the phone records with remembered portions of those conversations transcribed, a map of the house with the rooms marked, official statements where she had been able to get them, and photographs, not the kind you want to look at. And running through all of it, in the margins and on inserted pages, a second document: every place the day could have gone differently if she had just. If she had just kept him at school. If she had just called the house. If she had just.
She was an epidemiologist by training, and the binder was built like it. It was, I think, the most rigorous piece of work I have ever had handed to me, and before I understood anything else about her I understood that she had done it alone.
Then she did something I don’t think I’ll ever forget. She held it out toward me, across the space between the chairs, and she said: this is my son.
What the paper does
The things I did with Cicely are the same things I would do again, and I would not hand any of them back.
I have come to use two constructs as objects in working with traumatic loss.
The first is a coin. Its face represents what happened: the event, the loss itself, the thing that would go on a target list. Turn it over and the reverse is what did not happen that was needed. The comfort that didn’t come. The person who wasn’t there. The being-believed that never arrived. Run your thumb around the edge of the coin and you have what can no longer happen in the form it was supposed to: the conversation that won’t be had, the future that was built on someone who is gone. Three facets of one experience, kept distinguishable while they are held together.
The second, I call the totem. A totem is an object that carries more meaning than it shows, and in grief work it is our name for whatever the lost person, or the painful response to losing them, is still holding up inside the bereaved person’s world. Robert Stolorow called the things it holds up the absolutisms of everyday life: the assurances so taken for granted they were never once stated as propositions or as if reality could unfold in any other way. A light left on means someone is coming home. A sound in the hall belongs to a person. Later means a room you will be in together. Trauma, Stolorow writes, is what happens when those assurances shatter, and I have come to think grief is the slow discovery of how many of them there were.
And then there is a piece of paper, which is older in me than either the coin or the totem, that I use with nearly everyone whose loss was violent or sudden. It’s a plain sheet. In the top left I write me. Bottom left, mine. Top right, not me. Bottom right, not mine. Philip Bromberg has a phrase for the territory those four words try to map, me and not-me, and his argument is that a coherent self is not one that has eliminated the not-me but one that can stand in the spaces between its own states without falling through. So I say something like: in a reasonably integrated internal working model, we can keep these four regions roughly sorted, and so our experience of reality stays roughly sorted. What is mine to carry. What was done to me. What was never mine. Who I am, and who I am not.
Then I crumple the paper into a ball.
In trauma, I say, it’s more like this. The four regions are smashed together. What’s mine and what’s not mine are folded into each other, and you can’t read the labels anymore because they’re pressed against each other on the inside of the ball. Then I flatten it back out on the table with the heel of my hand, and I let them look at it. We can press it flat. We can work it. But then we realize, together, that it will never again be the white sheet it was before. It keeps its creases. The work was never about getting the paper back. It’s about learning to read it.
Every piece of that is good clinical work, and I believe in it, and I did all of it with Cicely. The coin on the whiteboard. The totem, eventually. The crumpled sheet, early, when she had been reading from the binder for most of an hour and I wanted to give her something to hold besides it.
But none of it is what I would now say she needed first.
What the binder was holding up
Here is what I think the binder was. It is my hypothesis and not hers; she never endorsed it, and she left before she could.
The binder kept the day open. As long as the sequence could still be reconstructed, as long as one more record might be obtained and one more branch of if-she-had-just might be traced, the death was not yet a fact. It was an investigation. And an investigation has a function a fact does not: someone is still working on it. Her son was, in the only way left to her, still being attended to. Every page was a form of keeping watch.
It did something else, too. Every if I had just is a terrible sentence to carry. It is also, if you turn it over, a sentence that preserves a world. If the day could have gone differently had she acted, then the day was governable. Mothers can keep sons safe. Vigilance works. The alternative to that sentence is not relief. The alternative is a world in which she did everything a loving parent does and it was not enough, which is a world in which no one can be kept safe by anyone, which is not a world a person can simply decide to move into because a therapist has pointed out that the facts don’t support self-blame.
So the self-blame was holding something up. The binder was the totem, in about as literal a form as I have ever encountered one, and I could see it by the end of the first session.
That is where this story turns on me.
This is my son
This is what I did, not what you should do.
A mother is holding out a binder and telling me it is her son. Somewhere in my chest there is the thing that happens when you are in the presence of a grief that size. And somewhere above it, faster, there is the other thing, the one I have spent nine essays warning you about in other people. I am understanding, or at least desperately trying to fit this experience into something that could be understood. I am already seeing the coin. I can see the face of it, the day, laid out in tabbed sections. I can see the reverse, the father who was supposed to be home. I can feel the edge coming, every future that had been built on him. And I can see, from my chair across from hers, with a clarity I would have been proud of in consultation, that what she is holding is a totem, and that the if I had just is keeping a world upright.
I did take the binder in my hands as she offered it across the carpet and coffee table. I’m not sure I could tell you now whether that was a decision, some customary obligation, or a compulsory movement my body reflexed into as my mind was racing. I didn’t say anything for what felt like an hour, after which I remember muttering how heavy it was, literally and figuratively, and how I could hardly imagine how difficult it had been to put together. All of which was true, and none of which was what she had said. She had not said this is my work. She had said this is my son, and she had extended him toward me with both hands, and the most precise thing I can say about what happened in me is that I met her son with a formulation.
Nobody watching would have seen a collapse. My face did not go still. My voice did not thin. I leaned in. If you had been grading me on presence that hour I would have passed, and that is exactly the problem, because presencing can fail in a direction the checklist can’t see. It fails when the therapist is fully in the room and the room has become the therapist’s understanding of the client rather than the client.
In The Two Channels I called the thing that makes that kind of work possible reciprocal dual attention: the client holds then and now, and the therapist holds a different pair, the enactment in front of them and the echo of it, in the client’s history and in their own. What I did with Cicely, I think, is let one of my timelines quietly eat the other. I stayed on the one where I understand. I lost the one where a woman I had met forty minutes earlier was handing me the only thing she had left of her child and watching my face to see what it would do.
The not enough is the whole point of this essay, so: why did I lose it? A mother whose son died is holding out a binder. What do you say? What could a person possibly be enough for, in that chair? My formulation was not vanity. It was the thing I reached for because I needed something to hold, and the coin is a very good thing to hold, and it let me stay in the room with something I could do.
That is the collapse into competence. It is made of the same not enough as the collapse into absence. It just dresses better.
The sentence
We did real work for six sessions, and I’d stand behind most of it.
By the second session the day was on my whiteboard. Not as a timeline; she already had one of those in a form more exhaustive than anything I could draw. As a coin. The face was hers, and I let it be. She corrected my sequence twice, and I corrected it the way she said. The reverse took longer, because the question it asks is a strange one for a person who has spent months asking only what happened: what did not happen that you needed? The father who was supposed to be home went there, and she could say so, which I don’t think she had said to anyone. So did something from afterward. The people who loved her had spoken about the day as if it were already settled, and she had needed one person to treat it as still open. Around the edge we put what would not happen now in the form it was supposed to. She added to that list in the car on the way home and brought the additions back, folded, in the front pocket of the binder.
We placed the day in time, too. Before it, a life built on the premise that if you look carefully enough you can see what is coming; she had made a career of exactly that, and a family. After it, the investigation, and the tables where other people’s eyes moved above her head. For the first time, she said, the day had edges. It was no longer the whole of her. She read from the binder less as the weeks went on. She still brought it.
Somewhere in the fifth session, I named the totem. I did it carefully. I had the preface ready, the one from The Two Channels about saying a thing in its sharpest form to see what it turns up. I said, more or less, that I wondered whether the binder was a way of keeping him here, and whether the if I had just might be playing an essential role for her, holding up a world in which he could have been saved, because the other world was unbearable. I said it slowly. I said it with my whole body in the chair.
It was a good sentence. It had been built, over five weeks, to be strong enough to point our work somewhere.
She came once more and then she stopped coming.
I didn’t know why at first. It would be the easiest thing in the world to make her leaving into proof that I had found the unbearable truth and she couldn’t face it, and that story is circular and it is about me. The formulation, its timing, the relationship, what she had wanted from therapy, what was happening at home, the logistics of a life that had just been detonated: all of those are possibilities, and the honest account is that I don’t get to choose among them. What I can say is that something I understood arrived in the room before the relationship could carry it, and that I had been so careful about the delivery that I never stopped to ask whether she had asked for it.
What I learned later
Some time after, in the way these things sometimes reach us, I learned what the binder had been at home.
Her husband had resented it. Not quietly. The binder had become a fixture of their marriage coming apart, and when he talked about the separation afterward, the binder was the thing he reached for to explain it. She worshipped that binder, he would say, so fucking much, like it could bring him back. She stopped caring about me a long time ago.
While this doesn’t fully explain why Cicely terminated services, it told me something about the room I had been sitting in, which I had not been able to see from inside it.
By the time Cicely carried the binder into my office, it had already been interpreted. The person closest to her had looked at the same object and told her what it meant. He said worship. He said it was a way of pretending her son could come back. He said it was proof she had stopped caring about the living. And then she came to a second room and held it out, and the person in that room looked at it with great care and, five weeks later, told her what it meant. I said totem. I said it was a way of keeping him here. I said it was holding up a world. I said all of it more gently than he did, with a better preface and a kinder voice, and I believed every word, and I believe most of them still.
But I think there is a version of her life in which two people who were supposed to hold her had, by the end, both explained her binder to her. One in contempt and one in care. And I’m not sure the difference was as large, from where she sat, as it was from where I did.
worn to cloth
Everything I’ve written so far is the view from my chair. The coin, the totem, the formulation, what I understood and when I understood it. That is the only voice I have for explaining, and it has a limit this essay keeps running into: there is no sentence of that kind that can get inside the binder. Explanation is what the husband did, and what I did. The only way I have found to go where she was is to stop explaining and watch a hand on a piece of paper.
The best way I’ve found to do that is to write about it, in symbols more than in narrative prose. That’s why I like poetry. It stays close to the table and the hour and the body, and it does not say what anything means. Read it the way you would sit with her, without needing it to resolve. The hand is hers. The sentence waiting in the air between the chairs is mine. The door at the end could be either of ours.
I did not write this then. I wrote it over years, in pieces, out of many rooms like the one I shared with Cicely; some lines are old and some are recent, and I’m not sure anymore which were hers. But I think it is my way of arriving at the thing I needed to see in that room and couldn’t yet. People are wanting to be held, and felt, for what they are working through. Not directed. At least not at first.
beneath the heel of a hand,
the day is smoothed.
the paper rises
where it has been folded.
again,
the heel of the hand,
a finger traced crease.
beyond the glass,
a faint backing chime.
a car door.
then another.
along the folds,
the fibers loosen.
months of opening
have worn the paper
nearly to cloth.
the date remains legible.
so does the hour.
around them,
the small weather
of being carried, handled, and held.
a deniable notion
as long as the paper holds.
after all,
how could it be?
a light left on
had meant
someone coming home.
a sound in the hall
had belonged
to a body.
later meant
a room
voices could be heard in.
beneath each ordinary act,
the world held together
without being asked.
now even the chair
must be trusted,
questioned,
doubted.
a palm flattens.
outward,
from the center.
again.
back past the fold.
past the first bending.
the white
before the ink.
a nail picks
at the stubborn ridge.
the fibers lift.
at other tables,
glances have passed
above the bowed head.
a mouth pulled sideways.
a laugh
kept almost
inside.
the paper folded smaller
after that.
carried close.
now opened
with both hands.
a corner eased free
as though something
might hurt.
then the heel again.
harder.
the latch within reach.
the telephone
not yet ringing.
one more look.
one hand
in the right place.
a sentence waits
in the air between chairs,
carefully made.
it, too,
has been built
to bear weight.
light crosses a sleeve.
outside,
keys finding a lock.
the afternoon continues
with terrible ease.
inside,
the paper is turned
and worked
from the other side.
somewhere, water runs
through the walls.
the clock advances.
at the fold,
a little daylight
comes through.
the hand stops.
one finger
beneath the thinning place.
the hour ends.
a key turns.
a bolt enters
its little pocket
in the wood.
the handle is tried.
then tried again.
on the table,
the crease slowly rises.
Three sheets of paper
I keep noticing that there are three pieces of paper in the room Cicely and I sat in, and I only taught her to read two of them.
The first is the binder, worn at the folds from months of opening, the date and the hour still legible. The second is the sheet I crumpled and flattened in front of her, the one we agreed would never go back to white. And the third is the sentence, carefully made, waiting in the air between the chairs. It, too, had been built to mean something. I had worked it the way she worked the binder, from both sides, past the fold, back toward some white before the ink where the understanding would be clean enough to hand over.
What I had missed is that the sentence was holding something up for me. It was my totem. It let me be the person who understood, in a room where understanding was the only form of enough on offer, and the alternative to it was to sit across from a mother with nothing in my hands but her son.
The Second Mirror said the mirror reflects, it doesn’t prescribe or sentence us to a way of being. I think that line was written by a therapist who had already learned this the hard way and hadn’t yet said where.
What restoration looks like when the map got ahead
So, how does presencing get restored, in the hour, when it collapsed in this direction? Not the flinch, which you can feel and soften out of. The knowing, which feels like doing the work.
I don’t have a procedure. I have a few things I’ve learned to do, and the first is the strangest, because it is almost nothing, and because it takes the longest.
When someone extends the totem, receive the person. I took the binder, and I would take it again. Both hands. What I would change is what came out of my mouth afterward. I told her it was heavy. I told her I couldn’t imagine putting it together. Both were true, and both were about the object. But to her, she had not handed me an object. The only sentence that answers this is my son is some version of: tell me about him. Not tell me about the day. Him.
This is the part of grief work that I find to be most difficult, because the right sentence is not the end of it. She may not have wanted that sentence. Not at first, and maybe not for a long time. I can picture it, because I have watched it since with other people and other objects. I say tell me about him, and she opens the binder. I say I’d like to know what he was like, and she turns to a tab. Every road back to her son runs through the day, because to her the binder is not a record of him. It is him. It is the last place he can still be found, and the only place where she is still doing something for him, and if I keep gently steering her away from it toward some truer version of her son that lives somewhere else, I have become one more person telling her where he is not.
Nicholas Wolterstorff, a philosopher who lost his own son on a mountain at twenty-five, reached for a word of Gerard Manley Hopkins’s to say what he was grieving. Hopkins used inscape for the inward, particular shape of a thing, whatever it is that makes it this one and not another. Wolterstorff used it for his son’s singular way of being in the world, and then for the death itself, which he insisted had an inscape of its own, unlike any other death. I have come to use the word for what is left afterward: the space a person leaves behind, which has their exact outline, and which goes on holding their memory the way a mold holds the shape of what was cast in it. The binder was Cicely’s way of keeping the inscape from wearing away. Every page was a hand pressed to the outline so it would not soften. And when I said tell me about him, I was asking her to leave the one place where his shape was still sharp. That is the asymmetry the word totem hides. A totem is only a totem from the outside. From inside, it is dense and unbound by time or linear expectations of consensus and truth. It is the thing that has to be maintained, every day, by hand, or the world comes down. So the question was never whether I could see what the binder was holding up. I could see it in the first hour. The question was whether the two of us could come to see it together, at a pace her world could survive, and that is a different achievement and a much slower one. It cannot be manufactured or delivered. It has to be arrived at, and the arriving is mostly made of my going where she points, as many times as she points there, and standing inside the inscape with her, and letting her show me her son in the only form she can still bear to, until that day stops being the only day.
Tell me about him might be the right sentence. It might also need to be said in week nine instead of week one, or never, because by then she has already told me, page by page, and we both know it, and neither of us has had to say the word totem out loud for it to have been seen. Held, not directed. The coin and the totem can wait. They are, after all, patient objects. The formulation that is true in week one can still be true in week nine, and it will be more useful then, because by then it might be ours.
Second, when you notice that you understand, go back to the face of the coin. Not the reverse, not the edge, not the totem. The face of the coin is the one place where you and the client are looking at the same object and the client holds the authority. The day happened. She knows what happened on the day. Every time I felt my understanding getting ahead of her, the most restorative move available was to return to the part of the map she could correct me on. What am I getting wrong about the sequence? Where would you put the rise?
Third, leave the meaning unnamed for longer than feels competent. I learned this one from a different client, a man whose sister died in a car accident his shop had serviced, and who could not stop reading the report. With him, responsibility didn’t get named as the totem until three earlier memories had been reprocessed and he could see it on his own, and when I finally said the word it landed as recognition, because by then it was his word too. The difference between the two cases is not that one formulation was right and the other wrong. I think they were both right. The difference is who authored it when it was said.
And fourth, let the client crumple the formulation. Not just correct it. Refuse it, change it, pick a different symbol, say the coin is stupid and the paper exercise is a gimmick. The map is only shared when disagreeing with it costs nothing. If a client cannot say no to my understanding without putting the relationship at risk, I have built a room in which the only thing she can do with my sentence is accommodate it, which is a fair description of what she was already doing at every other table in her life, and at her own. The glances above the bowed head. The laugh kept almost inside. The paper folded smaller after that.
What to do with this on Tuesday
Three practices, in the usual spirit.
Notice the moment you understand. Not the moment you feel something; by now you’re tracking that. The moment the formulation arrives. It has a texture, a small relief, a sense of having something to hold. Treat that relief as a readout of your own not enough rather than as evidence that you’ve arrived. Then ask, silently: does she have this yet? If the answer is no, the understanding is yours to carry for a while. Carrying it is the work.
When handed the totem, take it with both hands, and then say less than you want to. Whatever it is. The binder, the box of letters, the phone with the voicemails still on it. Do not interpret it in the first hour. Do not tell them how heavy it is, or how much work it must have been. Someone at home has very likely already told them what it means. Let it be exactly what they said it was, and ask about that. And when they keep pointing at it, go where they point. To them it is not a symbol of the person. For now, it is the person, and the only way to the one is through the other.
Run the paper exercise on yourself. Four quadrants. Me, mine, not me, not mine. Then crumple it. Your understanding of a client is in there somewhere, pressed against their understanding of themselves, and in a hard session you cannot always tell whose crease is whose. Some of what landed on that wall was mine. It usually is.
The crease slowly rises
I think about the bolt at the end of the poem more than any other line. A key turns, a bolt enters its little pocket in the wood, and the handle is tried, and then tried again. I wrote it not knowing who was on which side of the door, and I’ve decided to leave it that way, because I don’t know. She tried the handle. So did I. And the paper on the table rose back toward its fold the moment nobody was pressing on it, which is what an organization does, and which no sentence, however carefully made, can prevent.
The door we offered stays offered. I would rather say that than pretend to understand why she didn’t come back through it.
But I understand this much now. There was a mother, and a son, and a binder held out over a rug and table, and a therapist who answered with a coin. The coin was good. It was even true. But it was not what was handed to me.
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