The Power Of The Empty Chair

She was a woman in her early seventies. She looked tired, almost haggard, although neatly dressed.  She had obviously seen a lot of hardship in her life, but she wore it well.  She looked like someone you could trust, a “salt of the earth” kind of person.

It is unusual to see a senior come to a psychiatric clinic for the first time.  We see women of all ages, it is true; about 70% of the psychiatric patients in most average (not Department of Veterans Affairs) medical clinics are female.

She had been referred by a general physician who could do nothing for her headaches.  He had wisely decided that starting her on any kind of potentially addictive painkiller was a very bad idea.

I took a detailed history.  It seemed that the headaches came on when her husband yelled at her or threatened her.  He did that often enough.  He was of some kind of northern European origin.  She had married him after the death of her first husband in an accident; her first husband had been her real love-match.  But she was a traditional housewife, who wanted to keep house more than anything in the world.

She married her current husband and raised his four children from infancy.  He worked in a factory, had been promoted to a foreman and retired from that job.  She enjoyed her home.  But when husband retired, and she had raised all the children and they had left, she suddenly found herself with a critical husband with nothing particular to do around the house all day.  Watching TV and being critical of her really seemed to be his only activities.

The headaches had started soon after his retirement.  It was very clear that they were the only way she could escape his criticism.

I explained this to her, patiently.  She said she understood, although she was a little bit surprised that she had not been able to notice this herself.  She was a little ashamed that things sounded so obvious when I explained them to her.  I reassured her that she ought not to feel embarrassed, since a good counselor or therapist or psychiatrist was kind of like a giant mirror, who showed people things about themselves that they could not see on their own.

She reassured me that her husband was never physically threatening.  I suggested she come back in a week for a session with “empty chair technique.”

Now that term means a lot of things to a lot of different people, but as I explained it to her, most of the problems we have with other people are not really with those people, but with those people as we imagine them inside our heads.  So if we look at an empty chair and imagine the person is there, then I can help deal with the person as they are imagined in the chair.  This would avoid offending the real person, and give us a good way to work things through.  I assured her it usually helped.

She was agreeable but didn’t want to start until her next visit.  However, when she came back the next week, she looked totally different — Smiling, well dressed, had her hair done.  She winked at me.

The headaches were gone.

She said she had decided that the empty chair session was not worth waiting a whole week for.

She told off her husband —  exactly what I had told her not to do.  Not only that, she had left him and moved in with her next door neighbor.  Her husband had been a bit bewildered about the whole thing, but she was enjoying her visit with her next door neighbor, especially enjoying her husband’s visits to apologize.

She said that she had come back because I was so nice, and I deserved to know that my services were no longer necessary.  She said the “empty chair” thing did not make much sense to her and so she just talked to her husband and did what she had to do and she felt better.

She did not know if she wanted to leave her husband permanently or if she would move back in, but she was definitely enjoying going shopping with her neighbor-friend and she would make more decisions, later.

I told her she was lucky things had worked out as well as they had.  I wished her the best, and signed her out of the clinic.

I guess she knew her husband better than I did.  In general, when we have problems relating to someone, it is the person as we imagine them.  It may not be the person as they really are.  Some people are better than others at grasping the reality of a personality.  A lot of people get stuck on the person they carry around in their heads.

I love the empty chair technique and have been using it for many years, often with all sorts of embellishments.  Most of the time, we put a parent in the chair.  After a description, I might have a patient sit in the chair and interview that patient who “pretends” to be the parent.  A patient may realize, by doing this, why a parent is the way they are, and ultimately forgive them for their transgressions.  There is nothing I have found that generates empathy — a real feeling for another person — as quickly and efficiently as sitting in an empty chair and pretending to be them.

My patient had already figured out that her husband had a father who was pretty tough on his mother, so that was probably the way he thought men were supposed to act with women.

I have seen therapy students act intuitively with empty chairs.  It depends on the power of the memory and of the imagination.

Oh, the people, the worlds that we all carry around in our heads!  I remember when I had barely learned “empty chair” technique myself, I stumbled on a medical student who was sitting alone in a room full of a dozen cheap plastic bucket-chairs, the kind you always find in medical schools.  He had put several (imaginary) generations of his family into empty chairs, and was joyously exploring how his pioneer European ancestors had made it to the United States, and what they had been through.  I encouraged him to continue as I watched; he was amazing, moving, as he told me he understood the difficulties his grandparents had been through for the first time as he talked to them and changed chairs and pretended to be them.  He was awesome.

On the other hand, I have also had to train therapists who turned to me in tears and asked me “What do I say next?”

An important thing to know about anybody who is getting therapy is how they relate to reality, or what us shrink-types call “reality testing.”  I would never, ever try to use this kind of technique with anybody who had trouble knowing what was real and what wasn’t.

My patient had brought the technique into reality.  My ego was only mildly dented, to know she had done it without me.

Art and imagination can sometimes solve the most concrete of problems.

When I think of the art of imagining situations and empty chairs, I remember something Jung said, about women finding their expression in art or psychotherapy.  It struck me as strange when I first heard it, but I think of it now when I think of how I enjoy healing someone with an empty chair.

Sometimes I think that is a self-indulgent thought.  People who can confront problems in reality and heal them, like my headache patient, ought to be celebrated and venerated.