People can grow and change when they face the best and the worst in themselves, with the help of another person. Courage is the currency of this engagement and the example is set by the therapist. This “worst” is a set of early life adaptations that later in life prove to be maladaptive. However, even in the context of the “worst” one can search for and differentiate the “best.” The quest for survival is the goal of all behavior, however counterproductive. It evokes talents that, if delineated from the failure, can be the basis of a productive life.

My value system holds that, in one way or another, we must face pain and experience it as a condition of growth. Indeed, facing one’s unhappiness with an involved, attentive other person can itself be a positive new experience. It is also useful to explore the positive aspects of that pain and how through our adaptations pain has stimulated and shaped the strongest aspects of our personality.

This is in sharp contrast to the belief system in our time that holds and encourages the position that it is “cool” to avoid pain. The drug culture began in the post-World War II period with legal tranquilizers encouraged by physicians and drug companies, spreading naturally to the young in the 1960s, who found illegal drugs more effective and appealing than their parents’ methods of escape.

These value models must be clearly delineated as different life perspectives and examined in terms of their ramifications as lifestyles, not as good or bad.

One of the conditions for healing in a therapeutic relationship is the ability of the practitioner to take a risk. It may be necessary at various times to risk the patient’s anger, to risk being wrong, to risk our pride.

In any case, the practitioner uses intuition to interpret and respond. Whether or not to allow the silence to go on and take the risk of not being “helpful,” whether or not to take a step toward the patient and risk a rebuff, the practitioner must be willing to accept the risk. He or she must be willing to make a mistake for the sake of the patient, and be willing to adjust his or her behavior accordingly, even to sit in silence for periods of time.

Indeed, the practitioner offers a model of courage to the patient, an act of caring, and a demonstration that one can make mistakes without loss of equilibrium or self-respect. It may be that the demonstration will require a specific admission of error, and even require withstanding the patient’s direct attack or indirect attempt to use the occasion to manipulate the practitioner through guilt. That is not important; the practitioner can demonstrate that a person’s value and self-respect are not diminished by making errors, and a mistake does not call for derogation or diminished dignity.

With regard to the issue of guilt, one of the most common and virulent forms of manipulation is the claim we make on other people’s freedom when they have wronged us in some fashion. If we cannot get what we want from them directly, we use guilt to make them feel they owe us something. Parents do this to control children, and children to control parents; husbands and wives do the same. The patient has, most likely, experienced this form of relating and manipulation through guilt. It is an opportunity to exercise power that the powerless are not easily able to forego.

The practitioner’s mistake is an opportunity for manipulation by the patient through guilt. It is very important, therefore, that the practitioner be firm in resisting this maneuver, admit the error, but deny anyone’s temptation to abuse him or her because of it. All we owe is an apology, not our integrity. This is extremely important for patients, who will learn, albeit the hard way, to be liberated from their own shackles of guilt and will be freer to live and make mistakes without fear.

Another kind of risk involves action that in one’s opinion is in the best interest of the patient and possibly others, but that might evoke severe displeasure in the patient or family.

Example