Most people think of psychotherapy as a way to delve into the past and find reasons for their unhappiness. Although traditionally this has been the idea, there are more immediate ways a therapist can get clues. Take tissues for instance. Tissues are considered the tools of the trade in psychology. Every psychiatrist, psychologist, counselor and social worker has at least one open box in their office. In fact, tissues are so widely used that they are often taken for granted. However, upon closer examination, they can be the key to a client’s inner workings.
By observing how clients handle their tissues, a therapist can learn a great deal about their clients. For example, I had a client once who, upon tearing up, would go into her purse and take out the small packet of tissues to use in lightly wiping her eyes. Forget the fact that there were three large, open boxes within arms reach in my office. She is someone who is independent, does things for herself, and has a hard time asking for help. All this was embodied in the simple gesture of taking from her meager supply rather than taking from someone else’s abundant offering.
Then there was another patient who when sobbing would take one after another, throw them out after barely touching her face. While I sat there is awe, I wondered if I would be opening a new box before my next client came. Now this client has a history of binge eating, not tasting her food, and then moving on to the next item. I could see how hard it was for her to use what she had because she didn’t even experience having it in the first place.
Contrary to that scenario, there was a client who took a tissue and folded it neatly. She would fold and refold as she surreptitiously dabbed at her tears throughout the session. Needless to say, this client was organized and efficient and came in to work on having more fun, living more spontaneously. Then there was the client who would take her used tissues with her when she left. She didn’t want to leave her trash behind. She worried about what others thought of her and it was too scary to leave trash behind, as if she would have left behind a bad impression.
I could go on and on as there are as many ways to use tissues as there are clients. In each case we talked about how they used their tissues. And in each case they were able to take a safe circumstance and start making changes in their lives. What did it mean to leave tissues in the trash can, specifically placed there for that purpose? How scary that was at first, and how freeing in the end. Could a binge eater feel the tissue in her hand and use it until it was damp enough to throw out? Could she translate that into a meal? Yes she could. The folder was able to crumple her tissue in several sessions, and laughed with abandon at this simple gesture. And, the client who came with her own supply learned to use the office tissues, thus was eventually able to enjoy more satisfying relationships outside the therapy office.
These might all seem like silly examples. One might say that anyone could alter how they handle a tissue. But the tissue is a symbol. And all changes start with small steps. In taking a minute gesture and bringing consciousness to it, we can begin to make over our lives. Psychotherapy is about insight and expanding consciousness towards a greater quality of life. We can look at our past, and we can look at what’s going on in the here and now. Perhaps, sometimes a tissue isn’t just a tissue.