Dr. Gabbard Replies

To the Editor: In Dr. Metcalf’s letter, he suggests that I should not have disclosed to my patient that the terrorist attacks of September 11 had frightened me. He advocates that I should have offered “calm acceptance of [my] patient’s panic” and that I should have demonstrated that “the feelings could be mastered,” as I myself had done. This type of Monday morning quarterbacking is a major problem in discussions of difficult situations in psychotherapy. Dr. Metcalf proposes an alternative that I should have considered to maintain “proper” technique. In fact, I was only a couple of hours away from the most horrific and unprecedented attack on American soil in U.S. history. With the fate of family members in New York City uncertain, I was completely unable to offer “calm acceptance,” and I certainly had not mastered the feelings I was experiencing. The notion of making a choice of the sort advocated by Dr. Metcalf would have required Oscar-caliber acting ability that I, unfortunately, do not possess. My authentic response under the circumstances ultimately proved quite productive for the psychotherapy, despite its unorthodox and most assuredly human quality.