I am both a reader and a therapist. As a nurse therapist in private practice, I rely on continuing education, consultation with other therapists, and reading to increase competence. I am an avid reader and read many books on therapy to improve my skills. Some books in the bookcase remain partially or completely unread. Other books I return to again and again. Yalom (1989) and Fosha (2000) never fail to inspire me. Yalom, a renowned psychotherapist, is not afraid to admit his mistakes. Fosha, the founder of accelerated experiential dynamic psychotherapy, elucidates the therapeutic use of self that Travelbee (1969) talked about. I also read books of fiction; one author, Jane Austen, is a favorite and also a source of inspiration. Here lies one important intersection for me between my worlds of reader and therapist.
The Appeal of Austen
Jane Austen was a keen observer of people. Her view of human nature was unflinching yet, because of her humor, also embracing. The foibles in her characters can be seen in ourselves. We long for and hope to escape such clear-eyed vision. When we are the object of observation, we can take comfort in knowing our pettiness, self-deception, and weakness are universal traits. We can try to overcome them, but we must first see them. Austen was a master at seeing them. My goal as a therapist is to use myself therapeutically. When unflattering traits are viewed as part of humanness, it is easier to acknowledge them. If I know myself and can accept the good and the not so good, the chances of being therapeutic are far greater. Yalom (1989) is refreshingly open about his feelings about his patients. His emotions range from love to fury. Yalom (1989) allows the therapist to be human, to err, to recover, and to learn. One of the most helpful things I can do as a therapist is to admit mistakes both to myself and to my patients. One of the pleasures of reading Austen is watching the main characters misjudge and eventually recover.
Austen wrote about people and relationships. Other fiction writers do so as well, but Austen’s descriptions can be humorous or poignant or sharply critical and yet still somehow comforting. The books of Jane Austen have helped me take delight in our common humanity. Curiosity about people is what drew me to therapy and part of what draws me to the works of Austen again and again. Her books, written two centuries ago, have relevance for my work as a therapist today.
Summary of Themes
Throughout this article, I will refer primarily to three of Austen’s books and one reference to a character in a fourth book, Mary in Persuasion (Austen, 1818b). As in most of her books, characters in Pride and Prejudice (Austen, 1813) are confronted with issues of social class. When the heroine Elizabeth first meets Mr. Darcy, a man of great wealth, she is offended by his manner, which she perceives as arrogant. Rather than see exceptions, she attends to behavior and stories that reinforce the first impression. Meanwhile, Mr. Darcy is prideful and makes assumptions about Elizabeth based on the behavior of some of her family members. Both protagonists overcome their initial impressions and many obstacles when they get to know each other as individuals.
Sense and Sensibility (Austen, 1811) is a tale about two sisters who view and respond to the world very differently. One sister, Marianne, is romantic and emotional. To Marianne, feelings are indeed facts. At the other end of the spectrum is Elinor. She is stoic, and when she suffers, she suffers alone. They both move from their extreme positions and find a balance between emotion and reason.
Northanger Abbey (Austen, 1818a) is the story of a naïve young girl who is influenced by reading Gothic novels. The main character, Catherine, gets carried away in dramatic fantasy. She initially trusts others rather than her own judgment. It is a story of growing up.
Austen’s novels provide ideas about the structure of the therapeutic encounter. Her characters are representative of wisdom and naivety, of strength, and of weakness. Those are qualities we share and will encounter in our clients. Austen’s acceptance of our humanity is transmitted through the novels and can assist the therapist.
Beginning Therapy: The Frame
In the beginning of therapy, there is the frame. The frame and boundaries in the therapeutic relationship are essential. Without talking about it directly, Austen offers guidance for setting the frame from the first therapeutic encounter. The 19th-century civilities do not apply, but the sensitivity to comfort as supplied by ritual does apply. Embarking on therapy can be an intimidating business. Established rules make it easier for both parties. A night at Rosings in Pride and Prejudice (Austen, 1813) has a rhythm—the formal introductions, conversation, tea, the setting of the tables for cards. Therapy also has a rhythm—the formal introductions, the duo sitting across from each other, the structure of the conversation with respectful listening by the therapist, openness from the patient. The ritual provides safety. Safety is essential in establishing trust.
Sometimes the beginning of therapy is so exciting I want to jump right in. When I have given in to that impulse, I invariably find I neglect to cover essential information. For example, I might forget to discuss exceptions to confidentiality. Or, I might respond to the new person in front of me with ideas based on assumptions I have about him or her rather than learning about him or her as an individual first. Travelbee (1969) stated rapport is established when the nurse is able to respect the uniqueness of the other. Without rapport, early missteps can cause a rupture in the relationship. To ensure we cover our contract (i.e., the voluntary nature of the professional relationship as well as commitment to work together toward goals of treatment), I have developed my own ritual. It takes a little time but clear expectations and explanations are provided. I want the client to sense early on that I want to understand. Being able to count on the therapist—not just the words but also actions—provides the client with a sense of security and the beginning of trust. Trust allows patients to share what is most important to them. The dance of therapy can begin. Ritual provides the background music.
Saying Goodbye, Ending Therapy
Austen offers sound advice on leave-taking. Leave-taking in a therapeutic encounter refers to the end of each session as well as saying “goodbye” when treatment ends. The therapist should follow the lead of Catherine in Northanger Abbey (Austen, 1818a). It is interesting to notice how Catherine takes her leave: “After tasting the sweets of unreserved conversation they part with a most affectionate and lengthened shake of hands” (p. 19). I think this is a wise approach. The therapist should not initiate contact, including hugging, that might make a patient uncomfortable. A handshake is warm and respectful. Austen elucidates behavior that is not demonstrative and is respectful of boundaries. In the 21st century, instant intimacy is often the norm. Austen provides the therapist with a model of restraint. It is a paradigm that respects the patient’s boundaries—something we should teach as well as model.
The inability to manage feelings is a common problem underlying many psychiatric symptoms. Fosha (2000) discusses the need for clients to have a corrective emotional experience with the therapist. The therapist needs to be a safe and compassionate “true other” so the patient can access deep feelings. The manner in which Austen’s characters handle feelings and anxiety is illuminating.
Through the characters in Sense and Sensibility (Austen, 1811) and Northanger Abbey (Austen, 1818a), Austen demonstrates the danger in both giving over completely to one’s feelings and in not trusting one’s feelings enough. Marianne and Elinor are two very different sisters in Sense and Sensibility (Austen, 1811). Marianne is described as “everything but prudent” (Austen, 1811, p. 6). Furthermore, “her sorrows and joys could have no moderation” (Austen, 1811, p. 6). Marianne compounded her feelings of sadness by her actions. She refused food and rest. She obsessively replayed painful scenes in her mind. We know from our own experiences, as well as those of our patients, that healing requires some active participation on one’s own behalf. A modern description of what Marianne does is “believe her cognitive distortions.” We would say she has problems with affect regulation. As psychiatric nurses, we would want to teach her to soothe herself, to challenge her cognitive distortions.
Austen provides a model of affect modulation and logical cognitions in the other sister, Elinor. Marianne’s sister Elinor, who is more circumspect, advises her sister, “Pray be composed and do not betray what you feel to everybody present” (Austen, 1811, p. 173). However, “Being composed was not only beyond her reach. It was beyond her wish” (Austen, 1811, p. 173). Elinor is concerned for her and begs her to “exert yourself, dear Marianne if you would not kill yourself and all who love you” (Austen, 1811, p. 173).
I have felt that fear for clients when they are suffering. A rejection from a romantic attachment can be perceived as a plot to humiliate. When unchecked emotions threaten reason, Austen’s Elinor is one guide I consult because she is the embodiment of calm efficiency. The image helps me bear the pain with the client while also holding a light that shows a different perspective. Elinor is the picture of perfected affect modulation. Elinor knows her feelings and she too has strong feelings, yet she knows how to govern them. A hint of how she does that is shown in this remark: “I have many things to support me. I am not conscious of having provoked the disappointment by any imprudence of my own, and I have borne it as much as possible without spreading it farther” (Austen, 1811, p. 263). Elinor’s statement is an example of dealing with feelings in a healthy way, neither denying the feelings that are generated, nor amplifying them. We have met the ideal in Elinor who can both feel and deal.
At the other end of the spectrum is Catherine in Northanger Abbey (Austen, 1818a) who, when she notices her feelings, does not trust them. Learning to trust one’s feelings is a necessary skill. It is essential in making decisions. It is a building block for connection and communication with others. The following quotation refers to an interaction with Catherine’s friend’s father who is difficult: “It has been a release to get away from him. It puzzled her to account for this. It could not be General Tilney’s fault…she could only attribute [her dislike] to her own stupidity” (Austen, 1818a, p. 92). This is a marvelous example of the confusion that can ensue when feelings are not trusted. When Catherine’s girlfriend behaves badly, Catherine is likewise baffled: “Catherine, though not allowing herself to suspect her friend could not help watching her closely. The result of observation was not agreeable” (Austen, 1818a, p. 102).
It takes many chapters, and many examples of improper behavior by the friend, for Catherine to be convinced that her own impressions and feelings can be trusted. Austen’s description of Catherine is an example of that journey from distrust to trust and its happy results. I think of Catherine when a patient is on that rocky journey. It helps me to have the patience and hope to sustain us to the end. Those are happy days in therapy when I see patients trust themselves and their impressions, as Catherine finally did as well.
Anxiety, which according to Fosha (2000) can be a consequence of avoided feelings, is a symptom that brings people to therapy. Anxiety can be intensely uncomfortable and methods are sought to relieve it.
An example of good anxiety management is Elizabeth Bennet in Pride and Prejudice (Austen, 1813). Elizabeth is fortunate because “It was not in her nature…to increase her vexations by dwelling on them. She was confident of having performed her duty, and to fret over unavoidable evils, or augment them by anxiety was not in her disposition” (Austen, 1813, p. 218). Even if some of us are not so lucky in our dispositions, her view and habits might be cultivated with practice. Learning not to dwell on the “what ifs” and applying rational thoughts to combat irrational fears can help manage anxiety.
Two examples of poor anxiety management come to mind in the characters of Austen’s novels. Today Mrs. Bennet from Pride and Prejudice (Austen, 1813) and Mary from Persuasion (Austen, 1818b) would be diagnosed with somatization disorder. Both unknowingly translate anxiety and unsettled feelings into physical symptoms. It is not possible to convince them that their symptoms have a psychological component. Austen’s awareness of the dynamic allows the characters respite from the symptoms when their lives are going in the direction they prefer. These two characters inform my practice by reminding me of the importance of compassion, and the little effect confrontation has on symptoms. The symptoms serve a purpose. They will remain until there is a better way to cope with the feelings. As a therapist, it is my goal to help patients lower defenses and deal directly with their feelings. Often acknowledgement of their feelings lowers anxiety.
Understanding the Patient
Austen’s character Elizabeth also elucidates how therapists gain access to patients’ interior worlds where change is possible. For example, Elizabeth enlightens Mr. Wickham about her new views on Mr. Darcy: “When I said he improved on acquaintance, I did not mean that either his mind or manners were in a state of improvement, but that from knowing him better, his disposition was better understood” (Austen, 1813, p. 220). Gaining understanding takes time and patience. In the same novel, Austen shows readers how potentially dangerous it can be to make assumptions without facts or knowledge of the whole story. In Pride and Prejudice (Austen, 1813), Mr. Darcy initially seems arrogant and callous. Mr. Wickham seems charming and victimized by Mr. Darcy. What Elizabeth and readers come to understand is things are not as they seem. Trusting Mr. Wickham leads to disastrous consequences. Austen reminds me to take my time with clients. I naturally want to jump in with answers and interventions—after all, are we not supposed to do brief therapy? However, I need to wait. The story will emerge, and with it, the client’s own answers. Patience paves the path to understanding, and then the effectiveness of therapy is greatly enhanced.
Self-Disclosing to Clients
Mr. Darcy, in Pride and Prejudice (Austen, 1813), provided help in the manner of self-disclosure with patients. It can be helpful to share our personal reactions to clients’ revelations. Mr. Darcy provides a model for my own self-disclosure with a client. After a session that is particularly moving, I tell my client, in a manner similar to Mr. Darcy confessing to Elizabeth, how much I admire her. Austen provided me a way of expressing my ardent feelings clearly and succinctly. I am grateful for her example in reigning in effusiveness, which may have alarmed the patient.
Austen was skilled with language. I try to emulate her in choosing my words carefully. I cannot imagine her heroines saying something impulsively that would cause another person to lose face. There is gentleness in the approach, but the gentleness is allied with intelligence, honesty, and quick wit. I aspire and usually fall short of that level in discourse. The model is still worth my effort. Our words are our tools in being therapeutic, or not.
Jane Austen, through her novels, has been a gentle coach for me. Her compassionate and humorous view of our foibles strengthens my own compassion and aids my perspective. Her ethical view on the treatment of others reinforces kindliness. I am indebted to her for what I strive to be as a therapist—kind and compassionate. In addition, I want to be helpful without being overbearing and ethical without being preachy. Jane Austen is one of my muses.
- Austen, J. (1811). Sense and sensibility. London, England: T. Egerton.
- Austen, J. (1813). Pride and prejudice. London, England: T. Egerton.
- Austen, J. (1818a). Northanger Abbey. London, England: J. Murray.
- Austen, J. (1818b). Persuasion. London, England: J. Murray.
- Fosha, D. (2000). The transforming power of affect: A model of accelerated change. New York, NY: Basic Books.
- Travelbee, J. (1969). Intervention in psychiatric nursing: Process in the one-to-one relationship. Philadelphia, PA: F.A. Davis.
- Yalom, I.D. (1989). Love’s executioner and other tales of psychotherapy. New York, NY: Basic Books.