How We Make a Difference in Patients’ Lives

Notes From Sandra Buechler‘s Talk on December 7, 2013  

Katherine Williams and Jen Sermoneta

Sandra Buechler

Sandra Buechler

Interwoven with dialogue, explanation, clinical examples, quotes from poetry and theory, and her own avidly curious and calm presence, Dr. Buechler gave a systems view of emotion, identified types and sources of joy, and offered reflection questions to help us identify our own beliefs about emotions. She underscored her talk with selections from poetry and other writings. Here we offer a few notes, but they do not do justice to the full thread of her talk or to the experience of her wise and soothing presence. A big thanks to Elizabeth Carr for suggesting Dr. Buechler!

Life cures people

Our job is to help people recognize new experiences.

Emotions are the primary motivators in life — especially love, shame, and fear

Emotions are communications to the self and others. Interpersonal misunderstandings occur when a particular emotion is experiencedby one person, but received by another in a way that reflects the receiver’s emotion, rather than the communicator’s.

Emotions exist in a system

The therapist can help a patient feel more curious, which affects anger more effectively than “anger management.” The analytic attitude is really an attitude of curiosity.

We all have models or theories of emotion, but we often don’t notice them

They affect our therapeutic focus and effort, so have a tremendous impact on our work; she provided questions for therapist self-exploration (below).

Emotions, no matter how painful, have a function

We can’t help the patient to change without knowing what the function of the emotion is for him or her. In other words, we have to bring attention off the signal and onto the meaning of the signal.

When the patient’s way of life changes, his or her feelings will change

Since people don’t want to change the way they live but want the outcome to change, our task is to help patients to see their lives through a wider lens, which may enable them to be open to new experience in many aspects of their lives, which in turn opens the door for the possibility of change. This contrasts to narrowing the therapeutic focus to strategies for stopping drinking or changing one bad habit or another, which actually makes change less likely.


Dr. Buechler concluded with a series of questions we therapists can ask ourselves to better understand our beliefs about emotions:

  • Which emotion do you find the hardest to deal with when you feel it for a patient?
  • Which is the hardest emotion for you to deal with when you feel it in a patient?
  • How do you react to lack of expressed emotion?
  • Which emotion do you pay the least attention to?
  • What makes an emotional reaction seem normal to you? (How much fear should be expected? Is contempt ever something that’s useful? What makes you decide what’s normal — is it intensity, appropriateness, or something else?)

Joy is the universal antidote to loss and grief

Dr. Buechler triumphs the freedom of using a non sequitur to startle the patient into the possibility of opening up more available life, bringing with it the possibility of joy.  She lists some sources of joy:

  • What we experience in the process of growing nearer to the goal of becoming ourselves (Erich Fromm)
  • A sense of harmony and unity with the object of joy and the world (Carroll Izard); a feeling of being related to all things living
  • Joy is a feeling of self discovery, a new beginning, self renewal: Joy can be understood as a basic form of resonance (Paul Heisterkamp).
  • Psychodynamically, joy is complementary to the feeling of anxiety
  • The clinician’s non-narcissistic investment in the life of the patient
  • Oneness and connectedness (Estelle Frankl)
  • Feeling of floating, losing track of constraints of time, place, self – joy in losing oneself
  • Joy in seeing oneself clearly, such as through contrast
  • The joy of seeing underdogs triumph over obstacles (The Little Engine that Could)
  • The experience of being helpful, of really listening to another person’s story

Emotion in literature

Here are a few of the poems Dr. Buechler quotes from:

Richard Wilbur: The Writer

Mary Oliver: When Death Comes

Jason Shinder: Coda


crowd shot
maxine jen elizabeth at buechler
mike and leslie
pat janice and martha
Sandra Buechler at ICP+P

Sandra Buechler

Information about the talk:

Premised on emotion theory, Dr. Buechler’s talk will focus on using sadness and joy to make a significant impact on patients’ lives. Dr. Buechler will illustrate her talk with clinical material.  Dr. Buechler will differentiate grief from depression and discuss how we can help people bear the myriad of losses inherent in human experience. She will emphasize awareness of our own losses as clinicians and identify sources of resilience.

She will then turn toward joy as the “universal antidote” that can modulate negative affects.  She will discuss joy as it manifests in various clinical and non-clinical settings. In this context, Dr. Buechler will share thoughts about how clinicians can avoid burn-out and stay fully engaged in clinical practice.

About the speaker

Sandra Buechler, PhD, is a training and supervising analyst at the William Alanson White Institute in New York City. She also supervises at Columbia Presbyterian Medical Center and at the Institute for Contemporary Psychotherapy in New York City. A member of the editorial board of Contemporary Psychoanalysis, she has written papers on the analyst’s experiences of loneliness, loss, joy, and other aspects of the clinician’s feelings. She authored Clinical Values: Emotions that Guide Psychoanalytic Treatment (Analytic Press, 2004); Making a Difference in Patients’ Lives (Routledge, 2008), winner of the 2009 Gradiva Award for Outstanding Psychoanalytic Publication; and Still Practicing: The Heartaches and Joys of a Clinical Career (Routledge, April 2012).

Buechler’s work demonstrates a strong interest in the experience of being a therapist, and in her work as a supervisor and training analyst. As Tracy D. Morgan writes, “Sandra Buechler suggests that shame and loss are key components of a clinical career, and we would be best served to accept their presence and get used to their ongoing tug and pull. Indeed, clinical training is rife with shame. Buechler reminds us that in training to be a clinician, unlike most other professions, one must investigate one’s defenses, one’s inner conflicts and do so in public. How to mitigate the shame that ensues? She suggests that we can certainly reduce shame about shame. Shame then must be accepted as an ineluctable aspect of the training.”

Not only is Buechler’s topic germane; she also has a reputation as an engaging speaker. After Buechler’s 2012 talk at the William Alanson White Society, President Karen Marisak wrote, “Dr. Beuchler… presented a gorgeously written, clear, personal, literate, and yet also importantly theoretical paper about how our essential human characteristics of emotional motivation, character style, and defenses come to play in our clinical work where we are alike but also different, where each participant brings out certain aspects of the other, and where we can know about the others experience but always limited by our own ways of experiencing. How she was able to engage with and enlarge our program theme was a delight… The program was inspiring, leaving me and I believe many others with an enriched understanding of ourselves and our work.”

We look forward to welcoming Sandra Buechler to ICP+P on December 7th.

Learning Objectives

At the end of this conference, participants will be able to:

  1. Analyze basic premises drawn from emotion theory that are useful in clinical work. Explain ways clinicians can help patients to bear grief.
  2. Identify sources of joy, both in clinical exchanges and, more generally, in interpersonal life.
  3. Demonstrate the use of positive affective experiences to avoid professional burnout.
  4. Observe their own beliefs/premises about how we, as therapists, help people deal with painful feelings.