I’m sure my clients have their own opinions about the moments when I am most useless. People who want my advice about whom to marry, which school to go to, whether or not they should move out of the city, or to tell them what they should do next – I’m certain find me exquisitely frustrating.

But the clinical experience of pure uselessness, surrendering utterly and with some dignity to our real limitations, is a far more excruciating process.

There are different flavors of suffering: some smack of justice, and we taste something sweet in our mouths in the moment the crows come home to roost; some suffering feels generative, the sand in the oyster that produces a pearl; and some suffering violently blasts huge healthy holes through our defenses – allowing intimacy and relatedness to pour in.

Moving through the endless suffering of bereavement and the too finite dying process is heartbreaking, but the inevitability and universality have made this particular kind of powerlessness familiar to me. Other kinds of crises have a recognizable Hegelian flow: homeostasis, disruption/chaos, re-organization. Thesis, anti-thesis, synthesis. Great waves of adrenaline and despair may crash through the office, but I am generally able to stay oriented, grounded, keep breathing, and trust that we will get through this.

I’m most likely to be knocked off my feet, caught in my own existential dilemma by the kind of destructive suffering that appears, for some good amount of time, to be just fucking pointless. Victimizing, crippling, sickening, destructive: “Random Horrible Inescapable Things Happening to Good People” kinds of suffering. Tragic coincidences, the terrible hand of cruel fate. Chronic, inescapable, uninformative pain. The biblical suffering of Job, the oracle-entrapped Oedipus. The kind of shocking and fateful events that made Kurt Vonnegut say: “If there is a God, he must sure hate people.”

Some people, the truly heroic, are able to wrest meaning out of such occurrences, actively assigning meaning and creating empowering narratives for themselves. Others find some form of Faith that such pain serves their growth. Some people reach backward to karmic history for explanations, some reach skyward toward God’s Eternal Plan. Others powerfully, forcefully, refuse to search for meaning – surviving on raw courage and cold, hard pragmatism alone.

However it goes down, it is not my place to tell anyone – or even organize my own belief – about what such events could or should mean. It is simply not my prerogative, not my experience, to define. I must find a way to sit in the meaningless of it all for the duration – until, and if, the client finds their own relationship to their suffering.

In that interim, I do my best to manage my fear. I may spend weekly session after session with a hot twisted wire in place of my vocal chords, my feet and hands tingling with adrenaline. I am sometimes agitated, over-activated – driven by the fear that I will be worse than useless, the lifeguard taken under by a drowning man. I can at times over-leap to help clients “get on top” of the experience, find group support, seek legal redress, right wrongs, get medical intervention or alternative therapies, encourage and teach mindfulness mediation. Sometimes this puts some useful structure around a crisis – sometimes it further overwhelms both of us.

I can, when flooded by existential crisis myself, forget that people dealing with such Kierkegaardian “fear and trembling and sickness unto death” may primarily need me to sit still and keep my eyes and heart squarely open. Barbara Stevens Sullivan, in her latest book on Jung and Bion The Mystery of Analytical Work says that there are times when conducting psychotherapy is like being called upon to perform “brain surgery in the midst of a double earthquake – and the epicenter of one of those quakes is in the therapist’s core.”

I stop or sometimes – thankfully – my clients stop me. We breathe. I remember what I can do: I can keep company. I can bear witness. I can promise not to look away and to never retreat.

And do my best, with all my limitations, to vicariously tolerate the intolerable.