When I was a resident in the mid-1950s, my supervisor was in a training analysis with Dr. Frieda Fromm-Reichmann, and I heard some interesting anecdotes that Dr. Fromm-Reichmann had told about herself. On her immigration voyage to the United States, she practiced her English with a young American man on the ship. Near the end of the voyage she asked him, in her heavily accented English, "Now I want that you should teach me the dirty little four-letter words that you use to say how your really FEEL."

I once attended a meeting where she reviewed the analysis of a schizophrenic patient with the patient. They were sitting in two chairs facing the audience at an angle to each other. Dr. Fromm-Reichmann asked the patient whether there was any one moment that had made a crucial difference in her recovery. The answer has guided me ever since:

"Oh, yes. It was Christmas Eve in 19__. You had been sitting with me for an hour a day for a year, and I had refused to say anything to you. When you left on Christmas Eve, you said you would be back tomorrow, and I knew I had you [in a broken promise, like all the other people]. No one was going to come to see me on Christmas Day—but you came!"

I have always remembered that lesson in the possible importance of seemingly insignificant acts in therapy.