Sherry Turkle, a sociologist and psychologist who studies the impact of technology on relationships, wrote recently about the need for face-to-face conversation in a world increasingly dominated by texting and smartphones. It is through this “talking cure” that we build empathy, intimacy, and self-reflection, coming to know ourselves and others deeply.

Turkle wasn’t talking about Freud, but she was describing the mainstay of psychotherapy.

Soon after Turkle’s essay appeared, new research questioning the efficacy of talk therapy in treating depression made headlines. That same day, I listened to a podcast about Dr. James O’Connell, who has been providing healthcare to Boston’s homeless population since 1985.

O’Connell’s approach is more art than science.  He described having to unlearn the techniques and arrogance he’d perfected as an ER doctor when he took a job at a homeless shelter. The nurses, unimpressed with his skills, advised him to keep quiet about his medical expertise. They instructed O’Connell to spend his first two months doing nothing but soaking the feet of those living on the street.

“Don’t judge, these people have been through hell,” the nurses told him. “You will not gain anyone’s trust without being present.”

O’Connell spoke of the profound isolation and loneliness as well as the tremendous courage and resourcefulness of the men and women he came to know in his decades on the street. He believes the adversity they experienced would have broken him. This knowledge is fundamental to engaging in such hard work:

“We’re all broken in our own way,” O’Connell says. “It’s a connection with that brokenness that actually keeps us going.”

O’Connell’s words took me back to what inspired me to become a therapist: volunteering at a crisis hotline.

I had never before encountered the level of adversity our callers faced—poverty, abuse, addiction, chronic mental illness. Like O’Connell, I was awed by the courage and dignity of those whose lives were unimaginably precarious. The work was hard, but I loved it—the listening, the immediacy of the connection, feeling that my presence made a difference. Nothing much changed in anyone’s life, mine or theirs. Yet everything changed because we mattered to one another.

This is the essence of therapy. Our work is a modest endeavor–a conversation, a space of undivided, unhurried attention and exploration. The talking cure depends on humility and presence. These are the ineffable, unmeasurable things that matter—on the streets, in conversation, and in psychotherapy.

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 How do you preserve conversation in a technology-obsessed world? What is the essence of presence for you?

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(Originally published in Impulse, the electronic newsletter of the Northern California Society for Psychoanalytic Psychology)