I totally agree with Austin's last post.

Sometimes the absolutely most curative thing which happens in case taking occurs when a patient makes an observation which is truly profound, stultifyingly true, and unbelievably unobserved before our conversation.

Eg: here's a skeleton version of one of my favourite cases: A patient presenting with complaints of fibromyalgia, raynaud's disease, migraine, exhaustion, and 2 cases of mono or mono-like diseases in history, at age 11 and again at age 17.

After taking the case with the patient and patient's partner in consult, I made arrangements to phone back pt. later on that evening (we had run out of time, pt's partner had to go to another appt., and I needed more information).
Things were just getting good--pt. was telling of a recurrent, seemingly life-long dream of sleeping in bed, alone, and hearing door of house open; hearing footsteps approach stairs and then bed, hearing and feeling...but not seeing...intruder forcing himself onto now awake, hiding, and terrified but helpless pt., in bed...when pt.'s partner had to go and we stopped our discussion.

I sent patient home with the question: what was going on in your life when you were 11 years old?

Later when I called, pt. was alone in home and answered this question. Pt. babysat sister's children at this age and was repeatedly molested by brother-in-law, who would wait for his children to be put to bed before attacking. Pt. usually put the children to bed and would then go to bed for the evening too, and sure enough, the attacker would creep into the patient's bedroom, climb on bed, cover pt's eyes and attempt to rape pt.
Finally pt. was able to extricate self from baby sitting duties and fell ill with first bout of mononucleosis.

This memory had been suppressed for many years.

I waited for the pt. to finish telling me this story on the phone, asked for clarificaton regarding the pt's emotional state (trembling and angry, tearful), and then exclaimed, "Hey, do you realize that what you describe is almost exactly the same as your recurrent nightmare?"

Pt. agreed, shocked, seeing the similarity of the dream with the suppressed memory for the first time. Back came the anger, the feelings of helplessness, the tension of the situation, the fear of speaking about it openly...and the pt. understood why the body was actually behaving as if it were still in hiding, under the covers, avoiding the assault, avoiding being "discovered" as part of this collection of events. Muscles tensed, keeping perfectly still, terrified, hands and feet cold and paralysed by limited movement--and doing this for so long exhaustion set it. Pt. realised the similarity of physical symptoms to the situation described.

All I had to do then was pick a remedy good enough not to get in the way of the curative realisation the pt. had made.

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...and deliverance has many faces<br />but grace<br />is an aquaintance of mine