"I just want it to stop," Joanna said desperately.

But that's all she said in our first session.

Joanna X. had been referred to me by City Hospital following a suicide attempt. According to her file, Joanna's mother called for an ambulance after finding her 21-year-old daughter in the kitchen with her wrists slashed open. During her recovery, Joanna refused to speak - to her mother, the nurses, the physician.

When she and her mother entered my office, Joanna plopped down in the chair across from me like a corpse. Her wrists were still stitched and messy-looking. Her mother slipped out into the waiting room and I scrutinized the body language of this new patient.

"Hello, Joanna," I said. "I'm Dr. Lowen. I received my Ph. D. in psychology from Princeton University, I'm married and we're expecting our first daughter in October. Can you tell me about yourself?"

Joanna rolled her head from her breastbone and turned her icepick eyes up to pierce mine. She said nothing.

"Your mother tells me you've been going through some rough patches lately. Can you tell me about that?" I persisted, holding her eyes with mine. We sat in silence broken only by the sounds of the fish tank beneath the windowsill. "Joanna?"

The young woman leaned closer to me, her eyes widening as she seemed to look deeper into me. In those eyes I could have sworn I saw a sad little girl hiding—hiding behind not only this veil of silence, but behind thick, glacial walls; but those icy eyes could only chip away toward the outer world. She was cognizant of what was going on around her, but something was holding her back. I couldn't know what exactly it was unless she opened up to me. I allowed Joanna to sit this way, examining my eyes (I wonder what she saw?), for a long while.

Without warning, Joanna flung herself back against the leather seat and shut her eyes. Tears seeped out from between her eyelids and she made no move to hide them. Her arms went limp, palms up as if in supplication, her stitches displayed in all their ugliness. "I just want it to stop," Joanna said desperately.

But that's all she said in our first session.