Patients Who Haunt the Therapist

It’s almost Halloween. Time to talk of a patient who haunts me.

I put her in the category of Greek tragedy. After you do therapy for a while, you get a sense of a singular place called “Grim Future;” and a person, admirable in many ways, whose tragic flaw will take her there. Usually, you only witness the first few acts of the drama.

But you are certain, even though the data say therapists are flawed predictors.

These are the patients with whom you are powerless. Not a good thing for a peculiar profession, one hoping to prevent disaster, enable happiness.

She was a university student. Her parents actually did the leg-work to find a therapist to “fix” her. I came recommended, though an odd choice for a family steeped in “hellfire and brimstone” faith, the folks who strangle nearby innocents with certainty of the right and wrong of everything. Their rigidity frightened me, people who sat so tightly wound in my office I thought they might vaporize. Hisssssssssssssssss!

I’d be seeing the daughter, however, I said to myself. I told them she would be my patient, not they; once I evaluated her and assuming I believed good might be done. I “would not, could not” (as Dr. Seuss says) report back to them; short of imminent risk of self-harm or danger to someone else. They seemed to agree.

She walked in and springtime came with her. A silvery thing, she lit the room, though I cannot explain how. A “presence.” Therapists take in everything or try to.

This young woman was tall, perhaps 5’10” and willowy; black hair against porcelain skin, a pleasant face. Her complexion was so fair I could almost see through her. Someone else had, I suspected, and seen there was no will in her to resist much of anything.

She was not the most expressive person I ever treated, more sadly placid. Not serene, but the kind of calm derived from having the fight drained from you. Almost weary. Her parents had sucked the life out of her. Think vampires. The wind would take her where it chose. Right now she had youth and beauty, but as they say about the short careers in the National Football League (NFL), the three initials really mean “not for long.” Of course, I didn’t understand all this immediately.

Her parents wanted her to follow some “serious,” academic track. She was a dancer. They wanted her earthbound. She wished to leap. Bad combination.

Many of us try to get the love we couldn’t get at home, don’t we, at least for a while? My patient was looking for such affection. Her folks didn’t like her boyfriend: he was not a member of their suburban, uppity class, and worse (to them) freighted with a minority heritage. But before you feel too sympathetic toward him, you must learn more.

I discovered he had introduced her to cocaine, which he also used: a drug, for her, like a key for her internal lock. There she found release, relief, and ecstasy. There, she was no longer anyone’s hostage. But, of course, she’d simply gone from being her parents’ chattel to that of the boyfriend and the drug.

Treatment didn’t go on for long. The job of freeing a person from parental dominance or a lover’s grip must wait if simply getting through the day is difficult.  I explored addiction treatment with her. I don’t recall if she began or not, but her interest was only dutiful. Soon enough her parents discovered her use and blamed me for not telling them. Therapy ended.

The character of Alfieri, in Arthur Miller’s A View From the Bridge, says the following:

There are times when you want to spread an alarm, but nothing has happened. I knew, I knew then and there – I could have finished the whole story that afternoon. It wasn’t as though there was a mystery to unravel, I could see every step coming, step after step, like a dark figure walking down a hall toward a certain door. I knew where (she) was heading for, and I knew where (she) was going to end. And I sat here many afternoons asking myself why, being an intelligent man, I was so powerless to stop it. And I even went to a certain old lady in the neighborhood, a very wise old woman, and I told her, and she only nodded and said, ‘Pray for (her) …’

The cynics say counselors are only interested in money, making a fine living off the pain of others. Well, some few are, but most of us want the best for everyone, not just our patients. We are rewarded by human contact and flourishing.

Yes, we cannot help without a therapeutic distance. The invisible boundary doesn’t inoculate us all the time. People we know, in and out of therapy, get inside. It happens to us as to you. We are not sculpted from stone.

Halloween is an odd day to be thinking of prayer, but apt perhaps. This year, when you tuck your candy-buzzed child into bed, and after all your treats have been gobbled up by greedy little monsters, sit back and rest and be grateful if no ghosts haunt you. Then, if you have a picture of this fragile creature because my story was well-told, pray for the (now, no longer young) woman, if she lives.

And for your counselor. This, from an ex-therapist who doesn’t believe in God.

The top painting is Marie, by Peder Severin Krøyer. The second image is The Ghost, by Tsukioka Yoshitoshi. Both are sourced from Wikimedia Commons.

Do Therapists Only Care about Money? An Airplane Morality Tale

I will not persuade you.

No, I will not persuade you therapists are not in it for the money. If all you see are greenbacks in their eyes (🤑), I don’t imagine I can dislodge your thoughts. I can’t deny we work for a living. Indeed, some of us live well, go on vacations, have pricey things. No, I will not persuade you, but instead offer you a story about one noble and gifted therapist.

Perhaps then you will persuade yourself.

Three people make up our cast. Two participants, one observer. All occupied one side of an aisle on a commercial flight. Little identifying information about the 30ish man in the window seat will be mentioned.

I had the aisle seat. Call me the observer. A pretty lady with thick brown hair sat between the young man and me. Bald men, at least this one, notice luxuriant hair!

As we waited on the tarmac, I saw the window-seated gentleman fanning himself. True, the compartment was a bit stuffy before take-off, but I wondered why he hadn’t opened the nozzle above to create a cooling air flow. Perhaps he hasn’t traveled often, I thought. I reached over the napping woman and touched his arm, pointed up, and twisted the nozzle. He smiled and the fanning stopped. I went back to reading my book.

The sleepy woman’s eyes opened:

I became aware of some intense breathing from the gentleman to my right, turned to look at him, and noticed he was sweating profusely. I asked him if he was okay, and our interaction began …

He told me he ‘hates flying,’ especially, the take-offs and landings. I recognized the brief conversation helped him to regain control of his breathing, so decided to continue distracting him by engaging in some light discourse. I was also very, very relieved he wasn’t having a heart attack! He told me he was traveling to visit his girlfriend, and when I joked it would be her turn to visit him next time, he laughed, ‘Oh no, she’s moving (here); I’m not doing this again!’ He shared that he has a young daughter who loves to sing and so I invited him to tell me more about her. He seemed to appreciate the distraction and smiled when he spoke about her.

My focus was to remind him to take deep breaths, attending to the slow inhalation/exhalation of his breath. This gentleman seemed somewhat embarrassed, but also quite grateful, and certainly did not eschew my help.

After we reached cruising altitude, he seemed much calmer. From time to time his breathing turned faster and more shallow, which would prompt me to engage in conversation to provide a distraction. We spoke about his destination. I shared some of my favorite places there and he told me what his girlfriend had planned. I encouraged him to enjoy the weekend, fearing he would worry about the return flight instead. I also supported his willingness to fly, given his clear dislike of it!

When we began descending, our fellow-passenger was in distress again. I turned my head toward him, and thought I was directing my voice quietly just to him, never imagining you (on the opposite side) would be privy to the ‘therapy.’ I was focused intently upon him, as a counselor would be with a client.

I used ‘grounding’ mindfulness, and ‘present moment awareness’ strategies to help him control his breathing, and distract him from his fear. I coached him through some diaphragmatic breathing by instructing him to put his hands on top of his ‘belly’ (which sounds less serious than ‘diaphragm,’ and somehow always prompts a smile).

I asked him to attend to the rise and fall of his hands on his belly, and the feel of his hands against one another. When I noticed he was holding a soft velour hat, I encouraged him to pay attention to its texture. I coached him to pay attention to the muscles in his feet, legs, arms, shoulders, and neck, to experience each area relax, to wiggle his toes — anything to take his mind off the descending plane. I kept cycling through the breathing exercises. It seemed to help him, fortunately.  Of course, I also supported his positive progress.

Once we landed, he again seemed quite grateful but a bit embarrassed. I worried for him on the return flight, so tried to empower him, as we regularly do with our clients, by reminding him he managed the trip with the help of some newly-learned techniques which he could do for himself.

What did I feel during this exchange? I focused on calling up anything I could think of to help him, and keeping my voice calm and steady, as he was struggling a lot! I was pleased in a wondrous way, that I happened to be there and able to help. Such serendipity in the world!

I was also a little embarrassed to discover my ‘therapy session’ was overheard. (The gentleman behind us caught my eye when we stood up to de-plane, to acknowledge the ‘session,’ as did another person in that row). I hoped he and others were not distracted by the repetitive refrain, and that my struggling seatmate was not self-conscious about anyone overhearing. I felt a bit of the ‘therapist’s high’ that happens once in a while, when we have helped another person to find the ability to succeed, and we hope, empowered him to use the new tools to help themselves going forward. I was amazed that by some coincidence I was in that particular seat, at that time and I forgot all about the nap I had eagerly anticipated.

If anything, Catherine “Candy” Davies minimizes all she did, and the gift she displayed in doing it. A tour de force for sure. For over two-and-a-half hours Candy worked with the gentleman, sped through a sandwich, read a few magazine pages, but retained constant awareness of her ‘patient’s’ emotional state. I congratulated her when we landed and she introduced me to her husband waiting inside the airport. Later I found her online and asked if I could share her story. She kindly provided most of the details you’ve just read.

Candy was not always a therapist. She earned an MBA and worked for a large corporation, as well as a non-profit. She’s also been a teacher of college business courses:

My ‘midlife crisis’ led me to a career change, and a return to school to earn an MSW.  I have been working at SUNY, New Paltz (the State University of New York, New Paltz Campus) since 2007 and am happily married to husband Bill. We have two grown children of whom we are very proud.

When I shared the story with Bill, he commented it was yet another example my career change was the right decision.  I agreed with him, for it put me in a place to help this young man.

Legendary basketball coach, John Wooden, said: “The true test of a (person’s) character is what he does when no one is watching.” Even though a few of us listened-in (you can’t hear everything on an airplane and my book was engrossing), I would remind you Candy remained unaware of her audience until the end.

Maybe now you have persuaded yourself — by virtue of my seat-mate’s basic decency and therapeutic talent — that counselors are not the self-interested rascals you thought we were. Then again, maybe not.

But regardless of what you think, Candy will still be out there, giving her best, healing when possible, living her values.

Biased though I am and special though she is, in my experience she is not alone.

Below “Candy” Davies SUNY photo, is a High Contrast, Stylized Vector Image showing hands helping each other, the work of Phollox. The last image is A Helping Hand, by Jean-Paul Haag. All but the photo are sourced from Wikimedia Commons.

How Therapists Fool Themselves

Snowball therapy

The above photo of Kyle Young’s album “Snowball Therapy” is not meant to suggest anything negative about his music. Unfortunately, however, there are probably a few therapists who are using forms of “therapy” that are nearly as preposterous as that name implies.

The fallibilities of therapists could probably fill several books. I will not win much applause from colleagues by telling you how therapists sometimes fool themselves. The list below does not apply to all healers, but the self-deceptions are more common than one would wish. Here are a few of the ways that counselors sometimes lack a realistic appraisal of themselves and their work:

1. “I’m not doing this for the money.” While almost all therapists come to the profession in order to do some “good,” most also have to make a living like everyone else. Quite a few will discount their fees for certain patients, but most set some number as the very bottom-line that is acceptable compensation, meaning that clients without medical insurance coverage or a heavy wallet go without.

Those practitioners who do lots of marketing and employ other therapists clearly are mindful of the potential for profit. All this is fine, but it also means that there is more than one reason that therapists do the work; and that for some, money is of equal or greater importance than the work itself. Keep in mind the old joke about the MD who is asked about his specialty. His answer is: “My specialty is diseases of the rich.”

2. “I can treat almost any diagnosis.” There are too many different ways a life can go wrong and too many areas of skill and knowledge required to help put things right. No one has seen them all and knows them all, but some think they do. If your counselor claims omniscience or anything close, run — run fast!

Watch out for a therapist who thinks of himself as some sort of therapeutic comic book hero.

Watch out for a therapist who thinks of himself as some sort of therapeutic comic book hero.

3. There is no research supporting what I do, but I know it works.” Some therapists go so far as to write books about their style of treatment despite a lack of research support. They claim that their experience justifies their approach, citing anecdotal evidence which no scientist would take seriously. They ignore the fact that empirically validated treatments exist for conditions like Obsessive Compulsive Disorder (OCD) and Social Anxiety Disorder, to name only two.

In effect, these healers practice the rough equivalent of using an unproven folk-remedy to cure cancer. They tend not to read scientific journals that publish rigorously designed, peer-reviewed articles, dismissing them as too “academic and impractical,” and may not even have the training to adequately understand such research reports. Good luck if you are the patient of one of these people.

4. “We need to continue; you aren’t where you need to be yet.” Several potential problems are found here, even though it might be true that the patient could benefit from something more. First comes the question of why therapy hasn’t already accomplished what it needs to do. The therapist may have taken this person as far as he is now capable of going, regardless of who might treat him; or else lacks the skills needed to take him further. Is the healer’s desire to extend therapy motivated by money? What is the treatment plan to get the person to the finish line and is the patient prepared to make the effort and pay with his time and hard-won dollars?

The truth is that we humans are never perfected in all the things that could make our lives better, yet most of us continue without lifelong therapy. The decision to end must come sometime.

5. “My personal issues haven’t compromised my ability to do therapy.” I have known (or known about) therapists who treated obesity despite their own considerable overweight, who treated addiction despite themselves smoking two or more packs of cigarettes a day, and who were cheating on their spouses (sometimes with patients). I’ve heard of therapists practicing with their own untreated (and perhaps undiagnosed) Attention Deficit Hyperactivity Disorder (ADHD); others with undiagnosed or untreated Bipolar Disorder.

The list of human weaknesses in therapists is not much different from the list you will find in non-therapists. Having problems at home, as therapists sometimes do, can be enormously distracting, to say the least. The more chaotic and disturbed is the healer’s life, the less effectively can he help anyone.

6. “My values don’t influence my ability to do therapy.” I’ve known therapists who were very religious, going so far as to encourage their patients to adopt a similar view; and atheist counselors who were troubled by patients who had strong religious beliefs. I’ve known those who can’t easily talk about death because they are terrified of it, a problem when dealing with someone who has mortality issues. Therapists must either refuse to see certain people, refer them to others, or heal themselves in order to practice honorably and well. Unfortunately, some practitioners deny their own limitations and the extent to which their own beliefs and issues can affect therapy.

Finally, the biggest self-deception of them all:

7. “My patients get better — I’m a good therapist.” Maybe not. Remember that most people come to therapy at a low point in their lives, perhaps even a crisis. Time passes, whether in therapy or out. Most of us tend to bounce back. As researchers know, the real question is whether the person you are treating would have done as well or better with a different treatment, without treatment; or with someone like a relative, a friend, or a clergyman who did little more than listening and hand-holding.

A few therapists forget the admonition made to physicians: “First do no harm.” Indeed, there are counselors who believe they are doing just fine, but who have failed to diagnose the difference between Bipolar (Manic-Depressive) Disorder and other varieties of depression; or missed recognizing that a patient has partially compensated for his non-hyperactive problems of attention and concentration by dint of intellect and effort, and thereby effectively disguised his need for medication.

Those diagnostic failures virtually guarantee frustration and discouragement in the patient, who then has one more life disappointment to add to a long list; and who might never return to therapy with a genuinely competent therapist. The “doc,” meanwhile blames the client (or the severity of the patient’s problems) instead of his own incorrect evaluation.

Part of the dilemma for prospective patients is that most don’t investigate therapeutic options years in advance of the decision to seek help, nor can they reasonably be expected to. Indeed, they usually spend much less time researching potential treatments than they do when investigating which car to buy. Rather, clients typically come to therapy at life’s low ebb, review the list of people who accept their insurance, and look upon the therapist as a licensed authority who will surely have all the answers. Yes, we are licensed, but that doesn’t guarantee our competence any more than it does for cosmetologists, physicians, cemetery managers, real-estate agents, or barbers, all of whom need to be licensed in the State of Illinois.

There is nothing better than knowing what you are getting into and with whom, even if you are out of gas; especially if you are out of gas. Get recommendations from your friends or your MD if you can. Early on, find out what your diagnosis is and do research on the web concerning empirically validated treatments for that condition.

Therapists generally mean well and some are really terrific. Literally, life-savers. But, like any other group, we are subject to our own self-deceptions. A few counselors should be placed on a pedestal, a few underneath one.

Advocate for yourself.

You may find the following related post of interest: When Helping Hurts: Therapists Who Need Therapy.

The top photo is from Kyle Young’s fourth album. The second image is of “Retman,” an actual therapeutic comic book hero. The first three initials, R.E.T., stand for Rational Emotive Therapy. The cartoon is the work of Razvantonescu, International Institute for Advanced Studies of Psychotherapy and Mental Health. Both works are sourced from Wikimedia Commons.