Stop, drop, & roll: Encountering Clients in Public

I had one of those days where if the sequence of events that happened on this day were depicted in a movie or a novel, you would never believe it. Totally unrealistic, you'd say, so far fetched! Well, I feel compelled to share what happened with you for two reasons: (1) it has relevance to my life as a burgeoning clinical psychologist and (2) I think it will help me with getting over how strange the day was--like exposure therapy. Here goes...

As part of a long held Sunday ritual, my husband and I set out for breakfast at one of our favorite local breakfast/lunch joints, let's call it Sallie's. Sallie's has been a locals' haunt that has recently enjoyed the patronage of newbies who became hip to it from some good ole Food Network exposure. Thankfully, its dive charm didn't lend itself to be totally overrun by tourists and bored outsiders. It's edgy-hipster appeal melds well with the urban charm of the rough-around-the-edges location in a way that speaks to most of the artists, rockers, and DIY-millionaires who like keepin' it real in the hood (creatives as Deet would say). As we make our way to Sallie's, crossing the street like two Froggers dodgeing traffic, I see this guy who looks familiar sitting at one of the outdoor tables. Hmm, I think to myself, where do I know him. Usually, when I feel that way, the person is an extra or supporting character on TV or in some movie. Nope, not this guy. Finally, when my neural networks made a data match somewhere in my memory bank, I realized this was a former client. Actually, he was half of a couples case my colleague and I saw for a summer. A sense of dread, anxiety, and a little nausea spread over me like a thick smoothie. I try to see who he's with without them noticing. Ah, it's definitely her, I know that profile from anywhere. Ugh, I thought, why them, why now, and why at Sallie's?! My Sallie's?! They live across town...way, way, way, across town. The server, who knows us by now, gets ready to seat us at our usual table outside. "No, we're doing inside today, pal, INside," I say emphatically. He's surprised but chuckles and obliges. Whew.

This couples case was a tough one. There was a lot of--ahem--sensitive issues going on. After some time it was clear that one person wanted to be in therapy while the other didn't. What complicated things even more was that the one who wanted therapy was originally seeking out sex therapy... but refused to talk about sex. We were not allowed to discuss sex, which, as you can imagine, makes sex therapy a little difficult. We ended up doing a lot of couples communication counseling. Eventually, there was a lot of frustration on our end with missed/canceled appointments and they felt like we were being to pushy. There were a number of angry outbursts, crying, and unpredictable reactions to topics we brought up. Right before my colleague and I were about to call it quits, they dumped us. Though they admitted that the one person wasn't interested in therapy, it just wasn't working for them. Fine with us!

Now my husband and I were seated on the other side of a window facing this couple's table. Joy. What does one do in this unfortunate situation? Part of the confidentiality agreement is that I cannot disclose the nature of our relationship in public without the client's approval. Therefore, when I see a client in public I cannot acknowledge that I know them, lest whoever they're with asks, "Who's that?: They need to initiate contact for me to acknowledge them. So that gets me off the hook. I had a feeling that this couple wouldn't initiate any contact, but you never know. They had a flair for the dramatic.

While I start meticulously looking at every item on the menu, something I rarely do since I have a usual order, I can keep track of where the couple is in my periphery. My husband has no idea what's going on this whole time but senses that something's up. "What'cha gonna order, hun?" I ask him. "The same thing I always order, you?" he says. "Oh, I don't know...might switch it up today...switchin' things up!" I responded, sounding a touch insane. Meanwhile, the man of the couple gets up and walks past my table to the bathroom. This is odd because no one uses the bathroom at Sallie's. It's way far back in the restaurant and you have to walk through the kitchen...and, honestly, it's gross. I sense that they're totally onto me. My eyes stay glued to the menu. I see him, in my periphery, leaving the restroom as he heads outside, again passing my table. Then the woman goes to the bathroom, passing my table on the way. WHAT GIVES?!?! How typical! They are trying to make me uncomfortable, my paranoia leads me to believe. Finally, she comes out and they leave. I put my menu down and let out a big sigh. "What the hell is going on with you?" my husband asks. I tell him that clients were sitting there and he laughs. He laughs even harder when I describe my theory that they were purposefully making me uncomfortable. "Maybe they just needed to go to the bathroom," he says, still laughing. "Maybe," I say, "but maybe not." I laugh and finally order my usual.

As we enjoy our meal, a group sits at the table next to us. As their conversation develops, I over hear a guy talking about his studies in psychology and seeing clients. At one point he says, "So yeah, I've got my Masters which basically makes me a clinical psychologist." I nearly vomit all over my half empty plate. My husband, who also heard this, starts to laugh a little. A master's degree does not a clinical psychologist make. It can make you a therapist in a number of different areas, but not a clinical psychologist. I don't spend years of my life tortured and stressed, working my self into the ground to get a Ph.D. to have idiots like this calling themselves clinical psychologists. The man continues, "Oh yeah, I'll be seeing clients on my own pretty soon, which is great. You know, big bucks. And I believe in it to, you know, therapy, it sort of works." Oh yea, sure, therapy sorta works. Why not try it out? The guy doesn't even believe in the work!! I'm livid and shaking at this point. Then the group's conversation shifts to the topic of awkward moments when people run into their therapists outside therapy. Can you believe that? Can you BELIEVE that? Thankfully, we were done with breakfast. "You ready to go?" hubby asks me. "You bet your ass I am!"

It's not me, it's you: Getting dumped by a client

Just when I thought things were going so well--when the therapeutic alliance was strengthening and my client and I were truly bonding--I got THE e-mail. The "I need a break" e-mail. Yes, I was dumped by my client a few days ago and, to add insult to injury, she did it over e-mail. Just so you know, I don't normally communicate with clients over e-mail, partly because of the lack of confidentiality on the internet, but mostly because it's too easy to do last-minute cancellations when you don't have to actually speak to someone who can tell that you're lying about your sudden bout of Swine Flu. Usually, when a client switches up how the medium they use to contact you, something's going on. This client, a particularly tech-savvy granny that I had yet to blog about, e-mailed me to re-schedule our previous session. This was the first time she e-mailed me and it raised a red flag in my mind. Alas, in an effort to be efficient, I responded and rescheduled. The other reason I don't communicate with clients over e-mail is that it's too easy for me to forget to write down our re-scheduled sessions when I get their note. That said, I missed our session. Yes, yes...I know that sounds like a totally abhorrent thing to do to a client but before you start hating me, let's discuss some background context, shall we?

This client, let's call her TSG (obviously for Tech-savvy-granny), sought counseling through my program and requested home visits. Ah, yes, home visits. I've done far more home visits than I truly care to do ever again. The only reason why I took this was that she didn't live too far from me and, because I'm no longer taking classes and am on fellowship (read: just getting paid without TAing or RAing), I would be home more, making this a convenient arrangement. Oh, she also requested a therapist with a sense of humor and I was flattered to know that my supervisor, upon hearing this, thought of me. (When you're in grad school, you take whatever positive reinforcement you can get, trust me.) When we met, things went very smoothly. We got along well and I felt that she had really started opening up to me, which suggested that we had developed a strong therapeutic alliance...or, at least it was getting there. As with the best laid plans, I soon realized that this arrangement was far from convenient. TSG did not, in fact, live as close to me as I had thought. The commute to her house became more and more annoying as I competed for road space with Hollywood's finest agents, starlets, and wannabes who tend to drive stupid fast while texting. I found myself thanking my lucky stars for my jungle cat-like reflexes whenever I made it to TSG's place in one, albeit shaky, piece.

One day, I arrive to TSG's condo for our session and, surprisingly, her son answered the intercom and told me he didn't know where his mother was and that he was a little worried. I became worried, too. She's an older woman and who knows what could have happened to her. My worst fear in working with older adults is that they won't make it through therapy. I thought, for sure, this was it, so I became panicked. I hung around for 20 minutes, brainstorming with TSG Jr. about her possible whereabouts and then decided to leave. FIVE HOURS LATER, I get a call from TSG that she had totally forgotten our session--she was absolutely mortified and apologetic. I was so relieved she was alive that I was uncharacteristically accepting of the snafu instead of spending a half hour discussing what her no-showing "means" to her. Another detail that should be noted is that we never had a set weekly meeting time. We scheduled sessions as we went along from week to week. I don't normally do this as it's hard for everyone involved to keep track of our sessions and it makes it too easy to reschedule and move things around. There's something about a weekly set session that communicates a commitment to therapy--that it's a priority and that this time is set aside specifically for our work together. Anyway, we didn't do that and that's my fault. In some way, I thought it would make my schedule-planning more flexible and, therefore, more convenient. (Yes, thinking of myself. Naughty therapist!)

So fast forward to TSG e-mailing me to reschedule. We reschedule. I miss the session. Halfway through what would have been our session, I e-mail her apologizing and offering to rearrange things just to see her. I hit send. I waited. At this point, I do believe I should've called her. Another mistake on my part. Actually, I think I should have called her when she e-mailed me the first time since I thought it was so odd. But, giving into my fear of being seen as reading too much into things, I didn't. God forbid I read too much into things--I'm a therapist, after all. (Note to self: Trust your gut!) Anyway, I get a response from her to the effect that she was so happy we met and thinks I'm a wonderful person but she felt she needed a break from therapy. Also, thrown in there, was something to the effect that this was the result of neither of us sticking to the program. (What program? Ab-hoc therapy isn't a program?)

My heart sunk. I sat back in my chair letting a powerful wave of sadness, fear, and sense of failure swish around me on the inside. I suck, I thought to myself. I missed a session and she dumped me. But wait a minute, she stood me up once before...we were actually even! She sucks! I started reflecting on our past sessions and realized that there wasn't much that was coming out of our supposed work together, anyway. Honestly, I was doing all of the work. She was quite stubborn and was always getting herself into pickles, often by her putting her swollen, arthritic foot in her mouth. But I couldn't find a way to share my feelings about her communication style, which was that her style wasn't working and was usually offensive to others. I guess the therapy wasn't working and, perhaps, the therapeutic alliance I thought was growing in strength wasn't there at all. This was like that period after a breakup when all of the tell-tale signs of a failing relationship become clear upon reflection. Of course she wants a break! How could I have been so blind?!

Losing a client can be a difficult experience for even the most seasoned psychologists. For a one in training, it can be devastating. I don't have years of successful cases to make me feel like I'm a decent therapist and that this one just didn't work out. Losing a client, to me, means that I suck, suck, suck. When I was just starting out in grad school, I used to have this mantra: I suck, I suck, I suck. I would say this quickly, kind of like Jan Brady's "Marsha, Marsha, Marsha!" I used it as sort of negative reinforcement to motivate myself to work harder (not very healthy, I know). Now, in addition to softly repeating that old mantra, I'm holding onto the first few lines of TSG's note for dear life, the ones about her being happy we met and thinking I'm a lovely person (yes, she said that). I feel like that's all I've got until I meet with my supervisor. I know I'll go through the anger phase soon (Who makes home visits anymore anyways? You were so lucky to have me! Lucky, ya hear!?!) and eventually get over her but the wound is too raw right now--the suck-age a bit too great. Now you know breaking up, romantically or professionally, is hard to do. Pass the gelato, please.

Summertime fun? Meeting DT

Summer is a time of leisure and a touch of laziness where you do just enough to get by in order to savor the down time. What did I do this summer? I took on 3 new cases! Way to take a load off, huh? Anyway, since I haven't talked about my cases in a while, here's a lil nugget to get things started.

DT, or as I fondly call her Deet (yes, like the toxic chemical), was referred to me from a colleague who I consider one of the best therapists in our program. She let me know immediately that Deet was not easy. Upon hearing this I knew immediately that this would be an Axis II case: personality disorders. Well, actually, to be accurate, Axis II is really about "underlying personality conditions" (i.e. longstanding traits) and it includes mental retardation. What would I have given for Deet to be mentally retarded! By their very nature, personality disorders are extremely difficult to treat. For one thing, the "disordered" individual usually doesn't think that there is anything wrong with them. Quite the contrary, they often think that they're great...and better than you...at least when you're dealing with the narcissistic types. As luck would have it, Deet was diagnosed by my colleague as having Narcissistic Personality Disorder. Awesome. "You probably won't like her at first," says my colleague, "I sure didn't." This from someone who I think may be the kindest person I know. Double awesome.

As you may recall, my last run-in with Axis II was with Mrs. P. I have since terminated her case. I miss her feisty, albeit racist, comments about her caregivers. There was something truly endearing about her that made me not hate her so much. Maybe it was the fact that she was closing on 90 and just waiting to die, I don't know. I hoped that Deet would be a tragic hot mess, like Mrs. P, so that I wouldn't hate her immediately. She'd grown on me, like a fungus (thanks, Mermaids).

So, I met with Deet. She's a small specimen...tiny in every which way and I felt like a monster in her presence. She looked me up and down...and I mean UP and DOWN, no inch went unexamined. This made me feel uncomfortable, which then made me angry. I thought to myself, I don't like her and she hasn't even said a word to me. I then gave her a once-over, my instinctive reaction when feeling judged. Not very mature, I admit.

What are her presenting problems?
1. She has trouble with her relationships (shocker). She longs for a romantic partner but that hasn't happened. According to Deet, people just don't get her, especially "non-creatives". These are people who do not have careers in the arts and, therefore, shouldn't exist. She also doesn't have very many female friends. Allegedly, women don't get her, either. Whenever a woman says that she has trouble having female friends, a red flag goes up in my mind. It usually means that they have trouble communicating and may often put the ole foot in the giant gaping mouth.

2. She's stuck in her career: a struggling composer. She's been working on an epic opera about parrots for the past 20 years. Yes, the past 20 years. "What I do is really hard, you see. How can I make you understand. OK, it's like imagine you're working towards your PhD, only it's really really hard. Imagine you're doing that for 20 years. You know what I mean?" In my head, I think: No, I don't know what you mean. After all, I'm just a silly PhD student working on a useless and mindlessly easy degree. It took all the strength in me not to deck her. No wonder no one likes her. She’s not likable. I try to shift my inner monologue from the hateful/judgmental place to a more empathetic one in order to stay calm and acknowledge that this person is in pain and needs help...lots of help. Maybe I'm not qualified? Maybe I should transfer her? (teehee)

As she progresses with her tales of woe, letting me into her darkest corners of her current life, her childhood, and her most intimate thoughts, I felt my muscles ease up and I started to really feel for her. She's sad, lonely and scared. Who wouldn't have their defenses up when first meeting someone in that state. I actually had to admit that she could be somewhat amusing when she wasn't being hypercritical of everyone in her life and a total hater. The problem is that she thinks she’s pretty awesome just the way she is. Um, I guess she was sick the day they taught social skills in kindergarten. It’s funny how therapy often acts as make-up classes for missed kindergarten days—only there’s no milk and cookies or nap time. Sigh.

Breaking up is hard to do: The fight over a kidney

I'm sick today. Just a nasty little cold, nothing too drastic, but enough to stay home. While I was falling asleep on a sweet Nyquil high, I thought I saw something on the news about a man who is in a messy divorce, mostly because his wife cheated on him and he now wants his kidney back. What the? I chocked it up to my compromised cognitive state and rolled over to commence the deepest sleep ever. This morning, I've come to realize that I was not drunk on cold meds at all when I read about this story on the Huffington Post...it's true!

Love scorned is a dangerous thing, especially when an organ is at stake! So, it turns out that this Long Island surgeon, frustrated with how the divorce proceedings were going, particularly that he is being kept from seeing his children, is requesting monetary compensation for the kidney he gave his wife to save her life in 2001. Allegedly, she began having an affair about 18 months after the transplant. Call me crazy but aren't gifts, as in the "gift of life", off limits in divorce...I could be totally wrong.

There are so many issues involved in this hot crazy mess. For starters, how can you cheat on the guy who gave you his kidney...to save your life?! Marriage, and any romantic relationship, is complicated. We obviously don't know the whole story. It may very well be that the marriage wasn't working to begin with. Should you stay married to someone just because they gave you a life-saving organ? I actually don't think so. That's manipulative. Relationships are what they are. Shouldn't she have had a heart and broken this off before the affair? Maybe she doesn't have a heart...calling all donors! (Sorry, sad organ donor joke).

The second issue is the motive for his request. He deserves being paid for his kidney because she didn't hold up her end of the marriage. I'm not sure how I feel about this. He says he doesn't regret his donation and that it was the happiest moment in his life. So why drag this into the divorce just to get some financial leverage? It's low.

I think these two should get a diagnosis of "cuckcoo". I would give my husband an organ in a...ha ha..heartbeat. If he cheated on me, I think I would just use this fact as a way of making him hate himself...over and over again. I don't think I would ask for the monetary value of it, though. That way I could remind him of how awesome I am and what a jerk he is to have lost me. Then again, it doesn't look like the economy will be picking up anytime soon. Who knows. (Just kidding, hubs!)

Group Therapy: Proof of the Laughing Cure

Every other week I have the pleasure of leading a support group for adult offspring caring for a parent(s) with Alzheimer's (AD) or Dementia. If you've never been to a support group, I highly recommend attending because they can actually be helpful and surprisingly fun. Our (as in my co-therapist Emma and my) group, is hilarious. We go from discussing how watching a parent become almost completely on their adult child, essentially switching their child-parent roles, can be the hardest part of it all to finding the best fried chicken in L.A. How'd we get there? Well, one of the members discussed how her mother enjoyed getting up early and taking the bus to the 99 cents store. This wasn't the wandering-type of behavior that is characteristic of some dementias, especially AD. It was purposeful and she always returned.

One day, however, a woman was at her door with our group member's mother and said that she found her on by Slausson and Crenshaw, streets in a pretty rough area of L.A. At hearing this, the group started chiming in with oooos, ooohs, dangs, and shoots. One particularly charismatic fellow, the one male in the group who Emma and I know all the ladies have a major crush on, says, "Isn't that there that fry-chi place is?" "Mmmmhmm. That's it alright," chiming in another member. "Child, that might be the nastiest place downtown but, girl, that is some damn fine chicken!" Now, we're all cracking up. "Maybe mom was hungry!" Emma, who's a little more professional than I am in these settings smiles while I am cracking up with the rest of them. "I'm getting hungry now. Who wants to go wander?" I throw in. We all laugh. Ahhh, therapy is fun.

Aside from entertaining each other, this group truly cares for the wellbeing of its members. When a new member joins us, everyone starts asking him/her, usually her, questions about things they've struggled with, like getting their parent to eat (appetite can disappear with AD), dealing with temper tantrums (of their parent and those they want to throw but can't), and what to do when their parent wakes us and suddenly realizes they don't know where they are or what's going on. That's when we talk about the most pressing issue: guns. Every member of our group has had to either hide or take away a gun, sometimes guns, that their parent had for protection. In the wise words of Albert (what I'll call our sole dude of the bunch), "You have got to get that gun outta the house. One day, for protection, that gun will be pointed at you and your momma won't know who the hell you are. You can't be havin' that. Oh no." He's right. AD patients often forget who people are, even their own children. Imagine waking up in a strange place and someone comes into your room. If I knew I had a gun, I might just grad it, too. AD can be extremely frightening. The first question we ask each new member is if they know of any firearms in their parent's home. It never occurred to me that this would be such a popular issue that we'd need to raise it almost every meeting. It's likely a combination of a generation thing and a location/safety thing that these older folk are packing heat. It's sad, really. Pretty soon after the grim warnings, the group finds some humor in the topic, as usual. We were helping one member come up with a plan, or little white lie, to get her father's rifle. She said that if she came back to the next meeting with both eyes, we'd know she got the gun, safely.

P.S: This picture was taken of a group therapy session led by Carl Rogers, the famous humanist psychologist, in 1966. Cool, huh? PhDini=dork.

Ms. G Part II

Against my better judgment, I climb through the brush into the dark tunnel, of leaves and perhaps a furry woodland creature or two, after my client who is already 30 yards away. She is fast, almost too fast for someone suffering from whole body arthritis. I follow her voice to a clearing looking down upon a small creek. Theres a rock about the size of a child-size bean bag chair and my client motions for me to sit on the other half of the rock...patting it and smiling. The rock, you should know, is at the bottom of a steep slope and with one wrong step I would be taking not-so-elegant swan dive into this magical frickin creek. The rock, you should also know, has as much sitting surface a small decorative couch pillow--half of which, is now taken up by my petite client's ass. My ass, on the contrary, is not as petite. Needless to say, I make my way down to the rock and ever so gently balance my one cheek on the stone while using all of the muscles in my lower body to keep me from rolling off of it down to my watery demise in the creek.

We are now back to back, as there is limited room on the rock, and I'm holding the tape recorder up by my shoulder to catch what she's saying. She's been going on this whole time about the stress management techniques she's been using and how Clark dropped in this week to get his life together after AA. I have to admit, the forest was quite lovely. The air smelled clean and the light was soft as it broke through the leaves. We sat there for some time and talked. Things were fine until Ms. G mentioned seeing bobcats and mountain lions in the area. I shot up as if I sat on a tack, nearly tumbling into the water below. "You're kidding right?" I ask, nervously. "Nope. I most certainly am not, " she responds with a smirk on her face. "Oh, uh. I see. Um." This is all on tape, mind you. "Shall we start heading back?" I ask trying to hide my panic. I don't like not having control over my environment when working with clients. That's the luxury of having an office where clients come to you for sessions.

We headed back to the homestead, over the river and through the woods. Ms. G's husband and Clark were standing outside and waved at us. "We're just about to go shootin'" Clark yucks. Ms. G and I go inside, I go into the den where we have our sessions and she goes to the bathroom. As I'm sitting there, getting my things together, Ms. G's husband comes in, "Just getting my kit and things. I'll be out of your way before you know it." He's rummaging in a closet and swings around with what looks like a tackle box in one hand and a long, dark rifle in the other. I gasp. He has progressive Alzheimer's and he's holding a rifle about three feet away from me. He smiles and leaves the room. I, on the other hand, sat there frozen. I start to breathe when Ms. G comes back to the room and sits brightly next to me, under the bust of a stuffed deer with large, kind eyes. I'm still in a state of shock as we wrap up our bizarre session--bizarre to me, not Ms. G.

Ms. G Part I: Lost in the Forrest with Guns and Alzehimer's

Sometimes I like to make things active in a session. If a goal of the client is to get more walking into his or her routine, I suggest we have a walking session. Usually these are relatively quiet strolls around the block while discussing how things have been going. Recently, things got a little more exciting.

Let me introduce Ms. G, a petite, feisty, and quick witted woman as American as baked beans at a summer wienie roast. In her late 50's, Ms. G has been a caregiver for her husband for decades and has recently found herself in a rut. A creative, fun-loving, and energetic fireball, she's lost herself in the monotony of daily routines that are, for the sake of storytelling, about as exciting as watching the paint dry in her semi-renovated living room. She misses doing things for herself and would like to exercise more. So, I offer a walking session. Her eyes light up and she asks me if I'm up for a challenge. A little taken off guard, I say sure.

Something else that you should know is that I make house calls to Ms. G. Is this typical of a clinician? No, it's not. Is it typical of a psychologist in training trying to get as many diverse therapeutic experiences while racking up clinical hours to get into a competitive internship after her dissertation proposal? Yes. Actually, since I am currently in what we call the "Older Adult Track" my client load is primarily elderly folks who may be homebound. Ms. G does not fall into this category. I see her at her home simply because I misunderstood where she lived. She lives in a town that has the same name as a street that is 10 minutes away from where I live. Ms. G actually lives about 4 freeway trips north east of Los Feliz, a more rural-feeling, politically conservative, suburb with a down-home country feel.

I arrive to our session dressed to go for a walk. Ms. G greets me at the door in form-fitting slacks, a denim button down under a quilted vest, Easy Spirit walking shoes, and a long tree branch that I assume she uses as a walking stick (though I never understood the point of a walking stick as it seems to be just another thing to carry). I'm a little alarmed, to say the least. This little lady means business. "Are you ready to hike, my dear?" she asked me, beaming. "Uh, yes. I am, I think." She laughs and I follow her into her house, through the living, out the sliding glass doors to her back yard where hummingbirds are buzzing all around us. With the tiny birds zipping around my head and and the morning sun illuminating the plants in the yard with an almost aura-like glow, I have to admit, there was a magical quality to the place.

Ms. G marched to the back of the yard and climbed over a small wall through some brush and turned around extending her hand out to me. "Where are we going?" I asked. "Sherwood Forrest!" she replied. Like in the Robin Hood story? Hmm. I follow her over the wall and through the brush to an open field that felt like we reached the end of the earth. Nothing but rolling hills and uncultivated land as far as the eye could see. Two people were standing there; Ms. G's husband and Clark, their new friend. Ms. G's husband could easily be the sweetest man I've ever met. He's also somewhat petite, shrunken with age, and due to his progressing Alzheimer's his communications are always short and innocent sounding. Clark, on the other hand, is large and lumbering, and reminds me of Lenny from Of Mice and Men. His big red face lights up when we're introduced and I make sure my wedding ring is visible by rubbing my face with my left hand. Ms. G's husband and Clark were discussing going shooting, with rifles somewhere. They both wish us luck on our "hike" and I get nervous. What the hell have I gotten myself into?

Before I know it, Ms. G is racing up an uphill path into the wilderness. I have to jog behind her to catch up. She's huffing and puffing away up the hill and we reach a larger path, or dirt road, that we follow up hill for 10 minutes or so. I have my tape recorder in hand and try to get her to focus on how she's handling the stress of caregiving and what she's been doing to take care of herself. I'm out of breath, sadly, and I worry that this walk is way more involved than I would have hoped. But we press on while Ms. G discusses her new list making strategies, taking bubble baths, and how it's nice to have Charlie around to distract her husband. She stops in front of a small opening in some bushes and proceeds to climb through it, disappearing into a dark abyss of leaves and and dry branches. I stood there dumbfounded. Does she expect me to climb down this rabbit hole of a passage with her to God knows where? Yes, she does. She expects me to follow her into the woods because of the apparent intimacy that the therapeutic relationship elicits in clients. She trusts me so why shouldn't I trust her. The only thing is, I'm not supposed to trust her--she just doesn't know this. Most clients don't.

To be continued...

Ms. P and the Mental Giants

I've been seeing Ms. P for several months now. She is one of my most challenging clients and, therefore, my favorite of the bunch. She is wonderful in the way a love-blind new mother thinks her objectively ugly baby is the most beautiful creature to grace the human race with its presence. Yes, Ms. P is fantastic in a psychology case study sort of way. She is quite old (90s), spry, and very bright. She also doesn't care for people in similar ways as Daniel Plainview (Daniel Day-Lewis) in There Will Be Blood. She's got a competition in her, she doesn't want to see anyone else succeed, and she hates most people. Yet, as is typical borderline fare, she is deathly afraid of being alone (think Margot of Margot at the Wedding). Despite her unfortunate character flaws, she is a whopper of a storyteller.

Ms. P came to me for her mood--she was depressed, according to the form I received. If you ask her, she isn't depressed, she's just smarter than everyone else, which makes her sad. I always chuckle at these statements which, in turn, fuel her fire. "Let me tell you about X and Y...well these two mental giants think they've got me figured out but the only thing they've figured out is to come in from the rain!" she says of the only family members willing to check in on her from time to time--by phone, of course. Ms. P has the comedic timing of a Catskills stand-up act. "These days, no one has to work. In my day, if you didn't like your boss raising his voice to you then he'd tell you to find a boss who won't!" She is always so grateful for my commitment to working with her but makes sure I know that if she didn't like me, I wouldn't be there. She hates NYers, but I'm different. She's also pretty racist. It's some good times, our sessions, that's for sure.

We set small goals, like her getting her hair done by the next time I see her. I ask about how she feels after it's done since she looks dramatically different--younger and more energetic. "So now people say that I look nice before they try to screw me, am I right? Dear, it's the same shit different day, pardon my French. You know how important manners are to me." It is really difficult to get her to do anything quasi-therapeutic. "Honey, at my age, how am I supposed to change?" In some ways, she's right. What can I expect of this? Personality disorders are hard to work with in young clients. She's lived the majority of her life this way, isolated herself, and now wishes she wasn't alone. How can I undo this damage? Well, I'll be coming back to Ms. P, often, so stay tuned. Last week she admitted to seeing a little progress. I did a tiny victory dance in my mind. I'm sure she sensed it because she quickly added, "Don't get too excited." At least she was smirking.

"They say that time changes things, but you actually have to change them yourself."--A. Warhol

I originally wanted to start a blog to have a place to talk about my experiences in practicing clinical psychology. It's a lonely existence, the life of a psychologist. You have days filled with social encounters that usually involve deep, intellectually challenging conversations with people in some pretty peculiar circumstances, and you are bound to absolute secrecy. I find it rather paradoxical, however, because here we are telling everyone to share their feelings, get things out, work through thoughts and emotions, and I'm supposed to keep mum once the 50 minute hour is up. If I see a client in public, I'm not even supposed to acknowledge him or her. With some clients, I've spent years working on developing social skills only to abandon them completely at 10 to. Well, enough is enough. I need a way to process my feelings about the people I spend most of my days with. You don't know who I am so there's sure as hell no way you'll know who I'm talking about. Of course, names will be changed and I have ways of protecting the identities of every client. So there. Let's get ready to rumble...(I've just always wanted to say that!)