May 02


I had two “terminations” yesterday at my volunteer gig, i.e. people who decided that they’re done with therapy. This can happen in several different ways. The most popular, by far, is when a client just stops coming. They cancel several sessions and then don’t reschedule and that’s kind of that. This is called “getting fired” when it happens after you’ve told a client something he or she doesn’t neccesarily want to hear. I have had this happen a lot. When I was doing my practicum in managed care, a lot of clients would come to the end of their mental health benefit and they didn’t get to come back, no matter how they were doing or if they wanted to continue or what. (Let’s just skip over my rant on managed care, shall we?). And then there are folks who want to make something of an occasion of terminating. This used to be a lot more popular when people would be “in analysis” for years and years. I had to read this book by a neo-Freudian last year that got very detailed on what to expect during termination (which was supposed to take like eight sessions) and I’m afraid my rolled-eye response was to go “Uh, hello, most of my clients get to have eight sessions, period! Ain’t got no time!”

But actually, yesterday I had someone who wanted to do just that. This person (I’m not going to even disclose this person’s gender) was very happy with where the therapy had gone for her/him, and gave me a very nice thank-you note, which of course I didn’t get to keep, but had to put in the file. Is it terrible if I say how completely gratifying this was for me, in the most selfish and egotistical way? I was so proud. I felt like I’d actually done something right for once, and that I’d trusted my intuition in terms of how to work with this person, and it had all paid off…for the client, I hope, but certainly for me. When you learn how to do therapy, the thing you hear all the time in class is “the most important tool is the self.” Meaning that yeah, you can learn all the fancy interventions you want, but in the end it’s all about how you interact and react to the client, and how the strange relationship that is therapy works. No one is going to get helped if they can’t trust you, or think you’re weird or cheesy, or just plain don’t like you. They don’t care that you got an A on your Behavioral Mod paper, or that you’ve been published in The Journal of Clinical Whatever, or that you presented a great paper at a conference just last week. It’s all about the two of you, right here, in the office, right now.

So, naturally, it’s unnerving for the client because, as I’ve mentioned before, therapy can be sort of a power trippy thing sometimes. It’s scary for the therapist too, because when a session goes badly, or you get fired, it’s really hard not to believe that it’s not all your fault. Your supervisor will usually say something like “It was their decision,” and that’s true, but still, it’s all about the “tool of the self, ” right? “Well,” you think, “clearly I must not have been using my tool very well, now have I?” Uh, that sounds sort of dirty. You know what I mean. I’m just saying it’s hard not to take it personally, and to feel a little scared because your livelihood, for those therapists who actually make a living at it, really does depend on your personality, and some days…well, it’s just not pretty. Because, again, your client doesn’t care (and in most cases, will never even know) that your boyfriend broke up with you, or that you are hungover, or that you have a new puppy that you’re trying to crate train and you’ve just about had it. It’s not about you, see. But where do you put all that, when you’re in session? That’s what I’m trying to learn now, and it’s really hard. I know my best and most helpful sessions are when I’ve been able to just put me aside and open up to what the client is saying and feeling and doing, but I’m sorry to tell you those are few and far between. Most of the time I have to struggle not to say, “Oh, I totally know how you feel. You should hear what my dad says!” and to remind myself, again, that it’s not about me. It’s not about me.

I’m sure you can imagine, being the good and sympathetic people who read my journal (right?) how cool it was to get a thank you note that let me know that I’d done a good job and helped this person out. The best part was knowing that somehow, I had actually succeeded in making it all about the client. I don’t think this person even knew that I was struggling, which makes it so much the better. But you know what else happened? That same day I had another client terminate, sort of by proxy. I wish I could go into the drama, but suffice it to say that this other person also gave me a thank you note, which said that she/he wouldn’t be coming back because he/she was moving away this weekend. The note said that she/he appreciated our time together in therapy. Now, this stunned me, because this other person had consistently been my most difficult client and I had spent a lot of time with my supervisor deconstructing everything I said to him/her, and lamenting that I just couldn’t figure out what was going on, or what I should do, and all the “issues” it brought up for me. So it was really the best thing ever to think that this other person had somehow found some good in all that chaos and confusion I was feeling.

I have few illusions about my desire to “help people…” I no longer believe that I as a social worker can do much of that. I know I’m doing this therapy thing as a way to save myself, that it always really is all about me to some extent. I guess I’m just grateful to know that even though my motivations are, frankly, pretty self-obsessed, somehow something good can come of it for other people, even when I’m not expecting it can or will. Actually, most of the time, the good comes when I’m not expecting it.