Dose #21: Clients: We're Not Supposed To Love Them...
"What is tolerance? It is the consequence of humanity. We are all formed of frailty and error; let us pardon reciprocally each other's folly - that is the first law of nature."
Therapists have a lot to consider. For professional as well as ethical reasons we should be on time, keep promises made, protect privacy, stay up-to-date with the science of behaviour, return calls when called ("always before the end of day"), accurately record what goes on in every meeting, and keep watch over the person at risk for harm to themselves or others. We're taught to refrain from touching clients. That includes hugging or hand-holding, no matter the need for comfort. We should avoid giving compliments that might be misunderstood.
We should be good listeners; objective, respectful and warm, while maintaining professional reserve. To be overly responsive could be confusing, triggering a client's need to please or impress. And, to establish the right understanding of what a therapeutic alliance is, we should avoid talking about ourselves.
Whether or not we follow the rules, we get to know our clients well. We meet them when they're headed off to college, we walk with them through infidelities and divorce, and when end of life is their next, unfamiliar challenge, we listen as they tell us what they'll miss.
No one teaches us this, but, we're not supposed to love them. Of course not.
Humans have a lot in common. We're driven to know things, to learn. Like all of nature, we carry the instinct to grow. We seek happiness and strive to accomplish. But, what we value, how we go about getting the things we want and the circumstances surrounding the shapes and characters we are at the start, then become...are not the same.
Some differences break the heart, some make it sing, some remain a mystery. Like the young man who told me he had a stockpile of ammunition hidden under the stairwell in his home. The man who revealed his wife was his sister. Or the woman whose boyfriend was a high-ranking mobster, the man who spent most of his life in prison after shooting someone in a bar, the woman who told me her boyfriend was using his law degree to cheat the elderly out of their savings.
Or, the stunning 13-year-old owner of 7 Prada bags who told me trips to Paris and London had grown boring. The mother whose three-year-old son said an angel had visited, beckoning him to come the night before he died. The lovely young woman choked and left for dead in the back seat of her car whose departed family members told her it wasn't her "time", and the woman whose chocolate lab jumped into the client chair, staring back at me as if waiting for therapy while her owner stretched out on the floor with a migraine.
Stories about overcoming the effects of painful experiences are similar, not in context, but in the disposition and values called upon when our world is falling apart. Some count on the self, for others a self must be borrowed, long enough for the storm to pass, long enough for a budding confidence to appear.
But, we're not supposed to love them.
Years ago a 50-something man came into the office saying he'd heard Cognitive Therapy could help him "think better". He was greying, overweight, a gait more side-to-side than forward, a downtown New York 'tough-guy' way about him. He wore sneakers and a zippered jacket over a t-shirt with bold lettering - "NYC". New York was his place and he was proud.
His life began in a rundown tenement on the Lower East Side where chaos, hunger, cold, and broken sleep were the norm. At 5 he would lie awake waiting for exhaustion to overtake his warring, alcoholic parents. Night after night he hoped they wouldn't die.
Tired and hungry during the day, school was a challenge he felt he couldn't meet. With no lunch money, worn shoes, used, unwashed clothes, "not like the other kids", he skipped school more days than he attended, then quit when he was nine, walking out of 3rd grade with less than a 1st-grade education. During one of his parents' drunken brawls, they kicked him out. No money. No friend. No place to go. Nothing. He was ten.
He became a "street kid" by day, and trying to stay close to his parents, slept most nights on the roof of their building - "They didn't even know I was there". He stole food in local shops, picked through garbage cans and dumpsters, and made friends with kids like himself. For short periods he would stay at a friend's apartment, but many freezing New York nights he slept in hallways of buildings with unlocked doors. When he was twelve a local shopkeeper offered him a job sweeping the floor, helping with stock, running errands.
How did this man end up in an Upper East Side behavioural clinic, a place with a 'fancy' lobby and higher than usual fees? How would he know about the latest, 'up and coming' therapeutic approach - this thing called "CBT" he said would help him "think better"? Could he afford therapy? Had he come to the wrong building?
As it turned out, money was not a problem. Working as a store clerk was the beginning of order in this man's life. When we met he was the owner of a packing and shipping company and three commercial buildings. A lesson for a naive therapist.
Children of alcoholic parents often prosper, warding off anxiety with control in the form of persistence - a strength associated with achievement. Added to financial success, he seemed to be at peace, grateful, pleased with the way his life was going, never blaming his parents - why was he here?
For years, he said, he'd been "faking it", calculating and compensating..."fooling people", pretending and hiding. He couldn't read or write - this man who'd accomplished so much was illiterate.
He spoke of living with shame and fear, surrounded by contracts, letters, directions, messages, manipulating situations and people to accomplish what he set out to do. Listening to him talk about how he found our office, a place where his secret would be kept, where he could ask for help with no loss of dignity, I was taken by how resourceful, how intelligent he was.
Rather than carrying around a child's reading book others might question, I asked him to buy the New York Daily News - every day. This would be our teaching tool.
His job was to cut out photographs he found interesting, choose a few words associated with the photo, then practice copying the words, compiling what he'd found into a list. Those would be the words we would work on in the week's session. We went over the alphabet again and again until he put it to song. In about eighteen months he learned to read and write. It was basic, but it was a beginning.
With time he grew more gentle, but the 'tough guy' never left - just in case. Four days before one of his final sessions I had surgery in one eye. I went to work covered in concealer, hoping no one would notice what was left of a black eye. As he walked into my office, his body grew large, a look of shock on his face..., like a character out of "The Godfather", "Who did this to you?", he asked. Had the sight of a bruise brought him back to an earlier time? The tone in his voice let me know he was ready to find the person who would harm his teacher. It took a lot of convincing for him to believe this was surgery and not the result of violence.
This man didn't need to learn how to "think better". And, I didn't use one single CBT technique. His speech revealed lack of education, but what he did with what he had, revealed remarkable determination and intelligence. With encouragement, freed from shame, the boy who slept on a roof whose best friend was hope - how could he possibly"think better"?
But, we're not supposed to love them.
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