Guest Posts, Therapy

A Therapist Confesses: “I Really, Really, Really Can’t Help You”

November 10, 2017
therapist

By Sherry Amatenstein, LCSW

Strands of white hair erupting from her scrunchie, *Evelyn perches on the black pleather chair, greedily gulping from her Poland Springs water bottle and says: “Sherry, yesterday I had one of the worst experiences of my life.  No, probably the worst.”

In the ten plus years I’ve been a therapist I’ve heard numerous variations of this sentence, often followed by a statement like: “The neurologist confirmed my mother has Alzheimer’s. I feel guilty that I still hate her” “I caught my fiancé making out with my best friend” “Maybe getting fired for the fourth time in three years is a sign the world is better off without me”…

This is Evelyn’s latest ‘worst experience’: “I was at CVS buying shampoo and this Chinese guy brushed up against me. I know he did something to the shampoo to hurt me. Should I use the shampoo or return it? I’m sooo anxious.”

I’m never happy to hear that someone is suffering.  I became a therapist in midlife after a career in journalism because I feel driven to be an easer of pain, in a small way to make a permanent, positive stamp on the life of another.

Few things top the exaltation of witnessing a patient finally recognize he or she is trapped in a circular, self-destructive pattern and come out with something like, “I keep bullying my wife because growing up I was constantly nauseated watching my father be such a milquetoast.”

Much of the time, though, I feel like a hamster on a wheel, as unable to help a patient move forward as I was to keep my parents from endlessly reliving the horror of their experiences during the holocaust.

Growing up, mom nightly tucked me into my stuffed animal decorated bed with stories of being wrenched from her family at age 14. Barely out of toddlerhood I could recite by heart details of how my grandparents and three aunts died – Auschwitz figured prominently. Now, in the middle of gorging on a 5 star restaurant dinner, my mind occasionally flashes on a war souvenir dad routinely passed around the table during holiday meals – a frayed photograph of skeletal newly dead naked prisoners piled atop one another.  The photo never slowed down the adults’ appetites, but the Manischewitz Concord Grape began flowing.

The first clue that being a therapist might not fully satisfy my savior complex occurred early in my second year at social work school.  Interning at Zucker Hillside, a psychiatric hospital in Queens,  I was both thrilled and terrified to be assigned my first patient. *Tuan, an 18-year-old college freshman, unable to handle the pressure he felt to garner all A’s had downed half a bottle of Ambien in his dorm room. During a family session his parents expressed unconditional love for Tuan along with eagerness to do whatever they could to facilitate his recovery. Watching the three hug, I did an inner Yippie: ‘Wow, I’m a natural.’

The morning of Tuan’s discharge, I was buzzed in for my shift at the locked inpatient unit Low 3, just in time to see my patient standing in the middle of the nurses’ station throw his breakfast tray across the hallway. He screamed at a spot on the wall, “You are evil. Stop torturing me or I will kill you.”

Alongside several gaping patients, I watched Tuan be wrestled into a straight jacket and sedated. It fell to me to call his parents with the news that their son would not be coming home that afternoon. Tuan had suffered a psychotic episode, indicating a possible diagnosis of schizophrenia.

With awe I watched Low 3’s staff quickly regroup and go about their duties.  I asked the psychiatrist on Tuan’s case, “How do you do it? I’ll be a mess for days.”

She patted my shoulder consolingly, “Eventually you get used to it,” and moved briskly onward, a corner of her crisp white coat soiled by a splash of Tuan’s egg yolk.

Several hundred patients later I am ‘used to it’.  At least enough. In my private practice I prefer patients who for the most part lead functional lives. They come to me triggered by anxiety, depression, suicidal ideation, grief, PTSD often stemming from physical and/or sexual abuse, impulsiveness, self-esteem issues, and difficulty conducting healthy relationships – with themselves and others.

I strive to be the safe haven, the listener, someone who encourages patients to express rather than repress the secrets and urges they fear will repulse others. When a patient exhibits the ability to ‘own’ his or her role in chronic unhappiness rather than casting blame a la: Why do people always let me down?  therapy can begin to move from crisis of the week to in depth discussions of who a person has been and who he or she can become now that the emotional barnacles are falling away.  On these occasions the 50-minute hour flies by and I am tempted to offer payment for this rare gift of spiritual joining.

Then there are clients like Evelyn, who I’ve been ‘treating’ once a week  for the last 20 months at the Queens-based mental health care outpatient clinic where I work on Thursdays and Saturdays.  Like many of the patients here with chronic mental illness, the 73-year-old is under the care of a staff psychiatrist who dispenses medications.

The clinic’s rules mandate any patient on psychotropic drugs must also be in talk therapy. Evelyn – long divorced, on disability, with an adult son who metes out infrequent phone calls  – is excited to have me as hostage.

While my body is trapped, mentally I’m reliving a recent session with a couple who finally bypassed their inevitable shoals of discord over the husband’s ever-growing ‘art’ collection of Disney memorabilia by recognizing each was operating from different emotional needs. *Ann said, ‘Okay, you don’t have to get rid of all 20 Mickey Mouse lithographs. Let’s compromise.”  *Dan said, “It’s not fair for me to take up most of the wall space with my passion.”

But Evelyn deserves my focus. She is the current patient in the chair.  I tamp down the pu-pu platter of pity and pissed-off-ness rising from my solar plexus and say in my best soothing tone: “I hear how tough this is for you, Evelyn. But do you remember what we talked about last week?”

She scratches her skull and more of the ponytail falls from the scrunchie. “Uh, uh, something about… an apple?”

“Yes.  Last week you were upset that a neighbor’s eye catching yours just as you bit into an apple ‘cursed’ the fruit. So what’s the similarity between these two incidents?”

“Uh, well. I threw away the apple though I’d already eaten two bites. But that doesn’t tell me if I should use the shampoo.”

My clinical mind is aware the falling-down-the-well feeling I experience in session with someone my ‘ministrations’ can’t impact is countertransference – the term used to denote a therapist’s still potent unconscious wounds being woken by a patient’s issues.  When the scar tissue is jabbed, I revert to my eight-year-old self who whispered, “Mommy, I wish I could make you all better.’”

I’ve grown proficient enough in my job to eventually grab toeholds that carry me up, up, up and out of the rabbit hole to the current Evelyn in the chair. Belatedly, I remember the mantra my supervisor has drummed into my head: “Let go of your agenda.  Be with the patient.”

I tune back in as Evelyn is saying yet again, “If Michael Bloomberg was taking care of me, I wouldn’t be so anxious all the time.” She adds half jokingly, “You’re my therapist.  Why can’t you make that happen?”

We laugh. I tell both of us, “Sorry, I left my magic wand at home. All I can do is listen to how you feel… But I wouldn’t count on Bloomberg becoming your White Knight.”

I’m not sure if my admission of helplessness helps Evelyn to take a wobbly step forward, but she departs from our typical end of session repartee. Instead of asking again for instruction on how to how to handle the object of her latest paranoid fixation, she declares, “I think I’ll use the shampoo.”

After congratulating Evelyn on this latent ability to distinguish delusion from reality, I usher her out.  There is five minutes before my next patient, bipolar and in rehab for a heroin addiction, occupies the black pleather chair.

True, I lack a magic wand. I am not the Anne Sullivan of talk therapy – capable of laying the groundwork for a miracle.  My bag of tricks involves bearing witness to who someone truly is without judgment and with empathy. That ability may not cure an incurable patient but on occasion it fills my soul.

*The name and identifying details of patients have been changed.

Sherry Amatenstein, LCSW is a NYC-based therapist and author of The Q&A Dating Book, Love Lessons From Bad Breakups and The Complete Marriage Counselor (www.marriedfaq.com). She also edited the anthology, How Does That Make You Feel: True Confessions From Both Sides of the Therapy Couch. Before becoming a therapist she spent two years volunteering at a suicide hotline. She was also an interviewer for Steven Spielberg’s USC Shoah, a foundation dedicated to taking audio-visual testimony from Holocaust survivors. Sherry runs seminars nationwide and has offered relationship advice on Today, Early Show, and NPR. When pressed, she admits to having conducted a pre-marriage counseling session on an episode of My Big Redneck Wedding. Her website is howdoesthatmakeyoufeelbook.com.

 

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