I walk back into our suite, place the food bag in the fridge, and decide to use the hour to catch up on chart notes. When I get to my desk, I notice that I have some voicemails.
The first is from John.
“Hi, it’s me,” his message begins. “Shit, I completely forgot to cancel until my phone beeped just now with our, um, appointment. Usually my assistant schedules everything but since I do the shrink thing myself . . . anyway, I can’t make it today. Work is insane and I can’t get away. Sorry about that.”
My initial thought is that John needs some space and will be back next week. I imagine that he wrestled up to the last minute with whether or not to come today, and that’s why he didn’t call in advance—and also why the standing food order appeared here without him.
But then I play my next message.
“Hi, it’s me again. So, um, I didn’t forget to call, actually.” There’s a long pause, so long that I think John may have hung up. I’m about to hit Delete when finally he continues. “I was going to tell you that, um, I’m not going to do therapy anymore, but don’t worry, it’s not because you’re an idiot. I realized that if I’m not sleeping, I should get sleep medication. Obviously. So I did and—problem solved! Better living through chemistry, ha-ha! And, uh, as for the other stuff we talked about, you know, all the stress I’m under, I guess that’s just life and if I get some sleep, I’ll be less annoyed by it all. Idiots will always be idiots and there’s no pill for that, right? We’d have to medicate half the city if there were!” He laughs at his joke, the same laugh I remember from when he said I’d be like his mistress. His laugh is his shelter.
“Anyway,” he goes on, “sorry for the late notice. And I know I owe you for today—don’t worry, I’m good for it.” He laughs again, then hangs up.
I stare at the phone. That’s it? No Thank you or even a Goodbye at the end, just . . . done? I had expected that something like this might happen after the first few sessions, but now that I’ve been seeing him for nearly six months, I’m surprised by his sudden departure. In his own way, John seemed to be forming an attachment to me. Or maybe it’s that I’ve been forming an attachment to him. I’ve come to feel real affection for John, to see flashes of humanity behind his obnoxious façade.
I think about John and his son Gabe, some boy or grown man who may or may not know his father. I wonder if on some level John wants to leave me with the burden of this mystery, a big fuck-you for not helping him feel better quickly enough. Take that, Sherlock, you idiot.
I want to let John know that I’m here, to somehow communicate that he—and I—can handle whatever he brings to therapy. I want him to know it’s safe to talk about Gabe here, however tricky that situation or relationship might be. At the same time, I want to respect where he is right now.
I don’t want to be the rapist.
It would be so much better to say all of this in person, though. In my informed-consent paperwork that I give to patients before they start treatment, I recommend that they participate in at least two termination sessions. I discuss this with new patients at the outset so that if something upsets them during treatment, they don’t act impulsively to rid themselves of the uncomfortable feelings. Even if they do feel it’s best to stop, at least the decision will have been reflected upon so they can leave feeling that they made a thoughtful and considered choice.
As I pull out some patient charts, I remember something John said while making the slip about Gabe. There’s too much estrogen in the house and nobody understands my perspective . . . I’m outnumbered . . . everyone wants something from me . . . nobody understands that I might need something too—like peace and quiet and some say in what goes on!
Now it makes sense; Gabe could counteract some of the estrogen. Maybe John believes that Gabe understands him—or would, if he were in John’s life.
I put down my pen and dial John’s number. When his voicemail beeps, I say, “Hi, John. It’s Lori. I got your message, and thanks for letting me know. I just put our lunches in the fridge, and I thought of last week when you said that nobody understands that you might need something too. I think you’re right that you need something, but I’m not so sure that nobody understands this. Everyone needs something—often, lots of things. I’d like to hear what it is that you need. You mentioned needing peace and quiet, and maybe finding peace and quieting down the noise in your head will involve Gabe, and maybe it won’t, but we don’t have to talk about Gabe if you don’t want to. I’m here if you change your mind and decide you want to come in next week to continue our conversation, even if it’s just one last time. My door is open to you. Bye for now.”
I make a note in John’s chart and then close it, but as I lean over the file cabinet, I decide not to move it into the Terminated Patients section today. I remember in medical school how hard it was for us students to accept that somebody had died and that there was nothing else we could do, to have to be the person to “call it”—to say aloud those dreaded words Time of death . . . I look at the clock—3:17.
Let’s give it one more week, I think. I’m not ready to call it just yet.
30
On the Clock
In my final year of graduate school, I was required to do a clinical traineeship. The traineeship is like a baby version of the three-thousand-hour internship that comes later and is required for licensure. By this point, I’d taken the necessary coursework, participated in classroom role-play simulations, and watched countless hours of videotape of renowned therapists conducting sessions. I’d also sat behind a one-way mirror and observed our most skilled professors in real-time therapy sessions.
Now it was time to get in a room with my own patients. Like most trainees in the field, I’d be doing this under supervision at a community clinic, much the way medical interns get their training in teaching hospitals.
On my first day, immediately after the orientation, my supervisor hands me a stack of charts and explains that the one on top will be my first case. The chart contains only basic information—name, birth date, address, phone number. The patient, Michelle, who is thirty and has listed her boyfriend as her emergency contact, will be arriving in an hour.
If it seems strange that this clinic is letting me, a person who has performed exactly zero hours of therapy, take on somebody’s treatment, it’s simply the way therapists are trained—by doing. Medical school was also a trial by fire; in medicine, students learned procedures by the “see one, do one, teach one” method. In other words, you watched a physician, say, palpate an abdomen, you palpated the next abdomen yourself, and then you taught another student how to palpate an abdomen. Presto! You’re deemed competent to palpate abdomens.
Therapy, though, felt different to me. I found performing a concrete task with specific steps, like palpating an abdomen or starting an IV, less nerve-racking than figuring out how to apply the numerous abstract psychological theories I’d studied over the past several years to the hundreds of possible scenarios that any one therapy patient might present.
Still, as I make my way to the waiting room to meet Michelle, I’m not terribly worried. This initial fifty-minute session is an intake, which means I’ll gather a history and establish some rapport with her. All I have to do is collect information using a specific set of questions as my guide, then I’ll bring those results to my supervisor so that we can formulate a treatment plan. I spent years as a journalist asking probing questions and establishing a comfort level with people I didn’t know.