How hard, I think, can this be?
Michelle is tall and too thin. Her clothes are rumpled, her hair unkempt, her skin pasty. Once we’re seated, I open by asking what brings her here, and she tells me that recently she has had trouble doing anything but cry.
Then, as if on cue, she starts crying. And by crying, I mean howling in the way one might if just informed that the person she loves most in the world has just died. There’s no warm-up, no wetness in her eyes that leads to a light drizzle and gradually a downpour. This is a level-four tsunami. Her entire body shakes, mucus drips from her nose, wheezy noises emanate from her throat, and, frankly, I’m not sure how she can breathe.
We’re thirty seconds in. This isn’t how the simulated intakes went at school.
Unless you’ve sat alone in a quiet room with a sobbing stranger, you don’t really know how simultaneously awkward and intimate it feels. To make matters weirder, I have no context for this outburst, because I haven’t gotten to the history part yet. I know nothing about this very distressed person sitting five feet away from me.
I’m not sure what to do or even where to look. If I look right at her, will she feel self-conscious? If I look away, will she feel ignored? Should I say something to engage with her or wait for her to finish crying? I’m so uncomfortable that I worry a nervous giggle might erupt. I try to stay focused, thinking about my list of questions, and I know I should be asking how long she’s felt this way (“history of present condition”), how severe it’s been, whether something happened that brought this on (a “precipitating event”).
But I do nothing. I wish that my supervisor were in the room with me right now. I feel totally useless.
The tsunami continues with no sign of letting up. I consider waiting it out, figuring she’ll run out of steam soon and then be ready to talk, the way my son would as a toddler after throwing a tantrum. But it just keeps going. And going. Finally I decide to say something, but as the words leave my lips, I’m convinced I’ve just uttered the dumbest thing that any therapist has ever said in the history of the field.
I say, “Yeah, you seem depressed, all right.”
I feel bad for this woman the instant I say it, like I should punctuate it with a big duh. This poor, depressed thirty-year-old is in tremendous pain, and she isn’t coming here so that a trainee on her first day can state the blatantly obvious. As I try to think how to correct my error, I wonder if she’ll request a different therapist. I’m sure she isn’t going to want somebody like me in charge of her care.
But instead Michelle stops crying. As quickly as she started, she wipes the tears away with a tissue and takes a long, deep breath. And then she half smiles.
“Yeah,” she says. “I am so fucking depressed.” She seems almost giddy to be saying this aloud. It’s the first time, she tells me, that somebody has said the word depressed about her condition.
She goes on to explain that she’s an architect who’s had some success, having been part of a team that designed a few high-profile buildings. She’s always been melancholy, she says, but nobody really knows the extent of it because she’s generally social and busy. About a year ago, though, she noticed a change. Her energy level decreased, as did her appetite. Just getting out of bed each morning felt like a huge effort. She wasn’t sleeping well. She fell out of love with her live-in boyfriend but wasn’t sure if it was because she was so down or because he wasn’t the right person for her. In the past few months, she’s been secretly crying every night in the bathroom while her boyfriend sleeps, making sure not to wake him. She’s never cried in front of anybody the way she has just cried in front of me.
She cries some more, and through her tears, she says, “This is like . . . emotional yoga.”
What has brought her here now, she confides, is that her work has started getting sloppy and her boss noticed. She can’t concentrate because trying not to cry is taking all of her focus. She looked up the symptoms of depression and ticked off all the boxes. She’s never been in therapy before but knows she needs help. Nobody, she says, looking me in the eye—not her friends, not her boyfriend, not her family—knows how depressed she is. Nobody but me.
Me. The trainee who has never done therapy before.
(If you ever want proof that what people present online is a prettier version of their lives, become a therapist and Google your patients. Later, when I Googled Michelle out of concern—I learned quickly never to do this again, to always let patients be the sole narrators of their stories—pages of hits popped up. I saw images of her receiving a prestigious award, smiling at an event standing next to a handsome guy, looking cool and confident and at peace with the world in a magazine photo spread. Online, she bore no resemblance to the person who sat across from me in that room.)
Now I talk to Michelle about her depression, find out if she’s contemplating suicide, get a sense of how functional she is, what her support system is like, what she does to cope. I’m mindful of the fact that I’ve got to bring a history to my supervisor—the clinic needs it for its records—but every time I ask a question, Michelle segues into something that leads us in a completely different direction. I subtly redirect, but that inevitably takes us someplace else, and I’m very aware that I’m getting nowhere with the history.
I decide to just listen for a while, but I can’t completely block out my thoughts: Do the other trainees know how to do this the first time out? Can you get fired from this gig on your first day? And, when Michelle starts crying again, Is there anything I can do or say that will help her even the slightest bit before she leaves in . . . wait, how many minutes are left?
I glance at the clock on the table next to the sofa. Ten minutes have passed.
No, I think. Surely we’ve been in here for more than ten minutes! It seems more like twenty or thirty or . . . I have no idea. Has it been only ten? Now Michelle is going into great detail about all the ways she’s screwing up her life. I go back to listening, then glance at the clock again: it’s still ten minutes past the hour.
That’s when I realize: The clock hands aren’t moving! The battery must have died. My cell phone is in another room, and while it’s likely that Michelle has one in her bag, I can’t exactly ask her what time it is in the middle of her story.
Great.
Now what? Should I arbitrarily say “Our time is up,” even though I have no sense of whether twenty or forty or sixty minutes have passed? What if I cut it off way too early or too late? I’m supposed to see my second new patient after this. Is he sitting in the waiting room wondering if I’ve forgotten his appointment?
Panicking, I’m no longer paying close attention to what Michelle is saying. Then I hear this:
“Is it over already? That went faster than I expected.”
“Hmm?” I say. Michelle points to somewhere behind my head and I turn around to look. There’s a clock on the wall right behind me so that patients can also see the time.
Oh. I had no idea, and I hope that she has no idea that I had no idea. All I know is that my heart is racing and that, though the session has gone quickly for Michelle, it felt like an eternity to me. It would take practice before I’d come to feel the rhythm of every session by instinct, to know that there was an arc to every hour, with the most intense parts in the middle third, and that you needed about three or five or ten minutes to put the patient back together, depending on the person’s fragility, the subject matter, the context. It would take years to learn what should or shouldn’t be brought up when and how to work with the time available to get the most out of it.