Leslie's BlogThe Clinic
Paul said I needed to work with a seasoned therapist, so he assigned me to shadow a social worker named Eleanor who had been at the clinic for over ten years. She was a middle-aged woman with a sweet face and graying hair parted primly down the middle with razor-edged exactness. She had a penchant for wearing denim prairie dresses, sensible, comfortable shoes and speaking in carefully measured, soft tones. With Eleanor’s next client alerted that I would be observing that morning’s session, I sat in a corner of the room with my back against the curtained display window, waiting for the door to open. The client, a plain woman wearing baggy clothes, glanced at me and nodded as she entered the room while Eleanor stood up and greeted her warmly. With the grace of a stately matron the client sat down, collected herself and turned to Eleanor, who was smiling encouragingly. Already I was beginning to drift off into a daydream at this stoic scene when a noise like a steam-whistle erupted from the client, startling me back to my battered Naugahyde chair. I snapped my head to attention as I witnessed what seemed like a vision of the client’s mouth growing ever larger and darker as her anguish crested into a crescendo threatening to fill the room. There were words being yelled, I was certain of that, but what she was actually saying was lost. An image flashed into my mind of “Alice In Wonderland,” in which Alice encountered the Red Queen in full-melt-down mode. I was in equal measure shocked and amazed. Now this was pathology.
In graduate program our counseling classes had consisted of students practicing on each other. For part of the classroom hour one of us would be “the client” and for the second half of the hour, we’d switch and the other would become “the therapist”. All of this had an incestuous feel to it, which sometimes we’d grouse about later in the hallways. But since this was how the classes were structured, we shrugged our shoulders, adjusted our attitudes and gamely discussed our “issues” or listened attentively to our “clients” in various spots of the classroom. The room sounded like a bee hive of, “Please, tell me more,” “How did that make you feel” (that one actually does get used), and “I’m confused, could you explain what you meant?” In working with other graduate students the discussions we tended to take to our faux-sessions were cautious, polite, and heavily edited. We sure as hell weren’t going to open up about deep traumatic issues with a classmate who upon graduation could become a colleague with a long memory. So nice and easy was the pace. Even during our graduate school internships we were generally in settings with clients who were more on the “worried-well” scale. Again, nothing too tough because we were just trying to learn how to be therapists and not expected to handle people with full-blown psychosis, self-destructive tendencies or complicated personality issues. Thus my delusion was born of how tough could it be to work as a psychotherapist? I had spent three whole weeks with my classmate, Jennifer, as her therapist and together we had figured out it was best to leave her schmuck boyfriend. She had even had tears in her eyes after our last in-class session, saying how much I had helped her. I felt that warm feeling of, “Yes! I can do this.” Never mind that had Jennifer told three random strangers on the street her story, she would have probably had the same general conclusion to send bad boyfriend packing. Obviously the fall was waiting for me, I just didn’t expect it be a punt-kick.
My smug comfortable feeling evaporated like a cool mist under a microwave as I sat pinned against the wall in the clinic, watching this client begin to unravel while rooting through her purse for what – a gun? A switch blade? My eyes darted to Eleanor, whose only body movement change was to furrow her brow into deepening concern and tilt her head about five-degrees, much like the RCA dog listening to his master’s voice. I was floored. Obviously this wasn’t something extraordinary. No one was going to call 911. No burly staff members were going to rush into the office in order to do a take-down on a threatening client. This was just her Monday 10 a.m. appointment.
Eleanor’s calm slowly trickled over to the client and eventually wound its way to me so I wasn’t actively engaged in some sort of flight-fight-freeze response. The client was able to go from a full-blown rage to an angry injustice at how she had been short-changed at the grocery store, as evidenced by the crumpled receipt she finally had dug out from the corner of her purse and brandished under Eleanor’s nose. Watching this therapist I could see that she actually became softer with the client to the point where her voice sounded like a dove cooing. Even her denim prairie dress took on a soft plumage quality as she nestled with a studied stillness into her chair, giving the client her full attention. All of this had the desired affect of soothing the client’s wounded ego, who 45-minutes before coming to the clinic had been at the grocery store demanding her 87-cents back from some cashier who had not been in the mood to cater to a crabby customer with sketchy math skills.
This was my introduction into the irony of how many new therapists begin their careers; we’re working with some of the most explosive, vulnerable, self-sabotaging people who often are pulled together daily by just the habit of living. And they have these therapists, freshly off the graduation stage, with ideas full of therapeutic theories and so little clue as to how to really relate to people in pain. I remember during my first year at the clinic that I would sometimes write down on the margins of my notepad the minutes left in the session until we could both be released from this yoked hour. Learning the art of listening was my task at hand, and looking back on those times, while I’m sure I didn’t do any damage, I doubt I was really that much help. What I struggled with was this sense that the work could go so much deeper, but that I was so lacking in the understanding and skills to get there. The pat phrases we had learned in graduate school were useful in maneuvering through the dialogue of a session, but it didn’t help me with how to step back and really understand the client’s desperation at looking at their lives and saying, “That’s it? And as I get older it’s all going to shoot toward hell’s hand basket?” It was that gulf of helplessness that I felt so acutely when encountered with the raw pain of Eleanor’s client that sent me adrift. How do you fix that?
One of the gifts of working at the clinic was it helped me grind that belief down into a dust. While I came to do “good”, the other therapists and case workers were more focused on how to help the clients figure out how to use their limited funds to pay rent and not blow their grocery money that month on scratch-off tickets or beer. With graduate school out of the way, my real education was beginning.