(UN)PLANNED OBSOLESCENCE

 

“Therapy is not meant to last forever,” I tell my kid clients during our first visit. After inviting them to express their feelings about being brought to counseling, I ask them to think about how they’ll know when the work of therapy is done. What will have changed for them?

In asking this, I hope to empower them and shape our work according to their priorities, not necessarily, or only, those of their caregivers. After all, change requires buy-in. Simultaneously, it is my way of planting a seed for one of therapy’s most important flowerings: the good goodbye.

Everyone can expect to experience loss over the fullness of a lifetime; but childhood, for the clients we see in community mental health, can already be replete with losses both clear and ambiguous. Parents especially seem to disappear, in the county where I currently work—into jail, substance use, other towns and states, other relationships and families, mental illness, accidents, suicide, and even death by homicide.

Such loss is complicated in untold ways, with impacts on identity and self-esteem, attachment, concentration, decision-making, moods, stress, coping style, and the immune system. A positive therapeutic relationship, while not “fixing” all that’s gone before, can be a corrective experience, providing safety, reliability, tolerance and adaptability, support and regard, healthy boundaries, respect, and (crucially) warmth. I would contend that when therapy “works,” that corrective quality is the main reason why.

Bringing closure to all the relating that’s come before, the good goodbye is one that is anticipated, planned for, and—though there’s room for sad feelings as well—celebrated together as an accomplishment. I like to provide client-specific “transitional objects,” small items that can carry forward the memory and meaning of our time together. I’ve given skeleton keys, worry stones, figurines, feathers, memory books, and (so far) one mixed CD, all accompanied by notes or letters of congratulations. One spunky little girl I see has already requested brownies, though the end is not yet in sight; for a teen with a love of savory sweets, I made rosemary shortbread.

Needless perhaps to say, all this preparation is as much for me as for the client. I, too, experience some attachment in my work with clients, to varying degrees, and the good goodbye helps me to find closure for work that has impacted me as well. (In The Body Keeps the Score, Bessel van der Kolk espouses the belief that clients can’t grow and change if they can’t see their impact on their worker; I’m hopeful that my clients can see theirs on me.)

The good goodbye is also a corrective experience for me for other losses, both personal and professional—those goodbyes that never resolve. When denied it—when, as happened late this spring, a favorite client simply drops off the map, our work together feels as open-ended and prone to fraying as an unfinished hem. Though coached by colleagues to trust and let go, it is hard not to comb over my memories of our last visit, for possible clues. Did an errant remark cause pain or offense that the client or caregiver wasn’t comfortable addressing?

It’s impossible to know. Some clients aren’t good about calling under any circumstances, let alone the momentous ones that announce the end. My lost client had made radical progress—was he just doing well enough that he felt he was done? Although I give all credit to him and his mom, did disappearing feel necessary to him, in order to own his gains? Or could it be that a lack of experience with healthy endings might have caused him and/or his mother to dread the emotions of closure? When people protect their emotions, it is often (and often unwittingly, though not always) at others’ expense.

In any case, I send my best wishes to him.

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Out of respect for client privacy, names here are always changed or omitted. Text and image copyrights held by me. If you enjoyed this piece, I hope you’ll consider sharing it. To subscribe and receive future posts, please look to the upper right on your computer screen, or scroll to the bottom of the page on your mobile device. “The Numbers Game” (July 2017) will be continued in a future post, when I have more stamina for the topic. Thank you for reading!

PRIDE

Ectoplasmic rainbow

“Did you tell your counselor what you said to me in the car?”

“No,” said Mercedes, with a smirk followed by a giggle.

“You should tell her!” her mom exclaimed.

“No, you tell her!”

“You don’t want to tell her?”

“No, I want to hear you.”

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Mercedes had come to services as a high-strung nine-year-old with separation anxiety. After eight months’ worth of escapades designed to develop her confidence, she was ten years old and seemed pretty near ready to command the universe. (Our fast-slow games and yarn telegraph in the hallway provided unintended ancillary outcomes in the smiles of amused and bemused colleagues passing by.)

As her parents described it to me, they had felt hostage to their daughter’s need for constant reassurance. She’d required accompaniment to her classroom each morning and a detailed outline in her planner regarding who would pick her up after school, when, and how. Her mother included a cheering note in Mercedes’s packed lunch each day. Mercedes couldn’t be left home alone for even a handful of minutes. Breaches of protocol led to tearful fits.

All that changed, and more. I’ll try to write another time about our work, much of it disguised as silliness. Notable here is her parents’ support of their daughter’s therapeutic homework, and Mercedes’s willingness to engage in same. More than anything I did, that made the difference. Deep breathing practice was added to her bedtime routine, along with a recitation of three things that made her happy. Three things every night without fail, that was the only rule—they could repeat or vary endlessly, and be substantial, like visiting grandparents, or lighter, like an extra-yummy breakfast.

Notable also, on the part of her parents, was their extraordinary ability to identify and celebrate positive change. Too many parents with whom I’ve worked have goal posts that constantly recede, such that nothing their kids do is ever enough. As an adult, I find that approach profoundly disheartening; how much worse must their kids feel? When Mercedes volunteered to take half the grocery list and split off from her dad in the store to find things—one of the early positive signs—the confidence and independence she expressed got the recognition they deserved. Blessings upon you, parents of Mercedes!

My inspiration to write about this family this particular week, however, came from another form of recognition, during our last visit. First, I presented Mercedes with the book of skills and stories she had created bit by bit. In the back, there was a letter from me. When we met, she’d chosen a skeleton key from a set of images, as the one representing something about what had brought her to counseling. “I hope when I’m done, I’ll have the key to my worries,” she’d said. Ceremonially, I presented her with an actual skeleton key, which I’d chosen the summer before from a tool chest at a flea market, with an inkling that it would serve a purpose someday.

In reviewing her accomplishments to date, Mercedes’s mom mentioned forgetting a note in the usual packed lunch; it wasn’t, to her surprise, the end of the world. A ruined batch of birthday cupcakes had Mercedes reassuring her mom, “It’s not worth getting upset about.” She could enter school by herself, and take the bus in the afternoon, looking after herself at home for an hour or two. She even seemed to enjoy her time alone. But the most striking detail shared that day, for me, had to do with her seemingly growing assertion of selfhood.

So what had happened in the car? Apparently her mom had made some reference to Mercedes growing up, how one day she’d be bringing boys home and taking her dad to a whole new level of stress. And apparently Mercedes had rejoined from the back seat, “What if I like girls?”

Mercedes giggled again, hearing me hear it.

“And what did I say?” asked her mom. Her lovely, fond, invested, teasing, caring, and committed mom, who had gamely partaken of all our adventures, including holding an end of red yarn while her daughter backed away unrolling the ball of it. “Are you still there?” I encouraged her to ask her mom every step or so, tugging the telegraph line, while her mother answered, “Still here,” tugging in reply. Eventually Mercedes rounded a corner and kept up an unspoken communication—out of sight, on her own, but still connected. We talked afterward about the metaphor of that—how our invisible connection to those we love might look, if we could see it, like that red yarn. Securely held while giving and receiving.

About her daughter possibly being gay, her mother turned the beam of her smile from Mercedes to me and back: “I told her that would be just fine with us.”

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Out of respect for client privacy, names are always changed. Text and image copyrights held by me. If you enjoyed this piece, please consider sharing it. To subscribe and receive future posts, please click the “Follow” button, accompanied by a plus-sign, in the lower right corner of your computer screen. Thank you for reading. I was greatly inspired, in my work with this client, by Playful Parenting and The Opposite of Worry, by Lawrence J. Cohen. My deepest condolences to all who have lost their loved ones to violent crimes, including hate crimes.

PAPIER-MACHE, IN TWO PARTS

This story starts at my inner-city parochial school, where supplies were so sparse that at one point we were sharing a single box of construction paper amongst grades Pre-K through 8. I can still recall my pride upon being chosen by Mrs. Z to leave my 1st grade classroom and walk down the grand black-tiled hall to request the box from another teacher—head held high in my state of importance, I fervently hoped to be witnessed.

What my school lacked in resources, it made up for amply in spirit, thanks in no small part to the cultural influence of the Spanish-speaking families in our parish. The Sisters who ran things, all Caucasian, embraced those families and honored Our Lady of Guadalupe. Looking back from this distance, in a culturally hostile hour, I admire the welcome offered by administrators who would have first come to know the neighborhood when it was all Polish, before the sugar skulls of the Day of the Dead bedecked the shelves of the shabby nearby bakery. A local woman was brought in to teach us Spanish hymns. Most thrilling were the piñatas.

Preparing for an all-school festival, each class worked together at long tables in the basement, soaking strips of newspaper in gummy flour paste and laying them bubbled and buckling over balloons. Smoothed, dried, painted, and strung up in the school gym—a magical transformation—they bobbed as each member of each class, taking turns, got to leverage one blind-folded swing, until a spill of candy hit the floor.

*

The story continues with Cybil, 14, who was hospitalized several times for suicidality before she came to the agency seeking services. I liked her instantly, which made it relatively easy to build the rapport that is crucial with any client, but perhaps especially with teens; she had a mordant wit and a sensitive heart, both of which provided points of connection. One evening early on she interrupted herself and looked up from her mandala, colored pencil poised, and asked, tremulously, “You know I’m not doing this for attention, right?” It was already clear she had heard that accusation many times before.

Thanks to Cybil’s engagement in session and commitment to her therapeutic homework, within several months, she had stopped cutting—then, later, purging. Much of our work, though, still lay ahead. Ahead, and below.

In ways beyond my ken, I’m sure the speculated hard inner core and molten outer core of the Earth make all life possible; but the hard inner core of pain and molten outer core of anger, beneath a crust of scars and mantle of “behaviors,” almost cost Cybil hers. She told me that it wasn’t so much that she didn’t want to talk about things, as that she didn’t know where to start.

Reception at the agency had a vestigial practice of printing visit slips, despite the transition to computerized record-keeping. Several clients were aware, when they turned them over to me, that I put them in a file marked “To Shred.” As she and her mother prepared to leave one night, Cybil handed me hers: “Oh, here, do you want this for your file?”

“Sure,” I replied, “unless you’d like to keep it for yours.”

“I’ll be able to wallpaper my room with them pretty soon.”

Her mother and I exchanged quick looks; she seemed to hear what I did. All that stigma, writ large in Cybil’s life. “Why wallpaper?” asked her mother. “How about papier-mâché?”

“Yes!”—I seized on that. “What about a piñata?” Cybil liked candy, and she deserved a celebration. Transformation for transformation. “You could fill it with sweet things and baubles!” I imagined—I hope we three collectively imagined—a jaunty silk scarf tied above her fine nose and wide smile.

“I like that,” she said. Her mom agreed.

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Out of respect for client privacy, names are always changed. If you enjoyed this piece, please consider sharing it. To subscribe and receive future posts, please click the “Follow” button, accompanied by a plus-sign, in the lower right corner of your computer screen.

 

 

A COUNTERVAILING MAGIC

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Last evening I was running some errands in town when the owner of a tiny used-and-antiquarian bookstore, bald in the style of a sea captain, flagged me down: he had a couple somethings I’d asked for months prior. So I went in, and settled into a narrow armchair, losing track of time until I realized that his open sign hadn’t been up, and I was likely keeping him from his tea.

He waved off my apology; he was staying late, as it happened. A young man would be bringing his girlfriend by, to guide her toward a certain book with a carved-out center containing—yes—a ring. Once said young man had proposed, the owner would clear a space for a small, well-appointed table, and a local restaurant would provide a catered meal. (I didn’t ask, but imagined a lone violinist there as well.)

Hearing that, surrounded by a warren of shelves all but obscuring the ancient blue wallpaper, with a peach-faced lovebird singing in the other room— “Alas, in a cage,” said the bookseller—was an instance of countervailing magic, the current that runs against the ills of the world. Such encounters—magic is always an encounter in some form or another—restore me to joy.

There is a great deal of pain involved in working with children. My first client, as an intern, was a little girl whose mother punched her in the nose and took an ax to her father’s car; she couldn’t concentrate in class and wept for the loss of an animal she’d loved, plus everything else, tears that shook her frame. We did a sensory inventory one day, and the wind spoke to her and told her to find her own safe place in the landscape at home; she let a pond remind her of peace, and the sun shining through a leafy trellis bring her hope. Magic: her dear, intelligent face, as we meditated at a picnic table, beneath the tall tall trees and a vibrant sky. May it carry her forth.

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A NEW MYTHOLOGY

 

Luz's winter coat

 

If you were holding my resume in your hands, you might knit your brows in perplexity at my apparent vocational 180, from the literary arts to clinical social work. I had to justify that even for an unpaid internship. But the fields aren’t really so different: both involve stories, and the language we use to tell them.

From creation myths (the Raven who steals the light; the “Vows” section in the New York Times) to a well-written obit, I’m easily moved when a narrative thread drops a plumb line through a person’s or a culture’s history.

Stories aren’t without their hazards, though. In a single day, we can tell ourselves dozens, often contradictory, tracking the vicissitudes of feelings and fortune. Yet we tend to privilege certain of those narratives above others, sometimes with disastrous results. Many suicides, for example, could be seen as failure narratives: My life will never get better than this.

The interaction between biology and story is too much for me to take on here and now, but suffice it to say our biological states predispose us in narrative directions.

In relationships, our dominant narratives tend to map out the roles that we play. Many kids who come to counseling have been marked within their families as The Problem, so long and so exclusively that they seem to stand no chance of being seen as anything else. While parents may legitimately worry about safety and trust, kids equally legitimately don’t want to have to drag past mistakes alongside them.

The work of counseling, then, is to open up the story, let it breathe, and help it gradually evolve. I believe that we all deserve to play more than one role in our lives, especially to be both nurturer and nurtured. In some settings—at work, for example, or among acquaintances—relatively simple and fixed roles may make sense. But too many of us in our private lives conduct our own personal Stanford Prison Experiment, becoming the (unhappy) parts we play.

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My still-much-missed client Luz was, at age 8, a great storyteller. “Once upon a time…” was all I’d have to say, then I’d take dictation. This started in our first visit, when I was fired up to try a narrative technique I’d read about. Through a Spanish interpreter, I asked Luz and her mother to tell me a story with animals playing their parts. (Luz’s mother began to cry relating the story of a daddy wolf who got sick and couldn’t provide for his wife and their children. Fortunately, that story ended well.)

Shy and brief at first, like Luz herself, the stories over time became more complex, until near the end of our time Luz told me this one:

Once upon a time, there were two turtles, and one turtle was Mama and a girl turtle named Luz. Luz, she always played with her dolls. One day, Mama Turtle said, “I’m going to the store—you stay inside and don’t open the window or door!” Luz Turtle was not listening; she was playing with her dolls. Then someone knocked on the door. “Ding-dong!” It was a hawk! The turtle, Luz, she opened the door and said, “What do you want, Hawk?” The hawk said, “I’m here to ask for a turtle to eat.” Luz ran upstairs and locked the door. The hawk was angry and flew up and then down the chimney into the room. Then he said, “Open the door, or I’m going to eat you!” and the turtle said, “Not by my shell!” The hawk knocked on the door, and the turtle escaped from the room through the window. “Where is that turtle?!” said the hawk. The turtle ran and found a fox—a police fox! The police fox said, “What’s wrong? Why are you running?” Luz Turtle said, “A hawk is chasing me! He wants to eat me!” The police fox asked, “Where is he?” Luz Turtle said, “In my house, in my room!” The police fox went to the house to talk to the hawk. “Oh, Hawk, go away—find another turtle to eat!” The hawk said, “What are you going to do about it?!” “I’ll put you in jail if you eat this little turtle!” said the fox. “I’ll get you next time,” the hawk said to Luz. After that, Mama Turtle came home. “What’s going on? Why is everything open? I told you to leave the door shut!” Luz Turtle said, “I’m sorry, Mama. I wasn’t listening.” Then she told the story about the hawk.

THE END

Luz had come to counseling with generalized anxiety, much of it related to border-crossing, separations, and the INS. She couldn’t bear to see her parents drive away, even on short errands. By the time of this story, however, several months into counseling, Luz seemed to have conquered her anxiety. With decreasing worry and increasing confidence, she began to act out other roles of childhood—kicking up a fuss about going to bed, for example, when she wanted to watch TV with her older siblings. (Luz’s mom seemed to take this in stride, fondly stroking her daughter’s cheek. Would that all parents could retain such positive regard when discussing tantrums.)

I see in the story of the turtle in peril a meeting and mingling of two major themes, fear and disobedience, with an experience of protection and survival—however tentative that survival might seem, from the hawk’s parting shot. Privately, because I love foxes, I delighted in Luz Turtle’s unlikely hero. (Had I told her they were my favorites? I couldn’t remember!) Openly, Luz delighted in her own wit, her “Not by my shell!” a turtle’s version of “Not by the hair on my chinny-chin-chin!”

Luz, walking with me down the hall in her winter boots and pompom hat. From her, I learned a new genre: the preservation myth.

 

*Real names are never used here, to protect client privacy. Luz’s story shared with permission.

A FUNNY THING HAPPENED ON THE WAY TO THERAPY…

The prism suspended above my window had ceased spinning its rainbows already that day, the sun having moved on. I’d been doing some desk work, just an average morning, when one of the agency’s supervisors knocked and asked if I had a minute. She came in and perched on a chair, the way people do with news to deliver.

It seemed that a parent had called her to express concerns about me—which set my mind spinning; I’d not yet even met the family. The daughter had been seen for intake a month prior, and the case had since languished, awaiting assignment. Then I was assigned and promptly made an outreach call. The mother answered, and we agreed, with some back and forth, on a time to meet. So far, so normal. The call ended pleasantly, I thought. What in heaven’s name could have gone wrong?

This is where the story gets funny, at least in the telling. It seemed the mother was worried that I wasn’t a good match for her daughter—whose presenting concern was anxiety—because I’d sounded too calm on the phone! Too calm, as we booked an appointment!

She should have seen me then, because calm I was not. The supervisor kindly assured me that such things can happen, mostly when a kid or parent takes a liking to their intake worker and doesn’t want to be moved to someone else for therapy; a lot of personal information gets gathered during intake, too, which can foster a sense of investment. That much made sense to me. Of all the brushes there are to be tarred with, however, “too calm” seemed absurd, and I’d be damned if I was going to be feathered, too. The supervisor advised me that I might be hearing from the mom and, with further reassurances, left. A scant ten minutes later, the phone rang.

Ten minutes was enough of a heads-up, as it turned out, and I was grateful to have had it. As much as I value my education for helping me help others, it has a special sweetness when I feel it working on me. It would have been all too easy for me to decide she was a “helicopter parent,” to label and feel at odds with her—to let my pride dominate. I was new and wanted nothing but unmitigated success. But when, after I said hello, the mother launched into a five-minute stream of exposition—studded with phrases like, “I don’t want you to take this personally, but”—well, I listened. I really listened. When she was finished, I said something like this:

“First of all, I want you to know how much I respect your investment in your daughter’s emotional well-being; I wish the same could be said of all parents. As to my own personal style, I guess I would say that in my experience, the most important thing when working with kids is to accept them for who they are, and the rest tends to follow. I’ve been looking forward to meeting you and your daughter, and I think it’s well worth it to keep our appointment and just see what unfolds. I feel confident that we’ll find a way to connect. But please do, as we go along, share any further concerns with me.”

Validation soothes the savage breast, to adapt an oft-misquoted phrase to my own ends. In validating the mom’s concerns, I soothed myself. The mother seemed mollified in the moment, and we went on to have a wonderful first visit. Her anxious daughter was, in fact, a bit of a firecracker; but I can fizz sparks myself, upon occasion, so I wasn’t worried. I let the mother see a little bit of that energy from me, during our first hour. I went through my introductory sequence, then we played a card game of the daughter’s invention, the three of us sitting cross-legged on the floor. The girl, a young preteen, addressed me by name multiple times, which I took as a good sign. (Kids don’t always do that.) The day before our next appointment, the mom called again—this time, just to RSVP. She wanted me to know they would be there.

 

 

AS ABOVE, SO BELOW

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If Robert Frost were still of this world, could I persuade him to rethink his philosophy? Even as the ground is carpeted with evidence that “nothing gold can stay,” I hope this spring morning will light my way through the coming year. This moment of equipoise, when the chartreuse maple flowers that scatter the ground are equal to those still gracing the tree—I hope in darker moments to recall it.

Those moments do come—though they come less often, and I recognize them now for what they are. As above, so below; as within, so without. It’s as easy for people today to mistake their shadows, their trailing rainclouds, for something permanently, metaphysically wrong with them, as it was for people in times past to mistake epilepsy for demonic possession. I have learned, thankfully, to make connections between my physical and emotional states.

I know, if I wake in a seeming panic, to reflect on what I ate the day before. Too much sugar? Too much salt? I know, when I feel my steps grow heavy, that my body still struggles with wheat and dairy, that my system is still in rehabilitation.

Cognitive-behavioral therapy, or CBT, continues to be the holy grail of mental health interventions, but I feel it’s sorely lacking. In the “cognitive triangle,” thoughts evoke feelings that result in behaviors. Where is the body, in that model?

Research is now abundant, and still growing, about the effects of diet on anxiety and depression, the role of probiotics in emotional resilience, the fact that trauma gets stored in all our cells, not just in the brain. But in this market-driven culture, genuine wellness—bodily integrity, emotional stability—turns too little profit. For every news item about, say, the microbiome, there are thousands of ads for, as Michael Pollan put it, “edible foodlike substances.”

This is not to say that everything I feel emotionally is purely a function of my physical state, that I can live unperturbed so long as I avoid x, y, and z foods. For one thing, the picture is a little more complicated; making generally good choices may not, alone, correct for deficits present from birth or some exposure.

For another thing, we’re social beings; attachment is itself biological. Loss is still loss, grief is still grief—and hard as they are, I wouldn’t have it any other way. I have no wish to be disaffected, to nod placidly to others as they come and go from my life. All I mean is that a kind of physical resilience helps steady me now, in a way it never did before. On stormy seas, I’m lashed to the mast of my health.