An hour? Therapy sessions are AN HOUR?!
My first reaction to Psychotherapy 101. First semester. First class. First day.
What will I talk to them about for an hour? What if they don’t want to talk to me? How will I know if I’m saying the right things? Will I be able to help them? What if I’m not effective? Will they call me out? Can they do that?
These are just a few of the very real thoughts that ran through my mind when I began my journey sitting in the [other] hot seat in a therapy session.
It was not long until I was actually in a live session (as opposed to the thousands of mock therapy sessions I had practiced with peers and professors), that I realized that there was so much I had to learn about the human experience (how to manage another’s vulnerability, for one).
My internal dialogue during my first real session went something like this:
Aright, here we go. The textbook said body language is important... don’t cross your legs or your arms because that makes you seem closed off and judgie.
Shit, okay now I’m just kind of uncomfortable sitting here like this.
I think it shows on my face. Can they tell I’m nervous? Oh god, I totally missed what they just said.
44 minutes left.
Imposter syndrome (via anxiety and neuroticism) quickly made home in my mind and led to constant second guessing of my abilities. Thoughts like “I should have said this...” or “Why didn’t I ask that instead?” incessantly flooded my mind in between sessions and made me wonder if I was really cut out for this career.
It was not long before I had my first defining moment as a therapist. Two years into the program, I was working as a practicum student at a short-term acute residential facility (e.g., a crisis house) for individuals suffering from a combination of mood, psychotic, personality, and substance use disorders.
One of my first patients (...clients? cases? I never know which one is the most appropriate term) was a 67-year-old man diagnosed with Schizophrenia, who was actively psychotic (he was experiencing ongoing auditory hallucinations and paranoia). We’ll call him Mr. Jones.
Mr. Jones started the session by moving his chair away from the window out of fear that the video cameras the FBI had placed in the facility would be recording him. He mumbled to himself throughout most of the session (as if responding to imaginary voices) and he repeatedly looked over his shoulder to make sure no one would creep up behind him and attack him, even though we were the only two people in the room.
Me being the generally over-prepared student that I was, spent hours reading and practicing different treatment interventions for psychosis. At this point, Mr. Jones and I had already decided that we would spend the session working on helping him cope with his voices (most of which were commanding and derogatory in nature and regularly taunted him).
This is how the session went:
Hi Mr. Jones, last time we chatted, we decided we would focus on helping you practice telling your voices to leave you alone. Did you make a list of what your voices say to you?
He handed me the list, and as planned, I did my part and took the role of his voices and began reading each of these statements aloud. His part included responding to me with things like “leave me alone” or “shut up, you’re not real” in an attempt to gain power and control over the voices.
What the course textbook told me would happen (an empowering and meaningful therapeutic moment between patient and therapist) and what actually happened (see below) left me wide-eyed and speechless.
By the time I reached the second item on the list – you’re worthless, no one likes you – this man... fell to his knees, trembling in fear, bawling. This man completely unraveled right in front of my eyes. This man was in a state of pure vulnerability.
I sat there shocked and waited for him to pour out his pain.
In that moment, I understood the true depth of psychosis. I realized that with this one intervention, this man was asked to face his deepest fear – his voices coming to life.
That day I learned my first lesson in life and in psychology: Textbooks teach you, but people train you.
My next defining moment was about one year later, when I began carving my niche in criminal psychology. I was working at an outpatient forensic psychology clinic with federal inmates who had just been released from prison for various offenses.
I was facilitating a group therapy session, which generally consisted of about 15 adult men and women. Our topic for that day? The social, legal, and psychological implications of substance use.
About 20 minutes into our discussion about what drugs do to your brain, one of the inmates stood up, looked at me with anger seeping from his eyes and said:
“You don’t know what it’s like. Who are YOU to help me?”
I froze for a moment, mostly because I agreed with him. I didn’t know what it was like to be addicted to heroin... to feel completely dependent on a drug. To feel so powerless. I wasn’t forced to grow up in a gang-ridden neighborhood or to watch one of my parents die via drug overdose at age 6. I had never been to prison. I had never needed to go to bed with a knife under my pillow in case someone attacked me in my sleep.
He was right – I didn’t know what it was like. So in that moment, I took a chance and decided to keep it real. I responded to his outburst with validation and understanding. So much so that he was surprised that I didn’t resort to anger or frustration or ask him to leave the room. I thanked him for his honesty, I agreed with his concerns, and I asked him to educate me.
That day I learned my second lesson: I don’t need to know everything, so long as I’m willing to learn.
These are just two of dozens of important lessons that I’ve learned from working with humans from all walks of life:
The 8-year-old suffering from Bipolar Disorder.
The 62-year-old recovering alcoholic.
The inmate on death row.
The 29-year-old begging to be saved from the depression that weighs her down every single day.
The child abuse victim learning to face details of his traumatic past... 20 years later.
Through these stories and through these remarkable people, I was lucky enough to find my purpose... lucky enough to learn the most valuable lessons this life has to offer.
Here are some of these lessons:
You cultivate your own strength. You may not feel strong today or this week or this month, but that seed is already planted inside of you, waiting to be nourished. Water it, nurture it with love, and watch it grow.
Broken does NOT mean damaged.
Your mind is very powerful. It will break you, if you allow it. And it will make you, if you allow it. You decide how that power is used.
You are never alone. Period.
Asking for help is scary. For one, it acknowledges that there is something that needs helping, a brokenness that needs fixing. It also sometimes (but really... always) requires that you face the darkness and talk about parts of your life that cause anger or sadness or shame. If you need time to decide to use the support that’s available to you, take time to decide. Just know that whenever that time comes, whenever you’re ready, there are people who are open and willing to listen, to sit with you in silence, to be whatever you need them to be.
We know that you know more about your experience – educate us, please.
You have purpose in this life. You are loved... truly loved. Your absence will devastate those around you. I know it’s hard. I know the powerlessness is crippling. I know it seems impossible, but you have it in you to fight back. So fight back.
I have nothing more to say than... thank you. Thank you for giving my life purpose, for allowing me into your world to understand your struggle, for showing me true courage... true resilience, for helping me realize so much about life that I would have otherwise been blind to.
I wish you peace, I wish you strength, I wish you love, I wish you life.