Diary of a Young Therapist

Recently, I helped a caregiver explain to a seven-year-old boy that his biological mother committed suicide.  Part of me wanted to advise that we not tell this boy about how his mother had died.  I felt and feel that suicide is an ugly ugly thing and wanted to protect this adorable boy from the truth of his mother’s death.  For a number of reasons, including the nature of the suicide, the child’s relationship to his mother, and, perhaps most importantly, the child’s age and developmental level, it was necessary and in the child’s best interest to explain to him that his mother had died by suicide.  

One of my first exposures to suicide was as an intern at a psychiatric hospital.  The night before one of my shifts, a 21-year-old man committed suicide in the hospital’s Crisis Response Center.  As I walked around my unit, I found myself knocking on doors and creaking doors open slowly, terrified of finding a dead body.  I was acutely aware of the drive and determination that a lot of people have to end their lives.  I remember feeling small and ineffectual up against this.  I felt heartache for the family that I imagined bringing this 21-year-old guy into the CRC to keep him safe from himself.  Sometimes there is no protecting people from themselves.  Some people will be lost.

I put a lot of thought into how to talk to this seven-year-old boy.  I got some amazing support and input from a co-worker and our shared supervisor.  Together we wrote a script that could guide this family in explaining the suicide to this young boy as part of an ongoing conversation.  The finished script was a collection of simple words and phrases that distilled the complexity and anguish of suicide into a very real, human, and somewhat easier to understand package.  The explanation and story that we created gave me comfort and some peace in the end, because in order to write this, I had to compress and simplify a very scary and scrambled experience.  

We have some very sad news.

We wrote in a pause here after this very simple statement.  Speaking slowly and allowing time for processing was important.  

Sometime this morning, your mommy died.

We also allowed for the boy’s reactions to dictate the amount of information that would be shared.  We operated under the assumption that children will dictate, through questions, what amount of information is needed as they process and make sense of incoming information.  So what came next was basically up to the boy.  But if the boy did ask how his mother had died, we’d go on to the next statement.

Sometimes, when people become so scared and sad, they get the idea to hurt their bodies to make their bodies stop working.  They think that if they stop their bodies from working, that they won’t have to feel so sad and scared anymore.  People think this because they can not see clearly that there are always people who can help with sad and scary feelings and help them to stay safe.

What we know is that your mommy was feeling very sad and scared, and that she made a decision to hurt her body by (specifics written here in a simple, clear way).  

This is a lot to burden a child with, but was, in this case, necessary and important.  Suicide is a burden to everyone it leaves behind.  The best and most loving thing that we can do for a child in this case is to provide a clear, non-shaming framework for understanding the death of his mother.  There is so much secrecy, shame, and silence around suicide as it stands; it can be helpful for a child’s first exposure to the nature of his mother’s death to be an open, honest, and supportive dialogue.

For me, it felt somewhat callous to frame death by suicide as a “decision” — particularly in explaining this woman’s suicide to her son.  At the same time, suicide is a decision, and I want this boy to know that he can’t simply fall into deep depression and suddenly die — that he always exercises some choice in how he manages his feelings.  Regardless of whether or not he was ready to hear about how his mother died, the next part was important to get out there the first time he heard about his mom dying.

It’s okay to feel angry, sad, confused, happy, and many other kinds of big feelings.  It’s even okay to have some of these feelings at the same time.

Happy?  What the fuck, you might say.  Recently, my supervisor verbalized something that I’ve observed and known for a long time: not all mothers love their children.  And while I believe that nearly all children have warm feelings or feelings of attachment for their biological parents, I have observed some children to experience relief when their parents are no longer in their lives.  I felt it was important to give space for this relief (“happiness”) and to normalize it.  

It’s awesome to plan ahead and to be thoughtful, but probably goes without saying that I didn’t say these words verbatim.  I don’t regret writing up this script at all, because it helped me gather my thoughts and I think will be a nice support for this boy’s family to help guide conversations at home.  But, in the world of therapy, improvisation, authenticity, and being truly present in the moment are key.

So when I had this actual conversation with the boy, he was wearing a Darth Vader mask.  We talked about his mommy’s death and how last week he had a fun sleep over and watched Star Wars.  He said “Luke’s mom died when he was like a baby and my mom is dead, too.”  So we talked about how he had that in common with Luke Skywalker in addition to making some of the points that were mentioned above.  We talked about how it was a pretty sad thing to have your mommy die, and we googled coloring pages of Lego Star Wars, printed them, and colored them in.  We tried to talk like Darth Vader.  We talked about how there were some happy memories that he had of mommy, and there were some sad ones, too.  

Thank god for George Lucas, for sleep overs, for google images of coloring pages, and for masks.  And thank god for life’s simple pleasures, because when they’re interwoven throughout tragic stories, they create something pretty beautiful and wonderfully authentic.  I don’t mean to suggest that talking about Star Wars makes suicide more palatable, nor do I believe for one second that Star Wars references can diminish the sadness that this boy feels and will feel throughout his life.  I speak for myself and my time in that room when I say that a boy’s fascination with Star Wars existing alongside suicide gives comfort, hope, and a sense that wonderful things can exist in spite of and even because of absolute fucking terrible shit.

I never know how to end these things when I sit down to writing them.  I feel the pressure to conclude with some grand statement or food for thought.  That I don’t have.  Just, what feels most appropriate to say is, thanks for reading this and sharing this little private piece of my life.  It means a lot.

Compassion for others comes very naturally to me, and I rely on this pretty much every day in my work with clients.  Without it, I couldn’t see the value, the humanity, and the potential in the people that I work with, and, by extension, I couldn’t feel hopeful or meaningfully engaged in my work. 

What hasn’t always come quite so naturally to me is compassion and empathy for myself.  Before I was a therapist, I had a relative blind spot when it came to my own internal experience.  I would, and still do, almost reflexively attune myself with others.  A theory that I have based vaguely in science is that the parts of my brain associated with picking up on subtle social cues are kind of overdeveloped, and make me more sensitive to others’ emotional expression.  Are you picking up what I’m putting down?  It’s vague conjectural science.  Also this is the internet so I feel pretty safe presenting hunches as fact.

Following my fake non-science logic further, I concluded that if so much of my attention and energy has been expended observing the emotional experiences of others and adjusting myself accordingly, I couldn’t have spent as much time and energy monitoring my own internal emotional state.  That’s science, right? 

Within the past couple of years, the compassion and attention that I’ve applied to others for pretty much my whole life has been turned inward.  It’s happened almost reflexively as I developed deep and meaningful connections with my clients.  The more I could empathize with and recognize that of myself in their lives and feelings, the easier it became for me to see myself.  The easier it becomes for me to forgive myself, love myself, and see the potential in myself, just as I always have for them.

A quote that comes to mind is “The most important relationship you have is with yourself.”  I believe this quote was made famous by Bette Midler or Derek Jeter or a French historical figure.  Since I’m already doing fake science, I should also misquote people.  I’m on a slippery slope toward becoming a narcissist internet whiner.

I’m not sure about your relationship with yourself being the most important relationship that you have.  Maybe that’s because the path to my relationship with myself has been paved with my relationships with others. 

Recently, a client related the story of her rape.  This story has stuck with me, and as a consequence, this client and her life have been showing up in my dreams.  Through listening to stories of rape, incest, and sexual abuse, I have come to understand much about myself.  First, I believe that I have a strong ability to remain present throughout these stories.  I can tolerate, perhaps more than others, the telling of these stories in their most graphic detail.  Second, what affects me the most about these stories — and what has been recurrent in my dreams as of late — is the extent to which abusers use emotional and psychological manipulation to lure children into sexual abuse.

This manipulation seems to be the most difficult for children and teenagers to discuss.  The details surrounding it seem to be the most laden with shame.  These are the details that make me feel honest-to-God nausea.  

I am sickened by the extent to which perpetrators use children’s needs, desires, and sensibilities against them.  I am sickened by the pre-meditation of abuse.  I’m sickened by the fact that people can use their intelligence, intuition, and charm to craft a painful and damaging experience.  In some stories, it becomes apparent to me that abusers invested months of time and money in order to groom a victim child, all the while preying upon the characteristics that make that child unique and special.  Sibling rivalries, insecurities, sports skills, attractiveness…all of these can be used to the advantage of the abuser.

I am frightened to death by these stories because they make me feel vulnerable.  To hear the story of a child and to see how truly helpless they were to protect themselves unnerves me.  I see how special treatment, gifts, and caring were used to win trust, and ultimately, access to a child.  In my own life, I become more skeptical of people and wary of their motives.  If I had children, I would never let them leave my sight — because, you know, that would allow them to grow into completely normal and well-adjusted people.

Just as my clients’ sense of safety in this world has been shattered, so too is my sense of safety disrupted.  I must go through a parallel process of restoring my own faith in humanity.  I can’t believe I just typed the phrase “restoring my faith in humanity.”  I must be like one step removed from sitting in a rocking chair with an immensely long grey braid and a home-made earthenware mug full of herbal tea in my hand. 

Actually, that sounds like a pretty cool way to end up.

Whenever possible and safe, hearing an apology from a caregiver can be incredibly healing for a child who has experienced abuse or neglect.  Of course, apology work is best undertaken with the support of professionals, and should only occur when it doesn’t compromise the safety of the child.  I really didn’t want to write the previous sentence, but my experiences with internet communication have made me automatically defensive of broad statements.  I just want people to think I’m smart and to never be angry with me.

To clarify what I mean by “apology work,” I’ll give a brief example.  Let’s talk about a mom who has physically abused her daughter.  Mom and daughter have each gone through their own treatment.  The daughter has received support to help her to recover from the trauma of her experience and is now in a place where she is able to speak openly about her physical abuse.  Mom is able to acknowledge and take responsibility for her actions and verbalizes this to her child.  Mom and daughter engage in open conversation about the abuse that occurred and the mother is able to acknowledge the pain she has caused her daughter and say “I’m sorry.”

This process teaches many things to both the parent and the child.  The child learns that abuse is not okay.  She learns that she did not deserve to be mistreated.  Because this child was abused by a caregiver — the person in this world who she relies on for protection — her faith in her caregiver’s ability to protect her and keep her from harm is hopefully, to some extent, restored.  The child’s sense of safety and security in this world is somewhat recovered.  The parent and child also learn to communicate more openly and honestly.

When this process goes according to plan, it is amazing to behold.  I feel like the Jesus of therapists. 

Needless to say, I don’t get to embark on this journey a great deal of the time.  Court, the system, and parents who are stuck in denial put up roadblocks.  So not all children get this very beautiful, meaningful experience.

I love apology work.  Part of the reason that I love apology work is the same reason that I enjoy working with insightful, hard working, stable clients — it makes me feel like I’m doing a good job.  No outsider will ever really have an audience into the nature of what I actually do, and therefore no one will ever really be able to laud me for my abilities as a therapist.   Because of this and because I am an overachieve and people pleaser by nature, I take any and all signs of progress in my clients as a pat on the back and sometimes delude myself into believing that their health and stability is 100% attributable to me and my completely unique skills as a therapist.  

The other reason that I love apology work is that I bear witness to the fact that reconciliation, growth, and healing is possible.  Every time a family allows me to go on this journey with them, they give me the gift of knowing that no matter how we mistreat one another, growth and healing is possible.  I know that there is not a happy ending to every story, and I know that in my life there will not be a happy ending to many of my own relationships and experiences.  Simply knowing that happy endings are real and possible, however, gives life a different flavor.  It also affords me some perspective on those unhappy and unfinished endings — that I have control over my own relationship to these loose strings and ultimately, that the final chapter may yet be unwritten.

In my final semester of my Masters in Social Work program, a professor shared with my class about her doctoral thesis on platonic love in the therapeutic relationship.  Her research found that while most therapists have platonic love for their clients, very few ever tell their clients that they love them. 

Had I not been doing psychotherapy for a full semester prior to this class, the significance of my professor’s research might have been lost on me forever.  Or at least for several years, until I am exposed to the same exact message, only this time in a far more pretentious, self-justifying, and expensive package that I have come to expect from continuing education classes.  Amiright?

I love many of my clients.  I care about all of them.  Perhaps this comes naturally because my clients are mostly very young children who are also very needy and vulnerable.  Many of them have adapted coping skills that make them endearing to adults — and this has allowed them to survive.  Perhaps the pairing of a 27-year-old woman who very much wants a family of her own and neglected, abused, and oftentimes unwanted children makes these feelings inevitable.  A part of me wants to care for and nurture children of my own, and I know that this need is at least in part being met through my work with my clients.  I acknowledge that I deeply wish to be a parent to many of my clients at times.  (This feels like as good a time as any to mention that if you are an attorney and make frequent appearances in Family Court, please stop reading my blog and reading up on all my most intimate thoughts so that you can use them against me.  It is easy enough to make me look like a young, inexperienced bleeding heart when I give testimony, so you should not need the extra ammo.)

I have chosen, on occasion, to tell certain clients of mine that I love them.  I have never regretted it.  As a rule of thumb, I’ve always asked myself to evaluate my motives for telling a child or teenager that I love him or her.  I’ve only actually told clients that I love them when I thought that doing so was in the best interest of the child’s treatment and would truly add to the efficacy or meaning of their treatment.  

While I have never regretting telling a client that I love him or her, I have regretted not saying it on a few occasions.  At times, I’ve been too consumed by my own mental back and forth that I missed my mark and the “right” moment — the moment that felt clinically appropriate and meaningful — passed.  For this reason, it is probably a very good thing that I see clients on a weekly basis.  This way I can always say things such as “Oh, by the way.  I almost forgot.  Do you remember last week how we talked about how every caregiver that you’ve ever had has abused you or abandoned you and you were questioning wether there was any real good in you that could ever make another human being truly care about you?  Yea, right after you said that I meant to tell you that I love you.  Anyway, moving on to this week…how has school been?  Did you or did you not make the basketball team?”

I think that love can be, in and of itself, therapeutic.  Love is re-affirming.  If a child tells you the story of her rape by a family member, and you tell her throughout the course of her treatment that you love her, she knows that she is truly deserving of love and capable of being loved.  She knows that people can know the truth of her existence — including the most painful, shameful, and ugly parts — and can still see how special she is and care about her deeply.  How powerful and healing of an experience is this in the case of the child who truly has no one else to do this for them, no one else to love them in this profound and simple way.