I began seeing a new client today who grew up in a large East Coast city… She reminded me of the five years I lived there, describing many of the neighborhoods where I had lived and had my first experiences as a fledgling psychotherapist. In particular she reminded me of the first psychotherapy client I saw and what an amazing teacher she had been for me.
I began my career as a psychotherapist 25 years ago as a resident house coordinator and counselor in a system of half-way houses in this city. We served a growing population of people who were leaving the state hospitals as a part of the movement toward “de-institutionalization” of the mentally ill. Most of my clients had been diagnosed as “early onset” “schizophrenics and tended to be young, fairly high functioning, and not at all like the stereotypical “chronic” patients released from the backwards of the hospitals who were typically given that label. I had begun working as a “resident house coordinator” in one of the houses—a job that involved living in the house, running group meetings, a work program, and providing emergency counseling for residents. I also saw a few clients weekly for sessions under the supervision of a psychiatrist who had established the system of houses and was their clinical director.
My first client was a young woman who had just joined my house as a resident after spending several months in a major hospital for people with paralysis from spinal cord injuries. A graduate student in one of the major universities in this city, she had suffered this injury falling from a seventh story window of the building where she worked, assuming in a major psychotic break that the world was ending and she was being rescued by a space ship that had come to whisk her away. Stepping out of the window onto what the thought was a ramp extended from the spaceship, to her great surprise she fell into a tree which broke her fall (and her back), saving her life and providing the impetus for a major shift of her identity to one that included that of being a mental patient and physically disabled person.
If this were not enough, I had “inherited” her from another counselor in our system of half-way houses with whom she had formed a very strong alliance. He had rather suddenly been forced to stop seeing all of his clients, because he learned that he had contracted a very virulent form of lung cancer and had only a few months to live. The other counselors in the system had taken over his case load, and for some reason that still remains unclear to me, she was assigned to me.
The first session was a blur. As I sat across from her and her wheelchair, I was struck by both by her beauty, intelligence, and the profound grief that gripped her as a result of the multiple losses she was forced to endure. She was not at all sure she belonged in the house and was even less sure she wanted to have anything to do with me. I couldn’t blame her. How could anybody have endured a crisis of the magnitude she had just endured without being filled with profound grief and bitterness. I was at a loss for words. All I could do is agree that life sucks and that she every reason to be pissed off her circumstances, me, the house, and the suffering that stretched out before her. In what proved to be a stroke of luck, my felt sense of inadequacy and awe at the complexity and gravity of her situation, struck me dumb—all I could do is mutter again and again that I would make every effort to not abandon her. I admitted I didn’t know much but was willing to listen and try to learn how to support her as long as she was willing to talk to me.
This turned out to be the best thing I could have said to her. All she wanted was a place where she could grieve, rage, and sort out her options. She also did not want to be labeled and treated like a mental patient. She pointed out that her fall into a tree had given her all the information she needed to unequivocally GET that there are conditions under which she can not trust her thinking and perceptions. Her top priority in the work would therefore be to learn how to recognize what she called “early warning signals” that she was losing it and to develop a way of riding them out, without using anti-psychotic medications which she strongly rejected because they dulled her intelligence and shut her down to an unbearable degree.
One of the important resources and tools that was available to her was a particular form of peer-counseling that was taught to all the residents in the house. This was done because of the strong belief held by the Clinical Director and staff that one very important source of healing available to all our clients was the challenge and opportunity provided by offering effective support to someone else. We had learned that many of the residents became exceptionally effective counselors and that finding and cultivating these relationships was extremely important in their own healing. I discovered quite early in our relationship that “Angela” was an excellent counselor for certain other residents in the house. Early on, it became increasingly clear that these skills and interests may eventually serve as the foundation for constructing a new identity.
In addition to her developing skills as a counselor, Angela had been a meditator before her psychotic break and accident. Her continued interest in meditation was clearly another resource to be supported and further developed. Armed with an inherent intelligence, curiosity, assertiveness, as well as the resources of counseling and meditation, over the next two years she began constructing a new identity as counselor for the disabled and skillful advocate for the mentally ill. She also built an effective support system of people within the counseling community she was building and among meditators she knew. She was increasingly effective at recognizing the “early warning signals” or “minimal cues” announcing periodic periods of decomposition and would gather her support system around her so that she could ride out these difficult times in her life. She had her own form of “advanced directives” long before such things were popular among those who have struggled with periods of madness. She also used mindfulness, significant dietary changes and body work to alter the frequency, severity, and nature of the periods of decomposition she experienced.
As I look back on my experience with Angela, I am filled with profound gratitude for the things she taught me—or the things I had to learn to continue to be of use to her. I am grateful that from the outset of my work as her counselor I learned that I had to trust that there was something larger than me, and even larger than our relationship in the room. My awareness of my limitations—limitation in experience, knowledge, and courage—forced me to surrender to the workings of a mind, spirit, will, that I knew was larger than mine and on whom I must depend to stay present in the relational field she and I shared. This reliance on the larger mind awakened me to the relational field and the process of sponsorship (although I didn’t have words for it then). This proved to be both a humbling and empowering realization.
I leaned that what we do with our clients requires that we think outside the boxes of psychiatric labels. Angela was a living testimony to the dangers and limitations of such labeling. Had I been more “experienced” and deeply indoctrinated in the language-game of medical model psychotherapy, I am sure the relationship would have been much more problematic, and the outcome less positive. I am extremely grateful that my relative ignorance and naivety forced me to listen with my heart and to hold on to the curiosity of a genuine “beginners mind.” I hope and pray that, while I learn more and more of the skills and knowledge of the practice to which I have been called, I continue also to hold on to my “beginners mind.”
I also learned that psychotherapy is a collaborative relationship and that I had to learn to sense and trust in both of our abilities to create and inhabit a world that bridged our very different ways of experiencing and knowing. The process of sensitizing myself to her unique private language system was a challenge that stretched me a great deal as a man and as a therapist and forced me to learn how to listen deeply beyond the surface meanings of our words and beyond language itself. This learning initiated a process that I have sought to practice ever since and I think it comes close to defining the essence of empathic understanding as I seek to understand and practice it today.
Finally, I learned that different aspects or stages in the therapeutic relationship require different skills or qualities of relationship. There were times when the best thing I could do as therapist was to stand back and get out of her way. There were other times when it was vitally important that I stand firm and hold my ground. There were yet other times when my capacity to love, validate and support, which has always been my most natural skill as therapist, was something she very much needed and which I happily gave. Above all, I slowly learned to recognize the different qualities of relationship that were required at different times or different contexts. This, of course, has been an ongoing challenge that I am still struggling to learn, something that self-relations has sensitized me to think about more and more.
I remember vividly the last session we had together a few days before I was to move away and begin my life here in Burlington. We spent most of the session reviewing all the many things she had accomplished. I remember asking her at one point, how she had figured out that she could somehow deal with all the new challenges life had thrust upon her and turn them into a crucible in forging a new identity. She said something that struck me at the time as extremely profound and revealing. She said, “When you are crossing four lanes of traffic in a busy city street in your wheelchair, you don’t have time for psychosis.”
About the author:
*Robert D. Rossel, Ph.D. is a Life Coach living and practicing in Los Altos Hills California. He is a long-time practitioner of self-relations psychotherapy and Ericksonian hypnotherapy. With an abiding interest in music, art, yoga, and other mind-body practices, Dr. Rossel is also a Buddhist who has sought for many years to find ways to apply meditation and mindfulness in his practice. He may be reached at 10490 Albertsworth Lane, Los Altos Hills, CA 94024. Address all correspondence to his E-mail address: Rosselrob@aol.com.