- Some therapy cases add humor, intrigue, awe, and spice to life, becoming fodder for storytelling (while maintaining confidentiality).
- A seasoned therapist, given the privileged communication, comes to know and understand human nature at a different level than a layman.
- An advanced degree in mental health fails to prepare one or all the what-if situations; you learn to wing it and try your best.
- All therapists at one time or another are confronted with sociopaths and criminal types out to take advantage.
In the spirit of Halloween, and some good fun, while super respecting sources, these are some therapy "war stories" with vital details changed to protect confidentiality. Many pronouns and locations have changed, along with nuances. In addition, many of these stories happened many, many decades ago. Each story is curious and fascinating in its way.
The longer you are in practice, the more you can appreciate how hard it is to be an effective therapist, given that your "work product" is a human being. Your work is hard to measure, and being a therapist is a lonely profession. A therapist can't share anything they did that day with anyone, except in sweeping generalities with colleagues. I am going to share the gist of six cases.
My kids (or wife, for that matter) never watched me work on "take-your kids-to-work day." And therapy-talk to small-talk is a difficult transition, but calming and relaxing, at least to me. Outside the office, I usually keep my therapist hat off. Doing therapy demands a different type of focus and observation.
Here are six (mostly positive) cases from the trenches to provide you a flavor of the therapy life, cases that dealt with happenstance, bad luck, odd happenings, danger, and misguided academic placements. These cases also prove "you never know." Some wild things happened.
1. The errant autobiography
The following (edited) article (in italics) appeared in The New York Times re-quoted here with the client's permission.
When Reid J. Daitzman, a clinical psychologist in Stamford, Conn., sees a new client, he often asks him or her to write an autobiography -- a thousand-word memoir about the highlights of life, including upbringing, education, work and relationships. Completion of the project is a measure of therapeutic motivation.
One client was seeking help with relationship problems. The man returned with 8,000 words.
And then he said, ''I probably won't be needing your services. I met someone. We hit it off right away, as if she knew me.''
As it turned out, the man had written his autobiography at his office work station, and when he printed it, a glitch sent this confidential document, with his E-mail address, to everyone in a specific department.
Among the recipients was a woman who read the man's life story and related to it.
''She falls in love,'' Dr. Daitzman writes. ''She immediately knows everything about him, sensitive information which would be slowly revealed on a date, or many dates or maybe never. In four months, they are engaged and married.''
2. The pill seekers
Many years ago, I used to have an office on the Yale campus working with a Yale psychiatrist, an M.D. who mainly prescribed medications. I was new and learning the ropes of private practice.
One day, after a cancellation, I had some time to daydream, looking at his library, inspecting his office. While looking around in more detail than usual, I noticed a strange object, a leather holstered .38 pistol that he apparently used as a prop when an addict demanded "pills" not medically necessary. I had no idea if the gun was loaded. I never opened the case.
Often, an addict, before the psychiatric evaluation, would demand mind-altering drugs. Pharmacies were more relaxed back then in filling such prescriptions. No reputable psychiatrist wanted to be labeled on the street as the "pill doctor."
The doctor, my colleague, said, "No." During his sessions, the gun case scared off most already high street drug addicts.
I got to thinking, what if some high pill seeker thought I could prescribe? I made a mental note of the location of the gun holster.
This situation happened pretty often. If the pill addicts demanded pills from me, I said I was a PH.D. and legally could not prescribe. I got "the look." These were criminal types and stormed out without paying.
A new client would often fake the presenting complaint to receive a prescription to stay high, get high, or to re-sell the pills on the streets. Things settled down after asking the front desk to make sure they told the client calling for an appointment I could not prescribe.
3. The woman who was afraid of insects
I was working with a woman on multiple psychological issues. Things were going well. One day, nervously, she said out of the blue, "I am deathly afraid of spiders and bugs. I didn't want to say anything since many people are." She was correct. People, via evolution, are repulsed by animals with more than ( a spider) or less than (a snake) two legs.
Here is where it gets weird. As the client talked about her fears, a humongous spider crawled up her white blouse towards her nose. It was like science-fiction, as if her imagination reified her thoughts. I was freaking out but not reacting. I am sure my eye pupils dilated to maximum, like in fight or flight.
Unburdened after sharing, she begins to sob and reaches for some tissues. As she placed the tissues to her nose and blew, the spider crawled inside the closed paper wad, her clenched fist crunching the spider, killing it. I offered her the wastebasket to discard the pile of soaked-spider tissues.
She left. I thought, "You can't make that up." Upon entering my office for the next few weeks, I was vigilant for spiders and anything that crawled. I informed the landlord, who disinfected my office. No spider ever reappeared.
4. The extortionists
A middle-aged married man contacted me on my office line and said that he and his wife sought marital counseling. We chatted and set up an appointment.
Their intake was late in the day during winter. It was already dark, and they entered wearing heavy coats. I greet them and have small talk seeking to establish rapport. About five minutes into the intake, both stand, open their heavy coats, are naked, then run out with the man shouting, “I am going to sue you for raping my wife.” In a movie, this is when the protagonist awakens, thinking, "I'm glad that was a dream."
Lo and behold, a few weeks later, a female lawyer calls and says in a calm voice, “I just had a guy here in my office claiming you raped his wife, but something seemed off about the story."
I said it was a ruse, an extortion plot, but still a possible "he said-she" said situation seeking damages. I never heard from anyone again.
5. The failing future genius
An upper-middle-class parent drags her kicking and screaming teenager to "therapy." He is failing all his high school courses and insists he started taking drugs. "Do something," she shouts. The boy seemed unconcerned. I asked her to wait in the waiting area.
I chat with the boy alone for a few minutes to understand his critical thinking, then write in the upper right-hand corner "144." Something seems off.
I tested my hypothesis. I always jot down based on my refined social cognition (from seeing clients) what I believe a person's IQ is. I administer the latest WAIS (IQ) test. He scored 143 in the upper 1% of the general population. My sense was he was an under-achiever. He also never touched drugs or alcohol.
He tells me he is bored stiff. With the mother's permission, I do additional specialized testing. I later wrote an IED (Individual Education Plan) and sent it to his school psychologist. The client is suddenly bounced into all AP classes. He pulls all A's and is later admitted to an Ivy.
If a parent and your child is failing, demand that the school psychologist do a (free) IED assessment. Who knows what you might discover?
6. The stretch limousine
For many years I had a ground floor office. I could see who drove up for an appointment. A new client, a lad about 17, leaves a stretch limousine. The driver parks and waits. I think, "This should be interesting."
The older teenage client says, "My parents don't give me the time of day. I wish they cared about me more and spent more time with me. The limo driver is my best friend." I thought, "You don't need a PH.D. to figure this one out."
I asked the client if it was okay to contact his father and share what was going on. He has no problem with that. In fact, he is using me to gain that emotional advantage. The father is a big shot. I call the bigwig father to request an audience. Getting through was like calling the Pope.
To my surprise, the father, separated, was open to the consultation. A week later, he drives his son to the second session. That alone blew his son's mind. It blew my mind.
The father had buried himself in work to cope with the separation feeling ashamed avoiding his son.
We worked on some family issues creating a behavioral contract. The mother re-entered the picture. As the marriage and family life improved, so did the son's mental health.
A word to the wise. Parental conflict does a number on kids' heads, so try not to be flippant about separating, and understand your decisions affect others.
Therapy war stories
Being a therapist is one of the more meaningful “jobs,” but you sometimes have spiders, drug addicts, and naked couples running around your office. Be prepared for anything, but you can't say a word.
Kottler, J. A. (2017). On Being A Therapist. Fifth Edition. Oxford University Press, Cambridge. England.
Van Gelder, L. (1997) ON THE JOB; When E-Mail Strikes the Wrong Target New York Times. October 5, 1997. Section 3, Page 8.