Note: This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.
As a therapist to adult outpatients, often with significant and chronic symptoms, I did not make it a practice to visit clients in the hospital. I always wanted them to know I was not the only person who could help them. I tried very hard not to foster too much dependence within the therapy relationship, especially with people who I had treated for a long time. But the situation with Robin during that hospitalization in 2003 felt very different. Her “meltdown” (this is her description of what happened, not mine) was anything but a typical situation. Dr. Greene had called and asked me to go see her and talk to her about ECTs the previous day, essentially setting a different precedent with Robin than usual. After the confusion about the ECTs, I was clear I needed to check in with her before taking the weekend off.
On that day I found Robin sitting on her bed in her room of the inpatient unit. She was wearing sweat pants and a sweatshirt, and was fidgeting with the “sculpie” she had been bringing with her to our therapy sessions. It was a multi-colored material similar to Silly Putty, which she was able to play with and keep her hands busy during times when she felt especially anxious. The inpatient staff had apparently deemed it “safe” to bring onto the unit.
Robin was very angry, which was unusual for her. “They’re trying to make me go to groups. I don’t want to,” she said. Because of her significant social anxiety and the fact that she had run many therapy groups during the course of her career, she felt both terrified about being open with other people, and embarrassed to find herself on the other side of the group therapy process. As we were talking she suddenly said another statement, out of the blue, that rocked me to the core.
“So, are you going to ditch me now?” she asked anxiously.
“Of course not! What would make you think that?” I asked, as baffled and shocked as I had been two days earlier when she asked me about my age.
“I thought you told me a long time ago that if I was too suicidal you would not work with me anymore,” she said. I was unable to hide my surprise and confusion, and spent some time reassuring her that I had absolutely no intention of “ditching” her. I was unable to figure out what led her to that mistaken belief. She could not remember what I had said or when I had said it. We talked for a little while longer. I tried to reason with her and suggested she go to the groups and fake it, hoping she might actually get something out of being open with people if I could just get her to agree to go. It didn’t work…she remained adamant about her refusal to attend group therapy or any activities with the other clients.
I went home and thought a lot about Robin that weekend. How she had gotten the idea I would stop working with her if she was “too suicidal,” whatever that meant, was a mystery to me. By that point in my career I was very used to working with people who were suicidal. There was no question in my mind that I would keep visiting Robin in the hospital. From the very beginning of that hospital stay it was becoming clear that my standard concern about fostering too much dependence was less of a concern than Robin feeling comfortable being open…with someone. I knew, without question, it needed to be me. She had always been more open with me than anyone else in her life. What she had to say would have completely freaked out her family and friends. The following Monday we had another discussion that shocked me even more than our conversations during the previous week. I was gradually realizing how much she had been keeping from me and everyone else over the years.
“I’ve always just wanted you to like and respect me,” Robin explained. “I didn’t want you to think I was crazy. And I really was afraid you would ditch me if I was too suicidal.” The first part made sense to me, given that I knew how much Robin worried about what other people thought of her. What did not make sense was that she thought I would stop working with her, for any reason.
“So, what made you think I would ditch you if you were too suicidal?” I asked her.
“I don’t remember,” she said. “It was a long time ago. I thought you said something that made me believe this.” Robin was sitting on her bed in the sterile room of the inpatient unit, with most of the comforts of home absent in order to make sure people could not access any items that might be used to hurt themselves or others. I was standing while I talked to her, as I did not want to be too informal and sit on her bed, and there were no extra chairs in the room. Too many chairs, I knew, had been thrown at people in anger during the course of inpatient stays. Extra chairs were stacked and kept in public areas where staff members were present to supervise.
As we were talking, with no warning Robin blurted out the words, “I made a suicide attempt a few years ago that I never told you about.” I was surprised, but had heard many people talk about suicide attempts. I wanted her to feel comfortable talking to me about what had happened. She kept playing with her “sculpie” and would not make eye contact. I sat down on the bed across from her, letting her know I was prepared to listen. But I was not even remotely prepared for what I was about to hear.
“It was about the time I left my job when that kid hit me in the face,” Robin said. I remembered the approximate time frame. She had been working at a residential treatment facility for children and adolescents and it had been getting more and more stressful for several months. She had been having difficulty managing the stress, was more depressed, was feeling pressure to quit her job, and we had been meeting more frequently in therapy than usual. I asked her what had happened in terms of her suicide attempt.
“I was still living in that house with my roommates…the one that had a garage,” Robin explained. “I waited until everyone left for work, and went into the garage and ran a hose from the tailpipe to the driver’s window. I turned on my Jeep and let it run.” Part of me was stunned! When I hear people talk about suicide attempts they are usually not this lethal. But, at the same time I knew Robin would have obsessively thought it all out very thoroughly, and she would have chosen a plan relatively certain to succeed. I was trying to process what she was telling me. I had not known any of this at the time. She reminded me that it had been about four years earlier. Part of my brain was reeling as I was trying to imagine how awful it must have been for Robin to feel so desperate, so hopeless and so unable to share this with anyone. Part of me was already wondering what else she had never felt comfortable telling me. The rest of my brain stayed focused in the present. I asked her what stopped her from killing herself that day.
“Well,” Robin said, appearing slightly embarrassed, “it was taking longer than I thought it would. I think I sat there for about forty-five minutes. I didn’t know why it was taking so long. Finally, I looked at my watch and suddenly realized that if I didn’t get going I was going to be late for work. I put everything away, and I went to work. I had a bad headache for the rest of the day.”
Wow! Inside, I was dumbfounded. Robin had revealed to me over the years that she had a number of obsessive-compulsive habits. But, at that time I was just trying to process what she was telling me. One of these obsessive-compulsive habits ended up saving her life that day…her compulsive need to be on time. Thank God! She was apparently not able to recognize that if she killed herself it wouldn’t matter if she was on time for work. By definition, obsessive-compulsive symptoms are irrational and difficult to resist. What a perfect example of this. Her compulsive need to be on time overrode her suicidal desire and intention! I was very grateful for those symptoms as I realized, all at once, that her OCD symptoms were more severe than I had ever realized and that her inability to be open with me had almost killed her.
I had always received good feedback about my ability as a therapist from clients, colleagues and supervisors. I generally felt good about myself in terms of my career and my ability to help people. But, I found myself in a complete crisis along with Robin during that hospital stay. I found myself asking myself, “How could I have been so oblivious?” “Why had I not been able to recognize that Robin was still dealing with so many more symptoms and painful emotions than she was saying?” I had realized early on in our work together that there were things she wasn’t comfortable telling me, but I had thought this was no longer an issue.
I found myself doing my own obsessing. “Why didn’t it occur to me that she might want to know something about me but was afraid to ask?” “Why didn’t I talk about our relationship, and make sure she was comfortable with it and being honest?” These were the questions I found myself thinking about. As I grasped the reality of the number of years we had worked together and everything she must have felt unable to say to me, I began to comprehend how completely alone she must have felt and how much that must have contributed to her symptoms of depression through the years. Robin’s crisis caused somewhat of a crisis for me…it led to me questioning everything we had been doing together in therapy. How did we get to this place, after I thought for ten years that we were on the right track? More importantly, the crisis motivated me to do everything I could possibly do to make it up to her. I felt like I had completely let her down.