Note: This is a serial blog. To start at the beginning, click on Chapter 1 – The Meltdown under “Categories” and start at the bottom.
After a three day Labor Day weekend, I drove my car into a parking space at work. Employees were required to leave the parking lot closest to the outpatient building free for clients and visitors, so it was a bit of a walk from the employee lot. On the beautiful agency campus I walked along a tree lined drive, overlooking a large grassy area with a sculpture garden as I made my way. As I was walking, I found myself thinking about Robin and wondering how her weekend had gone. We planned to talk on the phone later that afternoon. I had been concerned that she had been discharged from the hospital prematurely, so I was trying to prepare myself to hear just about anything.
“I had a bad weekend,” Robin said, not surprisingly, when we talked. “The weather was crappy and the plans I made fell through. I went out and bought some vodka yesterday and got drunk.”
What? I was instantly angry. It was the first time in my ten years as Robin’s therapist that I was angry at her. Through all her times of self-destructive behavior during the previous eight months, I had been able to stay patient and focused on Robin’s severe depression and difficulties with impulse control. I was able to empathize with how awful she must have felt, and to understand she would want to numb herself with alcohol. I calmly and firmly made it clear that I could not support or enable self-destructive behavior. I was always able to stay professional and therapeutic. But on that day in September 2003, I reached my limit.
I had already been irritated the previous Friday, after Robin campaigned with Dr. Greene to get out of the hospital before her mixed bipolar episode was actually stabilized, did not take the Ambien he prescribed for sleep, and then refused to plan to talk with me over the long weekend. To hear that she not only drank, but purposely went and bought vodka with the plan of getting drunk, scared me. If she didn’t take her medication and refrain from drinking, things could get very ugly again, very quickly.
I was angry mostly because Robin made a choice to not call me, and to get drunk instead. After all the ways I had extended the boundaries to help overcome her severe anxiety about reaching out to people, I was hurt that she was still unwilling to call me to avoid being self-destructive. Underneath anger, I would always tell my clients in therapy, is usually hurt or fear. That day I was feeling a lot of both. But what I felt consciously, was just plain anger.
The rational part of me knew Robin wasn’t thinking clearly, because she wasn’t yet stabilized. The therapist part of me, had it been operating, would have been able to hide my anger from Robin on the phone. But I was a human being who had extended myself for her, in many ways, over a long period of time. I was getting tired. The therapist part of me wasn’t able to override the hurt, scared and angry human part.
“Are you ready to get back on track and stop being self-destructive?” I asked, with a clearly angry tone in my voice.
“I’m not sure,” Robin said. “I’m trying. I went to work today and packed up all my stuff from my desk. Then I went to lunch with my co-workers. I had to fight to keep from crying during lunch.”
Of course. Robin was dealing with the enormous grief associated with losing her job. I wasn’t surprised she had a hard time while packing her office and seeing her co-workers. But, she did not have to do this today. From my angry perspective, I wondered whether she was choosing to immerse herself in the grief, almost as if she wanted an excuse to self-destruct. I knew I was taking it too personally that Robin drank. I had temporarily lost any ability to be therapeutic.
Our phone call was supposed to be a brief contact to discuss how things had gone over the weekend. We were scheduled to meet the next day. I was thinking clearly enough to know I needed to get off the phone and get myself calmed down, so I could be therapeutic during our session.
“I need you to get rid of the rest of the vodka you bought,” I said, emphatically.
“I’m not ready to do that,” Robin said, just as firmly.
Wow, okay. This was not going to go well. I shifted enough to say, less angrily, that we would talk more about all of it when we met the next day. I asked Robin about her suicidal thoughts.
“They are low,” she said. “I’m ruminating more about job stuff and what’s happening financially.” She assured me she would not kill herself before our appointment. I hung up, knowing I needed to get clear before our session the next day.
I needed to make a decision. I had made a very conscious judgment call shortly after Robin’s meltdown to make part of the focus in therapy our relationship. I realized the extent to which she had severe anxiety about being open with anyone. My decision to extend the boundaries within our relationship and to be open with her about the fact that I cared about her, had gradually allowed her to feel more comfortable being open with me, and then more open with her family. I knew my gut had steered me in the right direction.
I needed to trust my gut again. Robin and I had developed a close enough connection that I hoped I could influence her positively by being honest about my anger. If I knew she was stable, it would have been an easy decision. I would have trusted the connection and used the situation as a “teaching moment” in the therapy process. But she wasn’t stable. She was still not sleeping well, and her behavior over the weekend was evidence of impaired impulse control. There was a risk that if I talked about how angry I was, and she was not able to process it rationally, she could use it as yet another reason to kill herself. I had used our close connection, which I had fostered, as a way to keep her alive until she stabilized and could let more of her own people in. If she felt like our connection was ruptured in any way, I wasn’t sure whether that would push her toward more self-destructiveness.
Surprisingly, I didn’t agonize very long about my decision. My gut felt clear. I trusted the connection. Robin had stayed alive through so much partly, I believed, because she felt good about being able to be completely open and feel accepted by me. I knew I needed to be honest and direct with her in our session. I felt clear it was worth the risk, since she was continuing to be self-destructive and I needed to do what I could to stop this. When she arrived, I was a bit nervous about saying what I needed to say.
“Robin, we have talked a lot about our relationship over the last eight months. I’ve been more open with you in order to help you feel comfortable in close relationships. Part of close relationships is the ability to be open and direct about all feelings, both good and bad. I need you to know that yesterday, for the first time I was really angry at you,” I said. I went on to explain why.
“I could tell you were angry,” Robin replied. “I’ve already gotten rid of the vodka. I’m going to try to stop being self-destructive. I don’t want you to be mad at me.”
Thank God! All of a sudden I felt validated. All my questioning earlier in the year about whether I was doing the right thing by opening up to Robin and extending the boundaries, felt clearly like the right decision. She cared enough about me and about not making me angry, that she was willing to work harder to stay alive. I was relieved. Very relieved.
We went on to have a long discussion about cleaning out her office, and losing her job. She cried as we talked, which was unusual for her. I was glad she was beginning to feel more comfortable showing her emotions in front of me. She was open about how hard it was for her to accept her inability to work.
“Robin, I think it’s going to be important for you to have something productive to do. It doesn’t work for you to have too much unstructured time and so little social contact. I know you are grieving many losses. But maybe volunteer work of some kind would be a good distraction. I think it will help if you can shift your focus to rebuilding your life, rather than on what you have lost.”
“I agree,” Robin said. “But first I need to get some things settled. I need to finalize the bankruptcy and know whether I’ll be getting long-term disability. I’ve been thinking about it, and probably need to just go ahead and apply for Social Security Disability benefits too. There’s no point in putting it off.” She became tearful again, as she talked about how hard it was for her to admit she needed to take this step.
I wanted Robin to feel good about the progress she was making in treatment. It was enormous that she was being so open about her feelings, and allowing herself to cry with me. This would have never happened before her meltdown. I was also relieved to hear that she was thinking clearly, despite her enormous grief.
“Robin, I want you to know how huge I think it is that you are dealing with your strong emotions in a more healthy way. You drank over the weekend, but the fact that you are here, talking to me about how you feel and allowing yourself to cry, is a sign of all the progress you’ve made in therapy this year. If you can keep this up and let other people in, I think it will help you keep feeling better.”
Robin revealed that, despite what I was saying, she continued to believe her meltdown in January resulted from her “not doing a good enough job of keeping things under control.”
“I think the complete opposite is true,” I told her. “I think it was your life-long pattern of trying to keep everything inside that finally caught up. Learning to express your feelings in healthy ways is the key to healing. I think you have the ability to do this. This year has helped me to get much more clear about what we need to work on in therapy going forward.”
I felt much better after this session. I was no longer angry. It helped me to know Robin was willing to consider volunteer work, and to apply for Social Security Disability benefits. This was all progress in terms of her accepting the reality of her situation, despite her enormous grief. The next day, I was even more encouraged by her progress.
Robin called, unexpectedly. I was very surprised to hear why she called.
“I need to tell you about something you said in our session yesterday that hurt my feelings,” Robin said, sounding nervous. Wow! This was amazing. For her to be this assertive and direct with me, was unheard of.
“Please, tell me,” I said.
Robin and I had been talking about how bad she felt over the weekend when she chose to go buy vodka and get drunk. At another time in the conversation she talked about making a mix CD of songs during the weekend.
“When I was telling you about my CD you asked if it was a drunk and depressing CD,” she said. “I felt hurt because it took a lot for me to share my CDs with you. I felt like you were dismissing that.”
Oh my God. What a huge thing! I was instantly sorry. She was completely right. I had obviously still been angry when we talked about her CD. I had crossed the line, was unprofessional, and said something hurtful. When therapy focuses on the relationship between client and therapist, the theory is that it provides a safe place for clients to practice these kinds of relationship skills. I was absolutely thrilled that Robin felt safe enough to say this to me. This was the person who, eight months earlier, had confessed in the middle of a severe mixed bipolar episode that she had kept many details of how she had felt from me for a decade. All the work we had done together during the previous eight months was clearly paying off!
“Robin, I’m so sorry. You’re right. That was very hurtful,” I said very apologetically. “I’m so happy you felt like you could tell me this, and that you called to say it rather than waiting. Good for you. Please, forgive me. If I’m ever angry at you in the future I’ll be more careful about what I say.” I went on to explain that I had been very honored that she shared her very personal CDs with me, and did not mean to discount what a huge step this was for her.
We were scheduled to meet the following week. Robin was sleeping better and clearly stabilizing following her hospitalization for symptoms of mixed bipolar disorder. We talked about her plans for the weekend, and she assured me she would not drink. She stated it clearly and emphatically, “I don’t want to make you mad again.”
It wasn’t the best reason for her to avoid drinking. I would have preferred her to be internally motivated to stay stable and avoid relapse. But at that point, I wasn’t going to argue. Progress was happening!