If all sessions could be as good as the first

I wish I had tape recorded this first session with a hopeless, self-hating, manipulative and drug-addicted twenty-year-old. She was so empty of self-worth, so poisoned by self-hate, she wanted to “run away” from herself. She watched herself demanding daily money from boys, for the privilege of dating her. There had already been a handful of psychiatric hospitalizations and rehabs. This was the rare diagnostic (intake) session where I skipped the childhood question: What situations, events, family atmosphere do you believe had an impact on you? (I rarely have to specify: negative impact.) This was because we started late – she was an end-of-day hospital referral – and because we were floating in an unusually benign and healthful mineral spring that was all the good we needed for the moment. I must admit that this was largely a fluke of good feeling I had Wednesday late afternoon, just before the office closed for Thanksgiving. There she was feeling denuded of meaning but garbage, and the atmosphere was friendly, even sweet. There wasn’t a miserable acknowledgment she made that wasn’t accepted, understood, OK in pretty much a dear way. A rare thing happened then, where she was anxiously sad that the session had to end. But before it did, I broached the subject of Borderline Personality Disorder and disorder in general, or in its cosmic nature. Borderlines and others are manipulative, because as my old professor said, ‘manipulation is the person’s effort to get her legitimate needs met in a way I don’t approve.’

And then I remembered a line that was made for this moment. “We are not defective. We are injured.” I’d like to think that if you say and explain this right, especially after proving that our strange character is a survivalist one, you will get a person with almost too much hope, but not too much that you can’t offer real assurance that it will be answered.

Sometimes the first session is so good that later ones can’t be that good, for a number of reasons. One is that so many clients are diving for hope and healing, and maybe love, into that room, into that therapist, and one can’t keep diving: You land somewhere. You land in defenses, in reality, in character.

In one of Lynn Grodzki’s books on starting a private therapy practice, the author notes that therapists should not give away essential goods at the beginning. The client will feel enlightened and won’t return for sessions. I believe that failing to do so is a sign that the therapist has no principle, no direction but the anarchic process of Rogerian being-there.

I hope very much that my client returns. I hope that she will dive for a long time.