When I’m too
old to be tolerated at any mental health agency or counseling practice, I will wander,
with my Travel Nurse wife, about the states (requisite licenses in pocket) and
offer two- or three-session micro-therapy, a pressure-formed, organic
creation of mine. It came into being nineteen years ago when I worked at a
twenty-four-hour crisis center, weekends midnight to noon. There, acutely troubled
people would come in alone; policemen and psychologists* with their nihilistic
and juvenile detention and high
heels-wearing sons; families with psychotic Somali mothers who’d chew the
plastic seats off the chairs; suicidal folks “medically cleared” by the
hospital nine-tenths of a mile down the road, obnoxious Borderlines and lonely masturbation
addicts. My process developed mostly with the sane and serious clients who
would often be sent to a hospital psychiatric unit if I were not able to
facilitate some relief and resolution. This would happen – not infrequently,
really – in an hour or two, sometimes three. Understand that crisis
intervention in facilities such as this would generally consist of a twenty- or
thirty-minute face-to-face with clinician completing the Intake paperwork,
determining lethality (most suicidal, very few homicidal), offering warm
assurances, and sending the person home or to family, or to one of our
overnight rooms with a bolted-down cot, or to the CSU (crisis stabilization
unit: attached annex with beds, tv, food and activities), or to the mentioned
psych unit. I don’t recall why I was always allowed to luxuriate in lengthy client interactions,
though it must have been mostly because the graveyard shift was quieter, and shift
leaders knew I was the in-house “Sigmund Fred.”
You take the
knowledge of abyssal, childhood-based innumerable human pains and their natural
but difficult healing found in the Primal Therapy literature; share it with the
client in the four-dimensional empathy which that knowledge engenders; sink
into the instant “presenting problem” and its history; engage in that
feeling-centered process in an attenuated way; add a little personality and
fifty pounds of listening in a two-pound bag; find some
real but admittedly cultured optimism (which may include social-worky factors
like community resources, literature); say words that tell him he is not alone: you are here;
add self-disclosure of imperfection and troubles when poignant. Be earnestness,
warmth and circumspect humor; and the client’s suicidal or otherwise terrible
knot loosens, maybe unties. He feels better, brighter. Soon after, he may leave with the
sense that someone sees and knows some deep part of him even when he’s alone in
his apartment or going about his next day in his struggles. I honestly believe
we can send someone out there no longer feeling quite so alone.
A problem
presented when in subsequent therapy jobs I found myself almost unable not to
work in this fashion. What should have been the extended process of brief or
long-term therapy was too pregnant, too alpha and omega squeezed into a
dramatic, opening-up but possibly disquieting encounter. This may seem wrong on
its face: The clients were not in crisis, at least not in the same sense the earlier ones were. Yet, I felt that essentially there was no difference between the
crisis moment and the crisis life: those who sensed a wrongness about their
very existence and needed some immediate assurance, immediate saving. (Later, I realized it was my own insecurity that made me telescope everything.)
I learned to
foster in therapy a relationship. And of course to recognize the client’s need
to hide for a while – sometimes a long while – before she could trust. Weekly
therapy is more in accord with life. We need company. We need that extra lower
level of existential seriousness that at first just punctuates our normal days, then
disturbs them, then changes them.
There will
always be individuals ready for something fast, edifying, or different from the
therapy they had in the past. By then, in my mid-seventies, I’ll be confident
enough to feel I can help them in three non-crisis sessions.
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* These
professionals’ children are always troubled.
