Traveling Shrink's Micro-Therapy

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.

- - - - - - - - - - -

* These professionals’ children are always troubled.