accomplishments

There comes a point when you stop trying to explain.

Not because the pain is gone.

Not because the injustice no longer matters.

But because you know who you are.

I am not what they said I was.

I don’t have to win back trust—because I never broke it.

I’ve lived my life by the highest morals:
With gentleness.
With integrity.
With compassion for those who suffer.
With respect for others’ boundaries, bodies, and beliefs.

Even when I was invisible, I lived with purpose.
Even when I was silenced, I held onto truth.

Even when I was shattered, I chose not to shatter others.

A therapist once wrote that I was a gentle person.
She didn’t say it to defend me.
She didn’t say it to counter a narrative.
She said it because it was the truth.

It still is.

I’ve spent years trying to survive.

But survival isn’t the end of the story.

Now, I want to live.

Not to prove anything—
 

But because I still have something to give.

There’s a voice in me, buried under layers of pain and shame, that’s slowly growing louder.

It says:

You are not your trauma.
You are not what they assumed.
You are not the roles others cast you in.

You are a good person with passion and love to give.

You are still here.
Still standing.
Still healing.

And that is more than enough.

I now had a growing client base and an office of my own. I was accepting insurance payments and/or checks for services.  

I was set up to be able to bill Blue Cross/Blue Shield among others... and Medicare. Clinical Social Workers can't bill Medicaid in North Carolina for some reason. We can bill Medicare, though.  

Treating Schizophrenia with Psychotherapy

I was trying to find out if a colleague in the field, named Mary Ellen, who was working with some individuals who had schizophrenia, could find out if some of them wanted a therapy group. She was a volunteer/intern and through her contacts, she had been given the opportunity to work with a few clients in the community.  

They were staying at a nursing home not far away. I decided to offer the conference room as a meeting place for a support group for people with schizophrenia. Mary Ellen and I decided that there was a need for a support group that would be of interest to the people she was serving.  

She started bringing her clients to my office building. Depending on how many people showed up we would either use my office or the conference room.

This was a great learning experience for me. I really wanted to offer something for people who were battling such a debilitating and disturbing form of mental illness. It was sad that these individuals ranging in age from the late 20s to the 50s were all staying in a nursing home.  

I suppose that is better than being homeless. But usually, you think of nursing homes as being there for the elderly who cannot care for themselves. 

I had asked if any of them wanted to meet with me one-on-one for therapy. I was sensitive to the fact that some people might see this as a way for me to pad my income to enrich myself, especially if I met them at their residence, the nursing home.     

These individuals had Medicare and I could bill Medicare. While it's true that this would increase my income and bring in money for me that doesn't mean I wasn't genuinely interested in helping them. They wanted to have someone listen to them and to try and understand what they were experiencing.

They had a doctor that they were seeing. I knew that much and that they weren't seeing a therapist, though they had someone at the clinic who could provide psychotherapy if the staff person was so inclined to do so.   

It had been my observation that some people in my profession thought that the only remedy for schizophrenia was medication. I had noticed this when I was working at Sampson County Mental Health Center. I also remembered that when I was working there some of my clients, if not most of them, if asked, or if it was offered wanted to meet with me for psychotherapy.  

In my heart, I knew that I was trying to offer something good for people who might benefit from talking to someone who is grounded in reality but also very empathetic.  

In addition to just listening and trying to understand their experiences, I used a few psychological techniques to help them build their self-esteem. I also talked about some skills that would be useful in communicating and coping.

This wasn't something that went on for a long time but I did have a chance to work with some clients for a few weeks. 

The Treatment of Eating Disorders        

I did have a client named was Anne Marie who had anorexia which was particularly challenging because starvation can cause a variety of serious physical problems. There are also serious challenges in getting accurate information about binging and purging.  

It would become clear over time that a medical doctor needed to be the one who is primarily in charge of the care of someone with this serious problem. The empathy and rapport that I had developed with Anne Marie were great, but I still had concerns.

What seemed like a great challenge for me became something that was more serious and needed to be overseen by someone with an MD after their name, with admitting privileges at a hospital.   

Anne Marie had returned from college for health reasons and was living with her parents. We were able to have some family sessions as well. I felt it was important to find out about her health when I listened to the concerns that her parents had expressed. 

Anne Marie's parents became increasingly concerned that I wasn't doing enough and that her physical health was in danger. I was not in a position to assess her physical health. I didn't know why or how I was being expected to act as a central contact person for all of Anne Marie’s physical health and well-being. That was something that I had to make clear.

I had taken some training on the treatment of eating disorders, but it could not cover the physical/medical issues.

The last thing I wanted was to be responsible for someone's medical care or assessing a person's physical health. So, I explained this in-depth. 

I didn't want Anne Marie to feel like I was abandoning her or not on her side. I just needed to be sure that there was someone else that she was seeing for those issues related to her physical health. I couldn't be the one that asked if she had kept an appointment with her doctor or the one that weighed her and took other vital signs.  

Like so many others with eating disorders, Anne Marie had symptoms of Borderline Personality Disorder (BPD). There is a sense that you are walking on eggshells with a person who has BPD, where you are challenged repeatedly to demonstrate that you care about your client.  

Sometimes a person with BPD will cycle between idealizing someone like a therapist to hating them. In other words, we are talking about intense and unstable interpersonal relationships... chronic feelings of emptiness. Another symptom that is readily obvious as overlapping with anorexia nervosa is changing perceptions of self-identity and self-perception.      

For a person with anorexia, they might see themselves as overweight even when others see them as emaciated - grossly underweight. The feeling of food in them can trigger feelings of anxiety and lead to purging to vomit the food out of their stomachs after they eat.  

Obviously, this is very dangerous.  

I ended up transitioning to offering mainly group therapy for those who had anorexia. Bulimia was a disorder I felt comfortable treating. With Bulimia people have body image issues and they might binge and purge but they maintain a normal healthy weight.

 A couple of other girls/young women found me listed on the web, in the yellow pages, or through word of mouth. 

Out of this arrangement, I picked up a client who had been diagnosed with Bulimia. Her name was Jennifer.  

Jennifer's condition did not require the attention of a medical doctor as would be the case with Anne Marie who had anorexia.  

Jennifer didn't have this problem. She did put a tremendous amount of focus on her appearance and her sense of feminine beauty. Sadly, this need can make a person feel like their worth is tied to their body image.  

It was hard not to recognize the focus that she put on her body. She had undergone breast enhancement surgery. It would be naïve for us to avoid discussing details like this. These issues were precisely the kind of things that a person with bulimia needs to discuss with their therapist.  

Obviously, a healthy male therapist has to be aware of his reactions when he is meeting with an extremely attractive woman, which did describe Jennifer. A male therapist who acts like he doesn’t recognize things like this is lying or he is gay. 

Our natural human reaction does NOT mean we are going to cheat on our wives, nor does it mean that we are objectifying a woman! Human evolution has programmed us to react in certain ways.

The point is that we were going to explore these issues in therapy - issues related to her sense of worth as a person as well as her as a woman. While it's true that professional boundaries were going to be maintained, it is valid to explore transference and countertransference issues.  

I had studied psychodynamic and psychoanalytic theories, concepts, and ideas. Jennifer was interested in gaining some insights into herself and so this seemed like a good framework for some of our discussions.

We brought out into the open the thoughts she might have about the reactions she might want from men/guys in her life including her therapist. How did it make her feel that she was noticed in this way, based on her attractiveness?

Her understanding of these ideas grew over time. She talked about her experiences growing up. She was open to exploring dreams and their possible interpretations. She was intrigued by the ideas of Carl Jung, a contemporary of Sigmund Freud.  

Any approach that was aimed at insight and seeking to make connections between events in her life up until now was valuable for her to explore, she indicated. With the insights, she felt she was improving, and the binging and purging was happening less frequently. I thought that knowing why this was happening was less important than her interest in discussing seemingly unconnected events in her life.  

She did want to discuss the fact that she had agreed to be photographed nude by a friend of her boyfriend. I wondered when she told me this if she felt that she was seeking to see how I would react to her discussion of this fact. Did she want me to react with interest or excitement?

I asked her, "do you want to show me this?" I was curious as to her reaction.  

"I don't know," she said.  

I was concerned that she might feel like I was expecting her to show me the photograph(s). 

Now, I am supposed to lie to you and tell you that I didn’t want to see the photographs. Right! A beautiful woman is sitting in front of you, and she brings up the topic of being photographed nude and you want me to tell you that I didn’t for a second want to see the photographs? 

At the time, I was still very young and naïve. So, I felt guilty and discussed this with Marjorie who I was seeing for psychoanalysis. She wasn’t young and naïve. She was about 70.

She said, “Of course, you wanted to see the photographs.”

I said, “but I didn’t think that she was more beautiful than Lynn.”

“That’s okay, it would be worse if you were dishonest with yourself,” she said, adding “then you might fall victim to temptation.”

I settled back down into the couch – remember I was lying on a couch when I saw Marjorie. I said, “yeah, I wasn’t tempted to do anything.”

Anyway, getting back to therapy with Jennifer…

Jennifer said that she also was having some problems with a situation with her boyfriend. The way he spoke to her during foreplay seemed to be degrading to her.

That incident with her boyfriend inspired her to ask if I could see them both for couples counseling. Indeed, I had studied this, and I described some tools that I could bring to the sessions that might be helpful in achieving certain goals for both her and her boyfriend.   

We agreed that he could meet with me alone as well - before or after we met for couples counseling.  

This went on for a while. It was very rewarding for me because she was paying out of her pocket for my services, as opposed to having insurance that would cover the cost of therapy. If either one of them or both had been dissatisfied with my competency, they would not keep coming and paying for ongoing therapy or treatment.  

I only saw her boyfriend about three times alone and that was on the same days when we had couples counseling. I did continue to see Jennifer alone. We would examine her interests, desires, and expectations for her future, for her career, and what increased her sense of self-esteem and her feelings of self-worth.

It was great to see how empathy and respect for her had paid off with positive results as per her feedback. Again, she was paying by check out of her pocket and so if things were not working out for her, she had many other therapists she could consult in the area.  

In the next chapter, I will present some more challenging issues that I had to confront as a therapist.  

A few chapters earlier, I mentioned that my private practice had grown so very fast. It was amazing. There were many different clients that I was seeing with different problems or issues. 

Some of my skills opened up some opportunities for me. For example, I was curious and inspired by the effectiveness of hypnosis and the possible opportunities to use it to help people deal with "normal" experiences and problems, as well as more complex and debilitating problems.  

Let me give an example. I had a couple of clients come in to see me for help quitting smoking. There are scripts that exist and established protocols that I had learned during my training that were approved by the American Society of Clinical Hypnosis (ASCH).

Anyway, hypnosis can help with Major Depression and Anxiety as well. 

Getting My Own Office

With the support and help of Lynn, I selected a location in downtown Wilmington, on Chestnut Street.  

The rent was about $400 per month. Since I had been paying Chris $15 per hour when I used his office, every hour after 26 per month cost me more than $400 in the month. So, it was clearly more cost-effective to have my own office since I was easily needing the office for more than 26 hours.  

Everything was amazing and wonderful beyond my wildest dreams. This was real. I was feeling so proud of everything I had accomplished. I knew I had finally reached the height of my success - everything that I had been dreaming of for so long.  

Lynn and I met with the receptionist at the location, and she was really nice. She said that she would meet and greet clients when they come in and ask for me. Of course, she knew about confidentiality.    

They had a nice waiting room that was never full. A lawyer had been renting the office next to mine. It was a long building with about 10 different offices down the hallway. There were a few other therapists like me and others in different businesses.  

Next to my office, there was a conference room that any of us could use. There was a calendar behind the counter where the receptionist sits that is used to book the conference room when you expect that you will need it.  

I now had two phone numbers to give my clients. One of them went to the receptionist and she would ring my office if I was in and not in session. I had a way to indicate that I am with a client and should not be interrupted.  

It was late in 1998 when I made this transition... from a small private practice and renting an office for a few hours per week from Chris Hauge to having my own office with a receptionist, a waiting room of my own, full ownership of the single office room, and access to a conference room.  

Lynn and I started looking for deals at yard sales to decorate the office. We went to Office Depot and bought a desk and a nice comfortable chair for me to sit in next to the desk. We had to act quickly because everything was happening fast.  

We picked up a nice or fairly decent couch for a great price at a yard sale. I obviously cannot remember now decades later what things looked like. We also picked up a few nice pillows to make the couch comfortable. No one was going to sleep here but they could be helped to feel more comfortable.  

We also picked up a whiteboard for notes and illustrations with clients. Obviously, I needed to put my degree up on the wall along with my license and certifications, i.e., the certification as a Clinical Hypnotherapist with ASCH as well as other certificates I received at various training workshops.  

Lynn was a great help in picking out and decorating the office. I am not someone who cares how things look, so I needed help to feel comfortable that I had an office that looked inviting, comfortable, and professional. I am sure I would have been self-conscious if I didn’t have Lynn’s help.

I knew we needed - I needed - a couple more chairs in case I wanted to do group therapy. I figured I would need to do more of this than the availability of the conference room might allow.  

The conference room had a big table that filled most of the room. There was a phone in there and a large whiteboard at one end of the room.  

I also picked up some toys, a toy box, dolls, and a few other things. There was a couple that came to me to get help with their children. So, I needed a way to work with them. It is easier to work with children by letting them play if they are under the age of ten or twelve.  

I had studied play therapy since that time when I was a first-year intern at the New Hanover County Mental Health Center in 94. While I wasn't thinking I would have lots of kids come to see me, I thought I should have something for kids if necessary or if it would be helpful. 

The receptionist could call clients if necessary, she could help with typing, make copies, perhaps help with billing, as well as accepting payments from clients as they come in or after a session. I had a billing person who would help with billing clients for their sessions, so I didn't ask the receptionist to do any of that.  

We discussed the ideas about what she might want to do for me. I thought that due to the need for confidentiality that I would make calls to clients, but she could certainly pick up calls if they called into the office to cancel, reschedule, or to state that they were running late. She would announce to me when someone showed up and I would come down the hall and greet them.

I didn’t like having to collect payments myself, but I still felt that it would make sense for me to arrange payment agreements and accept payments personally rather than have the clients pay the receptionist, most of the time. Sometimes clients would leave a check upfront with the receptionist.

Sometimes, I would get anxious if someone was running late and I would walk down to the waiting room to see if I had missed the announcement. Plus, the receptionist only worked nine to five, Monday through Friday.  

After those hours, I had a key to enter the building, a key code to enter into the alarm, and I was expected to lock the door, obviously.  

So, I was ready to get to work.  

This was amazing! It was a time for celebration! I wanted to tell everyone I knew just how thrilled I was. I wanted to celebrate!

It was so wonderful to have someone to share this with - Lynn. So, we marked it with dinner and marked the occasion as it was so important ... I wanted to mark the importance of this accomplishment through a metaphorical plaque of honor to be remembered as an important marker in the history of my life and I want it told for generations to come!

I did it!

In the next chapter, I will pick up this story and begin to discuss the wide variety of clients, problems, and conditions I was treating as well as the types of interventions used.  

Family life is what makes life meaningful and joyful. Being able to pay attention to maintaining a balanced life is crucial when you’re working in the field of mental health. Some psychiatric disorders impact us as therapists who witness the pain of others.  

You might think I am only talking about the traumatic experiences of clients who have been hurt but anytime one is dealing with negative emotions all day can find that it puts a strain on us as therapists. We listen to the despair, sadness, and negativity of others and it can have an impact on us. 

The responsibility that we bear for the well-being of others requires us to have a life full of joy and peace outside the workweek. We need balance in life.

Wrong Impressions Regarding My Family

Of course, we want those who are part of our family to be proud of us. I was certain that I had the admiration of my brother and sister and that I had made my parents proud. As far as I could tell at the time, it had seemed that they would have been proud of me, finally. Their investment in my education had paid off. I had used it to get another degree, a graduate degree, then to get credentialed/licensed in my field.

They had to be proud. I had not been questioning this at the time. I just assumed they were happy for me as well. I had found love! That would make anyone feel good to know this about a family member. Anyone in any “normal family.”

I was the only one of my siblings who had gone this far in my education. 

While I am not saying I was better than my sister or my brother, but for Carrie, her career landed in her lap somewhat. She had moved back to Connecticut and found a job at Aetna. She learned that by furthering her education she could advance within the company. She shaped herself according to the company’s demands and expectations instead of finding the right career for herself.

Yes, I did it differently than Carrie. I wasn't letting any single company, organization, or agency have a say in where I went in life. I first found the best match for me in terms of a career path and then pursued that goal, overcoming any challenges along the way.  

I used the words "organization" and "agency" as opposed to just using the word "company" because, for my career, people work for agencies and companies.  

Anyway, my career path was carefully and deliberately chosen with the aid of psychology and a psychologist/counselor when I was in college. Then in the many years after that, I pursued employment opportunities based on my aptitudes, interests, and values. While I got advice and support from others, I made all the decisions myself with the insights I was gaining.  

My brother had not excelled in school either nor had he mapped out a specific career direction with ideas about what would be his best career direction. He went into the Marines for a while. He got married and found a job.

I thought that I was the family star and that everyone was proud of me. I have alluded to the fact that sometime later I would learn that this was not the case. To this day, I am baffled by the distance between what I assumed and what was going through their minds… I was shocked to discover just how messed up their thinking had been.

I had told my siblings and my parents why we couldn't have children and why we couldn't have a church wedding or a marriage license - Lynn's medical care could be cut off if she lost health care coverage.  

The fact that my sister worked for a company that sold health insurance was a topic we had to avoid. Lynn had a genetic illness and that disqualified her from insurance coverage. While it is reasonable for private companies to be unable to cover situations like this, I got no sense that Carrie cared at all about this, so the topic was taboo. 

I had been trying to keep the peace and stay cordial with my family of origin.  

Career Success and Friends

My friends were proud of me, as was my wife, Lynn. I had a social circle of like-minded poets who were part of the poetry scene in Wilmington. These friendships continued to grow.  

Sometimes when I was learning experiential therapy techniques that were part of the human potential’s movement, I was able to persuade my friends to participate in encounter sessions. This would be like using these techniques for those of us who are not coming together to work on a psychiatric problem. You don't do therapy with your friends or your wife for that matter.  

I might invite my friends to try something like psychodrama – a fancy word for role playing. Alternatively, I demonstrated guided imagery and visualization techniques. 

It was nice to see that my friends were interested in what I was learning and wanted to try things out with my guidance.

I also demonstrated clinical hypnosis with Lynn. She was receptive to the idea of visualizing her body fighting the symptoms of Cystic Fibrosis… maybe visualizing where the congestion was and directing her body to try to loosen it up.  

Anything to bring healing was worthy of trying.  

Most of the time she kept falling asleep when I did this. This was a bit frustrating to me but amusing.

I guess it reflected the trust and serenity Lynn found when she was with me.  

I was able to complete all the requirements for licensure as a Licensed Clinical Social Worker (LCSW) within the state of North Carolina before I left my employment at Sampson County Mental Health Center.  

It was clear that whatever problems I had on the job had nothing to do with how I performed with clients or patients.  

As I explained, I had sought feedback, counseling, support, and guidance from my colleagues. I had joined the local chapter of the Society for Clinical Social Workers which had regular meetings where I could interact with colleagues in a congenial setting where we got to share our ideas, request feedback on casework, and learn from one another.  

It is through these meetings that I kept in touch with Chris Hauge who was a mentor of mine as I have mentioned. 

I had approached Chris seeking advice on entering private practice because I looked up to him... I had known that he had kept a private practice for some time. He had been very supportive of my goals as they related to making a positive difference in the lives of others.

The Keys to Success and Accomplishments

As it turned out, Chris said that he was considering retirement and that he was cutting back his office hours. He offered to let me rent his office space at a certain rate per hour if I used the office. This was a very affordable way for me to find success.  

I believe it was about $15 per hour - Chris wasn't using the office anyway during these hours. He told me the hours in which he used the office and when the office would be available. He shared an office with a partner - they had the main waiting room and reception area and two private office rooms where providers, like myself, could meet with clients.  

If I had to build a private practice on my own, it could be challenging to get started. I would need to build a base of clients that would be paying every week for treatment with me. If you rent an office full time you have access to the building any time, day or night, but you pay a monthly rate to do this.  

The cost to rent an office every month would be higher than the costs that Lynn and I were paying to rent our home - though her mother had been renting it to us and therefore we had gotten a great deal, a cheap rate for rent.

Chris gave me a key, introduced me to his partner and we discussed how I would record the hours in which I was going to use the office. He had a schedule I could consult to find out when the office was available.  

There are so many things to consider when you are pursuing a career in this field and when you are seeking to work in private practice. As noted, I had to consider Professional Liability Insurance or malpractice insurance, which are different names for the same thing. Chris needed to know that I had this coverage.

Billing is another issue. I had to file insurance claims for treatment with a client's insurance company or agency. So, I had to get registered with various insurance companies including Medicare. 

I had contracted with someone to do the medical billing as well and I got a post office box (PO Box) for non-personal mail. 

Having all my mail go to Chris' office didn't seem like something that I wanted to do yet. If I did not go to the office because I didn't have a client that day, then I might miss my mail that day. There was a place where I could get a PO Box close to our home.

It's great to have someone with whom you can consult when you are doing all these things and Chris was helpful in this regard as well.

Then I had to advertise in the newspaper and online. The internet was still a bit new in the late 90s, but I was able to create a website.

Other Advice That I Received from Colleagues

It's important to reflect upon the support I got from colleagues as well as the therapy or treatment that I had been receiving.

I became interested or curious to learn something about psychoanalysis and I began to study this formally from an organization that provides certification in psychodynamic/psychoanalytic therapy. The organization provided learning objectives, credits, coursework, as well as certifications for mental health and psychological professionals.  

I would go and see Marjorie Israel, who worked out of her home. She was a clinical social worker like myself and I met her at those meetings. 

Marjorie invited me to her home office. It was an interesting and scenic location. She had a nice yard with flowers and plants in a beautiful and serene garden with a curving sidewalk.

I would lay back on her couch and do free association or recount my dreams. It was reminiscent of Freudian psychoanalysis with the psychoanalyst and the couch. Marjorie said that she had to modify her approach since psychoanalysis traditionally had been done with a client coming four or five days a week for years.

She also engaged in more talking than traditional psychoanalysis.

While so much of psychoanalytic theory is hard to prove with research, I was interested in a technique where I would not be censoring anything at all. I was interested in making sure that I covered everything going through my mind – my motivations and hidden desires. I didn’t want any issues from my past to interfere in my role as a therapist for clients. 

Clinical Hypnosis Training

As I was studying Clinical Hypnosis, I saw some of the ways this can be used to help others deal with various problems and challenges. Some of those challenges and problems that people turn to a hypnotherapist to overcome are well known, like smoking cessation, weight loss, and phobias.  

Anxiety and phobias can be overcome through behavioral techniques like systematic desensitization. In this technique, a person breaks down their phobia into progressively more challenging and/or frightening scenarios or steps while pairing that with relaxation.

So, for example, if one has a fear of flying, they might break things down so as to cover planning for the flight… driving to the airport… waiting to board the plane… getting onto the plane. They would visualize this during hypnosis.

Hypnosis can be used to create a feeling of peace, relaxation, and serenity. Then when the person is in this relaxed state of mind, they can visualize the anxiety-provoking situation. This now pairs a relaxation response with the stimuli or phobic situation, experience, or trigger.

Starting My Practice

One of my counselors cautioned me that Wilmington was a saturated market, meaning there probably isn't a market for another psychotherapist in the Wilmington area.  

I was going to prove him wrong, which would make him happy actually. I mean, he had my best interests in mind. He was speaking only about the market for therapists. 

I did start to pick up clients rather fast. I had selected a few words to use in the advertisements that I hoped would be problems that people in the area had and/or things that interested me. So, initially, I thought of advertising that I could help individuals who are dealing with anxiety, depression, eating disorders, relationships. I added that I could use hypnosis to help with quitting smoking, weight loss, or other problems.  

This seemed to work out well for me. I used a second phone number that rang at my home, but the location of where I was living was not revealed. 

One guy started paying me out of pocket for weight loss. 

Then I picked up a client who had relationship issues. He said that he was gay and asked if I could help. I reported that I could help. To me, relationships require active listening. So, I would demonstrate that in the sessions with the client and help him to learn how to increase his communication skills in the same way.  

It's interesting that people in relationships that are non-traditional relationships will understandably want to know if we are comfortable listening to details about their intimate relationships.  

Returning to the topic of psychoanalysis, we get terms like transference and countertransference from this field.

Transference is about how the client reacts to or responds to the therapist. It can relate to projection where a client projects onto the therapist ideas and feelings that exist in another relationship.

Countertransference is how therapists respond to the client and the client's behaviors. I was working on my own "issues" to ensure that none of my past was carried into the therapy sessions with others and would cloud my judgment. This was part of why I went for analysis with Marjorie.  

Anyway, I also picked up a client who was dealing with major depression. Another issue that I was treating was anorexia. I had taken on a client who was in college and had come home with her family hoping to return to college later.  

Eating disorders are particularly challenging, and so I will devote further time to this topic later. 

My client base was growing, and it was getting to the point that I needed more access to the office than what was available while renting from Chris. I also found that by paying a flat rate every month, I could save money.  

Recognizing these accomplishments was amazing and a cause for celebration. So, Lynn and I went out to dinner at one of our favorite restaurants. Everything was amazing and a celebration was called for!

This has been an overview of the various types of clients I was seeing and the problems or issues I was treating. Later chapters will go into more detail so I will ask you to keep reading with me.

First, let's talk about family life so that you, dear reader, will know that I had another life outside the office. 

It seemed like anything was possible indeed if you put your mind to it and work hard. There is a career or profession for everyone; an area where one is most adept; a field where one is meant to work. I had found my career and my direction in life and everything was falling into place.  

In this section of my autobiography, I will describe the success I found as a mental health professional, a therapist (a psychotherapist as opposed to a physical therapist), in private practice. Just getting to this place in life and in my career demonstrated the many accomplishments I had made in my life.   

I had achieved the recognition of my colleagues and the admiration of my friends and family. I felt like my family was now very proud of me and amazed at all my accomplishments. 

It would be a logical assumption to think that your family is proud of your accomplishments and happy for you. It would be years before I realized that this was not the case – that they had not cared about my happiness or success at all!

These were things that I sought after my whole life. I mean who doesn't want their parents, their brother, and sister to be proud of them? Or similarly, we want our friends to be amazed and to admire us for our accomplishments. I had friends who were interested in what I was learning and my accomplishments.

Among my colleagues, this success and these accomplishments gained me recognition in the field which is very valuable.  

We want our colleagues to recognize our success because this helps us network, get new client referrals, as well as confirm our sense that we are doing things right. We can appear as an authority in our field as well. Most importantly, this confirms for us that we have what it takes and our skills, talents, character, expertise, as well as trustworthiness, are recognized.   

I will describe the types of treatment techniques or modalities that I employed. You will learn about the various therapies and diagnoses, problems, or issues that my clients had for which they were seeking my treatment.  

Therapists in the mental health or psychiatric field use techniques that they choose to specialize in employing. It's not the same as treating a medical problem where there is a very specific treatment that exists for a specific problem. Instead, the skills of a therapist are employed and adapted to the needs of a client.  

I had always wanted to help others regardless of their income, i.e., the most financially vulnerable and well as those who are vulnerable due to other factors such as having a mental illness.

I could see clients on a pro-bono basis (for free) if they could not afford to pay for treatment.  

My life with Lynn was something that sustained me, brought me so much joy, peace, support, self-esteem, and self-confidence. Sometimes it is said that we shouldn't rely on others to feel good about ourselves or to maintain self-confidence. That might be true but if there is someone who gives us these positive feelings then that is very helpful and valuable.

In this section, I will describe all these things.

While I was working at Duplin-Sampson County Mental Health Center in Clinton, North Carolina, I had a number of different responsibilities. I was hired as a Social Worker III. That was my title. I worked as a therapist/psychotherapist and I had to do intake assessments, as well as maintain a caseload of some fifty or so clients who came for therapy and medication monitoring.  

I was frustrated that they didn't let us do therapy with clients without being interrupted. Other mental health clinics in North Carolina manage this but they couldn't figure this out. I would be meeting with someone and the receptionist(s) would get mad if I did not pick up the phone if I was in session with a client.  

Sometimes I would pick up on the second call and they (one young woman was the most irritating) would ask me why I didn't answer, and I'd say "I was working with a client - we are doing therapy. I was distracted."

"Well, she has to see the doctor and he's ready."  

I would think, and sometimes say, "I'm not ready" or "we aren't ready." I would then say “she’s a real bitch!”

I didn't like the psychiatrists and some of the staff. It didn't seem that they respected the clients. I worked side by side with other therapists/social workers, mental health nurses, and case managers.  

At least at this job, I was more than a case manager as I had been in my previous job that lasted all of one month. You don't have to have a Master's in Social Work to be a case manager. Plus, I was at home with Lynn every day.

The case managers would bring clients to the clinic for the day treatment program or for sessions with me. So, that was cool.  

I was meeting with a Licensed Clinical Social Worker (LCSW) and finishing up my requirements for becoming an LCSW myself - I was still provisional.  

I remember being in a staffing meeting when a psychiatrist remarked that he works with "chronic crazies all day."  It infuriated me. Plus, why did he think that he was free to speak like this in the clinic? Was this okay here? Did people have such little respect for clients with mental illness?

It's a good thing I was going to get all the hours I needed for my LCSW before leaving. I had in mind working in private practice once I was licensed. Can you blame me?  

I reasoned that I could still work with vulnerable people who didn't have lots of money. I had been told that there are ways to be accommodating to people with a limited income when you work in private practice. For one, you can work pro-bono – for free – if people can’t afford to pay or if they cannot afford the flat rate.

Anyway, one of my duties was to visit the local hospital to do evaluations at the local hospital to determine if someone required psychiatric hospitalization, such as was the case when suicide was involved.  

I would make an assessment as to what happened... how did they end up at the hospital? What method was used to end their lives if that was the case? Did they still have access to that weapon or method of suicide?

Most of the time they were indeed suicidal, and I had to go to the magistrate to request involuntary commitment orders. They would then be taken to the clinic (sometimes) to get the doctor (psychiatrist) to sign the order for commitment.  

I was never over-ruled in my assessment. I mention that because not everything I observed and concluded about the treatment of a client was something that the psychiatrists and I saw eye to eye on.  

Interestingly, some of these people who were committed to an inpatient hospital (I had to find a placement also) were my clients or I would offer to work with them. Here, I was sending them to a psychiatric hospital against their will for a commitment and they are happy to work with me when they get back!

I say all this to illustrate why I wanted to go into private practice. Not only would I have more control of how things are run but I knew that when it came to working directly with clients, I NEVER had any problems.

I did work with clients with psychotic disorders like schizophrenia and many people at the clinic seemed to see very little value in psychotherapy treatment for schizophrenia. So much revolved around the psychiatrists and they seemed to control the decisions about the treatment of mental illness or psychiatric disorders in the area for those who could not afford to go elsewhere.  

Culturally, the area is rather rural. Pig farms were very common around the area and this created a stench, to be honest. There were a lot of trailer parks. Pockets of Spanish-speaking communities dotted the countryside, and my knowledge of Spanish was useful.  

The population was over 50% white and just over 25% African American, but that being said, the ratio of clients at the clinic was about 50-50 White and Black. That reflects the role income plays in access to mental health services or being exposed to the mental health system.  

The attitudes of the staff to the extent that they were somewhat disrespectful of clients and the therapy process had more to do with the attitudes toward mental illness than racism.  

Towns were small. People knew one another.  

For example, there had been a violent murder in one of the nearby towns which made all the newspapers. The murder and trial had been a few years ago, but the sister of the murderer was still hiding her face in public. She was my client and she had come into the clinic wearing a scarf.

The things I was learning also seemed to be met with superstition among the religious folks of the area. I was studying clinical hypnosis and I remember one client saying she was afraid that the trance state might make her vulnerable to the Devil or Satan. That was the first time I had heard something like that.  

Some of the delusions that people had were obviously religious. That should come as no surprise in a rural county.  

I was curious and confused a bit at times by the nature of different hallucinations that I heard described. I met with people who described hearing voices, seeing things, and tactile hallucinations. When I say I was confused, I mean I had an open mind, but I could not readily understand what a particular experience was like. So, I listened to the descriptions of various experiences being described by clients.  

I wasn't judgmental or anything, but I sometimes didn't want to just take the word of the psychiatrist regarding a diagnosis and the proposed remedy.  

Take for example a client who had primarily tactile hallucinations of crawling sensations on her skin and possible delusions about an unknown disease. The doctor saw her for fifteen minutes and maintained her on Zyprexa. The side effects of this anti-psychotic were not as serious as those of older anti-psychotic medications like Haldol, but it was still a major tranquilizer.

There has been certain wisdom that only psychiatrists can diagnose mental illness or psychiatric disorders. I question that. I mean, the doctors were not doing medical tests when I brought the clients in front of them, and they processed clients every fifteen minutes.

Client Rights and Treatment Results That Match a Client's Needs and Concerns

I just felt it was valid to really listen to people to understand their experiences. Was the medication making their life better? That's what I wondered.  

My attitude toward at least one doctor was somewhat cautious if not suspicious - the doctor who referred to clients as "chronic crazies" and one of his colleagues.  

One day, I took a particular client of mine to see the psychiatrist. My client was complaining about the side effects of the medication. The doctor acted like he was ignoring him! And he held up the microphone to the dictation machine and dictated notes while speaking to the client. It was offensive to me!    

He was referred to a day treatment program, I went and looked for him. Technically I wasn't supposed to meet with him for treatment at this time, but he was on my caseload. He was still my client. I told him that he has a right to refuse to take medications and to put that in writing.  

That got me in some trouble. I was told that I should address it with the team!

Another client had schizophrenia and the general sense I got was that psychotherapy for this condition isn’t a high priority. This young woman wanted therapy with me. So, I just added it to the treatment plan. If that is what the client wanted, why not.

Luckily, they didn't go out of their way to over-rule the preferences I made for how I would provide treatment if there was time. 

By adding therapy to her treatment plan, that also obligated the case management team to bring her into the clinic because my client didn’t have her own transportation. The case managers were good about that and didn’t complain. 

These are just prototypical examples of my experiences.

Nancy's Curious Trauma Symptoms

I started seeing one client who had some unusual symptoms. Her name was Nancy. She had come in dealing with depression and panic attacks. Those were her diagnoses.  

Nancy was 27 when I started meeting with her.  

She began to describe some dissociative symptoms that one might find if a person has experienced something traumatic.

I would listen to her and ask her to clarify what she meant.

I had a few structured interview techniques that I was using to explore these experiences.

I would ask very open-ended questions like "Can you tell me what that is like?" I wanted to be sure that nothing I might feel about her experiences influenced her responses or my exploration.

Also, the interview questions that I was using as a guideline were very subjective. Asking "what's that like?" can help to increase our understanding of what life is like for a person. I use the word "our" understanding to indicate that both I and the client are working together to understand what is happening.  

I asked about traumatic experiences as well, such as sexual assault. She mentioned an event in which she had been sexually assaulted a couple of years ago.

I did try to broach the topic that something more might be going on than Major Depression and Panic Disorder. The doctor hardly seemed to be listening. Nancy was right there, and I was alternating my gaze between her and the doctor. 

He just asked more questions about her medications.

After meeting with the doctor, she said to me, “I was telling you that the medications are not helping with my problems.”

“I know and I wish I could do something about that,” I told Nancy. “I can’t advise you about medications.”

“He wasn’t even paying attention,” she said.

“I know but I am, right?” I asked.

“Yes, I appreciate that you believe me,” she said.

“Do you mean some people don’t believe you?” I asked.

“Well, my boyfriend doesn’t understand things and before you, I stopped coming to the clinic,” she said.

“What’s not to believe?” I asked.

“I don’t know,” she answered.

I had used a popular interview schedule that had some questions that were medical and thus outside my area of expertise but the information I gathered would be helpful.

We ruled out substance abuse or use.

It was somewhat amazing how competent and disciplined Nancy seemed. Her job and career did not indicate college plans, not yet. That's unfortunate that she had not considered this because she seemed bright and intelligent.  

We discussed her experiences of child abuse and trauma. This is where it got very disturbing. It’s also amazing what she remembered. I tried to keep this clinical and to avoid pulling her into any of the memories at this time. So, we moved along in a matter-of-fact manner.

The abuse in her childhood was both physical and sexual. It was rather disturbing what had been done to her by men and women. She confirmed that she had been forced to have sex with people of different sexes, ages, and even with animals as a way to make her feel shame or as a form of punishment.  

Obviously, this was all very disturbing.   

She admitted and described things in such a matter-of fact-way that made her seem so believable. It wasn’t like she stopped and said “no way, that’s really disturbing.” 

She would pause when I asked a question, then say "yes" or "no" to various questions. I tried not to use any suggestive phrasing or to indicate approval or disapproval for any of her answers.  

Sometimes people can over-represent their problems or symptoms as a cry for help or indicate a need for help - perhaps even to indicate that one deserves the more intensive treatment that is available.  

She would provide details after she answered "yes" to a question as she recalled examples of an event or an experience. She actually didn't seem overly eager to participate all the time in therapy. So, it didn't seem like she was going out of her way to gain my sympathy. 

This interview was done outside the clinic. We went outside because it seemed more accommodating to her. Her mood and interest changed at times. 

She was vaguely aware of hearing voices and a feeling that she was different at different times. Her experience of amnesia suggested a dissociative disorder.

There was so much more to explore. I did present my findings with the doctor at our next session and suggested that there might be more to explore.

At some point, when speaking to me alone, the doctor indicated that he thought I was suggesting that she had Dissociative Identity Disorder and that he didn’t believe in that disorder. That is a condition in which people have different personalities. 

I indicated that it is too early to tell but it was frustrating and confusing that any diagnostic disorder was “not believable.”

Unfortunately, my experiences at Sampson County Mental Health were ending. I was asked to resign. The chance to work more with Nancy was interrupted shortly after I had made such progress and had helped her to gain some insights and to feel like someone was listening to her.  

There were a number of reasons for my departure including going outside the traditional structure of the clinical staff, being behind on paperwork/charting, and a few minor issues that reflected my unique values that may have been out of step with this clinic.

I had gained the clinical supervision hours to qualify for the certification as a Licensed Clinical Social Worker and that meant I could go into private practice.

During the next section of this book, I will discuss my experiences in private practice. This was the height of my success and where I had been going with my career for as long. I had accomplished so much over the past fourteen years. So many accomplishments.  

Keep reading... with the next chapter. It will be exciting. I would love to share the story and the joy of these accomplishments.  

I have always believed that therapists should be willing to get therapy themselves. First of all, it can be educational to understand ourselves so that we can understand others. As such, our own therapy is a part of our education.  

We have all lived and been impacted by life. Some of the best therapists that I have known have been in treatment for various psychological issues and problems. Some of them also have dealt with additions... trauma, victimization, anxiety, and other problems.  

Perhaps it makes us more understanding of the struggles that others might face in life. We also have seen the healing power of psychology and psychotherapy treatment techniques. 

As an undergraduate student, I developed communication and social skills through the use of counseling and psychology. It included but was not limited to cognitive behavioral therapy techniques. It was something I had to do.  

I was obviously very successful in my efforts or I wouldn't be doing what I have been doing all these years.  

Certain skills that we learn as mental health professionals are learned through practice and experience. For example, consider hypnosis which I studied. Let me tell you about that.  

I had enquired of some of my colleagues what organization provides the best most recognized training and certification. The answer I got from some hypnotherapists that I knew was the American Society of Clinical Hypnosis (ASCH).  

I had been meeting with a therapist who provides clinical hypnosis to help me overcome some fears, anxiety, stress, phobias, and other issues - nothing debilitating but I was intrigued ever since I had some exposure to these ideas during my internship with Chris Hauge at "The Oaks." The use of hypnosis seemed to be somewhat similar to experiential techniques like gestalt therapy, inner child work, visualization and etc.  

So, after I got my degree and while I was working in the field, I traveled to Chapel Hill from Wilmington to participate in an ASCH-certified training program taught by a professional who was certified to provide training.  

It was fascinating and very useful. Somehow, I was able to get one day off from work and it was justified as required continuing education credits that all clinical social workers are required to obtain every year.  

I know that I was getting more than the minimum required training for licensed clinical social workers.  

Self-Discovery and My Own Personal Therapy/Treatment 

I had changed jobs a few times during that time period after graduation for reasons that had to do with my values and interests as compared to the settings where I worked. I did mention that there were some issues that I had with Brynn Marr. 

I had three jobs before I started my own private practice. I know that might seem bad because I had been changing jobs three times in about two years during the years 1996, 1997, and 1998. With Brynn Marr, I found that the ethics around how they operated were not consistent with my ethical values.  

Lynn had heard things about them and so she wasn't surprised that this didn't work out. Then I started a job in New Bern for one month in late December and into January of 1997 and I was miserable. I couldn't make sense of why Lynn was fine with me taking this job away from her from Monday through Friday.

I had gotten my own apartment up there, which was cold, empty, and desolate. Maybe I should have waited for a better job which would have been a better match and closer to home. This was a Case Manager position, and I was just doing screenings to determine if someone needed hospitalization for psychiatric reasons.

The biggest problem for me was being away from Lynn all week. Hadn't we committed ourselves to one another to live as husband and wife? She didn't seem to protest my choice to be away from her all week! That only made me more depressed. 

It just didn't seem right to me. I don't know if she thought it was a good opportunity for me and just didn't want to stand in the way of opportunities, but I wanted her to say she was sad that I was away. I know that if it had worked out, we would have to find a better place than the apartment I was renting.

I finally told her how miserable I was up there. I still had to pay rent to her mother for our home in Wilmington.  

Anyway, we were in love and I had to be with her. I could not visualize where this was going to go for me. We were much happier together. There was nothing that had happened to divide us during this time, but she understood that when it came to family and love, of course, I was driven by my passions. 

The job lasted only one month before I was fired! I had been allowed to resign from Brynn Marr but not from this job. I don’t even remember why I was fired but it was good that it happened that way.

Other parts of my life were dictated by rational thinking and careful decision making but love and family are what really mattered the most to me – to us!

So, I did get a job after that at Sampson County Mental Health Center.  

I was also in therapy to find out why I was having some problems matching my dreams, career aspirations, plans, and goals with practical examples of success. The decision itself to go into Social Work was a decision based on my values. I was idealistic all along in terms of what motivated my choices to pursue this career.     

As I mentioned earlier, there was one time when she went into the hospital when her lung functioning had fallen a bit low. Again, I, or we, had to live in each moment together without panicking about her health. Indeed, that had an impact on my mental health.  

No one that I was seeing at any time said to me that I have problems that limit my abilities as a mental health professional. Every problem, i.e., job change, was a learning experience.  

Of course, it's depressing and stressful when the woman you love has to be hospitalized because her lung functioning is problematic.  

Anyway, I was going for psychoanalysis, with Marjorie Israel, Clinical Hypnosis with another therapist, and I was seeing a therapist at the Family Counseling Center in Wilmington. I wasn't doing all this at the same time but there was some overlap.   

I took my responsibilities seriously and had a drive to be successful - more of a driving passion.  

There was another problem that had to be addressed. The impact of abuse or being assaulted by my parents previously was still a factor in my life - not so much on the job but at home. I had nightmares and I was struggling to understand my own sense of self-identity.  

I knew who I was, but some religious ideas had bothered me because they existed as absolutes - rules - that created fears and problems in our lives. Lynn was more open-minded and carefree. Anyway, I had ideas about right and wrong, and Lynn believed in things that didn't match those ideas.  

She was such a good person and very full of Christian love without being a Christian. There were certain beliefs that I had, and they were like absolute truths and Lynn would challenge me. So, I was still growing and developing in some ways.  

But we seemed to be arguing a great deal. So, we went for couples counseling at the Family Services Center in Wilmington. We saw an older guy who went on to be a Clinical Social Worker after working in a different field for a number of years. I think he was in his 60s.  

We made great progress when I had something of an epiphany. Lynn wasn't worried about the nightmares, but when I got mad, I sometimes threw things. She once said "what if I was there where you threw that... " whatever it was that I threw the last time.  

I thought "you weren't there, or I wouldn't have thrown it" but I didn't say that. I was deeply ashamed and shocked. "What was I thinking?"  I thought. To do anything to make Lynn scared was so unacceptable and wrong. I was scared because I knew that I was lucky to have Lynn in my life. And she doesn't put up with anything like some men and women in relationships put up with disrespect or anything.

Our arguments never got to the point of either one of us disrespecting the other person.

What I mean is that if she thought I knew she was scared and did it anyway, she would have left me. She was NEVER afraid to make sure to speak her mind. I mean if we were having an argument and if I tried to walk away in anger, she would follow me.  

She would say, "I'm not done talking to you." 

I had a punching bag, and I would hit that if I got angry and frustrated. But every time she followed me outside, I stopped to be sure not to hurt her or anything. I could not imagine letting anything scratch or bruise her precious body and she knew that for certain.  

She had seen the way I acted when she was in the hospital and had to get IV antibiotics and how much I told her I wanted to stop them from piercing her skin... but it had to be done.  

Anyway, it only took the shock of hearing those words “what if I was there when you threw that” …  those words sent chills up my spine. That kind of expression of anger could NEVER happen EVER. So, I had a powerful motivation to overcome my impulsive anger.  

I know it was related to the abuse I had experienced from my parents. So much pent-up anger! 

It was weird because Gestalt therapy encourages screaming and hitting a chair or something to release the anger that has been stuffed down inside as a result of abuse or trauma. I just had to do that in controlled ways.  

I was instantly cured of the ways I had been expressing anger when Lynn indicated that she is worried that someday I might accidentally hurt her. It took a while for me to compose myself after the shame I felt when she revealed this. Then I said, "it will NEVER happen again."    

She had responded, "I know."  

Obviously, she recognized the shame and conviction I had to ensure that I NEVER act in a way that is unacceptable to her. And I NEVER did repeat those behaviors. Not EVER! 

It truly sucks that a person can be so in love and have such a profoundly special relationship and still feel depressed at times. I suppose things were not perfect for us - I'm not talking about personal issues between us but just our situation, her health condition.      

With her limited income, she could have been the one person who might have expressed a desire for me to take jobs that paid more or for me to find employment with a large company that might provide insurance that would cover her.

Believe me, Lynn was not the type to hold back her thoughts, feelings, and desires. 

Post Graduate Continuing Education              

As stated above I was in training to gain the certification as a Clinical Hypnotherapist from the American Society of Clinical Hypnosis (ASCH). 

That wasn't the only area of expertise that I was pursuing.  

As I said earlier, I was glad to have the opportunity to get any kind of training that was available. I just loved learning new ideas, techniques, and tools.  

It was the mid to late 90s and there wasn't a treatment technique that didn't interest me.  

I was a part of the local chapter of the Society of Clinical Social Workers in Wilmington, which was for New Hanover County, NC. This was helpful in both finding out about training opportunities and in networking and collaborating with colleagues.  

Through this involvement, I could attend regular meetings, at least once a month, and discuss challenges that exist in our professional lives providing therapy to a range of clients with various diagnoses, conditions, or disorders.  

I will discuss this in greater detail in the next section of my book. First, I have a few more things to share about how I finally qualified for licensure as a Licensed Clinical Social Worker. 

One of the great experiences I had as a therapist, including during my role at Brynn Marr Psychiatric Hospital, was supervising an intern. I mean imagine the situation and everything that has come before in my life. I started college as someone lacking social skills and lacking communication skills. Yet here I was working in the field successfully where those specific skills are required, and I am supervising someone else who is looking to me for guidance.  

This is a testament to the passion and dedication that I had. I felt a sense of amazement at these many accomplishments and my success. Not only did patients look to me for guidance, insight, treatment, and direction but I had a student in the same field as me looking to me for education, guidance, and insights in a manner not so different than the way I looked to Chris Hauge, my mentor.  

Granted Chris had many more years of experience than I did, but this was still amazing. Mary was her name. She could have asked to work under the supervision of my colleague, Leslie, the other therapist on the unit but she observed us both and asked to work with me. 

There wasn’t anything wrong with Leslie. The situation described in the last chapter about how a hostile environment existed for Victoria was not something Leslie had done herself. 

Mary sat in on group sessions, met with new patients to gather information for the intake assessments, and sat in on individual therapy sessions with patients sometimes. This was helpful because I was finding that occasionally some patients would ask me to be their therapist instead of Leslie - I can't say that happened many times, but occasionally someone asked to switch.

I do not know why anyone was asking for me as their therapist. 

For what it's worth, and to me, it was worth a lot, no one had asked to switch therapists to work with Leslie instead of working with me. I may have had greater eagerness because I was new, but I've never lost that passion for trying to be the best I can be... to earn the respect and admiration of those I was serving.  

As I was saying in the last chapter, I did think that empathy is a quality that must be demonstrated. You can't just tell yourself that you are doing a good job and that you care about the welfare of others. You have to observe how people respond to you.  

So, did the patients continue to meet with me after an initial session? Yes. I mean, if you didn't accomplish anything with the patient, why would they return and/or ask to see you whenever they can? I could tell as I walked around the unit that people looked up and to me for my attention.  

Consider this, some people might be there involuntarily and waiting to get out as soon as possible. So, they would be going to group sessions to demonstrate that they are participating and to earn points with the staff who would decide they are ready to be discharged as soon as possible.  

In addition, while there are differences in the roles and there are boundary issues that differentiate patients and staff, there are still ways in which those boundaries and differences do not have to be so great that a patient doesn't feel comfortable wanting to interact with you and seek your help.  

Empathy as a Treatment Technique

Carl Rogers was a psychologist who pioneered the humanistic approach to psychology or psychotherapy which was also called client-centered therapy. He is known for his ideas about unconditional positive regard that a therapist should convey to a client or patient. This to me seemed like a basis for all other techniques.  

In a way, empathy develops by conveying the idea that the person is accepted and acceptable as they are and not based on some conditions about what they must be.  

As in previous chapters, the quality of the information gathered from a client or in this case a patient is directly related to the nature of the relationship and the sense of empathy that exists. As a therapist, we see things from the point of view of the other and experience with the other person. This increases the insights that can be gained for each person. For myself, as a therapist, I was looking for insights that would be useful in understanding the patients and helping them.  

Here is another example of how natural things seemed for me and how empathy, therapeutic technique, and skills were useful in helping a patient named Karen.  

I had noticed Karen in my group session one day and she seemed barely alive. Karen was a medium complexion African American young woman in her mid-20s. She was somewhat thin and was about five foot five or six.  

Mary brought her in to see me in the afternoon and said that she had interviewed Karen to gather information for the routine intake assessment that we were required to complete for the chart and to create a treatment plan.  

We sat down in my office and Mary tried to help Karen talk about some of the things that had happened to her. I was concerned and said, "You have been hurt."

In a very soft voice, she answered "yes."... adding "it wasn't the first time. My father and my brother did things to me when I was younger."

"I'm so sorry," I answered. "It's so sad that something like that should happen to someone so special."  

Some professionals worry about being authentic or genuine and complimenting others, but I had learned from Chris that there was a more natural way to be. Chris had been in the field for decades and was well respected so when he had introduced the idea of offering positive feedback to others because you can think of something to say even after only a brief encounter with a person that resonated with me.  

Karen looked so fragile, thin, sweet, and gentle. I was aware of counter-transference issues, so I kept some of those thoughts to myself but overall, it seemed hard to imagine not seeing her as a special person, so it just seemed so natural to say.  

It seemed like a look of sorrow came over her face which actually looked like it was a relief for her to be able to talk about what happened.  

She added, "I was raped" in a very feeble voice that was just barely audible and seemed to convey with it both a sense of relief in saying the words and a sense of shame as she looked away.  

"I am so sorry that happened to you. That is such a horrifying thing to happen to a woman," I said.  

I then added, "there are ways to process or work through the memory of the experience so that you can find some relief. I can help you to do this in a way that is safe while you are here... with me... with us."  

I wanted to do something. This was the setting for that. I had a sense that this didn't just happen last week. If she was shut down like this now, that meant that it must have been a weight that she had been unable to share with anyone... she must have felt a need to keep it to herself. Mary had been providing some insights from her earlier conversation.       

Karen seemed a bit curious and maybe confused about what we were going to do. I said, "there are experiential therapy techniques that are helpful in creating an experience of mastery over a traumatic event. Our imagination holds memories like this as snapshots that we are afraid to see. You won't be alone."

"You are safe now, right?"  

"Yes," she answered looking at me. I had studied some information about hypnosis and I was using only enough of those insights to try to resonate with her and to meet her experience - her breathing rate and such.  

While I was learning about experiential techniques with Chris, I had studied Fritz Perls and Milton Erickson as well as Bandler and Grinder, who developed Neuro-Linguistic Programming, where they drew upon the skills and techniques of geniuses in the field like Fritz Perls and Milton Erickson to model what the essence of what they were doing was.  

It seemed to me that this technique of matching the breathing rate, pulse, and vocal patterns was helpful in developing and demonstrating empathy because we had to tune into what the other person is experiencing.  

"I can stay with you too," said Mary.

"No, I don't want you to see," answered Karen.  

I had registered this as a need that I could understand because of the sense of shame that we sometimes feel at inappropriate times. I also recognized the need to be aware of transference and countertransference issues. Even if one doesn't specialize in Freudian or post-Freudian psychoanalysis, it is valuable to be aware of how a client or patient is reacting to us, how they are projecting their feelings unto us, and how we are reacting to them.  

Mary left and I said, "I am going to sit next to you and we can imagine a screen in front of you. This will allow you to review what happened like it was a movie instead of being overwhelmed by the pain and other negative emotions."

She asked, "you will be with me?"

"My voice will go with you."

"You don't have to say out loud everything that is happening... and you can stop any moment you want."

"I want to say what happened - it was bad," she said.

"Yes, it was bad what happened to you... but it's not happening now."

I knew that later we would also need to address the fact that what happened to her had nothing to do with her but I didn't want to give her too much information to think about until it was necessary to add more insights to help her. 

I suggested she take few deep breaths, close her eyes and picture a screen in front of her. I had been thinking about the gestalt therapy techniques that Chris used in the therapy groups. I had also been to individual therapy to work on some of my own past traumatic experiences to get a feel for how to do certain gestalt techniques. Chris and I briefly discussed the Neuro-Linguistic Programming Technique that I had read about as well...  

I also had taken a post-graduate continuing education course on related treatment techniques and ideas that relate to these experiential therapy approaches.  

Anyway, Karen was well-grounded with appropriate reality testing to benefit from this technique. Some visualization techniques can be problematic for someone who is having a psychotic break.    

I continued, "let's go back to when it happened. Imagine the scene in front of you if you can."    

I added, "You can squeeze my hand to know you are not alone and to help with your feelings when it gets scary or when you get mad..." placing my hand near hers on the arm of the chair.  

She grabbed and squeezed, and I said, "It's okay, that doesn't hurt me and you are okay."

"Let your body do what it wants to do, like kicking your feet in front or whatever."  

I knew from the techniques of Fritz Perls that to find the closure needed for relief we have to stop stifling our reactions and working to keep everything inside.  

She began to relax a bit as if the scene had faded from her.  

She opened her eyes and her face brightened and her posture looked different. She had a slight smile on her face.  

"Thank you," she said.

"No, thank you," I answered. "I mean for trusting me and for having a chance to see this look of relief on your face."  

"I feel... different," she said.  

I didn't say that I thought that more work would need to be done. Other things had happened to her and the impact of the rape was going to take more therapy to overcome.  

It seemed that what matters is that some sense of mastery can be found, and this can change a person's mindset and create a sense of possibilities... possibilities for healing from trauma.  

As always, I reflected upon the actions taken in the therapy session. It's always important to be aware of what is happening especially when you are close to another person - within the distance of human contact.  

I've had contact with a therapist myself though in a different way than squeezing someone's hand. Boundary issues are important. At the end of my counseling time in college, after five years working with the same psychologist, we hugged as guys do.  

During hypnosis with Chris and another hypnotherapist, I have had them tap my hand or knee first announcing that they are going to do that. There is even a technique where a hypnotherapist tries to verify with the client the phenomena of hypnotic trance by gently raising the hand and letting it hang in mid-air without awareness until attention returns to the arm and hand to allow it to slowly drop down to the person's lap. 

The point is that we do need to be aware of boundary issues, but it is possible to remain aware of what is happening. I had a wife at home, and I knew that nothing I had done was shameful in any way that I would hide it from Lynn.  

We were working on keeping her grounded in the here and now and in a safe place, so nothing romantic was creeping into the sessions.    

These were things that I considered, and much insight could be gained by going through psychoanalysis. I knew someone who was a psychoanalyst as a matter of fact. Her name was Marjorie Israel.  

Regardless of what different people think about psychoanalysis, there is a great deal of insight that can be gained by spending time free-associating and reflecting upon our reactions in different situations.  

The thoughts that I had when I approached her for analysis were that I wanted to find out about myself and what hidden or unrecognized motives and desires might exist within me that could have an impact on my work in the field with clients. I believe that there is common sense to the notion of transference and countertransference.  

I'll have to explain more of this in the next chapter.