A Bird in the Hand: Mere Psychotherapy, Part 4

Nothing is guaranteed. Not a single “thank you”, not fairness, not even our next breath. Everything can disappear in an instant…

A Bird in the Hand: Mere Psychotherapy, Part 4
…And still this emptiness persists. Perhaps this is as good as it gets. When you’ve given up the drink, and those nasty cigarettes. Now I leave the party early, at least with no regrets. Yeah this is as good as it get.”
~ Collin Haye, “Beautiful World”

James is ten years old. He’s recently been reunited with his mother after a custody battle lasting several years between the mother and her mother. James’ mother was in recovery for substance abuse (in addition to multiple chronic medical ailments) which compounded her traumatic flashbacks and anxiety; ultimately leading to brief imprisonment. It’s my understanding that James’ maternal grandmother was given temporary custody and, through a series of deceitful tactics, manipulated the legal system into obtaining more solidified guardianship.

James’ mother, now sober has regained temporary custody and I am to see over their reunification process. James is a sweet and shy boy. Given his age and development, our sessions oscillate between different expressive mediums, play therapy, and conventional talk therapy. James always seems flat, if not blunted, in our sessions, but I gather that he looks forward to them. He insists on finishing one session even after vomiting (nearly on my lap!) due to having the flu.

I see James weekly for two months at school and then begin working with his mother and her wife as a couple. Their relationship is strained by their living circumstances, and I am envisioning working with the entire family eventually anyway. James makes slow and steady strides, as do his mothers in their own work, so we begin family therapy twice per week.

The family as a whole is able to make remarkable progress, specifically in their ability to soothe and grow with each other. I begin to taper off treatment, only seeing the family once per week and James individually every other week. In our last session all members of the family thanked me several times for advocating for (collaboration with DFCS) and helping them.

Sincere expressions of gratitude are more rare than you think. They are something to savor. It’s important to remember to do that.

James’s and his family’s therapy was a success by all measures and treatment concludes. Three or four months later a colleague who had collaborated with me in working with James and his family sends a text message. The colleague knows I don’t read newspapers, so there’s a picture of an obituary attached. James’ biological mother had fatally overdosed.

I don’t feel guilty or responsible for perhaps prematurely stopping services. I feel a bittersweet curiosity come over me. I look out the window of my office as I wait for my next appointment. The sun is rising. I ponder over my coffee and imagine either a celebratory indulgence gone too far, or perhaps a full on relapse. I can’t imagine what catastrophe would have been required to trigger the later in the face of all the work the family had accomplished.

I stare at my phone’s blank screen for several minutes, then longingly back out the window. School buses are driving by. I was sorrowed beyond words, but no tears came. I feel the sun on my face and try to swallow the lesson the universe has handed me.

Nothing is guaranteed. Not a single “thank you”, not fairness, not even our next breath. Everything can disappear in an instant without any regard for the future or the past. Yet, what has already happened will always continue to be so. It’s summer time. Children are playing and laughing as they get off the bus. I can only imagine James’ mother as I last saw her, wearing humorously excessive amounts of makeup and smiling profusely ear-to-ear.

Afterward:

At the time I originally wrote this essay, some time (a couple years) had already passed since the original events. So, there is already plenty post-reflection that really gets at the heart of the matter. We’re not guaranteed anything and we never know which day will be our last.

By now, you may think many of my posts are morbid, fixating on suicide and end-of-life decisions. However, I’d like to think that by creating a “barbell” (see Nassim Taleb’s “Antifragile”) of my career — that is working with both the young (children) and the very old (dying) — I’ve gleaned some insight as to how to fill the space between.

Death is such a peculiar thing. How does it get decided who makes it where and when they end up? I have friends and colleagues that I think are much better therapists than me, but have left the field for one reason or another. Of course, we all know people who left this life “too soon.” That is we feel cheated that something(one) has been taken from us unfairly and we’re wounded for it.

The case of James, presented here, paints a clear picture that I had spent quite a lot of time with the family and obviously connections were made because of that. I don’t recall reconnecting with the family or attending the funeral of James’s mother. These are the complicated things no-one tells us (“helping professionals”) about in graduate school. These are the lessons we have to live, not just for our professional development; but for the “person of the professional” to be personal or personable at all.

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