Maybe You Should Talk to Someon - Lori Gottlieb Page 0,92
subtly redirect, but that inevitably takes us someplace else, and I’m very aware that I’m getting nowhere with the history.
I decide to just listen for a while, but I can’t completely block out my thoughts: Do the other trainees know how to do this the first time out? Can you get fired from this gig on your first day? And, when Michelle starts crying again, Is there anything I can do or say that will help her even the slightest bit before she leaves in . . . wait, how many minutes are left?
I glance at the clock on the table next to the sofa. Ten minutes have passed.
No, I think. Surely we’ve been in here for more than ten minutes! It seems more like twenty or thirty or . . . I have no idea. Has it been only ten? Now Michelle is going into great detail about all the ways she’s screwing up her life. I go back to listening, then glance at the clock again: it’s still ten minutes past the hour.
That’s when I realize: The clock hands aren’t moving! The battery must have died. My cell phone is in another room, and while it’s likely that Michelle has one in her bag, I can’t exactly ask her what time it is in the middle of her story.
Great.
Now what? Should I arbitrarily say “Our time is up,” even though I have no sense of whether twenty or forty or sixty minutes have passed? What if I cut it off way too early or too late? I’m supposed to see my second new patient after this. Is he sitting in the waiting room wondering if I’ve forgotten his appointment?
Panicking, I’m no longer paying close attention to what Michelle is saying. Then I hear this:
“Is it over already? That went faster than I expected.”
“Hmm?” I say. Michelle points to somewhere behind my head and I turn around to look. There’s a clock on the wall right behind me so that patients can also see the time.
Oh. I had no idea, and I hope that she has no idea that I had no idea. All I know is that my heart is racing and that, though the session has gone quickly for Michelle, it felt like an eternity to me. It would take practice before I’d come to feel the rhythm of every session by instinct, to know that there was an arc to every hour, with the most intense parts in the middle third, and that you needed about three or five or ten minutes to put the patient back together, depending on the person’s fragility, the subject matter, the context. It would take years to learn what should or shouldn’t be brought up when and how to work with the time available to get the most out of it.
I walk Michelle out, ashamed about getting flustered and distracted, of not gathering the history and having to report to my supervisor empty-handed. All through graduate school, we students had been awaiting the Big Day when we would lose our therapeutic virginity, and now, I think, mine turned out to be more disgrace than thrill.
Then, relief: Discussing the session that afternoon with my supervisor, she says that, despite my clumsiness, I did just fine. I’d sat with Michelle in her suffering, which for many people can be an unusual and powerful experience. Next time I won’t worry so much that I have to do something to stop it. I’d been there to listen when she needed to unload the burdensome secret of her depression. In the parlance of therapeutic theory, I’d “met the patient where she was”—history-taking be damned.
Years later, when I’ve done thousands of first sessions, and information-gathering has become second nature, I’ll use a different barometer to judge how it went: Did the patient feel understood? It always amazes me that someone can walk into a room as a stranger and then, after fifty minutes, leave feeling understood, but it happens nearly every time. When it doesn’t, the patient doesn’t return. And because Michelle did, something had gone right.
As for the clock snafu, though, my supervisor doesn’t mince words: “Don’t bullshit your patients.”
She lets that sink in, then goes on to explain that if I don’t know something, I should simply say, “I don’t know.” If I’m confused about the time, I should tell Michelle that I need to step out of the room for a second to bring in a working clock so that I’m not distracted.