The Client with “The Terrible Condition”
Alice sobbed the entire first session.
They were guttural and visceral sobs, the kind where nobody speaks, because nobody knows how, and the language exchanged is colored with misery and utter hopelessness.
Fifty minutes passed with hardly a word, but she stated she would see me next week.
I was jarred. I was intrigued. And, like I usually felt in my early days of therapy, I felt incompetent.
The next week, same time and same place for round two, the sobbing emerged with the same kind of frantic intensity and pitch. Ten minutes passed.
Finally, she told me why she was here. She warned me that her condition was “terrible.”
Alice was an unassuming client, young in age and average in appearance, with ordinary street clothes, who looked like she could blend in with any crowd, shared the secret she had planned to take to the grave. It was the secret she deemed immoral and unspeakable, and, as I would soon find out, it was the secret that propelled the urge to take her own life.
Her suicide attempt had been three days before our first session.
Here is where I indulge you with the diagnostic presenting problem. Here is where we collectively share an aha moment, a sudden understanding for why she wanted to die as a result from her own mental agony.
Instead, I will leave it at this: Alice’s condition could have been anything from Anorexia to Obsessive-Compulsive Disorder to Pedophilia to Schizophrenia. The condition, by nature, was a condition that she did not want and a condition she did not choose. Yet, it was inevitably part of her.
I went with the pretense that this “condition,” no matter how horrific she perceived it, did not matter.
Everything else around it mattered. The aftermath of her telling me mattered. The reality of her wanting to end her own life because of it mattered.
After Alice told me, the tears poured down her cheeks once again. The hate she had for herself was unrecognizable from any hate I’d ever seen a human have. It was concise and matter-of-fact, as if there were no other possibilities. Alice could not fathom an existence outside of gut-wrenching insecurity. She didn’t believe she deserved it.
At first, I embodied blank journal pages, playing as the soundboard for her free associating thoughts. Once she began talking, the words moved with ease, as if they had been rehearsed and memorized for years. I just listened intently, passionately, and wholeheartedly. I just listened because, when I’m stuck as a therapist, sometimes that’s all I can do.
Eventually, our sessions became more of an active dialogue, bouncing ideas off one another. We weren’t just therapist and client- we were two friends wandering amidst a rainy forest, searching for the best refuge and safety.
The more our trust for each other, the less we actually talked about “the condition.”
Rather, we talked about everything around it. Alice. had already devoted obsessive energy focusing and scrutinizing what it was and why she had it. The what and why didn’t matter so much, I soon learned.
“The condition” in the room is only one clue about the person’s makeup. Any good therapist avoids assumptions and stereotypes, takes time to learn about the client, understands that a diagnosis or deviated thought is just part of their life story. Rather than knowing “the condition,” I’m far more interested in the circulated thoughts and reactions surrounding it. I’m far more interested in how the client has framed her life around this reality.
Still, my lofty and naive goal was to “cure” her. After all, she wanted to be cured. And, I ached for her own self-hatred.
As we deepen our understanding of “whole selves,” we learn that parts or “conditions” are not cured. Personalities and behaviors do not disappear. With luck and intention, some can be enhanced or reduced, played around with and challenged, but most of the time, parts of ourselves just are.
Indeed, this was a part of her we couldn’t just avoid or wish away. Rather, we had to make room for it. Alice had to bring it to the table, make it a dinner guest, and have a conversation with it. Ultimately, we had to move towards accepting that this “condition” was part of her, and making peace with that would slowly begin to eradicate the chaotic war inside her mind.
Talk to this part of you, I would say. Tell it how you feel. Tell it your fears. Your hopes. If you can’t talk, write to it. Draw to it.
Alice chose to speak in it. For those in the psychotherapy profession, this intervention was a marriage of Gestalt principles with Internal Family Systems (though this was long before I knew what either of those were).
I want to tell it that it’s ruining my life. That I’m scared, I like, won’t ever be loved. And it’ll be this stupid thing’s fault.
I pressed on. What do you imagine that part would say back?
Alice stared at me for a moment. Uh. That it doesn’t really care.
So, this part of you is pretty heartless?
Client squirmed again. No, not heartless. Just kind of overprotective over me. Maybe doesn’t want to share me.
We continued with these kinds of dialogues. I wanted to bridge Alice’s connection to this part of herself while simultaneously detaching her from the resentment she held towards it. I wanted her to understand what messages “this part” was engraining in her. I wanted her to understand that “this part” had a different voice and different set of intentions than her authentic voice and intentions, and that she needed to learn how to distinguish them.
Until Alice could recognize this, she stayed in the shame, and shame is just a house built on the foundation of resentment, fear, and isolation. This is the house that slowly collapses. This is because shame is insidious, a slow and venomous living suicide. Any transient protection is juxtaposed by the impenetrable wall keeping us distanced and detached from the ones we need most. We have the benefit of being guarded and the consequence of being unreachable.
Where there is shame, whatever is fake remains fake, and whatever is real continues to be buried.
By engaging in “all the parts” of the self, we work towards healing any and all shame. We inevitably target the deep shame- that around “the condition”- because we are able to acknowledge its existence. We acknowledge that it is there, that it survives, that it will take space up in our mind. Similar to an alcoholic with a strong craving, Alice did not have to act on any impulses she had. They were natural, and she just had to learn how to make her reactions to them neutral.
If “changing the condition” is not possible, accepting it is the only healthy option we have. Acceptance is the only entrance that gives us freedom for making the next best choice.
What does it feel like to accept this part of you? How does this part want to thank you for letting it just be?
It took her a year, but she finally learned that “her condition” was a part of her she needed to accept. It did not define her, but it was a part of her, and we could allow it to exist in her inner realm without such a harsh reaction.
Recently, Alice contacted me, years after we had parted our separate ways. She told me that she has found peace with herself. She no longer sees herself as a monster. She feels optimistic about her life.
Her work isn’t done, she told me. She’s still working on this total acceptance of self, and she still has her hard days…but then again, don’t we all?
- All reasonable efforts have been made by this writer to protect utmost client confidentiality. Because of this, names and identifying details in this piece have been changed, omitted, and/or embellished.