In the 1990’s I was doing on call work as a therapist in a day treatment program. A day treatment program is theoretically for people who have been given a diagnosis of a “serious mental illness.” They come and spend the day with their peers for social interaction, intermittent 1:1 therapy with their assigned counselor, and various groups, which could be anything from cooking class to group psychotherapy.
On this particular day, I was working with one other therapist, and a therapist who was serving as the interim director. I was the most experienced of the three. The interim director was working on her doctoral degree in psychology, as I recall.
There was a client attending that day who I will call Sue. Sue seemed more disturbed and distraught than usual. Both of us counselors working directly with the clients had noticed it and attempted to talk Sue about how she was doing (without making much headway). But the interim director had been in her office all morning.
It was lunch time. We were talking with clients, and suddenly, someone asked, “Where’s Sue?” The other counselor and I quickly took a look around… no Sue. Someone said they heard her say she was heading to the railroad tracks. Sue used a wheelchair. The railroad tracks were just up the road from the building we were in.
I said, “I’m going after her!”
I ran out of the building, around the bend, and up the hill. As soon as the tracks came into view, I saw Sue parked on them. Trains ran on these tracks intermittently all day. Sue looked as if she was planning on letting herself get hit by one.
Sue saw me coming. I walked up to her and started to talk. Indeed, Sue did not want to budge. She wanted to get hit by a train. I knew if I tried to push her off the tracks, we would just get into a battle of the wheelchair. I didn’t want to fight her.
So I listened to Sue. She was suffering as a human being, like we all do at times. I wish I had written this story down 25 years ago when it happened. I would have remembered more of what she said and what I said. But I remember she wanted to die. I remember I was scared. What if a train came? What would I do? Would I be able to get her off the tracks?
Sue was upset because she felt nobody understood her. I did my best to empathize. She didn’t want to get off the tracks, because she knew what would happen. She’d be taken to the psychiatric hospital and admitted involuntarily. She’d be forcibly treated, with drugs and possibly physical restraint. Maybe even ECT would be prescribed. She didn’t want any of that.
At a certain point, something shifted inside her. She wheeled herself off the tracks. She didn’t want to go back to the building, because she felt embarrassed and ashamed. She also figured that she’d be forced to go to the hospital if she went back to the day treatment program. So I told her I’d stay there with her. But it turned out it didn’t matter, because an ambulance showed up at the tracks.
The other counselor also arrived on foot about that time.
Sue got into the back of the ambulance because essentially she didn’t have a choice. I felt sad, because I knew she most certainly wouldn’t have anyone to really listen to her on the inpatient unit. Oh yeah, they’d talk to her, and evaluate her, but they wouldn’t be thinking about healing her, just how to manage her, patch her up enough until she said she didn’t want to kill herself anymore.
When the counselor and I got back to the building, the other clients had left for the day and the interim director said she wanted to talk to us in her office.
I thought she might ask me what happened, what the client said, what I said, and thank me for my help. But that was not what was about to transpire.
What happened was that we, especially me, got “in trouble.” The interim director told me NEVER to leave the premises and go after a client ever again. Liability or some such. Did I understand?
I understood, but I did not agree. I probably said okay to her face, but inside, I knew she was wrong. Dead wrong. I was right. Of course, how could I not be? How could it not be right to try and save someone’s life?
Sarah: you followed your Heart and she saw You cared, that’s what brought the better ending that day.
It’s not about the “right words” , best approach, technique nor type of therapy . It is about being genuine, it’s about moving your feet.
Thirty years ago I was in Sue’s condition. At the end oif my rope. It is a big hurdle simply to ask for help because what is faltering is hope in humanity. My dr. Did it for me when he said: no matter the hour of the night, if you need to talk to me this is my number. I never used it. Knowing he was there was enough for me.
I am so overwhelmed by this story. I admire your courage and your kindness, and it is so sad that all these managers with their concerns about liability are destroying real therapy like the one you practiced at that center. Or rather they were destroying is back in the 1990s - by now, their mission is accomplished, and real therapy with its courage and empathy is in its death throes.