I dreaded the first face-to-face family therapy session since covid. I had pimples on my chin from masking and I didn't care to put on make-up, barely doing that in the before times. I had studied family therapy exhaustively in my 20s, fruitlessly trying to figure something out about my own family that never materialized. Therapist heal thyself.
Now I faced the angry 15 year old girl with the goth look and a small, knowing smile. No screen between us. No buffer. I decided I would show her I was HER therapist even as her family pushed back.
There was a dialectic in this family's presentation. The parents were in denial about how severe their daughter's self doubt appeared. I had nailed it quickly, because I read and reread her discharge papers late into the night. It involved a meltdown on the first day of camp. They chalked it up to teen angst. They said their hometown was too stressful and they would move 500 miles away to change it up. Tomorrow. Telling the kids with me there was a manipulation. I had to stay on my toes. We do not do the heavy lifting for our clients. We simply help them navigate. My skills turned to process: how do you feel? What do you feel and when do you feel it? Again the daughter registered the fear for the whole family by biting her lips and scowling.
The mother seemed cold; said she didn't like therapy. I instantly disliked her and saw her daughter's black eye make-up and wondered why she was so dark and stormy. I saw the mother's constricted thinking on her face when she declared, "I had bad therapy in the past," and looked away, not toward, her child.
Sensing dark secrets I waited for them to make their agenda clearer, but gently guided them back and back to their daughter who defiantly stated: " I can't do things," while her sister smirked. Attractive all. The parents naively thinking their child was in a stage. But the fixedness of her all-or-nothing was exhausting me. Is there no possibility that things could improve because you're moving to the country on a whim? How? Why? The father was bonded w me as soon as he proclaimed he had read "The Family Crucible," a primer on family therapy. He was on my team. The rest of them not so much.
What do you want from your new life I said to the identified patient. How do you see yourself. How can we help you. I just want space, she said. This had been going on for years. The child didn't have anxiety, I thought, well yes agoraphobia - but it was the depression that left her stuck as if frozen in some 4th grade irrevocable choice that ended in bullying. There needs to be a bridge between mother and daughter. How did I know? Doesn't matter. What I knew was to ask about the process. How do you feel now, talking it out? Could you ask your mom for what you need from her? And here began the real work. Tears.
At the end we sat in silence. Good effort I said. And then I turned to the fragile, depressed girl, "I look forward to being your therapist."
**Addendum: a week later I got my dear John letter. Thank you for your help as we move forward - in the new area we will be seeking in person therapy... Best of luck I say and invite the next family in...
***There was no further communication between myself and her future therapist or family therapist or psychiatrist.