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Thursday, August 11, 2005

Small, Small World

A man waits anxiously in Exam Room 1 for the nurse who is about to perform a simple, yet delicate medical procedure. She enters, smiling, and introduces herself, first and last name. Then she says, as she prepares the instruments and gestures him into position, "I know your wife."

"You do?"

"Yes, I know her well. She's very nice."

"How do you know her?"

"I used to be a client of hers." He doesn't know what to say. His wife is a psychotherapist, treating people with a wide variety of mental disorders and life situations. Apparently this woman has looked beyond the name on his chart, to find out if he is married to her former therapist. His wife is very careful not to interact with clients or former clients outside of work, if it is at all preventable. Should he stop the procedure and ask for someone else? Just then a cold, powerful sensation smashes against his left temple, and his glasses are knocked off.

"Oops!" she squeals, and laughs . . .

My office is just outside the city limits of a major city, major population center. It is an area where there are more therapists than you can shake a stick at. Yet I am often reminded of just how small the world is. As a general rule, I don't treat family members of my individual clients. And I don't treat people whom I am likely to encounter in other areas of my life, e.g., my vet, my dry cleaner, a teacher at my child's school. My boundaries in these matters are far more cautious than some of my colleagues, but that's my choice. And sometimes, it doesn't seem to matter, because, it's a small world after all.

Many years ago, when my office was in the inner city, I treated a young mother, suffering from depression. When she was a child, her mother had died from complications of alcoholism. My client had a history of having been in foster care, and was now having trouble with her new marriage and new baby. She was also estranged from her sister, who was an alcoholic, and was gay. My client did not accept that her sister was lesbian.

I completed therapy with that woman, and about 6 years after we terminated, I sat across from a new client, a recovering alcoholic, who came to me hoping to learn to make better choices in her work life and financial life. She also needed to recover from some childhood trauma. In about the third session, her story started sounding awfully familiar. The mom's escapades, the foster homes, the younger sister whom she had tried to raise. Then it hit me. Here I was with the sister of the client I'd treated years ago. That was a bit of a dilemma. Her story matched point by point with her sister's old story; except my client was not telling me that she was gay. But I knew; because her sister had told me. It is not unusual for someone to withhold such information for a while. Sometimes I already suspect by the time they tell me, sometimes not. But never before or since have I already known, because of prior information from a family member.

I felt very stuck. I could not say to this client, "I know you're gay, because your sister told me years ago." I could not let her know that I knew her sister; that would be a violation of my former client's privacy. At the same time, it did not seem ethical to work with this woman, while "pretending" that I did not know such vital information about her. What to do, what to do . . .

I only had to ponder my dilemma for about a week, when my new client came in and said, "Oh, my sister said to tell you, 'hi.'" Whew. They were no longer estranged, and my former client had told my current client of our prior relationship, including the fact that I knew she was gay.

Another time, I was seeing a family in which the mother's brother was divorced. Very little mention was made of this brother; he and his sister were simply not close. At the same time, I was seeing the ex-wife of this mother's brother. (You with me?) This went on for months before I became aware of the connections. There was no good reason to terminate after this realization, but I was careful to never schedule these clients back-to-back.

Once, I was working with a family who had a fifteen-old-daughter who had been molested by an uncle. There was a court case pending, and there was tremendous family upheaval. The father and uncle worked together in the grandfather's business. Everyone in the extended family had turned against my clients, saying that the girl was lying. The aunt, wife of the accused uncle, was particularly unkind to the daughter in my family. I worked with these people for about two years. As we were approaching termination, I received a call from a very distraught woman whose parish priest had referred her to me.

She was having marital problems, problems with her young adult daughter, and dealing with the stress of accusations which had been made against her husband, and which she was now starting to believe. Yes, she was the wife of the perpetrator in my client family's story. Before I realized who she was, I was about to schedule a consultation. When she began to give details about the family business, the light bulb came on. This was a hard one, because we had had really good rapport on the phone to that point, and because this was a woman who had agonized for ages about calling a therapist. For me to "reject" her meant that she may become too discouraged to get help. I had already agreed to see her, and I had to backtrack. As gently and diplomatically as I could, I told her that during the course of our call, I realized that there were some ethical considerations that would prevent me from seeing her. That it had nothing to do with her, but with some prior commitments on my part. I was incredibly vague. I suppose I could have lied about why I wouldn't see her. I chose vagueness over lying. I did send her off with names of some other therapists whom I thought could help.

Then there was the man whose name was so unusual that I recognized him immediately when I got his phone message. He was the man with whom I had served on the board of a local private school, just a couple of years earlier. I returned his call, thinking it was unusual that he would have called me at work, since that board was very casual, we would not have hesitated to call one another at home. When I identified myself, and offered that I was returning his call, he launched into a story. It remains one of the most heartbreaking stories I have heard from an adult. He began talking, and crying, and did not stop for several minutes. I realized that he had called me as a shrink, not as a fellow board member. What I didn't know was whether he knew that he already knew me. But I didn't think so. And I was right.

I began with, "You know, Rociferous, you and I have met . . . " He didn't know. Someone had given him my name and he had called, barely even reading the name on the paper. I suggested that I help him find someone else, but he was adamant that he was no longer serving on that board, and that he could not tell this story again this week. I agreed to see him. So far, I believe it was a good decision.

Sometimes I tell clients early in our relationship, about how I handle those situations when we might meet in public. Even in this huge area, it happens all the time. When I was new to my work, I saw some clients in a store once, when I was with my family and they were with theirs. I ignored them. I thought, on the spot, that that would be the best way to preserve their privacy. They were pissed. Very insulted. So I came up with the spiel I give now, something like, "If I see you out in public, I will not acknowledge you, in order to protect your privacy. I have no way of knowing if the people you are with know that you're in therapy, or if you would want them to know. And the people I am with certainly don't know you're in therapy. You are welcome to acknowledge me, and then, of course I will speak to you, but only if you go first." So far, every time, they have spoken to me. And then they speak to my husband and kid, saying nice things about me, and telling them how they know me. If they don't tell my husband how they know me, he will know anyway, because I simply say, "Jif, this is Lisa." The fact that I offer no additional information is, of course, additional information itself, about how I must know this person. So far, this system works.

I don't tell my husband who my clients are, or were. But sometimes, my clients tell him. Like last week. Like in the freaky deaky story that started this post. Remember Jif's ear trouble? It has persisted. After his doc's appointment last week, to which he took LG, he told me the story. The "procedure" was an ear irrigation.

Jif asks me, "Do you know Jane Jones?" The name sounded familiar, but then, a name like that would. "She said she used to be your client."

"Oh, OK. Yea, why? Where'd you see her?"

"She's a nurse at Dr. Mac's office. She did my ear today." When I heard this, my brain went all fuzzy and smelly; like bread in a third grade mold experiment.

"WHAT?" Even as alarmed as I was, and even with Jane having been the one who violated her own privacy, I could not give Jif details about her diagnosis, or treatment, or prognosis. But I did keep saying things like, "No. She's not a nurse. Oh, my gosh, no, she is not a nurse, not not not a nurse, not a nurse . . . . "

LG offers, "Maybe she became a nurse since you saw her last."

How can I put this? "She is not someone who could . . . or would . . . ever really be um, eligible, or um qualified to be a nurse . . . . " She's crazy as hell, oh, the stories I could tell . . .

After she introduced herself to my husband and to my child, and shot my husband in the head -- thank GOD her only weapon was a giant syringe!!!! -- and splattered my kid with the ricocheting water, sending her cowering in the corner, the doc came in and rescued my family from Calamity Jane.

I don't like this one bit. I imagine that our doc, an exceptionally kind person, took pity on Jane, also a patient of hers, and gave her some sort of assisting job. But please, oh please, keep her out of our orifices! And our files! Aaaaggghhhh!

We are outta here, again. Just for a long weekend this time, back on Monday. Thanks for visiting, be good to one another. XOXXOX

47 heads are better than one . . .

Blogger dawn said...

This comment has been removed by a blog administrator.

Anonymous Anonymous said...

Once I was standing in line at the grocery store, and a lady in the next line (standing with friends) said hello, then "Where do I know you from? I know I know you."

I usually try to avoid responding to this question, insisting that I have a face that looks familiar to everyone. But she pressed on. Finally I leaned in and whispered, "I work in felony court." Her face turned red, and she busied herself looking at the impulse rack. Apparently her friends didn't know she'd ever been arrested.

Enjoy your time off!

Anonymous Anonymous said...

oops -- forgot to sign my post --

Blogger Dawn said...

oops sorry. ok, i think that you're very wise for telling your clients ahead of time about meetings in public places.i get freaked when i run into one of my old teachers. never know what to say,or say nothing at all.anyway,
hope you have a great weekend.

Blogger eclectic said...

Funny stuff, Susie --and a bit scary with Calamity Jane and all... In our line of work, Mr. E and I face similar confidentiality issues and this is a small town. It can be difficult at times.

Have a great weekend! Hey everybody: TWISTER's BACK!!

Left knee: Green

Blogger SierraBella said...

Have you thought about wearing a wig and sunglasses when you go out? You need to hide those booty-flies.
Of course people might think you're a celebrity instead!
They'll never know you're a Blogebrity though.

Blogger Dawn said...

oh oh, one more thing. hope your toilet paper supply is ample

Anonymous Sharkey said...

I like how you tiptoed around a bit when explaining Jane's issues to Jif, but when it comes to telling the internet you're all "She's crazy as hell, oh, the stories I could tell."

(I know you'd never violate a client's privacy here, no matter how funny the stories would be.)

Have an awesome weekend!

Blogger little sister said...

That has to be the most amazing story I've read in a blog...one of the most, anyway...now I know why Psycho is psycho ;-)

have a great weekend, susie :D

Blogger Squirl said...

I can definitely see the pitfalls in your profession. Those are pretty tricky situations.

Enjoy your weekend!

Right hand blue! unless you're left-handed.

Blogger mrtl said...

Is this your roundabout way of telling us not to pursue you as a therapist? lol

Have a wonderful weekend!

Blogger WILLIAM said...

I absolutely fascinated by your profession. Okay not really I am fascinated by YOU and how you handle your profession. Very tricky and delicate. Amazing.

As I read the first part I was thinking the movie Kathie Bates in Misery.

Blogger Bucky Four-Eyes said...

Frrr-EAKY! What must've gone through your head as Jif related the super-soaker story...oy!
I know sooooo many people by face from the various retail and college-related jobs I've held over the years, and so much of the time I look at people and wonder, "Where do I know you from?" I'm so glad I don't see people in the capacity you do - I'd remember way too much about each and every one of them.

Have a great time this weekend, and never mind when your neighbors call to tell you that your "dirty blogger friends" are havin' a party at your house.

Left shoulder...green!

Blogger Bente said...

Oy yoi yoi!

Have a great weekend!

Blogger SRH said...

My wife would always alert me to her past clients by mentioning "apple pie." That way we knoew to avoid areas where cleints were. Especially since all of her clients were either in abusive relationships or dealing with the aftermath of abusive relationships.

With the therapists that I have gone to, I have to acknowledge them first, before any interaction will occur. It is a good rule.

Anonymous Anonymous said...

Great! You've made a real effort!
I have a Wedding Photographers Northampton site/blog. It pretty much covers Wedding Photographers Northampton related stuff. Check it out if you get time :-)

Anonymous lawbrat said...

These are great. Poor Jif...with the crazy 'nurse' and all. Geesh. Sometimes it must be so difficult to know so much about people you can possibly run into.

Have a great long weekend.

Right hand yellow.

Blogger Torrie said...

GREAT post!

Blogger Weetzie said...

I must agree w/William! Have a great weekend! =)

Blogger Greenthumb said...

Kind of a worst nightmare come true ordeal.

Have a fab-o weekend. We'll leave the lights on for ya.

Right Knee Yellow!

Bucky, get yer ass outta my face! SQUIRL!!! Make her stop!

Blogger Bucky Four-Eyes said...

You love it, Greenie.
And I'm WAAAAAAY bigger than Squirl...

Blogger Jeffs place said...

In my business word of mouth and referralls is the only way I can survive. I deal with people who race and want me to remain silent about what parts they are using but have to count on them telling their buddies bout me. I think racers are crazy too by the way.

Blogger Nina said...

I hadn't thought about it, but we deal with things the same way. I would of had a hard time with Jane though . . . I would of said OMG she is flipping crazy, at least I would have wanted too. :)

Blogger echrai said...

Eek! Sorta scary. I openly admit that I went through therapy when I was younger. I was depressed. Not to a tremendous extent, but my mother was wise enough to get me into therapy with someone I was comfortable with. It made those years in high school when I battled with low self-esteem and other such issues so much easier to deal with. I only ran into my therapist a few times. I didn't volunteer where I knew her from, but I was willing to greet her and introduce myself to her husband. It turns out they were theatre buffs and came to some of the productions I was in.

I imagine many of your clients are like I was - regular people battling their personal demons that don't necessarily come out in public. Then again, there are a few, I'm sure, that it would make you very nervous to have just appearing in your life. Case in point.

Good story if a bit unsettling. :) I enjoyed reading it and putting myself in your shoes.

Blogger Squirl said...

Greenthumb, I'm sorry, but I've been able to make Bucky do anything. At least, not since she was old enough that I couldn't spank her anymore.

Bucky, be nice, okay???

Blogger Bucky Four-Eyes said...

*takes ass out of Greenie's tear-stained face*

Oh, all right!
You people need to loosen up in hyah.

Blogger Squirl said...

That's better Bucky. Now left asscheek on green. Hey, that's green not Greenie!

Blogger OldHorsetailSnake said...

You're a good one, Miss Susie.

Blogger SoozieQ said...

Wow. just wow. Funny and amazing and SCARY, all at once!

I love reading what you write. I've just never said "Hi" before.


Have a great long weekend!

Blogger SassyFemme said...

Just having a good chuckle while reading your blog...

Blogger snaps79 said...

My clients always know who I am before I know who they are. There's one of me, hundreds of them. There have been a few times where I've been working in the hood and people will approach me, friendly as ever, and I have no idea who they are. I play along, though, and end the conversation quickly. It's weird that in such a big city, you still bump into people. People you'd rather NOT bump into.

Blogger Bucky Four-Eyes said...

HDL, I think the universe conspires to propel us toward those we really don't wanna see, as often as possible.

And I'm not pointin' any fingers, but why is the Twister mat sticky?

Um, you guys wanna play Monopoly or somethin' instead? I get to be the top hat!

Blogger whfropera said...

This comment has been removed by a blog administrator.

Blogger whfropera said...

and I'll take the old shoe - its raining here, and my arthritis won't let me play Twister.

Blogger Bucky Four-Eyes said...

Opera gal, then the old shoe is yours.

Is this gonna be regular Monopoly, where I steal money from the bank and hide it in my underpants, or is this gonna be strip Monopoly, where I have to be more creative about where I stash the cash?

Blogger whfropera said...

as long as you don't ask me to retrieve it for you, get as creative as you want...

Blogger eclectic said...

Monopoly?! Oh god...fine then. Just put me in jail now, because I never get to collect 200 dollars, I always go directly to jail. *sigh* Can I at least have the Twister mat in there?

Blogger Cori said...

You are cordially invited to a housewarming party at my new place, Chaos with Class. Please update your blogroll or bloglines feed now that my former address has been taken over by some “unsavory” types. I’d love to have you visit my open house and please, bring a housewarming gift. I love gifts!

Blogger Bucky Four-Eyes said...

How come nobody wants to buy the waterworks?

Marvin Gardens...MINE!

Blogger Susie said...

gina, oops! That's a good one :)

blogaholic, I'm sure they're happy to see you. It is always disconcerting to me to see people in a place where they don't "belong."

eclectic, I can imagine "yes, I represented your brother . . ." CLEAN UP THE MAT THIS TIME!

sierrabella, pretending to be a celebrity is a very appealing idea to me . . . maybe when I'm just about ready to retire and don't give a crap whether the general public thinks I'm insane :)

blogaholic, yes, thank you, we were well-wiped (TMI?)

sharkey, yes, some of "my" best stories can never be told, because they're not really MY stories.

lilsis, well, it surely freaked me out when Jif told me :0

squirl, yes, it's tricky; sometimes as tricky as Twister :)

mrtl, no roundabout about it -- I'm not seeing any of you nutjobs! (Incidentally, that is greenie's official diagnosis for me, "nutjob")

william, I'm not kidding, the thought of this woman performing an "operation" of any sort on my husband, freaked. me. OUT!

bucky, see comment to william. I have this thing that if people aren't in the context that I normally see them, it takes me an embarrassingly long time to figure out who they are!
The neighbors have been calling :(

bente, you can say that again! And thank you.

srh, your wife was very diplomatic. I mean she coulda said, "fruit cake" . . .

lawbrat, it can get tricky. Hey, that's your left hand!

thanks, torrie!

thanks, weetzie!

greenie, hi, sweetie. I've been reading you but haven't commented, because I have too much to say (that makes sense, right?) I'll talk to you soon.

BUCKY! Don't make me pull this blog over!

jeff, I would imagine that there is a certain amount of "crazy" among racers. Incidentally, there's a certain amount of "crazy" among therapists, too. I realize that this comes as a shock to readers of this blog ;)

nina, I know, now I'm dreading the next time I have to go to the doc.

echrai, I'm glad you said this. Yes, the truth is MANY, if not most, of my clients are very high-functioning, intelligent, kind, interesting people. People with whom, if I weren't their therapist, I would love to be their friend.

squirl, oh, you stopped spanking her when she turned 40?

bucky, that's better. Don't use the assless chaps for evil.

squirl, let's just skip the green ones, it's too dangerous with greenie playing (or too much fun for him?)

hoss, right backatcha

soozieq, welcome! Love your name. I've seen you around, I like what you write, too! :)

sassyfemme, I'm always glad to give you a chuckle

HDL, that's the thing, it doesn't seem to matter that it's such a big place, everybody's still always tripping over one another's bidniss!

bucky, well, of course you would be the top hat. That makes me smile. You were born to be the top hat.

operagirl, I like the old shoe

bucky, get the money out of your underpants. Wait, you don't have any underpants . . .

operagirl, this is bucky. You KNOW she's going to ask you to retrieve it.

eclectic, I have NEVER enjoyed a game of Monopoly. I think it sucks, actually. That and LIFE. I hate 'em.

cori, thanks for the invite. I will come over. I clicked on your old place in my "favorites." There goes the neighborhood :0

bucky, I just don't like this game. I like Marvin Gaye, can I buy some Marvin Gaye . . .

Blogger Justin said...

Wow, you have a knack for the written word! I'm impressed, you've taken a good story, and made it really great. I love the way you lay out your ideas and give us a road map on where you are going. I really liked the narrative you gave us to start the post with!

Do you have a minor in English? Do you ever write any short stories? I'd really like to see one, if you do.

Oh, and if you couldn't tell, I like your blog, lol.


Blogger Bucky Four-Eyes said...

Susie, for you, we'll make it Marvin Gaye-dens.

And I think Monopoly sucks, too. I'm more of a Trivial Pursuit geek. Monopoly, when played correctly, gives me diarrhea.

Blogger Susie said...

justin, welcome, aren't you nice? I don't deserve all that, but that doesn't stop me from enjoying it :) I have written lots of stories about my life, here, but no fiction; I would like to try some day, but I'm a big chicken. I'm hoping blogging will help me with the chickenness.

bucky, I like Trivial Pursuit, too. And I like word games. Strategy and money games, not so much.

Blogger Redhead Mommy said...

How freaking scarey is that? Are you going to talk to the doctor?? I mean, there has got to be a way you can delicately explain that you do NOT want that woman near your files, since you have a prior professional relationship...or something fancy like that!

Blogger this.is.damon said...

I love your blog Susie ... you of course know this already. Its always such good reading. The problem lies in that you WRITE TOO MUCH! LOL

This is entirely my problem, as I want to read all these posts, and consequently comment each. That's not going to happen ... well, the "commenting each" part at least. But rest assured I'm going to read them all ;)

Blogger Nessa said...

oh my gosh, what a horrible story!!!!!

Blogger Amy said...

Interesting stories--and scary!!! I tell my clients the same thing; I will not acknowledge them outside of the office unless they acknowledge me first. I'd like to hear more abour your work!


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