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."
"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