Jeff Levy, LCSW
Mental Health, Relationships, Trauma, Identity
Jeff Levy, LCSW
(originally posted on Branching Out: The Live Oak Blog, March 2014)
When I talk about the work I do I with other professionals and students, I often share that some of my most intimate relationships are with my clients. I frequently see eyebrows raise; often two people glancing at one another with a knowing look. I imagine they are silently communicating their judgment---that I have a problem with boundaries. I wonder if they are thinking that I am lonely, or sad…or that I don’t know how to meet my needs in my personal relationships.
These Are Unique Relationships
After all, if I am the helper in a helping relationship, shouldn’t I be clear about the professional nature of my relationship with clients? Most therapists would agree, myself included, that the relationship I have with my clients isn’t reciprocal in a traditional sense. I am there as the listener and the one trained to ask the “right questions” and share the “right skills.” The relationship I have with my clients is unique in that it may be the only relationship we have that starts with the intended goal of ending. If we work to address the reasons someone has come to see me; if isolation is reduced; if anger is expressed more productively; if changes are made, then it’s time to say goodbye.
What is seldom discussed, however, is the extent to which I invite my clients to share honestly with me and my responsibility to be honest with them. I am expected to be fully present and to tell the truth. If I am doing my job well, I don’t lie. I don’t hide behind pleasantries. I am not distant because I’ve had a hard day. I need to be involved in the process of change, which includes an unwavering commitment to building the strongest relationship possible. And while my clients might not know the details of my life, they know me in ways that few others do. Together we hold pain, joy, hopes, and secrets. In doing so, we are joined—sometimes forever—even when our therapy relationship has ended. This is a different kind of reciprocity.
Our Connections With Our Clients
I have been seeing Andrea on and off for almost 14 years. When we first met, she accepted an entry level job in a marketing firm the first year after graduating from college. She came to see me because the transition from college was difficult and she was experiencing some interpersonal problems managing conflict with co-workers. This course of therapy was relatively brief, lasting only the duration of her year in the job. Following this year, she took a position in New York City and was there for two years before returning to Chicago.
When she returned, she accepted a full-time job in Chicago with expansive responsibilities. Shortly after beginning work, she returned to therapy. While she was in New York, her parents had divorced after 33 years of marriage. She was surprised by her strong reactions to this news. “I’m 26 years old and not living at home anymore. I don’t know why this is having such a strong impact on me,” she wondered.
She knew her parents had struggled over the years. Her father felt isolated and depressed in his marriage to her mother, but she never imagined they would divorce. As we talked further about her reactions, she confessed to having found a journal of her father’s in which he talked about serious bouts of paralyzing anxiety. She was 15 when she found the journal. As always when someone shares a secret with me, I asked Andrea who else she had told. “Only you” she said.
After coming to terms with her parents’ divorce, our therapy ended once again. Five years later, Andrea returned when her father was diagnosed with a progressive neurological disorder. She was traveling back and forth from her home in Chicago to her father’s home in Iowa. She was wracked with guilt over not having spent more time with him and holding the secret of his anxiety. She became one of his primary caregivers in his last months. When he died, she was overwhelmed by grief and by her inability to share with him her understanding of his struggles when he was alive.
Our Clients’ Connection With Us
One month after Andrea’s father died, I was called out of town urgently, as my own father was dying from a long history of cardiac disease and congestive heart failure. I had to call my clients from the airport to cancel sessions, and Andrea was the first person I called. At that time, I had known her for almost 10 years. I called her to cancel, hoping for her voicemail. Instead she answered the phone. I told her I thought I would be gone for a few weeks due to a family emergency and would let her know when I would be back. After some brief consultation with colleagues, this is what I had decided I would share with my clients.
After 10 years of being present with her, I was not as aware, at the time, how present Andrea had been with me. “Something’s very wrong”, she said. “ I can tell in your voice”. What is it?” What do you say to someone with whom you have been your honest self for 10 years; to someone with whom you have been fully present, committed, and authentic? “My father is dying,” I said. “I’m not sure how long I’ll be away, but I’ll call you when I’m back.” Only the truth seemed acceptable in the moment.
I returned to Chicago after my father’s death and prepared to return to work. I called my clients and began re-scheduling. It was not a conscious decision at the time to schedule Andrea as my first and only client on the day I returned to work. But that’s exactly what I did. Our session began as it usually did, but quickly shifted to Andrea’s acknowledgment of my loss. “How are you?” she asked.
Not surprising in retrospect, but at the time, I was startled by the quick rise of sadness, my throat constricting, and the flash of heat rising in my face. I shared briefly my experience of my father’s death and the grief that remained. And then we returned to her loss with what felt like a deeper connection. The experience we shared was only possible because of the intimacy that had developed over time and the expectation of honesty, especially in the here and now. At the close of our session, hand on the door and ready to leave, Andrea stated, rather than asked, “I know I’m your first client since you’ve been back. Thank you.”
Being Committed to Honesty
It’s impossible to be present in our work without a commitment to complete honesty in the room. Most of the time, this honesty is relegated to the present moment. And while we think this allows us to more completely know our clients, we don’t often consider the extent to which this allows our clients to know us. The words we choose, the expressions on our face, the examples we give, our thoughtful use of self-disclosure—these all build our clients’ connection with us, and also build our connection with our clients.
In long-term therapy relationships, not only are we directly present to our client’s life experiences, but they are present to ours. They are privy to our life challenges even when we don’t share them explicitly. We bring ourselves into the room in anticipated and unanticipated ways. Truth and a commitment to honesty foster a vulnerability that, at times, transcends the present moment.
It’s true. Some of my most intimate relationships are with my clients. There is no shame in that. It doesn’t imply that I have a sad and isolated personal life. Or that I have violated the boundaries of our therapeutic relationship. Instead, I’ve come to accept and affirm the profound connection that is built from a relationship that has at its very core and inception, the expectation of honesty.
Several months ago I opened the door to my office to see a 40 year old man sitting in the waiting area. I didn’t recognize him at first but after a second glance, I saw him as the 15 year old boy he was when I worked with him at a residential treatment facility 25 years ago. “I looked you up and found you,” he said, “because I wasn’t sure where else to go.”
“To care for another individual means to know and to experience the other as fully as possible.”
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