A Therapist's Epiphany: A Psychological Construct

Recently a patient, we’ll call him Jack, had a terrible accident.  Jack hovered on the threshold between living and dying-beginning the arduous journey that would take him through months of healing and rehabilitation or stepping over into the other world where there would be no healing and no living. 

Jack’s situation impacted me on a level I had never before considered. I am, as we euphemistically call it, a “seasoned” therapist.  I have been doing clinical work for decades.  I will often think, justifiably or not, that there is nothing I haven’t seen or heard throughout the years of my work.  There is no situation I haven’t encountered to some degree.  I am well equipped for whatever enters my consultation room.  But I was wrong.  I was not equipped for what happened to Jack.

I had been treating Jack for quite a long time with some very intensive therapy.  Jack had a hard life.  Our work together was deep, difficult and meaningful.  We had established the therapeutic bond that we, as therapists, strive to achieve with our patients-the bond that gives room for the safe, honest therapy that has the greatest potential for healing.

When Jack’s family contacted me about Jack’s accident and the situation he was in, I was understandably very upset.  This was not a case of countertransference, it was simply human emotion.  Jack was on life support.  The family wanted guidance from me. After all, I knew Jack better than anyone.  I would know what he would want.  And this was what hit me like a tidal wave.  While Jack’s loved ones knew Jack and the parts of himself he chose to share with them, I was Jack’s vault. The entirety of Jack’s story-his feelings, his experiences, his struggles, hopes and fears were known only to Jack and to me. If Jack was no more, I alone, would be holding of all of who Jack was.

Throughout the years that I have been doing clinical work I have said goodbye to many patients. Some for wonderful reasons-they are better and can navigate life on their own. Some I have had to say goodbye to because of practical reasons-those unwanted events that force an ending between therapist and patient.  Sadly, some I have had to say goodbye to because of illness and death.  Jack was different. In all of the other cases, there was a process  and a preparation for termination.  They and I had an opportunity to to bring to a close our work, our thoughts and our emotions.  They got to say goodbye and I got to say goodbye.  We had closure.  This case was different.  It wasn’t simply that Jack had died. That would have been very difficult in its own way.  In this case, there was a decision to be made and after his family made that decision, what was I to do with the content of Jack’s life? I knew I could not could not try to influence their decision one way or the other but I can’t deny that I wanted Jack to be able to once again, hold his life.

I thought long and hard about how to contextualize what I was struggling with. I considered a hypothetical analogous situation.  What if a woman was going on a short trip.  She went to her friend and asked a favor.  Would that friend take care of a jewelry box full of sentimental heirlooms that were precious to her while she was away.  Tragically, that woman dies while on her trip.  Her friend knows of no one the deceased would want her to give the jewels to.  She is in possession of them but they are not her jewels to keep and she is unable to give them to another.  Where does that leave her?

Therein lies my epiphany.  We, as therapists, hold the lives of our patients…with them.  We understand this when we undergo our training.  We also understand that we will walk beside our patients as they work through, heal, cope and/or accept their struggles and their damage.  We turn those parts of their lives back over to them as they progress through their therapy. What I didn’t understand until I got the call from Jack’s family was that sometimes we encounter an abrupt ending-an ending with no foreshadowing, no expectation and no closure-an ending that leaves us holding one’s life story with no  closure and no one to turn it over to.  We collect these lives and sometimes, I guess, we must keep them forever.