I just had a child leave.  The mother ended therapy by leaving a message to cancel the next session and then saying, “Can we talk?”  I knew what the discussion would be.  There had been plenty of hints, plenty of “how long will therapy take?” and “do you think he would do o.k. just getting therapy in the schools?”  I called her, preparing myself carefully for the conversation, reminding myself to be supportive of the mother, confident in the child, gracious in my desire to help.  

 

I did, in fact, want to help.  I wanted to help this mother take what steps she judged appropriate for her child and family.  I wanted to be of whatever service I could in a process that had been brewing for a while. I wanted to be a good counselor—patient, attentive, responsive, a font of listening skills—and I also wanted to avoid derailing the mother’s plan, because what I wanted most of all was for this mother and child to leave.

 

What is our experience when we have a therapy that is not going well? What do we feel and think when we dread a client’s session? How do we make sense of the simultaneous desires to help and to be freed? What do we say to ourselves when we feel trapped by a professional commitment?

 

I saw this child for three months after referral from a previous SLP.  I expected a happy, cooperative, “almost-finished” child who would transition to a new therapist easily. I expected a family that came regularly and happily.  In other words, I expected a “good case” that would affirm my experience as a speech-language pathologist.

 

Instead I found myself sitting in a room with a quiet child with the saddest eyes I have seen in a long time, a child who spoke little and was compliant but disengaged. At first I attributed this to the transition to a new therapist, a new room, a new time of day.  I assumed we just needed time to get to know one another.  But week after week I was left with an empty feeling, one that translated quickly into a sense of anxiety.  

 

I checked in with the mother and was assured that the boy could be “reserved” and that he was “fine” about coming.  I sensed that the transition with the mother was also taking time, and I downplayed my concerns.  I gave the child a chance to talk about his feelings, using photos of children showing different emotions.  (My heart broke the first time he tapped weakly on “happy,” his doleful face sagging.)  

 

Our sessions continued, filled with the activities that constitute speech practice, and I dutifully sent home practice activities from our “make it and take it” segments.  I planned aggressively, was ultra-prepared, pulled out my best toys, took data, and reinforced desperately.  I wanted to do all the right things—what I teach students to do—but I found there was one thing I couldn’t do.

 

I couldn’t connect with the child. As physically close as we were, practically knee-to-knee at my little table, I felt miles away, as if looking at him across a huge, cold lake.  I did not know how to bridge the distance, how to swim by myself across that wide expanse and establish a true relationship.  I felt a desire to reach him, a desire to know him. I wanted to help him, be kind to him, comfort him.  I wanted to make him laugh or even smile.  But I felt as if I was doing a performance in the dark, and I didn’t know if he was in the room with me.  As I felt increasingly desperate and alone, I compensated by being overly cheerful, becoming the dreaded high-pitched speech therapist who says “good job!” in excessively bright tones.

 

Is it any wonder I felt relief when the mother discontinued the therapy? Is it any wonder I felt celebratory?  I didn’t realize how burdened I had felt until I was hit with the freedom of being let go.  In fact, I had known week to week that I dreaded the sessions, but I had not been willing to admit the full force of my emotions.  When the child started to choose the “tired” picture, saying it was a “long day,” I assuaged my concerns by assuming that the after-school session was a big piece of the problem.

 

After the immediate wave of relief upon therapy’s cancellation, I felt a host of feelings, the hatch door sprung open to where they had been stored. I felt worried about why I had not been able to relate—had I done something wrong?—and angry that I’d worked so hard without reward. I felt embarrassed that I had been unable to help this child after a referral from another SLP and afraid I was revealing my inadequacies.  And in the end, I felt guilty and ashamed for being so unbelievably relieved that he was gone.

 

The emotional world of the SLP—or OT or PT or tutor or any other helper—is often hidden territory.  So many of us who arrive at a helping profession have an abundance of emotions mixed with a driving desire to help.  It is a potent combination that must be tempered by self-awareness and boundaries (another minefield for many of us).   If we are willing to explore this world honestly, if we accept our feelings and stay attuned to the lessons that come from failures as well as successes, then we have a chance to harness the power of our emotions rather than being buried by their weight.

 

I have watched many clients leave.  I have cheered for families moving on to new experiences, celebrated with families over joyous progress, talked seriously with families about challenges ahead.  I have felt satisfied, happy, excited, proud, confident, and rewarded.  My recent experience is not the first time I have added worried, guilty, relieved, and humbled to the list.  Nor is it the first time I have felt overly emotional in response to a client—too much anxiety, too much fear, too much difficulty putting down thoughts of the therapy and worries over my services.  

 

Whether in the tower or the trenches (or in the grocery store on a bad day), I am prone to losing my boundaries—emotions and sense of self mixed with those of the client, separateness blurred, clarity defeated. Regardless of what was going on for this child or family, the therapy became my struggle because it threatened my view of myself as a (capable) therapist.

 

As a final note I will add that I had difficulty writing this blog entry despite knowing I wanted to write it.  Finding words to relay the experience was hard for me, as if connecting with myself—as I do through writing—was mirroring the problems I had connecting with this client.  Several aborted attempts did not capture the experience’s significance or the truth I felt in it. In the end I stared down my disappointment and wrote the entry you see here, realizing I had to let the entry be whatever it was right now.  When we create—whether through writing or drawing or doing therapy, we must make the choice to either put forth the effort or just not bother.  If we choose to try, we are confronted with the constancy of our task:  find our connections with others, strive for excellent work, maintain integrity, and know that we risk failure.