The Patient I Fell in Love With

A few months ago I submitted this piece to the New York Times’ Modern Love section under my real name. It is one of my favorite things that I’ve written and I was sure the editor would recognize its brilliance. He did not, and rejected it via a form letter. At first I was bitter and sullen. Then I decided his egregious lapse in judgment was a blessing in disguise — this story is probably a little too personal to run under my real name. So here it is. If you were the Modern Love editor, would you publish it?

I met with J every Tuesday at 2 p.m. This was several years ago when I was a Marriage and Family Therapy intern and he was a junkie a few months into recovery. Recently separated from my husband of nine years, I had shed my former glittery existence — globe-trotting, thrice-weekly yoga classes, hosting martini parties in my elegant hillside manse with the Mediterranean-tiled pool — for a new life as a frazzled single mother and writer-turned-therapist living in the humdrum flats of the city. J was fresh out of rehab, mourning the death of his music career. He emerged from his studio apartment only for AA meetings and therapy. It was hard to tell which one of us was the bigger train wreck.

En route to amassing the 3000 hours required for licensure, I was volunteering at a sliding-scale mental health clinic along with 70 other interns. We practiced the therapeutic interventions we were acquiring in supervision on the human smorgasbord walking through the clinic doors: struggling actors; couples in crisis; court-mandated clients; elderly folks with chronic mental illness.

Before my Tuesday sessions with J, I would sit slumped on the couch in the Counselor’s Lounge, Starbucks in hand, mentally pep-talking myself into those 50 long minutes awaiting me. The 50 minutes I would try, and fail spectacularly, to help my most challenging patient patch his tattered psyche.

The lounge was where interns congregated, bouncing ideas off each other before sessions, debriefing afterwards if those interventions backfired and the patient stormed out of the room. One look at my clenched face, my white knuckles gripping my coffee cup, and my colleagues knew: “Oh, you’re seeing him?”

I was flummoxed by J. I unpacked our sessions in supervision, searching for clues for a diagnosis and a treatment plan. Having survived a horrifically traumatic childhood, J was unable to tell his story in anything resembling a coherent narrative. So I got things in bits and pieces, garbled sentences, some details so surreal that I was never sure what was true.

His psychotic mother disappeared for days, leaving J and his younger sister to subsist on whatever they could scrounge form the kitchen pantry.

His mother returned, screaming at the kids for unknown transgressions. J would lock himself and his sister in his bedroom, drowning out their mother’s tirades by playing “drums” with coat hangars and an upside-down laundry basket.

His father got custody, ostensibly rescuing the two children from their abusive mother — until something unspeakable happened between J and his stepmother. His father’s solution was to kick J out of the house, and ship him off to military school.

Things got even blurrier after that. J wasn’t sure if he graduated high school. He ingested every illegal substance imaginable. He lived on the streets, somehow wound up in art school, then into a band as a guitarist. There was a falling-out with the bandmates. J OD’d a few times, but miraculously survived and landed in rehab. A few months into AA, at the behest of his sponsor, he showed up at my clinic for therapy, dressed in the hipster uniform he would wear to every session: blue jeans, a vintage button-down shirt, Vans sneakers, and Ray-Bans.

“First Do No Harm” is the Hippocratic Oath taken by psychotherapists. During every session with J, I wondered if I were doing more harm than good. If I asked him a question, his standard response was to scream: “Everything you ask hurts!” When I tried a Gestalt technique, asking him what he was feeling in his body, he would bellow: “I feel like my chest is going to explode!”

If I let him as the questions, he turned the session into the Therapist Inquisition. “Where did you go to school?” ; “Do you have a PhD or just a Masters?”; “Are you licensed or are you an intern?”; “How long have you been doing this, anyway?”

I had been doing “this” for all of three months and nothing in my clinical training had prepared me for J. Sitting across from him, being grilled or yelled at, I often felt like Butterfly McQueen in Gone with the Wind, dissolving into a bundle of hysterics as she babbled: “I ain’t never birthed no babies!” And by the smirk on J’s face, I imagined he knew I had no idea what I was doing.

Sometimes J would sink into a pit of palpably depressed silence. I tried empathic containment: “I imagine you’re feeling really hopeless right now.” More smirks. I tried intersubjective disclosure. “When you’re quiet like that, I feel far away from you, and I wonder if you feel the same?” Another explosion: “I don’t want to get close to anyone! It hurts too much!” I tried a paradoxical intervention, telling him not to talk at all. He didn’t take the bait. We sat in thunderous silence for 30 minutes. He scowled at me, and at this point, I scowled right back at him.

My sessions with J were starting to feel as painful as the couples therapy I’d had with my ex-husband during the final fumes of our marriage. I was still reeling from the sting of being a failed married person; was I going to be a failed therapist too?

Huge chunks of J’s life were missing from his memory. He often wondered aloud what was real, what was a dream, what was a flashback. Was he psychotic, I asked my supervisors? Did he have PTSD? Was his brain just fried from years of ingesting things that were not meant to be ingested?

After six months of getting nowhere — “my life isn’t getting any better!!” — and after one particularly torturous session during which J threw his fee, two wadded-up $5 bills, at my feet, I begged my supervisor to let me terminate with him and transfer his care to another counselor.

“Keep at it,” my supervisor said. “It’s unlikely things would be better with anyone else.”

I began family therapy training. My teacher recommended getting as many family members in the room as possible. Siblings in particular, she said, understand things that parents don’t.

So one day I asked J if he would invite his sister to a session. He told me that was a stupid idea; what would it accomplish, anyway? I wanted to tell him I had no clue, that I was grasping at therapeutic straws. Instead, I paraphrased what my teacher had said: “Your sister might be able to fill in some of the blanks for you, especially since there’s so much you don’t remember.”

After weeks of refusing to bring his sister to therapy, he showed up one Tuesday with her in tow. She sat next to her brother on the couch. I explained why I’d asked her to come. I said that there were gaps in J’s memory, that he wasn’t sure what had happened to him, and that maybe she understood things he didn’t.

She did. She understood that J took the blows that were meant for her. She understood what had happened between J and his stepmother, that their father made J the fall guy. She tried to visit J in military school, but their father forbade her any contact. She assured him that nothing had been his fault, that he had spent his childhood trying to protect her from two crazy parents and one crazy stepmother.

“I wanted to talk to you about everything,” she told him, sobbing. “But I didn’t see you for years. And then…I didn’t know how to bring it up. You were the best brother. I wouldn’t be alive without you.”

What happened during those 50 minutes was pure alchemy. J’s combative shell melted away. He asked questions, and so did I. His sister gathered the fragments of J’s missing years and laid them out in a straightforward narrative that, devastatingly sad as it was, made sense.

In the months that followed, J’s intrapsychic hard drive reconfigured itself. He no longer spoke in enigmatic bursts, but in coherent thoughts. We could actually have a conversation without him blowing up or shutting down. He stayed sober and sponsored AA newbies. He started to play music — something he’d sworn he’d never do again.

When I opened my private practice, he came with me. He arrived every Tuesday at 2 p.m., precise as a Swiss watch. One Fourth of July, he waited outside my empty office for an hour. He was angry about it the next session — “I don’t celebrate the 4th of July!” — but we worked through it.

He put a band together, found a music producer who let him use his recording studio for free. Months later, when J put the CD in my hand, I cried.

When finances dictated that I get a full-time agency job, I closed down my practice and referred my clients out. I gave J several choices of therapists, but he didn’t want to see anyone else. When our last session was over, he handed me my check. We stood by the door, grinning awkwardly at each other.

“Can I hug you?” he asked.

Physical touch is a dicey proposition in therapy, especially with patients who have been abused. First, do no harm, I told myself. And then I realized: this patient had turned me into a real therapist, and it was time for me to make up my own mind. I decided that the harm would be not to embrace him: this man with whom I had shared a kind of intimacy I had never shared with my ex-husband.

We hugged, and after we pulled apart, he looked me straight in the eye. Without a trace of embarrassment or a hint of a come-on, he said, simply: “I love you.”

“I love you too,” I said. Then I watched him walk out of my office and get on with his life.