There comes a point and time in every growing therapist’s development when they have to let go of all the tools and tricks. They have to trust that what they have learned is now second nature, and rest into the moment, into the relationship with their client. The following story details that moment in my life.
When Tony was just two days old, the Department of Child and Family Services removed him from the care of his mother as she tested positive for cocaine and other substances. He was immediately placed into foster care and into the home of a foster mother with at least four other children. He was removed from that home due to allegations of neglect when he was eleven months, and over the next two years spent time in at least three other foster homes. By the time Tony was three, the impact of multiple placements, neglect, and exposure to drugs when in his mother’s womb was obvious. He would rock himself, bang his head on the wall or headboard of his bed. He was difficult to soothe, oppositional, would have several severe tantrums every day. His caregivers at the time struggled to find ways to control him.
Tony stayed in one foster home from the time he was three until he was six and entered grade school for the first time. Unfortunately, with school came a whole host of other problems. Unlike other kids his age, Tony had no idea how to get along with friends, how to understand their feelings, how to show empathy. He would tease, threaten, bully, physically attack, and provoke his peers. His teachers struggled to control him, and eventually Tony was expelled from school in the first grade, still at the age of six. Also at this time, his foster family had had enough and gave what’s called a 7-day notice. This basically means that they are giving DCFS a week to find a new home for Tony. They did, and Tony was placed in a residential care facility, an RCL-14 facility, the highest level of such care in the state short of psychiatric hospitalization.
At the young age of six, Tony was placed in a facility with 60 other boys, ages 6-17. He was the youngest and the smallest. This is when I met Tony for the first time. I had just started working at this home as an intern, and had been assigned a caseload of 7 boys. Tony was now one of my clients. My job, as a clinician, was to provide individual therapy. My background had been in somatic psychology, and I was used to working with high functioning adults. I had no idea what to do with these kids. We received some rudimentary training and were advised to stick with cognitive behavioral approaches, as they were shown to be the most efficacious. I felt like a foreigner in a strange land.
And so, I started to work with Tony in such a manner, working specifically on his behaviors, creating behavior charts, incentive programs, dissecting his thinking and his decision making. I had mood and feeling charts, anger management games, and consequential thinking development tools. Yet I knew I was missing something. Somewhere in the back of mind, or maybe in my heart, I knew that I wasn’t reaching him, that I wasn’t meeting his needs. He was frustrated with me, bored. Our sessions were tedious, I hated them. I didn’t look forward to seeing him and began to resent for the feelings I was having. How dare this little kid make me feel so inadequate!
One day, I received a call from our crisis unit. Tony had run away again, left school in a rage, and ran out into the neighborhood. He was gone for several hours before they found him and brought him back. As was standard protocol in such situations, I was required to come down to the crisis unit and perform a safety and risk evaluation with Tony. I brought him back to my office and started to ask him the standard questions on the form, “On a scale from 1-10, how angry are you?” “10!” “OK, 10. Complete this sentence, I feel like hurting myself never, sometimes, or all of the time.” “All of the time!” Tony was getting angrier and angrier. So was I. This wasn’t working, and I knew it. As I proceeded to follow the standard protocol, to keep within the bounds of what was expected of me, he began to escalate. Finally, he had enough, stood up on top of his chair, and screamed through his tears “Why won’t you just be with me!”
In that moment, I melted. I dropped all the cognitive behavioral facade, and I trusted my body and my feelings to do what was right. There before me was a tiny, tired, terrified little boy. He had never had a mother, or a father, he didn’t know how to get along with people, he didn’t know how to be civilized. He did however know that he need something. In an instant I saw the infant in him, crying to be held. I cried. I put down my clipboard, looked deeply into his eyes. I opened my arms and said nothing. It took only a moment, he felt the shift, and came running towards me, falling into my arms. He sobbed and so did I. My body knew exactly what to do, and it was not on any chart, or form, or strategic plan. He needed to be held, as if he were an infant. And so I held him, rocked him, soothed him for what felt like hours. He eventually fell asleep in my arms.
This story illustrates what has been shown to be the most important predictor of a positive therapeutic experience. When all is said and done, it is not the theoretical orientation, nor the specific interventions, that make therapy good. It is the quality of the relationship, the attachment, between therapist and client, that allows the client to feel safe, respected, accepted, and builds the ground for change. Tony was met by me when I simply allowed myself to be with him.
I worked with Tony for several years after that. After that moment, our work deepened, and I kept trusting myself that I knew instinctively what to do for this little guy. When our paths parted, his life continued to be a struggle, in and out of group homes and foster care. I’ve lost touch with Tony. He is now probably 18 or so. I can only hope that those moments of deep attachment and attunement made some difference in his chaotic life.
Chris Tickner is a Pasadena psychotherapist, child therapist, and clinical supervisor practicing holistic psychotherapy, where he combines mindfulness psychotherapy, somatic therapy, neuroscience, and good old fasion humor and compassion to form a a powerful treatment that is transformative and holistic. There are thousands of California psychotherapists, and finding a counselor or finding a therapist can be daunting. On his website, Chris provides a primer to help you find the therapist that is perfect for you! Chris is also a Pasadena therapist specializing in anxiety psychotherapy and depression psychotherapy.