Calling on Loving Kindness in the Clinical Setting -- for Clients and Ourselves
By Leslie A. Chertok, LMHC
Breathe deeply, maintain eye contact. I closed the door behind my clients, took two steps to my desk, and crumpled into the chair. I stared out the window into the dark night until my head cleared, then packed up my briefcase and went home.
More imbibing-minded colleagues might have made a beeline for the neighborhood bar or liquor cabinet. I imagined with each sip the knot of inner doubt dwindling into the quiet resolve of professional perspective. But I had grown up watching my father drink. He would return each night after a long day and pour Smirnoff over ice, which he then topped off repeatedly. So I had made a personal commitment never to use alcohol as a primary stress-management tool. And as inviting as my cozy sofa looked, I knew that if I sat down, it would be hours before I roused myself. Instead, I resigned myself to a late night walk with my dog.
There are no streetlights on my road. I walked by moonlight, grateful the air was still. Between my feet crunching on the gravel and the rambunctious-ness of the dog, the deer were warned of our presence. Comforted by the peace, I was able to replay the distressing session in my head.
It began two weeks earlier when I sat down for an intake with “Amy” and “Emily” concerning their 5-year-old niece, “Carlee.” Carlee’s biological parents were neglectful methamphetamine addicts, and her father had been in jail for abusing her mother. Amy and Emily had been involved in Car-lee’s life since her birth and had watched with increasing fear as her home life deteriorated. Child Protective Services finally intervened and placed Carlee with this loving couple.
They had managed parenting for three years without assistance. As both were in the education field with much experience in child development, they were more prepared than most for the challenges they faced. The couple had already raised Emily’s biological son, now 19 and no longer living at home. They sought treatment because there were some issues that had not resolved over time, even in their loving, consistent home. Carlee still threw hours-long tantrums multiple times each week, and she was extremely anxious, hyper-vigilant, and often controlling. Plus she had significant separation anxiety.
Carlee is very intelligent and creative, a girly girl who loves to dress in pretty pink and purple outfits. She also loves animals. I had learned much in the intake session when I met with Amy and Emily alone. Tonight was our second session, and my first with Carlee present. Within the first five minutes I had already escorted her back to the waiting room, where she exhibited full-blown rage.
I had not expected this, nor had I consciously provoked it. Carlee simply had zero tolerance for not being in control of our interaction, and I underestimated her likely response. I stood with her in the waiting room, the office door left slightly ajar so that her parents could hear our interactions. I instructed her that if she wanted their help, all she needed to do was ask them. Unlike securely attached children, she never did.
At the peak of her tantrum, Carlee’s face was red, tears wet her cheeks, and her fists were clenched as she roared at me, “Clover is going to kill you! Clover is going to kill you!” (I later learned that Clover was her 6-year-old cat.) Clearly, this was not how I wanted the session to go.
Initially I was surprised, like someone whose carelessly discarded cigarette initiates a wildfire. I should not have been. I hate this part! When are you going to stop working with kids with attachment disorder? These parents are well-connected in the social work community and could hurt your reputation. What if they get up and leave? I felt like a failure.
The inner barrage was old neurological patterning awakened by this disturbing situation. I hated what was happening. What the hell were you thinking? You know better! She’s diagnosed with Reactive Attachment Disorder. That is why she was referred to you!
Needless to say, I was distracted from being the understanding therapist Carlee needed. Thankfully, I remembered that being present in the moment and benevolent toward my own experience are both necessary precursors for holding a compassionate space for others. I began the process of making peace with myself, thus interrupting the downward landslide.
I began with a deep breath. I checked in with my body and noted that I was tense, shoulders raised as if trying to appear larger to scare off a predator. Emotionally I felt overwhelmed, and there was a subtle trepidation. As I attended to my emotional self, I noticed that I vacillated between feeling defeated, and panicked. Slowly, my critical mind began to ease.
This practice of tuning in first to the body, then to the emotions, and finally to the mind, was taught to me by Tu Moonwalker as a re-centering tool. A spiritual mentor and counselor, Moonwalker is also an artist and craftswoman and author of the book, Business Revolution through Ancestral Wisdom.
Next I reminded myself that whether I liked it or not (clearly not!), this was how the session was going. I noted the size of my attacker and the beautiful flowers in the waiting room. Beneath Carlee’s screaming, I heard the calming sound of bamboo flutes over the speakers. I perceived that there was no physical threat. I breathed and helped my body relax.
As I reminded myself of my job and my client’s terror, my emotional space began to shift. I spoke as soothingly to myself as I did to Carlee. I began to practice Maitri, a Sanskrit word for unconditional love for oneself. No matter what was happening, I had my own back. I supported myself. I could be present with whatever arose. My mind, now determined to help, had already ceased combat mode and was now part of the team.
Staying gently present with my experience, I tuned back in to Carlee. She was still vacillating between rage and tears. While crying, she’d sag against the wall toward her parents, still not asking for help. My heart ached for her struggle. She saw me as enemy number one. From Carlee’s perspective, she was literally in fear for her life. For a 5-year-old to feel so threatened by the simple act of allowing loving parents or an appropriate adult to be in control of a situation pained my heart—even though I have worked with hundreds of children with similar issues. Her protective attack kept up for over 45 minutes. Moments of reprieve were quickly followed by furious screaming and stomping.
I now could see Carlee’s parents huddled together on the couch without worrying about my 17-year career being sunk. I offered them a reassuring smile. Their eyes told me that we were on the same page. They would not intervene just to reduce their own discomfort. (Psychologist Karen Wegela, PhD, uses the term “idiot compassion” to describe actions that appear to be compassionate, but are actually a way of avoiding discomfort and reinforcing the underlying problem.) Instead, we would all have to wait Carlee out—who, like most people who have experienced extreme neglect, could wait an inordinate amount of time.
Later I was to learn that, as troubled as Emily and Amy were to see Carlee in distress, they were used to these outbursts; it was the primary reason they had sought out counseling. They were relieved at Carlee’s exhibition and hopeful that I might have something to offer.
Carlee never did ask for help, nor did she make it back into the office that day. In the two years since, she has made tremendous progress and has learned to utilize her parents (and therapy) to support her in her fun-filled life. That first night, when I had said goodbye and closed the door, I could not know this. I could not know that two years later she would have the insight and fortitude, from the back seat of the car, crying, to interrupt her arguing parents and tell them that the scene was reminding her of her birthparents’ fighting, and that she was scared.
She then added, “I think we should talk about this with Leslie next week.” That first night, I had only hope, the knowledge that I was striving to act in her best interest, and a heart full of compassion for her, her parents, and myself.
Needless to say, I was exhausted that day and, yes, that night I needed a walk. As I walked and replayed the night’s events, other difficult sessions flittered in and out of my mind. One in particular knotted my stomach as I recalled my anger at the child taunting me from behind my couch. I had spoken too harshly and had felt my heart shut down. I had no compassion. In that session, I was not able to be present with my feelings of powerlessness and also remain neutral and loving. Instead, I stayed angry at my client and at myself.
As I walked, something that was bound very tight, loosened. As I walked, I forgave myself, again.
Leslie Chertok is a Licensed Mental Health Counselor. Her private practice is in Tacoma, Wash. Working with a diverse clientele, she emphasizes the cultivation of deep self-acceptance as an essential element of healing for both adults and children. For more information about her practice, or to contact Chertok, visit her website.