A young woman stumbles into therapy with a distracted social worker.
A young woman stumbles into therapy with a distracted social worker.
Doorknob still jiggles. Is this door really closed? Is anyone from maintenance ever going to fix this damn door?
Klunk. Jiggle. Jiggle. Click. Ah…Finally.
Now…turn your attention to your new client. Early 30’s woman.
“Hi, my name is Frank, What brings you here today. How can I help you?“. Are you ever going to come up with a new greeting for new clients? I know you, Frank. No. No, You won’t.
My new client mumbles something not quite audible. Patience. Wait for more words.
I Clear my throat. Cough.
My new client seems barely aware I’m even here.
She’s dressed like a homeless person. She appears clean. But she has four or five layers of mismatched shirts and jackets. Also, she has a mismatched scarf wrapped around her neck several times. A mismatched and worn ski hat is pulled down over most of her head hiding much of her face.
The young lady mumbles something again. What did she say?
I cough again. I clear my throat. “It says here your name is Hannah?”
She nods. She looks in my direction…Or maybe at the bookshelf behind me. I really do have to straighten up that bookshelf…it is full of impressive book titles which I have never read. I share the office with another counselor…alternate days…we both inherited this office from previous occupants…who appear to have been avid readers of psychiatry, psychology, self help, and new age.
I Repeat my original question, “What brings you in today, Hannah, How can I help you?”
The new client, Hannah, adjusts her ski hat. A lock of long dark hair spills out from beneath her cap…much of it falls in front of her face enveloping her over-sized glasses. Her face remains almost completely hidden. But I Can’t help but notice, though, if looking at just the right angle, I’m pretty sure, there’s a cute face hiding beneath all of that.
She wears the black tights that all the young ladies are wearing these days. But they’re mostly hidden by her long and crumbled gray coat and a pair of over-sized all-weather boots. It’s January…but it’s not that bad outside today…why the fishing boots?
Still no response, so, again, “What brings you here today, Hannah?“.
Hannah mumbles more perceptibly, “You take my insurance”.
Ah…first words…now we’re cooking…Kind of a concrete answer… But not unusual for a first session.
With my most patient tone, “I mean, why did you feel a need to see a therapist?”
Hannah, “Oh…To get this form signed”.
More concrete. Back the concrete truck up.
Don’t ask a lot of details… just grab the form….pretend your reading it… maybe there will be a clue…a conversation starter….maybe more words will ensue.
Hannah hands over some papers…all part of some sort of form…A crumpled mess of folded papers.
Crumpled, Are you surprised, Frank?
It’s a familiar-looking form with various boxes to fill out. It’s a leave of absence form.
I look back up at Hannah who appears to be a cute girl hiding under a pile un-ironed laundry, “Need some time off from work? Tell me what’s going on?“.
Hannah, shaky, sheepishly, “I didn’t ask for time off but my boss asked me to get this signed”.
Okey Dokey…Leave of absence forms are usually initiated by clients…but I’ve seen this before….sometimes employers ask the client to get an absence form filled out and signed to help get an employee some time off from work… usually when the employee has a lot of absences. I imagine sometimes the employer is very specific about what they want, but usually, the clients just hear ‘get this paper signed’. I ask, “Any idea why your boss wants this filled out?“.
Hannah, in a matter of fact tone, “No”.
Okay, frank, go with the flow, “When do you want to start your leave? How long do you need to be out of work?“.
“I don’t know”, her tone getting a little odd now…a little irritable…though she doesn’t seem like an irritable person.
Change the subject, “let me ask you some of my standard questions.”
“How old are you?”
Hannah responds quickly enough, “I’ll be 31 in February”.
“Tell me about your family”.
Cute girl…or not…this is going to be a long hour.
Are your mom and dad still together?
Hannah thinks for a second then, “yes”.
“How’s your relationship with your parents?”
Take a deep breath Frank.
Rephrase your questions. “How…”
Hannah interrupts, “fine.”
I like to ask about siblings, “Do you have any brothers or sisters?”
Hanna mumbles something, something, “brother”, something something.
I’m not sure what she said. I’ll Take a stab in the dark, “How’s your relationship?”
Hannah’s face, from what I can see, looks angry… angry?
But I continue, “How old is your brother?”
Hannah, exasperated, but loud and clear, a first for my new client, “I said he passed away”.
She’s angry..but I can’t help but notice there’s still some sort of sweet, almost musical quality to her voice. Within seconds her face switches from angry, to sad, to tearful.
You did it again Frank, “I’m sorry, Hannah”, you just have a way with clients, Frank. Look around…where’s the tissue box? This is about to get real. I can never find that damn box when I need it. My eyes still darting around the room for the tissues, “Can you tell me more about your brother?”
Hannah is quiet. Hannah grimaces then…Still holding back tears. Where’s that damn tissue box?
I look around one last time and more deliberately.
There it is on the chair next to the door under my winter jacket.
Hannah asks, “Do you hear that?”
She winces. She furrows her brow. Her eyes are closed but directed to the floor now.
“It’s getting louder..you don’t hear it?”
I listen. All I hear is the sound of cars whizzing back and forth on the street out front of the office.
Hannah, “My head hurts”
“Where does it hurt Hannah?”
Hannah points with her right index finger to her right temple then opens up her hand as if to cup the whole right side of her head and slowly waves around the whole right side of her head.
“Have you had this before?”
She nods yes.
“Does it come and go…or is it with you all the time?”
Hannah, “comes and goes”.
“sharp pain… or dull pain?”
Hannah, “It’s a throbbing dull…then gets sharp….to the point… ”
Hannah doesn’t finish.
“Have you told your psychiatrist?”
Hannah nods yes.
“What does he give you?”
Hannah responds, “Sertraline…I think?”
I nod, yes that’s also called “Zoloft”.
“Yes”, Hannah nods.
Hannah, exhaling like someone letting out their very last breath on earth, “Can we talk about something else?”
What time is it? Need to end session soon, Hannah had gotten here late, I definitely want to get to know her better…but this day is going to get out of control if I don’t move her along.
Marathon question time…speed rounds.
“Does anyone in your family have Anxiety, Depression, Bipolar?”
Hannah, “I know mom took something for depression for a while…”
She pauses…Then, “My brother didn’t seem to have anything.”
“How did you lose your brother Hannah?”
Hannah, more reposed, “He was in the army…in Iraq”.
The clock is running… Stay calm Frank.
But, I have to ask the question.
“Can you tell me how you feel about losing your brother Hannah?”
Her eyes well up… I half stand up… slowly walk to the chair by the door…grab the tissue box. I side step over to Hannah and offer her the tissue box.
She grabs 2 or 3 tissues, “I can’t talk about that”.
I’m kind of relieved…for now…
“Okay…let me ask some other questions…Are you married?“.
Hanna shakes her head. I think she’s saying ‘no’
“Do you have any kids, Hannah?”
Hannah, lowers her head and sneaks her hand under oversize glasses and forcefully rubs each eye with the tissue, and shakes head no.
“When was your last long term relationship?”
Hannah shrugs, “I um… I guess a while ago”.
“How long was your last relationship?”
Hannah, The Shrugger, shrugs, “I dunno…about 2 years.
“How did it end?”
Hannah, “Can we talk about something else?
I’m running out of time today so, “Sure”
I just need the big picture….but we’ll have to talk about these things eventually.
“Any Long term relationships before that one?”
Hannah shrugged again, but then, “Nothing serious”. Hannah the Shrugger, Shrugged again.
I’ll dive deeper next appointment, “Okay”.
She’s now looking at the mess of papers on my desk. I really should have tossed the remains of my lunch. There are a couple of magazines. I wonder if she can tell my stapler is broken.
There’s a bunch of pens; More than half of them are out of ink. I don’t know which ones work and which ones don’t. Stacks of brochures from various pharm reps and such. A pile of brochures for one local rehab form the most prominent prominence on my desktop. We both seem to be looking at that same pile at the same time. I pick up the topmost brochure.
I hold it in my hand and look down at it. I like this brochure…Not sure If I like the facility so much…But I like the brochure. I thumb through the first couple of pages and find my favorite page. “Thought distortions”.
I rip that page out of the brochure. I look towards Hannah.
She’s half staring at the brochure and half staring out the window behind me.
“I like this page, Hannah”
I get up and walk it over to her.
I expect her to ask, “what’s this?” But nothing.
“This is a list of thought distortions”
I wait to see if that sinks in.
“Everyone has thought distortions.”
“This is a list of the twelve most common thought distortions”.
“Again, everyone has thought distortions…But… sometimes thought distortions get
No real response.
“When they get overwhelming…it’s helpful…to be able to recognize them.”
“Does that make sense, Hannah?”
She nods, as if to say yes, she looks at the time on her cell phone, she makes a deliberate attempt to fold the list neatly and stuffs it in her pocketbook. I bet next time I see that list it will be crumbled. If I see it again.
Hannah’s eyes are becoming sleepy. I pause for a moment and observe her eyes slowly shift their gaze… drifting slowly as if by gravity, to the ground.
Time is running out.
“I would like you to go through that list between now and our next appointment…. just go through the list and see if all the definitions make sense to you”
Hannah’s eyes drift down even further, they are,now, not just staring at the floor, but something deeper, I would say, possibly searching for the center of the earth? maybe?
“Are you Okay, Hannah?”
Hannah startles a bit. She picks up her head. Her eyes try to focus but they aren’t quite up to the challenge. they still want to drift back to the earth.
Hannah, “No…I think I’m good…“.
“I’d like to ask you… If you had to compare your anxiety and your depression…what is worse for you?”
Unperturbed, “If you had to rate anxiety and depression from 1 to 10…10 being the worst… how
bad is your anxiety?”
Hannah shrugged, “Nine.“, and shrugged again.
“How bad is depression…1 to 10?“.
“Any worries Hannah?”
Hannah, shrugged, “yeah…?”
“What do you worry about Hannah?”
Shrugging again, “I dunno……everything…I guess”.
Don’t stop Frank, “Any irritability, are you easily annoyed?
Hannah, quicker, “Yeah…yes”.
What annoys you, Hannah?
“People? do people annoy you?
Again Hannah shrugs
Sprint to the end, “How’s your sleep, Hannah?
“Do you fall asleep right away?
“Do you have a lot of thoughts that you can’t get rid of?
Hannah nods yes.
“What do you think about?
Hanna shrugs again, “I dunno…everything”.
Time stops for no one.
I nod, “Any thoughts of dying or self-harm?”
Hannah, as if expecting this question, quickly, emphatically shakes her head as if to say no, “Nope.”
“Have you ever had panic attacks?
“When was your last?
Hanna shrugs but looks me in the eye, directly, for the first time.
I really should dive deeper. But time is running.
“How long have you been on the Sertraline?
Hannah, slowly, as if doing an SAT math question, “a couple of weeks maybe”.
“Give it some more time I think”.
“Any medical problems Hanna? Any history of seizures?
Hanna shakes her head, “no”.
Any eating disorders?
Hannah, again, shakes her head, “no”.
Hannah doesn’t answer.
I ask again, “Any blackouts, Hannah?”
Hannah, “I dunno…I guess a couple drinking blackouts”.
“When was your last?
Hannah, “I think last new years”
“Are you a big drinker Hannah?
Hannah, “In college I had a couple of bad hangovers…I barely have 2 or 3 drinks a month now.
Last New Year’s was a.. fluke”
“Do you use any other substances? Do you use marijuana?
Hannah shakes her head as if to say “no”.
I believe her.
“Any history of surgeries Hannah?
Hannah shakes her head, “nope.
“Are you on any medications other than Sertraline?
My Client shakes her head, “Nope.
“Tell me… where do you live and where have you lived?
Hannah thinks for a minute… “I live with my Aunt which is about halfway between the Mall and the train station”
“How long have you lived with your Aunt?
I nod, How about before that?
Hannah, “South Jersey”
“How long were you there?
“My whole life”
“Tell me about school Hannah…How did you do in school?”
Hannah seems engaged for the first time in our short acquaintance,
“School? I was always a good…I always did well in school”
“You said you went to college?
Hannah, “Yes…but I dropped out after a couple of years”?
Should I ask why? Nope…Next session.
“How about friends? Did you have a big group of friends? Small group, or were you more introverted?
Hannah, “oh yeah…in school I always had a big group of friends.
“How about now?
I wait for a second.
Hannah, “I don’t go out much anymore. I still get calls here and there from old school mates.
“Do you return their calls?
Hannah shrugs, “I dunno…sometimes.”
I look at the clock. I’m already 15 minutes late for my next session.
“I apologize Hannah…I have to start wrapping things up…
Hannah seems puzzled for a second, but then seems to rememeber we are ‘on the clock’.
At first, there’s some indecisiveness, she fumbles through her pocketbook, almost raccoon-like. But, then in one motion, she puts her phone in the pocketbook, swings the pocketbook over her shoulder and confidently, quickly, powerfully stands up from the couch and offers her hand to me to shake goodbye.
I’m startled by her sudden directness.
For a brief second, I see a very confident, attractive, young lady.
I quickly offer “Do you think we covered everything we needed to cover today, Hannah?
Hannah, “Yes…I think I’m good… Do I schedule my next appointment with you?”
Glad to know she’s coming back.
“No…our admin folks out front do all my scheduling…Do you think you can come back in a week or two?”
Hannah slumps, “I’m sorry…My insurance was very clear that they would only pay for 12 sessions..”
Her confidence…seems to deflate… if only slightly…
Hannah, “I was really hoping to make those 12 sessions stretch for the whole year…”
Once a month just doesn’t sound like enough…but…I relent, “That will be fine Hannah”
I’m closer to her now. I reach my hand out to shake her out-held hand.
We clasp hands. Her hand shake is surprisingly warm and friendly.
She sings “Good to meet you…Good Bye…Good Day…Frank”
she walks towards the door. Strong posture, for a few steps. But by the time she is closing the door behind her I see her posture revert back to that of the slumped little homeless-looking wreck that originally walked in. I take a deep breath. The smell of perfume is notably absent. Nothing. I look at the couch where she had just been sitting. Nothing. Was there some little wrinkle, or some little crumb, or something, Anything, some sort of reminder that she had ever been there?
Was she ever here at all?
I look at my notes.
“Well, at least I have my notes, Frank”.
I hear Hannah’s voice in my head “Well At least we’ll always have Paris, Frank”.
Published on February 01, 2020
Contains explicit content ⚠️
Genre: Psychological Thriller