A Very Personal Account of a Very Professional Relationship

Towards the relative beginning of my career in Psychotherapy, some eighteen years ago, a mother contacted me asking whether I would take on her teenage son. I had no specialization at the time and was growing my practice, I took in all ages and all sorts. 

Every new client who sits across from them excites young therapists, young in experience and often in age. We feel challenged, motivated, privileged, inquisitive and somewhere stirred into the mix, incapable and afraid of failing our clients’ expectations. The ideal scenario sees us never losing that position in its entirety. 

There is no client group that is more skilled in stirring insecurity in a young therapist than teenagers, even more so, teenagers who refuse to eat. 

Teenagers do know it all. They speak with an unparalleled sense of conviction. They are well researched (even though their sources are sometimes questionable) and they are dramatic and strong in their stance. Teenagers have a genuine sense of feeling alien, misunderstood by adults and missed by their peers. They often experience a huge sense of isolation and a desperate need to connect, easily disappointed and therefore not quick to trust.

The mother explained briefly over the phone that her son was refusing to eat quantities and food types that would ‘fatten him’. He had successfully lost weight and what I later understood – got hooked on self-deprivation. The boy was finally feeling he was in control (please note the huge over simplification for the readers benefit).

Inexperienced therapists rely on available research and literature. Having never worked with a male anorexic by that point in my career – I hit the books hard, you could say that come that very first session I was ridiculously well versed in theory, interventions and exercises. I had already designed a mental plan of where this was going to go, I was prepared. Talk about control issues! 

Now here’s why I flushed that plan down the loo. 
I met him!

I have a superpower. People who are therapists by vocation often do. It takes us a while to identify, acknowledge and understand our superpowers because text books make little reference to material that cannot be quantified, explained scientifically or tangible. 

And here it is – I can read people super fast – like a human emotional x-ray machine AND, as a result, I am fast to love anyone who sits across from me in my therapy space. Reading people fast means simply that you are privy to their vulnerabilities so all the bullshit that they present – defense and coping mechanisms which are often super relevant and necessary – are less of an obstacle to quick contact. Think of it as the difference between dial-up and broadband. It’s not a sexual or romantic love, sometimes a parental love, mostly a love and awe of the beautiful resilience sitting across from you and a clear understanding of how to help through connection.

The love a therapist feels towards clients can only exist within the clearest of boundaries, it is a gentle negotiation of genuine care and a clear professional relationship.

So there he sat, raw, misunderstood and filled with a mix of entitlement and shame. This teenage boy who to some extent still believed that he was just on a diet. To the naked eye, the boy was severely anorexic.

I could blow my own trumpet and tell you that all my years of studying, my professional experience and those hours of preparation fixed the boy. But they didn’t, so I won’t. That said, I can tell you what did result in shifts of belief, attitude and behavior. I listened. I listened and I observed. And from those observations I fed back. (God I hate starting a sentence with And but there you have it – it’s done, let’s move on).

The teenage years are very much about developing our own separate identity. It’s almost kind of harder when we come from a loving, nurturing and close family who might experience the distancing teenager as troubled or changing. That teenager might feel disloyal and especially confused. We need to create some form of chaos and conflict in order to separate, in order to develop ourselves separately to whom our parents are. In his own way this boy was trying to do just that – he was breaking free, separating and killing himself in the process.

The boy didn’t really want to talk to me at first, he didn’t want to be there altogether, to him this was all a misunderstanding and I was just some extra bit of intrusive adult who strived to alter what to him was a perfect combination of health and weight loss. He didn’t see what I saw. He didn’t understand his mother’s concerns. We were all just extra and in the way of what he knew to be true.

Over time and with much subtlety and patience we had our moments, moments of awkward silence and moments of awkward non-silence. And then we had moments of space consumed with intimacy and trust and venting. We talked about crappy stuff and meaningful stuff and then I blinked and we had connected. One session, I pointed out that he consistently sat at the very edge of his seat and we spent a whole hour talking about his control issues – how did that happen? – let me re-phrase that, how did he let me get in enough to reach his control issues? Then again, I’m pretty likeable and cool.

We co-created an intimate and meaningful space for the boy to talk, question, allow himself to be challenged. He trusted me and I was in awe and respectful of his process. I don’t know who was more scared of the process at that point. You know when a stray kitten takes food from your hands the first time, you almost worry they never will again if you flinch. That was me for a while. Until together, we melted into the process and it got easy and efficient and eventually …… successful.

He got there, he got it. He understood the difference between self-care and self-harm. He felt safe enough to explore and experiment and at some point, he was done. And then we parted ways.

At the cost of sounding like an over-inflated simplification of a hugely complex process, I am in no way trying to minimize the seriousness of anorexia or the plight of teenage boys, but in a nutshell, that is the therapy process for you. With hundreds of theories in our heads and an open heart, we meet, we connect and we do the work. It is a set of private and intimate conversations that lead to a better headspace with ripple effects in our lives outside of therapy.

I’ve been a therapist nearing twenty years and it still baffles me when previous clients send me a text message asking “do you remember me’? Here’s an inside note from a therapist’s notebook…. We have loved you all and forget none of you. When therapy ends we wonder and hope that life is treating you with love and care and we are forever proud that you have moved on successfully. We often learn more from you than you have done from us.