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Wednesday, 26 April 2006 00:00

Use Eagles if Necessary, Chapter 4: My First Patient

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When my session on a Friday was over I got up and proceeded to the door of the consultation room. As I passed Jean’s chair he handed me a piece of paper. He’d never done this and I asked what it was. It had a woman’s name and phone number on it. “Call her and set up an appointment,” he said. “She’ll be your first patient.”

I almost fainted. I had no inkling he was going to do this. “Are you sure I’m ready?” I asked, hardly believing I was really going to see a patient.

“You’re more than ready.”

“How do I set up an appointment?” I said, more to myself than him.

He looked at me like I was 5 years old and said, “See what openings we have at the front desk,” and out the door he went, leaving me staring at the paper in my hand.

After I composed myself I called “Trisha,” telling her I was Jim Joyce from The Institute for Child Development and Family Guidance, returning her call. She responded in the chipperest of voices. “Oh, thank you for calling me back. I really do want to talk to someone. Will you be my doctor?”

Nobody had ever called me a doctor and I certainly didn’t feel like one. The thought of a title never crossed my mind. I hesitated then said, “I’ll be the one seeing you. Please call me Jim.” I then asked if it was urgent that she come in (in other words, was she suicidal?) and she said no — she just wanted to sort some things out in her head. “General stuff,” she called it. She wasn’t sure of the Institute’s location so I gave her directions.

“Thanks, Jim. I hope you’re as nice in person as you sound on the telephone. When can we get together?”

We set up an appointment for the following Monday morning. When I hung up I noticed my heart was pounding and my palms were wet.

I’d been nervous before but never for such a duration. The weekend was a blur as I pored over my textbooks, unopened for at least a year. My ongoing training now was simply my ongoing personal analysis. But much of that was “boy” stuff and my first patient was a “girl.” What did I know about girls? Nothing! And what did she mean by “general stuff?” I was a wreck.

On Monday morning I got to The Institute an hour before Trisha’s appointment and began drinking coffee, smoking cigarettes and pacing. In the back of my mind was the thought, actually a wish, that Trisha would not show up. She certainly didn’t sound like she needed a shrink. She sounded a lot happier than me.

I watched the first group of patients being greeted by their analysts and disappear down the hallway. It was inconceivable to me that soon I would join this elite group and would actually have a patient of my own. Then my stomach flipped as I had the thought: my God, what if I say the wrong thing? She’s going to depend on me to help her and my every word will be scrutinized. And if I don’t calm down she’ll notice that I’m nervous and she’ll think she caused it. What if she runs out of the building in tears?

With 20 minutes to go before her appointment I convinced myself that I had no business “seeing someone.” With mounting panic I sought out my buddy, Richard Geer, a pediatrician and co-founder of The Institute. Although primarily a medical doctor, he was psychoanalytically astute. As a doctor of children he had a front row seat to observe the makings of future mental health patients. “I hate mothers,” he used to say.

The Institute was in the St. Joseph Hospital complex in Durango, Colo., and I walked as fast as I could to Dick’s office. It took all of my will power to not break into a sprint. Lucky for me he was between patients.

“Dick, I’ve got to see you,” I said. He noted my anxious state.

“In there,” he said, pointing the end of his pipe toward his office. “What’s wrong?”

“I’m seeing my first patient in a few minutes, if she shows up, and I don’t have a clue what to say. I don’t know how to be psychoanalyst. I’m still a patient!”

Dick grunted and told me to sit down. “You don’t have to say anything. Here’s what you do.” He scribbled something on a prescription pad in his doctor’s handwriting and gave it to me. “Hx – Int – Res.” I stared at it then asked, “What the hell does this mean?”

“Get the history. Interpret. Take to resolution. That’s all there is to it. The first part should take at least six months.”

I felt better. Asking Trisha questions about her past would be easy and I had six months to get her history. The other stuff I could figure out later. I thanked him and left. (I carried that slip of paper in my wallet for 10 years until it fell apart.)

I rushed back to The Institute. In the waiting room was an elderly couple and a beautiful 30-something woman. “Jim,” Rachel the receptionist said, “Trisha is here. She’s your nine o’clock.” I silently thanked Rachel for not saying, “Your first patient.”

Trisha stood up, gave me a big smile, and we shook hands. “How do you do’s” and “nice to meet you’s,” were exchanged. “After you,” I said, gesturing down the hallway. “The third door on the right.”

I followed her down the hall and could not help but notice my patient had a very pretty rear end. “God, I’m still sick,” I thought to myself. “I should not be a psychoanalyst!”

She walked into the room and hesitated. “Am I supposed to lie on the couch or sit in a chair?”

“However you’d be most comfortable,” I said, impressed with her openness.

“I’ll take a chair for now,” she said and seated herself. I took the other one.

She placed her tote bag on the floor beside the chair, crossed her legs and folded her hands in her lap. She was wearing moccasins, jeans, and a blue turtleneck under a suede vest. Her auburn hair was in a pony tail tied with a blue ribbon. There was a hint of lip gloss, subtle blush and hoop earrings. Colorado perfect. As she continued to smile at me it became obvious she wanted me to say something first. I knew I was supposed to wait for her to start talking, but the words popped out of my mouth: “How can I help you?”

She burst into tears.

Remembering that shrinks were not to interrupt crying, I passed her a Kleenex. She took it without looking up and continued to sob. My stomach flipped as I wondered what I was doing in that room. Then the terrible thought crossed my mind, “What if she never stops crying?” But she eventually composed herself, looked into my eyes and with the trust of a child said, “My life is a disaster. Will you really help me?”

“Yes,” I said, and held her gaze. It was the most sincere “yes” of my life and at that moment Trisha and I connected. It no longer mattered that she was a girl and I was a boy. We were fellow travelers through life ... and I was 15 chapters ahead of her.

“Tell me about yourself,” I said, “and take your time. I want to know all about Trisha.” Her relief was palpable — and I realized what I was doing in that room.

I learned in our first hour Trisha had a PhD in geology. She’d taught at a university in California for six years and had recently moved to the Durango area to “Get her head on straight.” Her verbal skills and intelligence level were superior. Listening to her talk was at once pleasurable and somewhat intimidating. She was smart!

I also learned in the first session that Trisha was twice divorced, practiced birth control, had a casual sex life, had committed adultery in both marriages, and had had an abortion. Currently she had “Sworn off men.”

“I can get myself off just fine and don’t have to fix them breakfast,” she said with a faint smile. Trisha had done it all and I was glad that I’d resolved my Catholic conscience dilemma.

We began meeting twice a week. In between our sessions I could think of practically nothing other than Trisha. Was I helping her? What did her last dream mean? Does she know she’s my first patient? Should I tell her? Should I interpret her neurotic needs to please everyone or wait awhile? Am I talking too much? Am I talking enough? She didn’t seem quite herself in the last session. Maybe I’m screwing up. I was preoccupied to the point of obsession with Trisha. After a couple of weeks I told Jean, who was supervising me, that I could not stop thinking about Trisha and her problems. She was ever present in my mind. He laughed.

“I know what you’re going through, Jim. It’s called ‘The only patient syndrome.’ It happens to every beginning analyst.” He then handed me a piece of paper with a name and phone number.

“Here’s your next patient. Call him and set an appointment.”

All of a sudden Trisha no longer dominated my thoughts, except during our time together, thanks to “Don,” my patient number two. He was a disaster. When he came for his first appointment one eye was closed and the other bulged out. Like a terrified one-eyed horse he frantically scanned the room looking for a reason to bolt. He could sit in the chair for only a few minutes and then paced. Lying on the couch was out of the question. The man was buzzing with anxiety.

But in between sessions I didn’t worry about him. It was sort of like having children. When you only have one you worry constantly. When more show up you relax. Meanwhile, even without my worrying, my patients were getting better. Within three months Trisha’s ambivalence was lessening and she began to make tentative plans for her future. Don’s one eye was now completely open and the other one was back in its socket. I had noted with amazement the evolution of this “evening out” of his eyes — and he could now go an entire session without pacing. This is when the miracle of psychoanalysis became clear to me. I had said very few words to either of them other than to ask questions. I let them talk, and talk, and talk ... and I listened. And they were getting better.

In time I would help them piece together their thoughts and feelings by pointing out seemingly unconnected elements from their lives and showing how they were indeed connected. This would be the “Int” phase which would take the longest time and provide the lasting benefit from their analysis. But even without interpretations, the talking alone was enormously curative. It seemed ridiculous and just too simple.

Naturally I discussed this with Jean. “Jim,” he said, “Think about it. Who in their right mind is going to listen to somebody for an entire hour without interruption, and at the same time show concern? And who would be silly or stupid enough to actually ask them questions — giving them even more to talk about? And who could listen to all that convoluted rambling without making comments, suggestions and judgments? That’s what they pay us for — to listen to them. You’re allowing them to cure themselves. That’s a great gift.”

He proceeded to say that the longer I kept my thoughts and observations to myself, the healthier they would become and the more receptive they’d be when I did open my mouth. He assured me I would know, intuitively, when it was time to interpret. “You’re gaining their trust. They’ve never been able to trust anyone before. That’s why they’re here.” Then he added that I was doing very well and to keep listening. “You have connected with Don and Trisha. Stay connected and they’ll tell you everything you need to know to permanently heal them. He handed me another piece of paper with a name and phone number on it.

With a few months of seeing patients under supervision I began getting referrals. Trisha, Don and others began telling their friends about me and some of those friends called for appointments. And some of them told their friends who also called. My practice was filling up and finding supervision became a challenge. Less than a year after Trisha’s first appointment a man I worked with as a condominium salesman called the Institute and asked for an appointment with “Either Dr. Rosenbaum or Jim Joyce.”

I was a psychoanalyst.

Over the next several months The Smoky Mountain News will publish Waynesville author Jim Joyce’s memoir about the years he spent as a psychoanalyst. Each week we’ll begin a chapter in our Books section, and the chapter wil be finished on our Web site. You’ll also be able to find the previous chapters in their entirety on the Web site. The book is now available for purchase at rockpublishing.com/eagleshtm.

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