“Tell me what’s been going on.” I said.
“Who do you tell?” He said.
“I don’t tell anyone. If you are in danger of hurting yourself or someone else I may have to alert authorities. If you are in danger of only hurting yourself there are options outside of going to a higher level of care. That doesn’t mean expanding your care team won’t be requested in service of you receiving the most effective care. I will tell my supervisor some things. I am an intern so I may discuss areas of improvement on my end related to working on your case. I may try and problem solve with my supervisor. She would not tell anyone.”
“I think the birds can hear me thinking. I know they can’t. I think they can. Every morning they chirp because they’re responding to my thoughts.”
“Let’s assume you’re right. Why would it be a problem if the birds can hear you thinking?”
“I’m sorry if I overstepped.”
“This happens twice a year. Usually around March and October.”
“I think you’re in a better position than most clients. Knowing problem times is a large part of the battle. Do you want to tell me more?”
“It happens when I drink. I think people can hear me think. I drink so I think less. I keep drinking. Soon it’s never enough. Then I have what I think is a manic episode.”
“I don’t work too heavily with diagnosis, but thank you for letting me know. When you have these episodes, how long do they last?”
“And your feeling state during them – what’s that like?”
“Up. I’m fun until I’m terrified and then I fall apart.”
“Do you only drink?”
“Drugs change how we think. I find it hard to stay awake drinking. Every person is different.”
“Who do you tell?”
“Maybe my supervisor. I don’t tell them word for word everything that happens here. If drugs come up I can say some drug use.”
“When the booze gets weaker, yes.”
“That sounds consistent with a manic episode. Most doctors wouldn’t diagnose until it’s confirmed these symptoms aren’t substance induced. And you have this happen twice a year?”
“Yes. I can’t hold down a job and my family is tired of me.”
“I think we can help you. You won’t be where you want in a single session, but that doesn’t mean it won’t happen.”
“Are you serious?”
“Yes. I believe in you. I admire your courage in letting me know these things. It’s hard to talk honestly about the struggles we have.”
“Thank you. My chest feels lighter already.”
“That happens a lot. Next week?”
Next week doesn’t happen. The week after does. The birds come up again. In hats and face masks it’s hard to make out your client’s feelings. The week after he says let’s call. He calls on shift. I said he can’t call on shift again due to confidentiality. He said he’s just a Postmate. I explain that this is for him. He doesn’t want to use the clinician’s video call site. He will make calls. He says he wants to come to session when he misses one. Work gets in the way. He has two jobs. I believe him.
I talk with my supervisor about his attendance and I’m generous because I don’t want to lose him. I don’t want to lose my clients because I need to make hours. I fret over what can be billed as an hour and what can’t. I know what could be charged if this was about money. Money and experience are two very different things. I learned that gigging for experience leads to no money in music. You get known as someone who accepts that at clubs. In the professional sphere I’m paying my dues and learning the ropes before the training wheels come off. I decided to say every hour is something I’d bill. I’m aggressive in my billing. My supervisor says I shouldn’t be so concerned about hours, but my professors do. They don’t actually care about the work product. They just care about getting us through. If you encounter a serious ethical dilemma and report it the school will remove you from the site. If you get removed from the site your program gets delayed. You still have to pay for that semester. That’s your learning experience. At every level you are incentivized to shut up and find a way to deal with the things you should be able to confront. When you log every single hour of experience the silent hours where you really are working must also look productive. You are forced to lie, cheat, and steal all while calling yourself a wounded healer turned helping professional doing an unpaid internship out of the goodness of your heart.
The client says phone calls are easier with the pandemic. That’s fine by me.
I called him for our session.
“How are you today?” I said.
“Can I tell you something serious?” He said.
“Of course. You don’t have to immediately dig in unless you want to.”
“Please tell me.”
“I’m seeing a guy.”
“Thank you for being vulnerable with that. Is this what you thought the birds could hear?”
“Part of it.”
“Do you want to tell me more about why it’s serious for you to date a man?”
“I live with that woman. My family can’t know.”
“Aren’t you roommates?”
“And she wants to be more. We used to have sex, but now we are just roommates. I didn’t want to have sex. She made me. She said if I wouldn’t fuck her I’m not a real man. Any man who wouldn’t fuck her is a gay man. She moved in with me to escape an abusive ex. I said it’s okay for her and her kid to stay here. I didn’t think she’d be here for years. Then I started using her car after mine broke down. I can’t get in her way. I can’t afford to.”
“And you’re not together?”
“Does she still try to have sex with you?” I ask.
The client makes a noise into the phone.
“You’re allowed to say no to people’s sexual advances.”
“Well that’s the other thing.” He said.
“Tell me more.”
“I’m a top. My boyfriend is a switch, but his only fetish is to top the top. I think if he tops me I might not be able to top again.”
“Does he try to start without asking?”
“Yes. He’ll give oral to me and slide down and then try to make it like it’s natural.”
“You can tell him he must ask. We can talk about how to talk through this. If you don’t want to do this you don’t have to.”
“I want to make him happy.” He said.
“We can talk about this as much as you want. There’s a variety of approaches. Remember, therapy exists to help you live the life you want. With the right help you can be living the meaningful life you’re allowed to have.”
“Next week?” I said.
“Yes.” He said.
Next week he’s fifteen minutes late. His speech is slurred. I tell him with less time we can do less meaningful work this session. He says it won’t happen again. I ask a question.
“Did something cause you to be late?”
“I didn’t sleep well.”
“Did you drink?”
“Not a lot.”
“Even one drink can affect your sleep.”
“Do you still think the birds can hear you?”
“Have you considered that you have some legitimate reasons to be paranoid? Fear of being outed is a real thing. Not everyone is so lucky to live out.”
“I have been trying to for a long time. It takes effort. Not everyone is safe out.”
“No. I accept the risk. Can you safely be out?”
“I don’t think so.”
“I agree. Can you tell me why?”
“If she finds out I’m gay she’ll tell my family. My family can’t know. They’ll never speak to me again. Her brother saw me out with my boyfriend. What if he assumes from just that? He gives me work. And my boyfriend has a husband. He’s coming home soon. Every time I see him it feels like we’ll never see each other again. He wants to top me before his husband is back.”
“Slow down. Let’s take this piece by piece. What did he see you two doing? People go outside together. Your boyfriend has a husband? What’s the long term plan?”
“Who do you tell?”
“No one unless it’s relevant.”
“He saw us at the grocery store. We like to cook together. My boyfriend’s husband has frequent business trips that can last up to a month. When we have time together we have lots, and when he’s back I can’t even text him. I spend nights with him when I say I’m doing Postmates. We want to stay with each other, but he’s in a green card marriage.”
“Once again, it sounds like you have legitimate reasons to be paranoid.”
“That doesn’t make it easier.”
“I didn’t say it would. I hope it does at some point. You have legitimate fears. I want you to stop worrying that you’re paranoid. You’re paranoid with reason to be afraid. What type of work does your roommate’s brother give you?”
“Who do you tell?”
“Are you committing a crime?”
“I help with lawn care.” He said.
We wrap up the session. I always have supervision the same day as my most difficult client. This was never intentional as my supervision schedule jumped around.
My supervisor invited me in. She is a rock in this very difficult time.
“What’s going on?” She says.
“My very complicated client situation has now become a Gordian knot.” I say. She knows about the birds. I want to help people who may or may not be hallucinating for a multitude of reasons. I can level with difficult clients. I once was a difficult client.
“The new boyfriend.”
“Are you still talking about consent?”
“Yes. And he finally explained his situation.”
“The boyfriend is in a green card marriage. The husband takes business trips. The boyfriend gets aggressive the sooner the husband is coming home. He worries the roommate will figure him out because her brother saw them at the grocery store. Her brother employs him sometimes.”
“Sometimes? What does he do?”
“Okay. And you’re sure everything is true and you’re okay?”
“Yes and yes.”
“You can admit you need more help or can’t do this. This is your internship.”
“I know. It’s important to learn your limits by going beyond what you perceive them to be.”
“Keep me posted. Don’t let this get to you.” My supervisor said.
“Thank you for this time.” I said.
He’s late for the next session. I am direct. He said he wants me to be direct.
“What went wrong? You’re only late when something goes wrong.” I state.
“He saw me texting my boyfriend.”
“My roommate’s brother. We were driving to the baseball fields on a job and he saw me texting.”
“Why does it matter that you were texting? What were you doing together?”
“This is how I get the coke.”
“Who did he think you were texting?”
“Hopefully my boyfriend. Worse than other confusion.”
“Do you really think he’d think that?”
“Is there really reason to believe he knows?”
“Do you know straight men that go to the grocery store together?” He asks.
He misses two sessions. He schedules and no call no shows both. I tell my supervisor I’m worried.
“Are you not telling me anything?” She asks.
“No.” I need my hours.
“Try to get him on the line again. If he drops off these things will happen. You can’t hold on to every client. You’ll burn out immediately.”
I worry. He reschedules. I called him at his appointment time.
“It happened.” He said.
“What happened?” I ask.
“All of it.”
“You’re going to need to help me here.”
“She fucking found out. Her brother did suspect it. She checked my phone. Her son beat me up and kicked me out. I pissed blood, man. I pissed blood. They told my family. Everyone lied and now they want me in AA. They say I can’t get help unless I try AA. I don’t need AA. I worry they’re gonna hurt him. What if they tell his husband? I tried to kill myself and I couldn’t even do that.”
“I’m so sorry. Let me know how I can help you right now. We are going to have to assess for suicidality today and in the next few sessions.”
“I’m good now.”
“I’m sorry. You can’t say you’re good now and just move forward.”
“I’m good now.” He said.
— Gwen is a writer based out of Chicago. Her book Sent to the Silkworm House can be purchased from Expat Press. Her writing can be found at Expat Press, APOCALYPSE CONFIDENTIAL, Prism Thread, and Rejection Letters.