Dr Judith Guedalia

'Do You Have A Moment To Discuss Something With Me?'
It was late in the afternoon - well, early in the evening, and my last patient had canceled. I am grateful that I love my work, but also relish those "found" hours when someone needs to cancel, and the spot is not filled.
 I was sitting in the office peacefully getting some paperwork out of the way when the phone rang. "Do you have a moment to discuss something with me?" And without waiting for my response, she said: "My seven-year-old has been thrown out of school, I need an emergency appointment as they won't take him back without an evaluation."
 What could a seven-year-old have done to cause such consternation and dire response?
 So this is where I made my first mistake (in this conversation). I asked what happened to make the school so angry with him. A bit on the defensive, the mom said he had a fight with another boy. Too much anxiety and sniffles about a "fight with another boy." So I ventured further (continuing error of blithe conversation too late in the afternoon). "What got broken?" I asked in an easy-going manner. More tears and whimpering on the other side of the phone when she said: "A chair and the other boy's skull and nose." "Oops," I said to myself, "looks like you got in too-deep too-soon; let's try to get some distance from the present" (i.e. get away from this immediate event and get a broader picture).
 Taking what I thought was a different tack, I asked, "Do you have any experience with anyone else in the family, whose behavior resembles your son's?" Now she frightened, "How do you mean?" she asked. Well, I ventured, "letting anger get out of control and responding physically." She was quiet a moment and I took this as a positive sign that the conversation was becoming more rational, when she let out a primal wrenching cry. "My nephew murdered my sister" a few years ago."
 Whoa, this mild-mannered conversation has become a downright stampede of fears and emotions. "How old was he at the time?" "Fourteen years old," she answered, breathing heavily and painfully over the phone.
 "Okay," I said with a bit more levity than I felt, "We have at least six years to get your son help. And that's if he is as problematic as your nephew, which in all probability he is not." (So, I may have lied, but I'm not a neviyah [prophetess] and a little modesty was in order!)
 I suggested that she call her husband, and I'd wait for them at the office, so that we could talk about the school situation of her seven-year-old, without infecting the conversation with a horrible tragedy.

 Within a half-an-hour the couple was in my office. (Once he heard his wife's choked tears, there was no question that this was a drop-everything-and-come-to-an-urgent meeting). I used that time to go down to the cafeteria to get some juice and cakes, hoping to reduce cathexis from the "space" (psychoanalytic term relating to great concentration of emotional energy on one particular person, thing or idea.)

 What seemed to have happened, was a confluence of events which made the mom very vulnerable from the start; the phone call "after-hours" contributed to my being overly "relaxed," asking questions without any means of seeing or understanding the person's reactions, and the outcome had led to the slippery slope with "leaked information" that needed to be" "collected," so that the couple could leave with a measure of strength and dignity to get useful help in the near future.
 This would be different from the situation now, where we all got into a horribly traumatic topic too deeply and too quickly to make the experience anything but painful, destructive and devoid of therapeutic purpose.
 I gave them the name of a male colleague and suggested they go together first and discuss ways of their taking charge of helping, their only seven-year-old son, resolve some of his issues.
 We shook hands, and they left the office. Whew I breathed a sigh of relief, and called my husband and said that I needed to go out for dinner to give myself some space before going home. I said I had had a difficult meeting, and since this was a rare event, he readily acquiesced.
 We agreed to meet at a restaurant near our house. Just as we were being shown to our table, I heard a familiar gasp. I turned and saw that couple. They looked at me beseechingly, and I said to my husband that I had changed my mind and preferred to eat at home. He looked perplexed, but when he saw my resolute expression, and we left for the quiet safety of home.
Originally published in the Jewish Press on September 6, 2006.

Tags: Cathexis | Jewish Press