Sychronicity

“We plan our lives according to a dream that came to us in our childhood, and we find that life alters our plans. And yet, at the end, from a rare height, we also see that our dream was our fate. It's just that providence had other ideas as to how we would get there. Destiny plans a different route, or turns the dream around, as if it were a riddle, and fulfills the dream in ways we couldn't have expected.”

Ben Okri

I saw Tommy again today and am continually amazed at how well he seems to be holding up. I realize that a great deal of the damage that has been done to his psyche is still buried deep inside of him, but he has begun to talk about it, and if we can talk about it I can reinforce in him that it wasn’t his fault. If he can begin to internalize this, the intense guilt and shame most victims of sexual abuse feel may be at least partially neutralized. Much good came of his talking about what happened so soon after it happened, as now we can process this “secret” and not allow it to become buried deep in his unconscious and destroy his life.

There is much work still to do, perhaps a lifetime’s worth but we have started, and he is incredibly resilient. His strength has made me strong, and I hope he has also drawn something from me. I am beginning to feel responsible for him, and he is pulling a very strong paternal, nurturing feeling from me. This is dangerous. Although he absolutely needs a strong, familiar presence in his life right now, I have to be careful not to create a relationship based on dependence, for him or for me.

Later that night I go and see Darren, my patient who is a musician play a big show he has been looking forward to for quite some time. He told me it would mean a lot if I came to his show and so I came, but this too is problematic. Perhaps I am becoming to attached to my patients in the absence of any significant substance in my own life. This is something I want to think over and consider.

The issue here is one of boundaries. In a therapist’s office two people discuss some of the most intimate moments in a person’s life. The job of the therapist is to first build a powerful relationship with this person, and model, through this relationship, skills that the person can then take back to their lives. The therapist is not supposed to literally return with the person to his life.

Attending a concert of a patient certainly walks this line. Although we have a very easy-going therapeutic relationship, it is still ethically questionable. I went to this show with the intent of showing support and seeing someone I believe in realize a dream. I have always thought some of the ethical rules concerning this kind of thing were a little rigid and even silly, but at this point in my career I am in no position to be playing cowboy with the rules. I have to make a real examination if I am using my patients to fulfill some of my own needs related to loneliness and a need for companionship. I will give this some serious thought.

But sometimes you also have to throw the book out the window. In the case of Tommy, he needs an advocate, a friend, a surrogate parent, as well as a therapist. I am well aware that I am perhaps over stepping my bounds by trying to be all of these things for him, but I want to at least see him through a few weeks before I start thinking about the implications of this. I know all too well how children can get lost in the system. I myself was lost in the system. The sychronicity of this does not escape me. Tomorrow I will make another appointment to see my therapist.