Everything you’ve ever wanted to know about your therapist but were afraid to ask…

As a clinical social worker and intuitive psychotherapist, I am, at times a mystery to some of the people I know best.  I’m also aware that, with the pending publication of my memoir The Boy who Birthed me, that is about to change dramatically.   Facebook and Twitter posts have begun to pave the way for a transition and certainly this blog has the potential to become very revealing.  But I ease my way into such new territory consciously and deliberately.

I am, after all, a real human being. Perhaps the model of the therapist as an elusive yet warm holding place for an otherwise real person has been useful at times.  Still, I believe that it is in our authentic connections to one another that real healing exists.

So here are some of the goods:

Ahhh, the sofa!

Ahhh, the sofa!

  • Most of us have sat on someone else’s couch.  On the rare occasion, some of us even sit down for a good cry on our own couch (read below, “Saying Goodbye to Willow”). It’s true, none of us are without human issues, problems or traumas.  Many of us were offered free counseling as part of our Master’s program, some of us were even required to be the “client” as part of our training.  Others of us have unearthed life challenges as we’ve made our way into the therapist’s chair, and some of us continue to work through our own “stuff.”  Many of us have our own history of mental illness or have close family/friends who suffer in this way. Sometimes, it’s what makes us better at what we do.
  • You aren’t boring me and I don’t secretly think you’re pathetic or crazy.  I only raise this because it’s a concern that has been raised again and again.  The truth is, I do this work because I find it meaningful, stimulating, and healing.  To me, “crazy” or “pathetic” are not lined up with my desire to practice compassion and are much more an indication of one’s underlying insecurities (and yes, we therapists also have our share of those).  Once in a rare while I come to work tired, just like the rest of the world, but if you catch me yawning it’s because both of my kids had nightmares last night, not because my attention is elsewhere.
  • I want you to tell me when I slip up.  No one does their job perfectly. I pride myself upon being a solid, clinically skilled therapist with a lot of integrity.  Still, I sometimes miss the boat.  I want you to tell me when I’ve not been helpful, got it wrong, made a suggestion that didn’t serve you, or moved too quickly into territory for which you felt unprepared.  My commitment truly is to “First, do no harm.”  But if you ever experience hurt as a direct result of something I have said or done (back to the “I’m human” thing), please give us an opportunity to work it through together.  We may find that the outcome is more purposeful then either of us could have imagined.
  • Transference and counter-transference happen.  It’s why the phenomenon has its own name.  Transference is characterized by a (sometimes unconscious) redirecting of feelings from one person or issue onto another.  Sometimes clients perceive me as the “loving mother” or imagine I would make the “perfect mate.”  I have also been experienced as the “best friend I wish I had” or the “appreciative adult daughter.”  Likewise, sometimes clients remind me of my father or my 1st grade teacher or my son-in-fifteen-years.  Usually, these incidents of transference or counter-transference are great opportunities for learning.  I have developed an ability to be lovingly with you during difficult times without having to own your experience or take it on as my own.  This boundary is what enables me to offer you quality counseling without “burning out” or becoming so depleted that quitting the work I love is the only option. There are, however, times when I am invited to pause and see what of “my stuff” may be interacting with yours.  It’s a creative and intriguing dance in which, like all dancing, balance is the key.
  • We can’t be friends outside of therapy.  That wasn’t meant to sound harsh.  It’s just that, as much as I would love to meet you for lunch or have you over for a cook-out, if I became one of your friends I would lose the objectivity that makes me your therapist.  Your friends offer support, perhaps loving guidance.  But in the end, you needed a therapist which is why you sought me out.  If I became your friend, I would be doing you a great disservice. I would lose my perspective.  I would serve you better if we explored the longing that lies beneath that beautiful example of “transference.” (see above)
  • I really do care for you.  That wasn’t meant to sound creepy.  It’s just that, you share so much of yourself with me, I can’t help but feel love toward you.  It’s not a weird, inappropriate love or one without boundaries, it’s just a natural sense of loving kindness. Your willingness to experience your own humanity in my presence is a beautiful gift.  So thank you.

What else do you want to know? Seriously, ask away, and I will do my best to answer honestly and with the appropriate boundaries.  Now, please excuse me while I go have a good cry on the couch.

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Saying Goodbye to “Willow”

Sleepy Girl

Sleepy Willow (11 years)

Saying Goodbye to Willow

~A Story of Loss & Hope~

by Valerie R. McManus, originally posted 6/2012 (family members names have been changed)

I didn’t expect my children’s grief to be so…beautiful.  I expected the typical stages; denial, sadness, anger and so forth. But the raw openness and emotional insight of my five and eight year olds during these past few days has me awestruck.

At her well-dog veterinary appointment shortly after her tenth birthday, “Willow” appeared in perfect health.  Her enthusiastic demeanor in the exam room always delighted me, as did so many other things about her.

At our first meeting, Willow came bounding out of her breeder’s home as if being chased by bees.  Andrew and I stood there, stupidly, arms outstretched, eagerly waiting for her to come crashing into our arms, licking and nipping as all good puppies do.  Instead, Willow raced by us completely.  She hurtled her fat baby body over the side of a pen housing a half dozen other smaller puppies.  Within a minute she had pinned a small brown squirming fellow under her left paw and was chewing happily on his toy, which was held beneath her right paw.  Andrew and I looked at each other and burst out laughing.  “I love her,” Andrew said, proud beyond measure.

As a puppy, Willow was typically rambunctious, frisky and highly energetic.  She was affectionate and always unconditionally loving. But she had more than just those usual Labrador traits, she had color.

As Willow grew, she became confident and determined, dragging enormous branches and pieces of broken fence up to our backyard with pride. In true lab form, her love of swimming surpassed anything else and she often drew a crowd at the neighborhood lake.  Willow’s backside would wiggle with anticipation before she took a running leap into the cool water.  Her belly flops created enormous splashes and brought peals of laughter from children and adults alike.  On the rare occasion that she did not immediately locate whatever object we had thrown in for her retrieval, Willow would swim in big circles with determination, searching unrelentingly until she found a worthy piece of driftwood to return to us on shore.

When our eldest child, Ethan, was born, three-year-old Willow was immediately smitten.  Her intense desire to lick him incessantly was matched only by our desire to keep her from doing so!  On several occasions, she would find him briefly unattended in his bouncy seat and steal as many laps up the side of his face as she could before we returned.  Ethan’s birth was a traumatic one and he came home with us still recovering from birth injuries.  Willow kept watch beside Ethan’s crib on many nights, eagerly coming to our bedside when he began to cry.  If we did not move quickly enough for her, she would sit at our feet, staring at us intensely until we rose to tend to him.

By the time our second child, Alexa, was born, Willow and two-year-old Ethan were fast friends.  Ethan would often lounge beside Willow, ruffling her fur or laying his head across her front paws.  Willow responded, in turn, by following Ethan from room to room, often sleeping beside his big boy bed, gently responding to his playfulness.  The two were inseparable.

As Ethan got older, he became typically fearful of dark places and of going into the basement alone.  Willow was his trusted security guard.  As Ethan ran towards the staircase he’d call for her, “C’mon Willow! Want to go downstairs!?”  Willow would bound behind him, keeping him company, keeping his fears far at bay.  Her presence gave him a sense of courage and confidence that was, internally, “under construction.”

As she aged, Willow slowed down, as dogs do.  During Willow’s ten year physical, I asked Dr. Kane, casually, to talk to me about her impressions of Willow’s life expectancy.  “Most labs live an average of 12 years,” she stated matter-of-factly.  I felt momentarily shocked, “Yeah, but, look at her.  For Willow you probably think maybe 12-15 years old, right?”  Dr. Kane smiled, “On occasion a lab will live that long, but the average is twelve years.”  I shrugged; mostly unfazed as we returned home that afternoon, confident that Willow’s current state of supreme health was a certain indicator of the longevity to come.

It was only a few months later when we noticed that the cyst to the side of Willow’s neck had grown considerably.  When our vet decided it would be best to have it removed, we agreed.  Our surprise came when, routine blood work showed that Willow’s outside demeanor did not match her internal health.  Willow was quite anemic, her kidney’s appeared to be declining rapidly and her liver enzyme levels determined a rapid weakening in health.  Andrew and I were jolted with the news that our seemingly healthy vibrant pup was actually in the end stage of her life.

The kids took the news of Willow’s sickness fairly well.  There was no immediate cause for alarm as we were going to have her monitored closely.  But a few minor changes to her lifestyle quickly became major ones.  Willow’s scratching at her cyst, now inoperable due to her blood work, caused bouts of bleeding.  A plastic cone soon gave way to a blue inner tube, placed around her neck to prevent her scratching.  And it was only a few weeks before Willow could barely make it around the block without collapsing on the floor with exhaustion.  She detested her new “renal health” dog food and began limping on occasion.

During this time, we did not hide Willow’s condition from our children.  Calls to our veterinarian were made within earshot and when visitors noticed Willow’s diminishing energy we acknowledged out loud, “Yes, Willow hasn’t been feeling too well.  She’s quite old and some of her organs aren’t working properly anymore.”

Of course, Alexa and Ethan had also noticed Willow’s change in demeanor; she got up less frequently to greet them, and was not nearly as energetic.  Despite her ever-wagging tail, Willow barked for support when coming upstairs at night, she ate slower and less often.  She drank more and her interest in her favorite activities was near non-existent.  They watched me plead with Willow to take her pain medication as I crushed it into peanut butter or salmon flavored cream cheese or pressed it into slices of bread or cheese.

Then one morning, Willow couldn’t stand up.  Andrew carried her out to the yard and back again.  My heart plummeted into my stomach, knowing we needed to make the call to Dr. Kane’s office.  At the breakfast table Ethan commented, “That’s so sad that Willow can’t walk around.  What is she going to do?”  Alexa concurred mournfully, “Poor Willow.”  I sat down at the table and took a deep breath, “Guys, we all love Willow so much and we don’t want her to be in pain.  She’s gotten sicker over the past few weeks and soon it’s going to be time for us to let Dr. Kane help Willow die.”  Ethan’s eyes grew wide, “Okay, but not now, not today!” Ethan pleaded at the breakfast table, “I don’t want to talk about it now.”  Stage 1; Denial.  Alexa stared at her brother silently, sighed deeply and resumed eating her breakfast.

After seeing the kids off for the day, Andrew and I reminded each other of our earlier promise, we would adhere to objective indicators so as to resist the temptation to let her live too long.  I tearfully called our veterinary office and scheduled Willow’s euthanasia for the following evening.  That afternoon, Andrew and I called Ethan and Alexa into our family room for a talk.  “You both know Willow isn’t doing well.”  Ethan slumped into the sofa and I continued, “She can’t walk and she slept downstairs last night for the first time ever because she was too weak to come upstairs.  She hasn’t eaten much at all for the past few days and her organs are sicker.”  Ethan interrupted, “I don’t want to talk about this now.”  Andrew interjected, “But we have to, buddy.”  Ethan took a breath and I resumed, “I spoke to Willow’s doctor today and she said that it is time for us to help Willow die.”  Ethan sat bolt upright, “When!?”  Andrew put his arm around Ethan, “Tomorrow evening.”

I tried to pause, to just give them a moment to digest this, but found I couldn’t.  I rushed forward not wanting to make room for my children to fully experience the pain I knew was coming, “If you’d like, we’ll pull Alexa’s mattress into Ethan’s room tonight.  Daddy can carry Willow up to sleep in the room with you.  Then tomorrow, after camp, we’ll have some special time together with her to say goodbye.  You can feed her some of her favorite foods and you’ll have time to talk with her and pet her.  We can even make paw prints with an ink pad.”  Ethan’s eyes turned red and watery and he smiled, “Yeah, okay, let’s make paw prints of her and feed her candy.”  Alexa jumped up and sat down beside Willow on the floor, “Take a picture of me and Willow, Daddy.”

That night at bedtime, Alexa suddenly erupted into dramatic wails, “I don’t want Willow to die! I don’t want Willow to die!”  She sobbed over and over collapsing into my arms.  “I don’t want Willow to die, either, baby.”  Alexa articulated the depths of her heartbreak, “This is too much! I can’t handle this.  No one in my family has ever died.  It’s too much for me to handle.  Willow can’t die…”  In between her spells of crying, Andrew and I reassured the kids that this was a normal way to feel when someone we love dies.  We explained that the pain would not always feel this way and that her sad feelings would lift over time.  Alexa appeared relieved, “Really?  I won’t always feel this sad?”  How we often take for granted the underlying confidence that experience brings.  Stage 2; Pain and Sadness.

Ethan remained silent while his sister wept.  His eyes were red and tearful as he explained, “I feel like I need to really scream and cry so bad but I just can’t make it come out. “  He looked over at me with a grin, “Mom, make me cry.”  We laughed briefly before I answered, “Sometimes there is a part of us that isn’t completely ready to feel all our sadness.  It’s how your body protects you until you’re ready. That happens to me sometimes. I feel like I need to cry but I can’t.  When I tell Dad, he always says to me, ‘Do you want me to punch you in the nose?’”  The four of us laughed before another wave of despair hit Alexa and she howled into the room.  Andrew and I switched places, him sitting with Alexa on her mattress and me up on the bed.  I turned to Ethan as Andrew soothed our daughter, “You know, it’s okay.  Anything you feel is okay; even if it’s nothing.  And when all of you is ready, you’ll be able cry as much as you need and we’ll be here to help you through it.”  Ethan rolled from his back onto his side to face me.

Wednesday morning I dropped the kids off and returned to the car.  There I began to sob.  The windows were partly open but I didn’t care about people walking by me through the parking lot.  I took the day off of work and spent it walking around the house aimlessly, sitting with Willow, carrying her upstairs for a bath, laying with her on the floor, taking pictures, talking to her, walking around directionless and back to Willow.  The day dragged on and yet it rushed by too fast.  There never seemed to be enough time.

Just before ducking out to get the kids from camp, I dug out the rainbow colored ink pad from the barrage of art supplies stashed in my basement studio.  Willow sat patiently as I pressed her paw over and over from ink to paper before smoothing the remaining ink off with a paper towel.  Her tail thumped a couple of times before she began to doze.

Andrew arrived home and was immediately on the floor beside Willow.  He pet and talked to her before meeting me in the kitchen.  We stood beside the large dry-erase board colored with a list of all the things we plan to do as a family; Camp at Yosemite, Lego Land, Visit Ireland, Hike in Zion and Denali National Parks, ride Elephants, make our own ice cream…Our eyes meet, tearful.  Andrew popped open a marker and jotted down, “Kill dog.”  We broke into peals of laughter before he quickly erased the addition, both of us stuck between the joy of connection and the pain of loss.

After dinner, my aunt and uncle accompanied the kids and I outside, while Andrew carried Willow to the car.  Alexa climbed up the back of the SUV and perched herself beside Willow. Ethan leaned in, his hand outstretched.  Again, Alexa bawled her discontent while Ethan cried without sound.  “Willow can’t die! It’s not fair, I didn’t have as much time with her as Ethan did!”  Stage 3; Bargaining.

Dread waved over me.   Neither Andrew nor I wanted to tell our children to say a final goodbye to their dearest companion.  We allowed them a few extra minutes. “Okay guys, we have to say goodbye now.  It’s time.”  Both kids gently brushed their hands over Willow’s fur for the last time and whispered their goodbyes.  I pleaded with Andrew, “Just get in the car and let’s go.” The kids watched from the front step as we pulled down the driveway.

Lifting Willow out of the car, there was a whimper.  Andrew looked to me, “Did you hear that?” I sighed, “She’s ready.” Andrew nodded his agreement.  When Dr. Kane entered  the examination room, she pulled back Willow’s upper lip, examining her gums.  She frowned, “Wow.”  She looked over to us with a softened face and kind eyes, “You’re doing the right thing.  Her anemia has gotten worse and her gums are pale and tacky.  It’s the right time.” As Dr. Kane spoke I notice Willow staring at the wall behind me.  I looked several times to see where her intent gaze was resting but found nothing but a poster of the internal workings of an average dog.  Yet it is as if Willow was looking at someone, seeing something I did not, her neck straight with unwavering interest.  I thought silently, “Whoever is coming for her, must already be here.”

Dr. Kane sat with us, explaining the procedure and answering questions as we cried.  She was patient and tender and her words floated around me like a mother’s hand against the forehead of a sick child. When it came time to inject Willow with the anesthesia, Willow was calm and wagging as always, happy for all the attention. Andrew and I sat poised on either side of her.  Within a few seconds of the initial injection Willow’s gaze changed, darkening, and she let out a deep sighing snore.  The assistant technician gently laid Willow’s head on the floor and moved back gingerly. Andrew scooted in closer to Willow, continuing to coo his praises at our sweet puppy.  Dr. Kane quietly informs us, “She’s asleep now and she’s doing great so I’m going to continue and push the rest.”

Sobs shook my body as Willow’s eyes glazed and her breathing stilled.  A brief flutter of anxiety swept over me, “Omigod, is she dead?”  Dr. Kane withdrew the needle and began to take out her stethoscope, nodding, “Yes, I think she’s dead now but I’ll check.”  It amazed me how she could make such a statement sound so warm and soothing.  I wanted her to keep talking and never stop.

Dr. Kane pressed the instrument into Willows chest and belly and then lowered it.  She rested her hand on my back and confirmed Willow’s passing.  “Are you okay?” She interjects between my sobs, “Yeah, I’m okay, but I’m just so sad.” My voice sounds like that of a five-year-old. Andrew wiped at his face and I tossed him a tissue.  Dr. Kane grabbed me in a big hug and tells me how sorry she is.  “You did the right thing for her. I’m so sorry for your loss.” When we are ready, Dr. Kane left the room so we could somehow digest this by sitting with the body of our once lively friend.

“It’s so strange. I’ve never seen anyone I knew and loved dead before.”  Andrew nodded and we murmured quietly over Willow’s still form, both of us petting her soft fur. After a few minutes, we headed out to the parking lot.  Andrew pulled me in for a hug and we stood beside the car this way, crying. I savor Andrew’s comfort but, in that moment, was washed over by an intense desire to embrace him in the same way.  I wished I was six and a half feet tall. “It’s so weird to go home without her.”  Andrew opened the car door for me and I blubber loudly as he walked around to the other side.

When we arrived home, the kids were playing in the court.  Ethan was dressed in his red ninja costume and Alexa was running back and forth on the sidewalk, beaming a smile.  We were greeted warmly by my aunt and uncle as the kids ran up the driveway.  Ethan began to tear up and Alexa crumbled into wails, remembering where we’ve been.  Ethan turned away at the sound of his sister and hurried back down the driveway.  He did not stop running until he was more than half way around the court.  I watched him, from a distance, karate-chopping the air like the Zen master of his imagination.

Once back inside Andrew was tearful again, recalling how, when turning towards the front door, he had expected to see Willow laying there.

That night, Alexa gracefully moved further into the next stages of grief, crying and yelling, “It’s not fair, it’s not fair! I should have been born earlier so I could have more time with Willow…”  Stage 4; Anger. Alexa slammed her pillow up and down on her bed. I encouraged her to tell me how mad she felt and show me with her body.  After a few moments she collapsed onto my lap in a quiet heap.  In Ethan’s room, the tone was somber.  He had little to say and instead snuggled close to me. He sniffed a few times before falling asleep against my belly.

Thursday morning felt strange, empty.  There was no one clobbering down the stairs with us, no one to let out into the yard, no dog dishes to fill and no one pushing her way among our feet while children’s voices bellow, “Willow, get our from under the table!”  Still, the kids were cheerful at the table and it was not until I was buckling Alexa into her car seat that I saw her teary eyes and quivering lower lip.

After camp I took the kids to the movies, delaying our return to a hollow house.   Near the end of the film, a wave from Ethan’s arm caught my peripheral vision. I glanced over to see him wiping away tears streaming down his cheeks.  I ran my hand from his forehead down the back of his head, slowly.

The past few days have felt like an eternity.  We’ve washed bedding and vacuumed the carpet.  Andrew sniffs as he peels layers of Willow’s hair from our lint catch in the dryer.  I lie in the hammock and cry at the strange cavity in the yard.  It’s going to take time for the pain to lessen.  I know this and yet the gloomy abnormality overtakes us all easily.  And I’m honored to be gifted with this family; proud of how we wrap ourselves around each other in a private embrace.

For now, Alexa’s pain appears to have lessened as her head-first dive into loss has now brought her back to the surface.  Ethan’s grief is different; softer, slower.  He dances lightly from a brief, incomplete sorrow to denial and back to melancholy again, bumping up against devastation and then quickly diverting it’s unfolding. I dream of Willow nightly, of her romping during her prime, of pressing my face into her velvety fur.

And in all the sorrow of this loss, there are things that give me comfort. The kind words of friends and family, the knowledge that Willow was loved well and was well-loved, that her life was meaningful and strengthening and taught myself, Andrew and my children invaluable lessons about compassion and friendship.  But most of all, I’m grateful that Willow died as she lived; with a rainbow colored paw.

Willow

Willow