Lillian Rubin - The Man with the Beautiful Voice: And More Stories from the Other Side of the Couch

Its my first day at the clinic where Im about to begin my internship, the necessary prelude to getting licensed as a psychotherapist. A momentous day for me, routine for everyone else, so theres no fuss or ceremony to welcome me on board. Instead, after a brief meeting with my supervisor, who tells me how he expects me to be prepared for our biweekly sessions, a secretary shows me to the office Ill use, tells me how to get an outside line on the phone, points out the panic button on the wall just to the right of my chair, and leaves me with the chart for my first patient, a twenty-eight-year-old man named Mike who, according to the intake report, suffers from acute anxiety.

Im excited as I lead him down the hall from the waiting room to my office, eager to begin this work Ive chosen. Hes tall, probably a little over six feet, good-looking in a rugged sort of way, his square face, lined beyond his years, framed by unruly dark hair, his eyes an unreadable smoky black. He hesitates when we walk into the office, looks around as if wondering what hes doing here, and for a moment I think hes going to turn and leave. But he takes my cue when I point to a chair and drops into it, slouching down so deeply that his neck is invisible and his head seems to sprout directly out of his shoulders. Despite the warm spring day hes wearing a bulky down jacket, which he keeps zipped up to his chin, and his hands are jammed into his pockets as if glued there.

Ive read plenty of books, taken lots of classes, but none of them really prepared me for this moment, the first time I would sit in a room with another human being and think, Oh my God, this is it; somebodys life is in my hands.

I learned in my training that I must wait for the patient to begin the session, that how these opening moments are navigated, what a person chooses to start with, tell a therapist a lot. But no one ever told me what to do when a patient sits across from me immobile, except for a slight eye tic, and stares with an intensity that feels as if his eyes are boring holes in my head. I shift around in my chair, uncomfortable, off stride, my fragile confidence ebbing as the silence in the room becomes too heavy to bear. I know it has meaning; I know I should wait, but theres something vaguely menacing about the silence, and the minutes begin to feel very long. So I finally ask what brought him into the clinic. He shrugs but doesnt speak. I try another tack and ask him to tell me something about himself.

His eyes flicker away and, talking down into his jacket so that I have to strain forward to hear him, he volunteers only that hes a student at the university and also works part-time but has just been fired from his job.

Do you want to talk about that? I ask.

Hes agitated, but not enough to raise any alarms, as he tells me that his boss is an asshole, that he was always looking to get me on something, and that he finally found some fucking excuse to fire me. The motherfucking asshole was out to get me from the beginning, he concludes.

Im not sure what, if any, response to make, so I ask, How are you doing in school?

He looks at me warily, Why are you asking me about that?

Taken aback, I think for a moment. Ive been taught that I should turn his question back to him by asking what about my query is a problem for him. But something tells me not to do it, that my only chance with this guy is to answer him honestly, so I say, Because the two things you told me are that youre a student and that you were fired from your job. Clearly the job part of your life hasnt been going so well, so Im wondering about the school part.

He looks somewhat relieved and, although still tense and uncomfortable, begins to talk a bit about his life at school. Hes apparently an apt student, not top of the class but good enough. Some days, he says, he feels okay about school; other days he doesnt.

So far, so good, I tell myself, pleased that he seems to be opening up. Any idea what happens on the days you dont?

His agitation returns, How the hell should I know; its because of them.

Who?

He retreats to silence, only this time he isnt staring at me. Instead he looks like a trapped animal, his eyes darting around the room, his body suddenly upright and tense as if on guard against an attack. I wait a few heartbeats then say, You look upset. Do you want to talk about it?

What for? he growls. You wont believe me either. Nobody believes that theyre after me, but I know theyre there, just waiting.

Try me, I say encouragingly.

But by then hes gone, unable to hear anything but whats going on in his own head. He continues to rant, his words soon becoming an incoherent stream, while I sit transfixed, my thoughts leaping around uselessly. This guy is really crazy. So what did you think, that youd be seeing only sane people? Never mind that, what do I do now? Before I have a chance to figure out my next move, he pulls a short-bladed knife from his pocket and slams it repeatedly into the arm of his chair while screaming about those motherfucking bastards and promising to get them.

Im afraid to speak, afraid to move, afraid to sit still. After what seems like forever but is probably only seconds, I remember the panic button, reach down, and push it. Almost immediately two men storm into in my office and are all over Mike.

I hear later that they took him to the inpatient ward, where he was diagnosed with paranoid schizophrenia (a diagnosis that doesnt bode well for a return to sustained normal functioning) and held for treatment. Which means essentially that hell be medicated and kept there until he shows no more obvious symptoms, then released. The rest is predictable. Once out from under hospital supervision, hell most likely stop taking the medication that stabilized him, complaining that it makes him feel like a zombie (which is probably true when compared to his highly energized paranoid state), and pretty soon hell be back again in a continuing cycle of hospitalization and release.

When the chaos in the clinic subsides, Im summoned to meet with my supervisor, a seasoned psychoanalyst. He listens closely to my detailed recounting of the session, then chastises me for breaking the rule that says a therapist should wait to see whats on the patients mind before speaking. Its a technical error that can have serious consequences for the course of therapy as I hope youve just learned.

A technical error? The language chills me. A mistake in an architects calculations of the strength of a weight-bearing beam, the wrong command to a computer that brings up the dreaded fatal error