“He had been able to sense for weeks that the man was holding back and experience and intuition had told him to wait patiently and that eventually the next step which he should take would be illuminated for him.”         

At first, he didn’t take much notice of him. That is to say, no more than the others. His 11am on Wednesday was one of a few new patients he took on that summer this due probably somewhat to chance and somewhat to the fact that an old professor of his was slightly ill and had started to decline taking new patients and began passing them off to him instead. This felt good as it meant more business and indicated a form of confidence in him from his former instructor and mentor. By and large the new patients were uninteresting. This type of bland value judgment may sound odd coming from a therapist but in reality, in this profession just as any others there are cases or tasks or jobs that are more interesting than others. Wednesday at 11 was near the bottom on the scale of interest. A middle aged, upper middle class white man, who worked somewhere in the loop as a lawyer. He had grown up in the northern suburbs, gone to U of I for both undergrad and law school, lived in Lakeview with a wife, two kids and two dogs. This was the extent of the personal information that had been disclosed to him into the end of their fourth session. Most of the talk had ranged from stories about family to stories about childhood or his parents (both of whom were dead) but nothing had constituted any sort of real diagnostic interest.

            This was not, however, wholly unusual. In fact, it was quite common, especially amongst this particular patient’s demographic, that the real purpose of their arrival and subsequent participation in therapy remain obscure and somewhat hidden well into the patient therapist relationship. This was attributed to many factors including but not limited to that generation’s preconceived impressions about therapy and the type of people who needed it, his sex, and lack of trust developing patterns. Either way, this fact in itself only seemed to add to the unremarkability of the patient and his anecdotes.

            His interest became piqued after five sessions. His Wednesday at 11am walked in, sat down and after the initial formalities and small talk closed his mouth tight and went completely silent. They sat there for approximately five minutes until the patient finally spoke again and said he had something to confess. At this point the therapist became fully interested. He had not previously noticed how uninterested he had been in the patient that day until hearing the patient suddenly assert that he had something to confess. It was only then that the therapist realized that he had been gazing out of the window of his office at was become an increasingly brooding or ominous cloud pattern. He only then noticed that his thoughts had not been on the patient at all but they had instead been about the possibility of inclement weather and his unpreparedness for this given the initial weather report he had read earlier that morning before leaving his home.

He had been able to sense for weeks that the man was holding back and experience and intuition had told him to wait patiently and that eventually the next step which he should take would be illuminated for him. The therapists particular style lent heavily towards allowing the patient as much time as they thought they needed to reach the level of comfort required to be able to divulge intensely personal details and things for which they had probably been harshly judged or ridiculed in the past even if only by themselves. This forthcoming confession too, fit with the relatively normal therapeutic progress arch that the therapist had become accustomed to in treating this type of patient with their myriad reservations about therapy’s effectiveness.

            The therapist obviously proceeded by telling his Wednesday at 11am patient that of course he was free to confess whatever he liked. He assured him that this space was safe and confidential and generally employed all of the tired old therapist tropes of trust and responsibility and safety without any type of pressure (Not to imply that this reassurance was invalid or in any way phony, only to acknowledge their lack of need of being vividly reimagined here again). This was not quite enough for the patient. He insisted that the therapist be sure that whatever he was told he would listen. The therapist quite reasonably began to become a bit suspicious of what he might be told due to the increasing weight given to the forthcoming confession by the patient. For whatever reason, though, he did not get the impression that the patient was a killer or someone dangerous in any way to the point where he would have warned the patient that maybe if this were something incriminating the therapist would be forced to report such information to the police. Feeling that this would have been enough to discourage the actualization of the confession, despite its being a mere formality, he forewent this possibility and simply reassured the patient that yes all was safe and confidential here in order to implore him to continue speaking. The patient was quiet for about a minute and then said “okay”.

            The patient proceeded to complain to explain that what his true problem was that he hated almost everyone in the world aside from himself. He confessed that he was almost constantly filled with and anger and hatred that he could find no to eradicate from himself. He had been to other therapists and none had been effective. He complained angrily and violently for the remaining 50 minutes of the session. His complaints were racist and sexist and vile in every way. He railed against blacks, Muslims, women, Jews, the church, the government, liberals, conservatives, the Chinese, Mexicans, the poor, the rich, kids, old people, big business, hospitals, the Japanese, the media, the Russians and anything else that can be thought of. He obviously painted with broad strokes as the full extent of his contempt for these groups of people could not fully be encompassed in the remaining 50 minutes of the session. At the very end when he got up he looked into the therapist’s eyes and said, “Thank you”.

            The therapist was shocked but not altogether confused by this. He saw that the man was angry and exactly what he had hoped would happen now had, he had been shown the next step that he needed to take. This went on for three more weeks almost without any comment. The pattern became essentially a formal greeting a mutually acknowledged silence followed by 50-55 straight minutes of racist sexist hateful complaining. While at first it had been shocking it now became slightly disturbing to the therapist. He was hardly able to get a word in during the sessions and was beginning to dread each upcoming Wednesday. This even to the point that on Tuesday nights he was often unable to sleep, and as he laid in bed staring at the walls listening to his wife’s snoring he could think of nothing but all of the racist, hateful, violent ideas that his Wednesday at 11 would bring to him tomorrow. It even got so bad that his Wednesday at 9am became basically just a precursor to his Wednesday at 11am to the point where he really barely focused on the problems or what the elderly widow was saying at all.

            Finally, when sleeplessness and disengagement and general feelings of anger became a bit too much to bear before each Wednesday, he asked his 11am if they might first reflect on what had happened for the last month or so. The patient agreed, begrudgingly. The therapist posited the idea that the patient had presented a lot of anger and that is was maybe a way to deal with some of the things he had experienced personally, it was perhaps a way to shift the locus of what he felt such discontent for outside of himself and place it into the much easier target of others. He suggested that while the outlet was okay for now, and when contained to this environment, perhaps they should begin to explore some strategies for dealing with these feelings. The therapist felt the patient freeze up at this and there was again silence. Finally, the patient said that he had tried all that, that for years he had worked on fixing his anger, on coming to terms with it, on figuring out the cause of it and working on letting go whatever he was holding on to. He had tried other outlets, art therapy, boxing, running, weight lifting, journaling, painting, drinking and meditation. Nothing had worked for him and this was his last attempt. He said he had warned the therapist, which was true, and that he was now here under the pretense that this was a place that was safe and he was able to use the time however he saw fit or best for himself. In fact, the patient said, that this was the first time in maybe his entire life that he had felt happy. That being able to come to the therapist’s office, even just once a week, and unfilteredly release all of the vile, disturbing, terrible thoughts had allowed him to craft a rewarding and fulfilling life outside of the office. The therapist could not help but notice how his own experience embodied the exact inverse of this, namely that he had been fine before he began seeing this patient but was now begging to suffer in his personal life from the dread of the anger imparted on him. He nonetheless agreed to this and told him if he wanted to use this as an outlet he could continue to do so partially because he felt some sort of moral or professional responsibility not to abandon a method of treatment that seemed to be effective for the patient nor to pawn him off on to a colleague. He decided that with the parameters of the relationship established he would be better able to contain the feelings he had if not to the session at least to Wednesdays.

            The therapist was wrong about this. The feelings of dread and despair and hopelessness he had seemingly only got worse and worse. While it used to be only on Tuesday evenings he dreaded his Wednesday at 11am he was now dreading the coming Wednesday almost the minute that the patient left his office Wednesday at noon. In addition to this he was constantly thinking racist, sexist and violent things when he was on the bus or lying in bed or speaking to a server in a restaurant or eating lunch or any of the activities which had now lost their neutral aspect. He even started to have arguments with his wife who was an obvious and easy target for him on which to take out some the aggression that he now bore in response to continuing to see the patient. On top of all this, the therapist being the deeply principled professional he was, told no one about the patient, or about his hateful ramblings which further sunk him into the loneliness of the ideas that he was essentially a soundboard for and left him feeling even worse and more isolated and eventually angry.

            This went on for another 4 weeks before the therapist, sleep deprived, totally absent from his work and home life and angry and frustrated with himself and everyone around him finally decided he could not take it anymore. It was a Tuesday afternoon which had become a time of particularly strong anger and hatred and anxiety concerning what was coming the next morning at 11am. The therapist looked his patient’s information up which in itself constituted a breach of professionalism. Despite having used a fake name he was able to figure out from a firm name and a profile by picture who he was and the address of his law firm. The therapist left his office and got on the purple line towards the loop. He arrived there and looked around the building for a while. He stared up at the glass tower and walked into the front lobby. He waited until the desk attendant was speaking with someone else and followed a woman into the elevator. He got off on the 32nd floor and the law firms office was behind two glass doors on the north side of the building. He walked to the south side instead which was a long hallway until he found a janitor’s closet which was locked. Instead he found a bathroom and went inside and pulled the metal trash can out of its spot in the wall. The therapist walked back to the north side of the building and opened the two glass doors of the law firm. He walked past the secretary despite her protests and walked into the office of the patient. He was sitting on the phone at his desk and looked shocked to see the therapist. The therapist walked past him and threw the trash can through the window on the back wall sending shards of glass falling along with the snow onto north Michigan avenue.

Jack Madock