Psychotherapy Blog

 

The No-Fee Session

Posted by Simon Yisrael Feuerman, PsyD, LCSW on 5/20/14 - 11:15 PM
I live in a neighborhood in New Jersey where people say hello to one another in the street even if they don’t know each other well. One man stood out for me in the many years I am living here: He doesn’t say hello even though he sees me several times a week. He doesn’t even bother to nod his head. I could never understand what I had done to him, but I just felt as if he hated me.

One day not too long ago I was surprised to get a telephone call from him. “I really need your help, he said. “I need to talk. My son who is in his early 20's punched me in the face – lightly, but still a blow.” I understood very quickly that though he wasn’t injured physically, to be attacked by one’s son had to be a trauma. I gave him an appointment – a midday hour the following day and he showed up at the given time.

He went into detail about the incident and asked me all kinds of questions. His main purpose was to be helpful to his son, get him “the right medicine” as he called it. He wanted to know who I could recommend that might “help him.”

“Does your son feel he has a problem,” I asked.

“No, he thinks I have the problem.”

And then the man gave even more detail about a long and somewhat tortured relationship with his wayward son. “I could never give him what he needed.” He described his son as “lost and adrift” and again asserted that his son was in great need of “psychological help.”

“What does your son want from you?” I asked him.

“I don’t know,” the man said. “I don’t think I ever knew. All I know is that I have got to send him somewhere to get help.”

I can’t put my finger on exactly when, but I had the distinct feeling somewhere within the first 20 minutes of the session that this man had no intention of paying me for the session. He was going to take and take. He asked question after question about my experience. He sighed and talked, sighed and talked. The idea occurred to me that just as he had failed to say hello to me all these years and perhaps just as he had failed to give to his son, he would fail to give to me. Although it was hard to tell from one session, it seemed that he had little interest in knowing anything about himself and evinced even less interest in knowing something about his son. He wanted a 'solution.' At the same time as this realization dawned on me I threw myself into the work, giving him the best possible session I could give, listening and feeling the feelings as if he were giving me a million dollars.

As I listened to him, I saw the lines of trauma etched on his face. He was 57 years old, but looked somewhat older. I caught a glimpse of him as he walked toward my office. He didn’t walk so much as trudge as though he were walking through invisible snow drifts even though it was summer. Further discussion revealed that he was the son of elderly holocaust survivors. His relationship with neither his mother nor his father was what you would call “loving” or even “pleasant” in his words. “They are very bitter, un-giving people,” he explained. Apparently, he had inherited and internalized one thing from his parents: the idea that “nothing good can or ever will happen to you” and he lived his life accordingly, investing as little as he possibly could get away with.

It was not long before the session time was used up and beyond. Even as I rose to signify the end of the session, he remained seated, being both talkative and acquisitive. It felt that he was trying to extract as much as he possibly could from me.

It would have been tempting to broach the fee with him then. After all, he wanted something from me, wasn’t I entitled to “get” something from him. Quid pro quo, give something, get something. Isn’t that an idea that everyone can understand, even one with a distorted sense of entitlement?

I have come to understand, however, that often people’s sense of entitlement stems from not from evil or even greed, but is a maladaptive way of addressing their traumas. They are still angry about the long-ago past, but they don’t know that. Instead, they seek reparations perversely -- through something that feels like exploitation to the other, but they are unaware. For such damaged, wounded people, the language of quid pro quo, though utterly reasonable to you and me, can be experienced as a trauma. It is especially ironic (and enraging) because his own stance with the world is far more exacting and exploitative than the language of even exchange. It was more like: do for me and maybe, just maybe I will do for you.

Finally, he got up at the end of the session and weakly thanked me for my time. He made no mention at all of payment and neither did I make mention of it. We shook hands and he left.

When he walked out of the office, surprisingly, I did not feel the way I thought I would feel. Oddly, I felt enriched. He had given me a chance to understand him even as his view of the world and his son were distorted. I had made up my mind that my only objective was to provide him with a healing experience. Under no circumstances would I allow him to be re-traumatized even as he was a traumatized man who unconsciously traumatizes others, I knew he could only ingest kindness. Nothing else.

I had honored our profession and was nourished by the feeling of having done the right thing.

A few weeks later I saw him in the street. To my utter surprise he said hello to me for the first time. He updated me on his son’s status and then said, “You can send me a bill for the session.” He said it half-heartedly, I think, hoping that I wouldn’t actually do it, but there was a trace of sincerity there. It gave me cause to feel that perhaps with my kindness, I contributed a little bit to his healing.
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