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Education Nonfiction

Termination (I).

In mental health, termination is the word used to describe the process of ending psychotherapy. Note the word “process”: Termination should not be an anvil falling from the sky. Under ideal circumstances, patient and therapist address termination during their initial meeting.

Think of termination as an exit interview for psychotherapy that spans several appointments. Patient and therapist review what the patient learned about herself, her accomplishments and goals (did she reach them? did they change during the course of therapy? if so, why? etc.), her reactions to and opinions about treatment, and how she might use the experiences in therapy to help her in the future.

In this way, termination facilitates closure, that “often comforting or satisfying sense of finality”.

Termination can be a Big Deal because, for many people, the end of meaningful relationships is difficult. People can experience emotions that are not only distressing, but also compel them to behave in ways that are neither helpful nor effective. Think about a relationship you had that you believe ended poorly: The girlfriend or boyfriend who dumped you. The unexpected death of a parent or sibling whom you both loved and disliked. The dear friend who drifted away, purposely or not.

Sometimes, even for those uncomplicated relationships that end “well”, we feel conflicting emotions about them. Loss is difficult for most, if not all, people. It’s hard to say good-bye.

Thus, ideally, termination is neither abrupt nor unexpected. Both patient and therapist may recognize that the patient has achieved the goals of therapy (determined at the outset of treatment and adjusted accordingly, right?). In this instance, termination makes sense. Nevertheless, patient and therapist may still feel powerful emotions while going through this exit interview.

In reality, termination can be both abrupt and unexpected. Patients move; therapists move; the Stuff of life interferes with and prematurely ends the therapeutic relationship. If the patient feels connected to the therapist, the patient may then activate old habits of dealing with loss and strong emotions. These habits may have been the very things that brought the patient into treatment. Many therapists therefore believe that termination is the most important aspect of psychotherapy.

In the next few posts, I will write more about the reactions people—patients and therapists—may have during termination.

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Nonfiction

Leaving New York.

My first visit to New York City happened when I was eleven years old. My memories from that trip are hazy, though I clearly remember the taxi ride from the airport to midtown Manhattan. The sun had already set. All the windows of the taxi were rolled down. The warm evening air, honking from car horns, and twinkling city lights flooded the interior of the cab.

I was squashed between my parents in the back seat. They said nothing. The taxi swerved around cars, stopped suddenly, and blew through red traffic lights. Sitting stiffly, heads jutted forward, and hands balled into fists, they were terrified that they were going to die.

I looked out the window. Sleek buildings loomed above us. People swarmed the sidewalks. Carts selling fragrant foods were parked on street corners. Rows of shop signs illuminated the night.

I was thrilled. I decided that, one day, I would live in New York.

Three years ago, I was blessed with the opportunity to do just that.

My time here is coming to an end. I was recruited for a job in Seattle. Though I state with pride that I am a “West Coast person”, I have mixed feelings about leaving New York.

For the next few months, more posts than usual will focus on New York City. Recording these stories will help me remember my time here. I don’t want to forget.

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Routines.

The alarm began to ring. Refusing to acknowledge the morning, he reached over and patted the nightstand. Only when his fingers wrapped around his cell phone did he finally open one eye. He squinted. Then he groaned.

After plodding through his morning routine, he put on a dark suit and light necktie. The leather laptop bag bumped against his hip as he exited the apartment. He reflexively looked down, only to remember that he had cancelled the newspaper a month ago.

As he walked into the deli, the man with the funny hair walked out. They waved to each other. This is what they did every weekday for the past four years. He knew that the elderly woman in front of him would order—

“Small coffee, cream, no sugar, and an egg bagel with butter.”

As she shuffled away, he wondered if any of them noticed the change in his routine.

“Good morning, chief,” the man behind the counter said. “The usual?”

“Yeah, thanks.”

He fished a five dollar bill out of his wallet. He knew that he should make his own breakfast and stay at home. He couldn’t do it. Routines were difficult to change. He hoped that things would return to normal again soon.

“Have a good day,” the man behind the counter said as he stuffed napkins into the white sack. “See ya tomorrow.”

From the deli, he usually walked three blocks north and entered the skyscraper. He hadn’t gone there in over three months. His boss had said, “Look, I’m sorry, you’re a good guy and all, but we just can’t afford to to pay you.”

So now, he instead walked five blocks east with his coffee and muffin to the public space with free WiFi. While he was setting up his laptop to review classified ads online, a man in sagging jeans and a soiled sweatshirt walked past. In his hand was a tall aluminum can in a brown paper bag.

Taking a sip from his coffee, the other man thought, It’s five o’ clock somewhere.

The man had bought the aluminum can in the brown paper bag from the bodega around the corner. He was celebrating his morning’s success.

His day started at 3:30am because he knew that the sanitation trucks would arrive around 6:00am. He also wanted to avoid the morning rush. People in the neighborhood often yelled at him and threatened to call the police. His cart, when full, was bulky and difficult to maneuver in the crowds as they streamed towards the subway.

This morning, the superintendent of a high-rise apartment building saw him pushing his cart.

“Hey, Papi!” the superintendent said, waving at him. “Take my bags.”

The five overstuffed bags could not fit in his cart. He was delighted.

Aluminum cans and plastic bottles earned him five cents a piece. He was smiling as he pushed the cart forty blocks uptown. On a good day, he could pull in $100. With this donation from the superintendent, he got close to $200.

“Thank you!” he exclaimed when the grocery clerk put the cash into his hands. He stuffed the wrinkled bills into his tattered wallet and walked into the bodega. When he reached the back of the store, he opened the refrigerator case. Instead of plucking out a single can of beer, he decided to splurge.

“A case today, huh?” the bodega clerk murmured.

“It’s a good day,” he said.

Routines were difficult to change. He knew that things would return to normal again soon.

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The Wisdom of Children.

The nurse saw the little girl standing in the hallway. She was holding her mother’s hand.

“Hello, Clara! Look at you! You’re so cute in that pretty dress.”

“Thank you,” Clara said, looking down. Her feet swiveled against the tiled floor like windshield wipers. “Where’s my daddy?”

“He’s still seeing patients, but he’ll be back soon.”

Clara’s large eyes saw a clot of doctors in the arterial of the hospital ward. A few of them dislodged and floated into patient rooms.

Smiling at Clara, her mother asked, “Do you want to be a doctor like Daddy?”

Clara grimaced. “No. I don’t wanna be around sick people all the time.”

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Wesley’s Mother.

Wesley, how about you? How is your mother doing?”

He looked down. His fingers began to pick at the hem of his maroon jacket. Nearly two months had passed since he last spoke in the group. The other people sitting in the circle looked at him.

“About the same.” Wesley cleared his throat, then gave his usual report. “She still gets up in the middle of the night and tries to leave the house. She hasn’t figured out how to unlock the door. That’s good. Most of the time she recognizes who I am, but sometimes she gets upset when I try to get her back into bed. She screams at me. I’m surprised the neighbors haven’t called the police yet.”

A few people snickered.

“Dad passed away ten years ago from a stroke, but she still thinks he’s at work and will be home any minute. She looks out the window day and night.”

Wesley folded his arms in front of his chest and sighed.

“She thinks I steal her things. I can her hear right now: ‘Why do you keep taking my watch? You can buy your own! I’m going to call the police if you try taking it again!’ She gets so upset. She just doesn’t remember.”

People in the circle nodded in sympathy. Someone offered, “I’m sorry. My mom does the same thing. Sometimes I get so angry that I scream right back at her.”

There were more murmurs of recognition.

“Who’s with her right now?” someone asked.

“The housekeeper. She’s been with us for about fifteen years. She comes on Monday evenings. That’s how I can come here.”

“So you get a clean house and a break from your demented mom,” someone commented. People quietly laughed.

“I’m all she’s got now,” Wesley said.

The support group ended about twenty minutes later. An elderly man who recently joined the group put his hand on Wesley’s shoulder.

“You’re a good son. I wish my kid was as dedicated to his mom as you are to yours.”

Wesley reflexively turned his shoulder away, but smiled at the old man.

As was his habit since he joined the group nine months ago, Wesley took a cup of coffee with him for the walk home. The cup was empty by the time he reached his studio apartment.

After unlocking the three locks, he stepped inside. First he took off his shoes and jacket, then he put the cup next to the pile of mail on the table.

“Yes, Ma, I’m back.”

Wesley turned the bolts in the three locks. His foot nudged the stack of old newspapers closer to the wall. He sat down on his unmade bed.

“No, Ma, I didn’t take your watch.”

He peeled his socks off and tossed them onto the heap of clothes spilling out of his closet.

“No, Ma, did you hear what I said? I didn’t take your watch. I have my own watch. See this? This is my watch. I only have one watch.”

He grabbed the remote control and turned on the small television across the room. While rolling his eyes in annoyance, he pushed the button to increase the volume. The laugh track of a sitcom roared through his empty apartment.