It was going to be a tough case. During intake, the client had been particularly resistant to any sort of disclosure. To be honest, given his tight-lipped demeanor, I was not really sure why he sought therapy. His unwillingness to do more than moan and just sit there expressionless, near-catatonic, dead to the world, made me believe something was not as it seemed and there were deeper issues at play.
He did present in some distress, and in garbled language reported what appeared to be a desire to roam slowly and methodically around the deserted local malls and precincts. My client was clearly disturbed and after failed administration of the Beck Depression Index and Rorschach Inkblot test, I was still unable to find a suitable DSM diagnosis for him (maybe ‘adjustment disorder’ or ‘relationship issues.’) It would be unfair and likely inaccurate of me to judge him exclusively on his attire, but I estimated the client to be somewhere in his early forties judging by the silver and black peppering of his somewhat disheveled side- parted hair. At least it looked like a part. The client wore a pair of khakis which had seen better days, covered in dirt down the left side and splashed with some unidentifiable, gelatinous substance along the right leg.
His khaki trousers were topped by a blue polo shirt, darkened considerably around the collar and torn at the left armpit. The client smelled fertile, a little loamy, and I considered at one point eliciting a wellness check on his home life because by session two his state had progressed to an undeniable smell of decomposition. Dental hygiene was clearly not important to him. The client was patient and methodical and would have made an excellent poker player; stone faced, minimal tells, patchy body language – in fact patchy body in general - and cold dead hands.
In session the client remained unemotional with an unceasingly flat affect that in all my years of counseling I had never witnessed before. Despite repeated questioning and various approaches (art therapy, music therapy, and the occasional attempt at humor) the client simply stared at me, with blank eyes (clearly not “to die for”) and occasionally mumbled something all but indecipherable. I even tried mimicry, and drooled on myself, swaying, back and forth in my chair staring at him. No effect whatsoever. The most animated incident I witnessed with this client occurred when I sat next to him in an effort to offer support and closeness. Clearly this unemoting individual was fast becoming the most difficult and most resistant client I had ever worked with. And it wasn’t getting any better. My attempts to overcome resistance: self disclosure; confrontation about his silence; lack of expression and sharing were met with indifferent silence. The dead lock continued.
At the end of our session, I literally had to push him out into the street and then just sit watching him sway- like a drunk only more stiffly - shuffling from one foot to the other, down the street. In fact the most animation I observed was when a stray cat tried to rub up against his rotten green leg (yes, eventually bare skin became exposed beneath his filthy khakis). I never saw that cat again.
I risk breaching professional ethics, but I feel it important to be honest here and disclose that the client remained silent but became physically agitated when certain words were used, like ‘brains’ and ‘feeding.’ Very peculiar, especially in such an unusually subdued man. He became especially excited when I mentioned shopping malls and wandering with friends. This felt to me like a huge breakthrough because it pointed towards some sort of support network that the client had established. He acknowledged his excitement by a little gnawing on his hand and some bloody salivation upon his now fairly crusted, blue shirt. When discussing family of origin issues, I mentioned social influence on the family unit, at which point, I think he sort of chuckled, might even have smiled. I wanted to say ‘you are dead right,’ but bit my tongue (something he looked like he had done himself several times himself recently). Was this progress? Were the psychosocial flood gates of my client about to open? And if so, was I ready?
It was around session three that I realized with some horror what the gelatinous substance must have been and diligently weighed in the ethics of my duty to protect and warn the general populace but I had no victim nor survivor and come to think of it law enforcement had been lacking public visibility recently. I decided to press on regardless with therapy being attentive at keeping my distance, physically and emotionally from this, eco friendly ‘green’ client who always stumbled to session.
I was beginning to harbor concerns that it was unethical for me to take his money because the sessions seemed fruitless and unproductive. Perhaps some pro bono work would be more appropriate? His wavering and newly developed twitch was interesting in that it got me thinking about ‘symptom substitution’ (from which symptom I am unsure but at least I was thinking - something my client appeared unable or unwilling to do). Part of me wanted to tell him ‘just get a life’ but therapists do not give advice, so I refrained. Why not take a risk in therapy? It is not as if it will kill you! I thought to myself. I appreciated that he tried, maybe the timing was just not right, for whatever reason he came, we interacted and he moved on in his shuffling, one-foot-at-a-time, gate and shabby attire. I hoped his flat, emotionless affect was not infectious and from that point onwards made a conscious effort to breathe through my nose while in session.
It was becoming apparent it would soon be time for termination as my client began to show up late and with less frequency and was clearly wasting away right before my eyes. Was it time to facilitate some palliation? Maybe some end of life counseling? Maybe he was exhibiting some sort of denial but it was becoming obvious our time together was becoming finite. I got the feeling my client understood this more than most and when the termination session finally arrived it was with a huge amount of relief we said goodbye. My unarticulating client had been unwilling or unable to open up and share and yet we had done work today, of which caliber I am unsure but I felt pretty good about it. He was ready. We said goodbye, he nodded and it seemed to me as if his ordinarily milky eyes looked almost tearful. He smiled a rather crooked, toothless smile, drooled some, and of his own accord stepped out into the windy street. I watched him limp off into the dusk and wondered if he had been as infected as I had in session. He certainly looked it. What a tremendous amount of courage he had displayed. How much defiance he had shown in his commitment to silence. How resilient he had been despite some obviously challenging personal circumstances. And lastly how incredible his passion for and focus on sustenance was!
I remember him fondly. I am constantly reminded in my therapy room by a strange odor that wafts through from time to time and of course the implausibly large, apparently permanent stain that he left on my therapy couch that all clients hence have never failed to comment on.
Christian Billington is a counselor in training. He is passionate about end of life issues, grief and loss, trauma and the development of training to better prepare the emergency services for what they experience in the field.