Six years ago...
5.30 am. Your alarm goes off. You turn to your boyfriend, who is still sleeping and try to wake him up with a blow job... it doesn't work so you prepare for work, get into your gym kit and brush your teeth.
6.00 am. You are at the gym. Cardio for thirty minutes. Abs and arms for thirty minutes. Shower.
7.30 am. You are at the office. The sign on your door reads 'Martín McCallister, CLINICAL PSYCHOLOGIST'. You down a double espresso, a large fruit smoothie and a bowl of muesli. Then you review the notes of your clients for the day and catch up with your personal assistant.
8.00 am. Trevor Jones. Old client. Eighteen. Solitary. Pyromaniac. Tendency to dissect dead birds. Impression- Sociopath. Potential social danger.
9.30 am. Jennifer Chimumbe. Old Client. Forty-one. Recently divorced following the revelation of her husband's serial adultery. Emotionally fragile. Self-esteem issues. Impression- Clinical depression.
Snack time- One apple. Cashew nuts.
11.00 am. Reverend John Lowell. New client. Sixty-two. Deep sexual infatuation with five members of his congregation. Not acted on feelings yet. Feelings of guilt and self-loathing. Virgin. Impression- Psychological repression.
12.30 pm. Lunch- Two grilled chicken breasts. Salad. Fruit smoothie. Block of cheddar cheese. Water.
13.00 pm. Chantelle Tweedle. Old client. Twenty-eight. In long term relationship. Has two young children with her regular partner. Escalating frequency of risqué sexual adventures with strangers and extravagant shopping sprees. Pressure of speech noted. Impression- Mania (? bipolar disorder)
It is now 14.40. You tap your pen on your desk impatiently waiting for your next client. He is late and you hate tardiness. You duck your head out of your office and talk to your receptionist, Lynn.
"Has he called to cancel?"
"No." She says. "He is ten minutes late. What do you want to do, Marty?"
You look at your watch. "He is a new. I'll give him five more minutes but then I'll have to cancel otherwise I'll be late for Emma."
Emma Forster is a young soap star who lives in Chester with her professional footballer boyfriend. She insists on being seen at home. She doesn't have anything particularly wrong with her but she likes having regular 'mental health maintenance sessions' because 'I had a messed up childhood, me'. You humour her because you suspect that she is a little lonely and the money is good.
It would be nice, however, if you didn't feel like she was trying to seduce you every time you went round what with her increasingly skimpy clothes and the bedroom eyes she gives you.
You walk back into your office and take a seat. You pick up the file in front of you and read the referral letter.
Dear Dr McCallister,
I would be grateful for your review of this twenty year old man, who I suspect has severe post traumatic stress disorder, with a view to offering trauma-focussed cognitive behavioural therapy.
He went through a rather harrowing incident three months ago (find attached notes) and was an inpatient on our orthopaedic ward for a period of two weeks for fractures of both lower limbs and ribs. He also received neurological input for head injuries during this time.
He has made a remarkable physical recovery but I found him to be somewhat withdrawn at today's outpatient follow-up visit. On direct questioning he admitted to re-experiencing the event "as if I am right there all over again" in the form of constant intrusive nightmares and flashbacks. The mere mention of aspects of the event during our appointment gave rise to a panic attack and anxiety the like I have not seen in some time.
While I am discharging him from an orthopaedic point of view, I am concerned that he has ongoing mental health problems that need addressing.
Kind regards,
Mr. Khan
You start reading the attached documentation of the traumatic event that led to the referral and your heart squeezes with genuine pain, distress and disgust.
"Fuck." You say as you continue to read.
The door opens and Lynn peeks her head in. She says,
"He's here... finally..." She rolls her eyes heaven-wards.
You nod at her. "Let him in."
You stand up as a young man that looks fragile enough to break like a twig walks into the office tentatively.
"Mr. Hay?" You confirm as your firm handshake meets his lighter sweatier one.
"Yes." His says softly and then clears his throat. "I-, uh, I'm s-s-sorry I am late. I-"
You take in his tense demeanour. A thin film of sweat coats his skin. He is visibly shaking and his eyes dart around the room as if trying to take in every detail of it all at once.
"It's okay." You say calmly and offer a reassuring smile. "No problem at all. Sit."
You point at the empty chair in front of you as you take your seat. You can't understand it but straight away you feel a need to protect him; guard him from the shit of the world.
"Thanks."
You can't help but take in the three inch long hair free scar that runs on the left back of his head. You know how he got that from the notes in his file. You wince at the thought.
"My name is Martin McCallister but I want you to call me Martin. I am a clinical psychologist."
"Okay." He says nervously, fidgeting with his nails.
"Mr Khan referred you to me because he felt that while you were well healed from your injuries, you still weren't over what happened to you. What do you make of that?"
His stare is wide eyed. "You're Scottish."
You nod, allowing him to avoid the subject for a second. "From Glasgow. Home of the fried Mars Bar!"
You smile at him again trying to put him at ease.
"Sounds horrible." He muses.
"Aye. It's not my thing, that's for sure." You say.
"No." He whispers and then blinks slowly.
You allow the silence to engulf you both. Over the years you have learnt to use silence in therapy. It can be very useful.
"I've never been to Glasgow." He says eventually.
"No?" You say. "Where are you from? I want to say... Manchester?"
He smirks. "Close. Salford."
You nod and let the silence descend once more. You hear the tick of the second hand of the wall clock.
"Just... I d-d-don't think you can h-h-help me." Stephen whispers. A track of silent tears falls down his face silently.
"Why?" You ask just as softly.
He wipes his cheeks to make room for a fresh wave of wetness. He looks even younger than his years, sitting there looking vulnerable. It tugs at your heartstrings and makes you dig your nails into your palm to stop yourself from engulfing him in your arms.
He just shakes his head.
"Stephen-"
"Ste." He corrects you sharply. "Don't ever call me Stephen."
His angry tone is a surprise.
"Okay. Ste." You say. "Psychotherapy is all about building our relationship, you and me and seeing whether communication, dialogue and behavioural change can help you return to the person you once were. If you want to continue seeing me, our relationship will build up over weeks. It is a therapeutic relationship built on trust. The way you are feeling now is a reaction to what you went through. It has just got out of hand. With time, we will be able to come up with ways to help you cope with and avoid those feelings."
He looks like a caged animal despite your most soothing voice so you pour him a glass of water and watch as he gulps it down quickly. Your eyes zero in on his trembling hands.
"You think so?" He asks.
"I know so." You reply and then consider him. "This is your first time out of your house for some time, isn't it?"
He stares at the floor and nods. "S-s-sorry."
"Is that why you were late?" You realise.
He nods again. "I get scared... being out."
"It couldn't have been easy stepping out like that." You think out loud. Of course this trip to see you must be a living nightmare for him. You are amazed he hasn't bolted yet.
Despite his extreme anxiety the young man in front of you has inner strength; strength he has forgotten he has.
And if you are honest with yourself you are attracted to him like a slow flame in the pit of your stomach but you try and pour water over it. You can't make it burn, not if you want to help him. You need to keep things strictly professional.
"I am very impressed that you showed up, Ste. Seriously."
"Thanks. I guess."
He is not relaxed enough to engage in therapy in this state. Your office environment is too distant to what he knows and getting here is probably fraught with too many emotional challenges for him.
"Ste, I think it would be better if we did the next few sessions closer to your house."
He relaxes a bit just by hearing those words of yours. "Um, yeah. Martin? Could you come to my place. Please? Just at first?"
He lets out a shaky breath.
"Yeah sure." Your eyes meet and yours soften. "No problem."