When the Patients Gave me Therapy

Elisa A. Escalante/ LCSW/ 08-30-2023

“There are many different types of strength in this world; mental fortitude is a tremendous one. The reality is, you cannot measure someone’s mental fortitude, because you will never be in their mind to feel how much they are suffering through.” -EaE

I’ve had this amazing ability to numb out what my patients have told me, even if it’s exactly like something I had once experienced. But, it can go both ways. I will either numb it out, or feel it too heavily. Either way it can be a problem. But, not every therapy experience offers more trauma. Some therapy sessions I have given over the years have healed me in some way. It heals to help people. It heals to feel hope again. It feels good to also know that I am helping, a change agent, in a very positive way. They also have their own incredible tips and advice’s that they share with me. Things that they do to cope and help themselves feel better, affirmations that help get them through life, and struggles that end up turning into triumphs. Working with people, and seeing people, underneath those hardened shells is a beautiful thing. We are all covered in some type of protective layering after all. There is therapy in the therapeautic process.

The patient that had toxic relationships like mine “I will never trust anyone again. I will never be able to have someone look me in the eyes and tell me that they love me and for me to believe them”. This is what he stated after a break up led him to homelessness and then in an inpatient hospital due to suicidal thoughts and plans. After which he wound up living at his ex Wive’s w/ his teen kids; ‘an embarrassment and failure’ in his eyes. Though it hurt to hear someone talk so badly about themselves there was a deep part of me that understood it. I understood what it felt like to never want to trust again. When you give your all to a person that betrays you and throws you away like you meant nothing to them. To want to give up with living because you cannot see any hope for anything else. I was careful with him as to not chase him away. He needed patience because no one else was going to give him that. I completely normalized the concept of ‘being single forever’, because the reality is, that is an option. And you have the right to that if that’s what you need. (After two years post hospitalization, he actually did date again, and he took his sweet time!) It was good for me to see all of this. Because I came from one bad relationship into another one rather quickly; and the demise of the second relationship landed me in a very similiar spot as him. He will never know how much I thought about his strength through my own post relationship mental shocks/ hardships.

The patient that Sabotaged themselves into Homelessness Honestly, he felt impossible at times. He showed up, he left. Weeks away without communication and then prolonged 2-3 hour sessions when he was back just to catch me up. When he was around our clinic, he dug through the trash for food, I always did him the solid of pretending not to notice. The reason he was homeless? Very complex issues dealing with people in general. He couldn’t handle his room mates, so he gave up and packed up and left. He couldn’t handle his GF half the time? So he would run off and sleep in his car half the time, and couch surf with friends half the time. It took him months to admit he was homeless, I actually had to tell him he was; denial. It took months for me to forcibly take him down the hall to apply for food stamps; he did so reluctantly. It took almost 2 years for him to admit he had a history of sexual trauma during his military service. Through the process of helping him, I could see the barriers through every step. I saw the sabotage and in follow up sessions I could explain it to him: “Why are you picking a fight with the receptionist? They have nothing to do with anything besides checking you in?” “Don’t argue with your VA examiner, they simply need to get the info, write it and submit it.” “Providers are less likely to hear you when you are raising your tone”. Trauma and anxiety kept him in an endless loop of sabotaging resources prior to my treatment with him. By the time I was close to resigning from the VA, we got him to 100% Permanent and total disability. (This typically pays Veterans over 3,500 a month in NYC) The pride I had in helping the most ‘sabotagy person ever’ get what he needs was insurmountable. He cried with gratitude over our phone call when he learned he would finally be 100% VA compensated.

The only patient that made me Cry in session (non intentional of course) During covid timeframe, one of my elderly patients passed away; it was likely Pneumonia and covid together at the age of 88. He was not only an individual client but he was a part of one of the PTSD groups I facilitated. I had to tell each individual group member seperately on the phone (teletherapy) about this significant loss. One of the Vets told me that ‘this is why we (Veterans) don’t get close to people, we lose them too much, too young and too often’. Luckily I was on the phone because that line struck a cord. I had already lost too much, too young, and too often. And it made all the sense in the world, how isolated us Veterans truly are. I never dealt with grief in ‘an appropriate manner’. I always shut down, and still do. I’m like a faucet that closes tight, and occassionally I’ll release the valve a little but just to let a few tears out. But pretty soon I shut it tight again. Why? I’ve always worked way too hard and been way too busy to ‘fall a part’ so to speak. But during that phone session, I let all of that go and I grieved my patient with my other patient.

The patient that was neglected in the same way I was Anytime a child patient vents often about their parents, I like to pose the question of: “What is the purpose of parents? What are they supposed to do for you?” This 8 y/o client of mine answered with “They technically don’t have to do anything for us….”. That’s when I knew that I understood her on a deeper level than most, and she understood my childhood on a deeper level than most. Disheartening neglect that leaves you feeling unworthy of anything good. I’m not talking about simply: “My parents weren’t around much”. In this specific case, we both grew up with biological Mom’s that drugged themselves to a point of being too incapacitated to care for us. Sometimes all day, or multiple days. She had the added factor of her Mom telling her “I never wanted you in the first place”. I had the added factor of my Mom dropping me off with strangers so she could go off and party. She dealt with her deep voids by acting out in anger to get attention. I dealt with my deep void by going numb and pretending I never needed anyone, or anything, ever. I helped her learn to appreciate her Stepmom who was always present, in the way that I appreciated mine, though I rarely showed it. Because neglected kid’s will find a present and active parent to be an intrusive and ‘annoying one’. But, they are really just trying to do their job! And unlike our biological Mom’s, our Stepmoms did the most important thing for us: they stayed.

The patient that refused to work despite being able bodied This patient was a 2X Iraqi War Vet who was raised by 1st generation ‘Islanders’. He was taught that essentially you live to work and work and work some more. And that he did, he worked his ass off in High school, he worked his ass off when he would go to college in spurts, he worked many odd jobs before, during, and after his military reserve career. He obviously worked his ass off in Iraq and sustained PTSD & TBI injuries. By the time he came to my office he had not worked a job in almost 8 years. It became clear through our sessions he was ‘concientiously objecting the American work force’. It was almost like his own mini ‘silent strike’ against Capitalism. He also struggled to finish his BA because of undiagnosed brain injuries; I eventually referred him to neuropsychology for testing which confirmed this. My first compulsion was like anyone else’s would be; to empower him to get back to work. But when I recognized he was at a severe ‘stuck point’ in his life, I took the opposite approach. I accepted him as he was. We talked and talked and discovered and untangled and laughed and yelled and educated each other for about two years until he finally decided to try a ‘Part time Temporary job’, and he did it! He reminded me that a person’s value is not just about what they are doing in that moment; performance, productivity, money etc. I saw so much value in him even while he was unemployed on purpose and living with his Mom with only 50% VA disability. Living within his means and trying to simply… live. With meaningful connections, friendships, and even an intimate relationship.

The patient that had Social anxiety like mine This was a moment in time where I realized that I was giving such ‘incredible advice’ that the patient realized I had the same issue as him: Social anxiety. His Question during my rant: “Wait how do you understand this so well? Do you have the same problem as me??” I just went ahead and admitted it, YES. I have severe social anxiety. Put me in an area where bombs are going off before you put me in a room to speak publicly in front of eyeballs glaring at me. And I can actually vouch for this because bombs from enemy combatants on my FOB did not cause my “fight or flight” system nearly the stress that public speaking did. The root cause comes from external and internal factors blending together to cause a deep seated fear of judgement. But why? Well because we already judge ourselves. It’s the fear that our self judgements will be validated as true, yet again. Because in our childhood we dealt with traumas from others that led us to believe we are unworthy, incapable, wrong. We fear being seen and judged because we already believe to our core that our existence and our mannerisms are wrong. We come off as uncertain, because we are always uncertain. We fear other peoples judgments but overall, we fear our judgment the most. It’s a never ending self degrading cycle. The healing process must start with self acceptance.

The patient that recognized my personal crisis When I had to call it quits with my life in NYC, I had to do a closing session with every client. I made up a story that my Dad was ill and that I needed to go home and be with him. My Dad is still okay though, thankfully! The truth was too embarrassing. I got dumped by my fiancé at the time, he decided to leave me for a much younger girl we had coached at our gym. I was so mentally shocked that I didn’t have it in me to keep working for the VA, I was already burnt out. As I made plans to pack my shit and go move in with my Dad I was also studying for my advanced independent therapist licensing exam. This was a MISERABLE month; especially because I had to keep living with him (ex). Day after day I broke the news (lies) to my clients, one girl knew better though. (She had an extensive trauma history primarily due to the men in her past life) She asked me: “what about your fiancé, is he going to CA with you?” And I said “I don’t know we haven’t decided..”. She concluded by telling me “you get away from that guy, you don’t need any man. You got this”. Essentially, she told me that she knew it was a heartbreak I was dealing with, and she encouraged me to push forward. 💪🏼✅ (I dodged a rocket)