The Skeleton Cupboard (6 page)

I smiled and shook my head.

“Tell me as much as you can remember about the session.” She handed me a glass of water.

As I took it, I could see my hand shaking. I took a deep breath and tried to describe as much as I could remember: estranged from three children; obsessional love for youngest child, only son; ability to cry at will; my eyes; his knife; Freud and the penis. Shock does odd things to memory and I'm not sure how much she'd have understood. It all sounded bizarre.

I took a deep breath. “I'm sorry.”

She raised her eyebrows.

“I know I have messed up big-time. It won't happen again.”

“How did you mess up?”

I took a deep breath. “I should have seen it coming. I know this looks bad.” Chris opened her mouth to speak, but I had to keep talking: I just couldn't bear to hear what she was going to say. I kept saying sorry.

She handed me another tissue. “Your nose is running.”

Embarrassed, I blew my nose.

“I am not clear why you are apologizing.”

This was torture.

“For messing up with the patient, for causing a scene in the department, for potentially compromising your reputation and the reputation of the clinical course, for…”

She raised her hand to silence me. “Did you know he had sociopathic tendencies?”

“No. Sorry.”

“Did you know he was armed with a knife?”

Again I shook my head. “No.”

“What's with all the mea culpa? When I interviewed you, I thought you were more confident.” Chris sat back in her chair, took a gulp of coffee. “Please don't do a Mother Teresa on me, and please, please don't next pull out your sword and fall on it. OK?”

I took a deep breath. “I just want you to see that I am worth another chance.”

Chris pushed a critical incident form across the desk toward me and handed me a pen. “Let's start with you filling this out.”

I did. My hand was shaking.

Chris leaned over to look. “You need to write that bit out again—you've joined the ‘l' and ‘i' together so they look like a ‘u.' He didn't attack you with a ‘fuck knife,' did he?”

I looked up at her and saw a deadpan face. Her mouth twitched and we both started laughing.

“OK, I don't expect you to speak, but just try to listen. Mistake number one: They don't have to cry in the first session for you to be doing your job well. Leave that to the social workers.

“Mistake number two: Think about where you put the chairs and where you sit. If you need to ask them to excuse you as you make your way past them to push the panic button, then you are screwed.

“Mistake number three: If you ever feel out of your depth, then find a reason to leave and leave. This is a job, not a calling. If you want to save with self-sacrifice, then find a nunnery.

“Mistake number four: If they want to show you something, do not take your eyes off them as they reach for it. We do telling in our profession, not showing. Leave that to the drama therapists.

“Mistake number five: This was mine. I should have made sure that the department had screened this sociopath before you got him.

“Mistake number six: Don't discount Sigmund, because it seems you pulled him out in your hour of need and he came through for you. You crudely emasculated your patient and then cleverly rejoiced in his switchblade penis.

“Overall, well done. You did better than I would have expected from someone so inexperienced. Take a long weekend off and I'll see you next Wednesday.”

So she made one mistake and I made five, but still I did a good job. Sigmund helped me out, my eyes were still in their sockets and all was well with the world.

But what about Ray? I couldn't help but feel that I had totally and utterly let him down.

 

Two

AT THE BOTTOM OF THE DEEP BLUE SEA

When a child is hanging by the neck, grabbing her legs to hold her up isn't easy. They wriggle and they kick. Imogen struggled in silence. Then she kneed me in the face, hard, and I tasted blood. The stillness of the room belied the horribleness of the task.

“Hold her up, up, up!”

Grunts of effort in unison as a nurse and I hoisted the little girl's legs higher to relieve the pressure on her neck. Her dressing-gown cord had been looped over a slim copper pipe in the ceiling. Victorian plumbing was not designed with the health and safety of suicidal children in mind.

I couldn't believe how heavy a small-framed anorexic child feels when you have to support her as a dead weight.

“C'mon, guys—push up and hold … and hold…”

A snap of steel through fabric, followed by a bizarre pause in motion—everything still for a beat before the child dropped into our arms. My frustration melted into relief. I just wanted to hold this little vulnerable person and rock her gently, make her feel safe. Imogen, though, was having none of it. She lashed out, biting, kicking and snarling.

“Imogen, be still—let's work together here. Ow!”

Negotiations over, she was quickly flipped onto her stomach, arms held behind her back. Lying prostrate over bucking legs, I had a sudden urge to bite back, to sink my teeth into this angry, ungrateful kid and shock her into submission.

And then it was finished. Child sedated, taken off to the “chill-down” room—chic and bijou, nicely padded, sparsely furnished—while staff dispersed to other duties. Voices in the corridor: “What did the librarian say to the kid who wanted to borrow a book on suicide? Fuck off—you won't bring it back.”

Third week into placement number two and already I wanted to give up and go home.

*   *   *

I can't remember what I'd imagined it would be like. I'd reluctantly agreed with Chris to do my second six-month training placement in a medium-secure inpatient psychiatric unit for twelve- to sixteen-year-olds. I was spending my days with kids who wanted to do all manner of harm to themselves or to other people—to cut, to starve, to stab, to kill.

Once I'd had my few days off to recover from having Ray threaten to cut my eyes out of their sockets, the rest of my first placement had gone more smoothly. I hadn't yet worked out Chris, but she was proving to be a great clinical supervisor and I enjoyed our sessions. She was calm and brilliant, and I loved her ability to pull the strands of the complex stories told to me by my patients into a coherent narrative—a process I was learning to call “formulation.”

University had found a rhythm, and I'd made some friends among my fellow trainees. The lectures were interesting, even when I struggled with their content. I had already worked out that even though he had saved me in my moment of need with Ray, I was not a big fan of Sigmund and psychoanalysis. Interpretations, the unconscious, projection, transference and countertransference—it all felt so abstract and judgmental. And where was the evidence base?

I'd worked with some wonderful people since Ray. Occasionally George and I would have a brew with Edith, whom I'd grown to love. She'd been discharged and readmitted during my placement, just as George had predicted. My transgender heroes, “Josephine” and “Daphne,” would regularly knock on my cupboard door and check in with me—they made me feel safe. Leaving that placement had been difficult, and in the final week Chris had met with me to discuss placement number two.

“So, kids. Do you like them?”

I wasn't sure. I didn't know many. “Yeah, I love kids.”

“Good.”

She bit into a biscuit. I had begun to notice that Chris did a lot of eating and talking during our sessions, which I found pretty gross.

“And,” she continued, crumbs scattered over her shirt, “adolescents—you know, teenagers. You like them?”

Thanks for the translation—I know what an adolescent is.

I wasn't sure how to respond to this either. “Yeah?”

Chris dunked her biscuit into her tea and then extended a long tongue to lick in the sloppy, mushy end. “Were you a nice teenager?”

“I think I was OK.”

That was a massive lie—just ask my mother.

Chris smiled. “Shame. I had you pegged as a pain-in-the-arse teenager.”

I smiled, then wondered if I was allowed to. “I had my moments.”

“Thought so. Anyway, here's the thing. We've got a regional shortage of child placements and so I volunteered you to do yours in an inpatient unit for young teenagers.”

I had no idea what that was.

“Right…”

“You'll be dealing with kids who are presenting in a high level of crisis and so are too vulnerable to be treated in the community.”

“OK.”

Chris offered me the packet of Rich Tea. I shook my head.

“So,” she said, chomping into a fresh one, “you'll spend the next six months in a unit just outside of London working with a specialist multidisciplinary team assessing and treating kids and their families, who are often in crisis.” Chris smiled brightly and raised her eyebrows at me.

I swallowed hard. “OK. If you think I can…”

“Why wouldn't I?”

I blushed. I hated blushing. My heart started racing as I thought of Ray.

“Well, you know, it's just that I was kind of attacked by I guess what you would call a ‘patient in crisis' in my last placement, and that was in an outpatient department…”

Chris stared at me, unblinking. “And?”

My face felt red hot. I didn't want to tell her I was scared. “Well, based on my inability to manage Ray, perhaps I'm not ready to do this placement. You know, with kids and their families in crisis.”

Chris folded over the torn flap of the biscuit wrapper and shoved the packet into her large, overstuffed bag.

“I disagree. I think you can and should do this placement. You'll be protected by a strong staff team, and you've got me with you every step of the way.”

And so, reluctantly, I agreed. And it had started well. The staff team was strong. I liked the young people. I was really enjoying it until Imogen decided, that morning, to attempt to hang herself. Now I just wanted out.

Walking back to my office, I wondered why I had let Chris talk me into this. What was I trying to prove? I suppose there had been some fantasy about sailing in on a cloud of compassion and being the one—the only one—who really understood these kids and could save them.

Pretty arrogant.

I was training to do a job where I had license to ask anyone anything and get an answer, where I would be part of a decision-making process that could fundamentally alter someone else's life—it was important to remember that this didn't make me all-powerful. I smiled at this last thought: I wasn't the first person to imagine that she was the Almighty in this place.

Time to grab a coffee and go into the critical incident debriefing. How did the suicidal kid have a dressing-gown cord? Wasn't she on highest-level observation? Who had done the property search when she was admitted? A head was going to roll—thankfully, though, not mine.

*   *   *

The following afternoon, sitting opposite Imogen in our next session, I felt a hot ball of anger and frustration gather in my throat. What was wrong with this little girl? Why wouldn't she communicate with me? How could I possibly help her if she wouldn't talk?

I thought about transference and countertransference, tried hard to work out whose rage I was experiencing. The look on Imogen's face left me in no doubt that she was pissed off at being thwarted in her attempt to hang herself. She wanted to die, and we had stopped her. I got that.

But there was a lot of my rage sitting there with us.

I'd been seeing this twelve-year-old since she was admitted three weeks ago. As a clinical psychologist in my first year of training, and eager to prove myself to Chris after the last debacle with Ray, I had specifically requested that I be assigned to Imogen as her individual therapist and case manager. At first I was refused on the grounds of lack of experience—she was a tricky one, a complicated case. The social workers wanted her, the family therapist wanted her and the analyst wanted her.

But in the end I got her. No one else was receiving training in cognitive behavioral therapy. She came from a loving family, so no social work was needed, thanks. The soft-spoken, leather-moccasined, vegan family therapist had too many other cases, and anyway, the focus needed to be on the child this time around, not the family. And the analyst? I wouldn't let him near any child, especially not one like Imogen.

Instinctively, I leaned toward the here-and-now type of therapeutic intervention. I was suspicious of therapists who asked their patients to lie down and then took them back to their relationships with their mothers, spending most of the session out of their line of sight, in silence.

I didn't get analysis. I might have been much more open to the ideas if the analysts themselves weren't so bloody full of it. They were up their own rectums with self-importance; they seemed to believe that only they had read and understood the Holy Scripture of mental health.

For me, analysis had always been a bit too much like religion—purporting to possess the key to understanding the fundamental questions of life, but unable to provide any evidence to back up its case.

“I am so sorry that you don't feel any better about life after two years of thrice-weekly sessions. It pains me that you are still unable to form a meaningful relationship, and that on some days even washing your hair feels like an unattainable goal, but to question whether lying here on this couch while I silently write notes and say little is the right approach is—forgive me for pointing it out—a symptom of the difficulty you have in really connecting with this therapy, indicative of your difficulty in connecting with other people more broadly. It is clear that this rebellion is you acting out and sabotaging our relationship—as you so readily sabotage other relationships in your life. It suggests to me that you now need to see me five days a week instead of three, for an indeterminately long time—apart from every August, when I will be away on holiday.”