Therapy’s Elusive Edge

I am still perplexed by this 16-year-old whom I met over eight months before the pandemic ended our sessions. He chose me after screening five other therapists. And he chose me after a first meeting in which he sagged in his chair, grunted a few "I don't know" answers, and slouched out after 90 minutes without making eye contact or saying goodbye. Afterwards, I just hoped I conveyed that I knew it was hard for him to be there, that I respected him and was curious about his story.

So it began. We talked over board games. He described his father's shattering personality changes after suffering a severe concussion: irrational political outbursts, racist tirades, and rageful personal denunciations of family members. He's told me about his early years moving frequently for his father's job, and his shyness that made these moves painful. He completed the strengths inventory I gave him but disagreed with the results. I recommended homework based on his interests, and he did none of it: shoot hoops with a friend; identify two constellations in the night sky; get more details about an archery class he wanted to take; play a video game with his sister; walk through the mall and imagine that he owned the building. I stopped assigning homework. We kept talking. He kept talking,

We dealt in hypotheticals, from whether he could imagine himself tutoring a second grader in reading to whether his friends were glad to get texts from him; from the merits – or not – of studying a language to whether eliminating grades would improve or ruin education. Should parents require their kids to play a musical instrument or participate in team sports; is a gap year after high school a good idea; should everyone study algebra or debate or ethics or Shakespeare or ancient history or a practical vocational skills.

His mother said that he truly appreciated our meetings, though he didn't tell her the reasons. When I asked if our meetings were helpful, he emphatically said yes. Is it just having someone to talk to? No. Should we meet less frequently? No. Are there particular things we're doing that are helpful or not helpful? I don't know. If we ran out of steam, I introduced thought experiments. In a survey, 75% of NASA employees would take a one-way ticket to Mars. Would you? If you had to travel to another continent next week, where would you go? If you grew up during a different period of history, when would you choose, and what's the appeal? Which is better, giving $100 to charity or working three hours in soup kitchen? Given the choice of anyone in the world, whom would you want as a dinner guest?

To create concrete progress, we worked on learning strategies and self-discipline, and his grades improved. We discussed what comes after high school; he developed a list of 12 colleges that interested him. After much encouragement, he got a job and said it improved his confidence. He started lifting weights sometimes when he was bored instead of always turning to a videogame. He hung out more often with friends. He talked about having more understanding and kindness about his father's personality changes.

I don't know the end of this story because when the pandemic hit, he did not want to meet remotely. We agreed that he would call me if he wanted to talk. I know that our meetings mattered, though it's as hard for me to articulate that as it probably is for him. Usually it is a relatively simple matter to state what worked in therapy and why – or what didn't work and why. With this young man, the intangible parts of the relationship –probing and listening, focusing the conversation, making who he is both visible and acceptable - these were all at play. For this fellow, though, I may simply resort to Supreme Court Justice Potter Stewart's definition of obscenity: "I know it when I see it." We did good work. Really good work.