That really was a fantasy. She knew this empty yearning couldn’t be filled by work featuring a different set of clients. The one-way intimacy that any good therapist rigidly structured in counseling would apply to any and all clients, even the Hopi.
Now her life was dominated by those relationships of one-way intimacy. That explained it. Those professional relationships lacked a free, mutual exchange of thoughts and feelings; they lacked the zest of unlimited possibilities, they lacked a multitude of intriguing unknowns but most of all they lacked warmth and passion.
The image of Paul’s letter slipping down into oblivion came to her with a twinge of doubt. What did I throw away? Is the counseling really satisfying enough to replace that?
Then, Second guessing myself again. I thought this was over, resolved, done! This was just like her. In college, when she took tests she often went back over an exam and changed right answers into wrong ones.
She brought her feet up onto the bed and rolled over on her side, idly examining the small array of books atop her dresser. They were sandwiched between two rabbit-shaped book ends. If I were a Hopi, I would be in the Rabbit Clan, or maybe the Star Clan. The thought brought an immediate inward rebuttal. Not that I could choose, of course. It’s not like pledging a sorority. You’re born into a clan. I would have to take what I got.
Then the I Ching caught and held her attention. She considered it, hesitated, and then surrendered to the impulse. She gathered a pen, three coins, a notebook and her worn copy of the book. She sat on the floor with her back against the bed and began mentally to formulate her question. It couldn’t be “Will I ever get married again?” or even “Will I ever get laid again?” Years ago, a friend had introduced her to this book as a way to gain insight into personal issues. She quickly learned that it was pronounced 'E-Ching' rather than 'I-Ching'.
While others might consider it a system of divination or fortune telling, over the years she had learned that to use it with such 'yes-or-no' or 'will-I-ever' questions yielded confusion and frustration instead of answers. Asking for elucidation, counsel or insight proved more in keeping with the esoteric, philosophical nature of the ancient work.
She had read that Confucius, the very personification of ancient Eastern wisdom, had consulted the I Ching when in crisis. A forward to the book by a famed psychiatrist impressed her more. He advised Western minds to overcome their science-blinded world view to accept the validity of the I Ching. Somehow, that reassured her and endorsed her interest in the time honored guide for wise and correct behavior.
At last, she wrote down, “How should I conduct myself and what should I expect regarding a love life?” As she wrote, she recalled she had asked this question before, perhaps more than once, but she couldn’t remember the answer. Maybe she just hadn’t been satisfied with the answer.
She would throw the coins six times to create a diagram of six lines, beginning at the bottom and working toward the top. Her first throw showed two tails and a head. The next throws gave a mixture of solid lines and changing lines. The changing lines would reveal specific details about the question.
The name of this hexagram, number two out of the sixty-four that comprised the book, was 'The Passive Principle'. She began to read and skimmed some parts that were very abstract or didn’t seem to apply. Phrases about relationships between men and women were more understandable.
In part, the text read, 'The superior man...' (she had penciled in 'wo' to make it 'woman' and long ago ceased to notice the sexist bias of the text) '...If the superior man wants to lead, he fails; but if he follows, he finds help'.
Next, she read the additional messages given by the two changing lines, which referred to a mare, and being passive. She smiled. How strange, being compared to a female horse. Parts of this ancient tome could only be described as inscrutable but it seemed to say that she, the receptive and superior woman should do nothing, and let her prince come to her. She was too old for fairy tales, she thought, but her mood brightened.
She drew the second hexagram. This was hexagram number four. She turned to the page and saw, 'Youthful Folly. The young fool seeks answers. Only once will I inform him. If he asks two or three times, he is revealing his importunity.' Further down the page an explanation of the text clarified, directly, '...the text gives one answer only and refuses to be challenged by questions suggesting doubt'.
The testy accusation made her laugh aloud. Yes, she had asked this question before. The oracle was scolding her for asking it again. Still smiling, she put the book away and went for her walk.
***
Halloween brought just a few children to her door, decked out in the same kind of super hero, pumpkin, and princess costumes the smaller children
everywhere wore, along with older kids sporting bloody masks and other gruesome details.
Their numbers were far less than the hordes she had enjoyed back East. Bags of candy remained. She knew she would consume the goodies, followed by massive guilt, unless she took them to work to share with her coworkers and clients.
The staff’s gathering place at the office served many purposes. It was kitchen/break room/mail room/copy room in one. Located directly behind the reception area, it was accessible to both the east and west wings through two doors at right and left, with glass double doors at the rear that led to a small, walled patio. Since the building lacked a conference room or group therapy room, the therapists came here to discuss cases.
Ralph VanDeusen's wife, Sherry, was a counselor who had an office in the building. He would on occasion present a case in the conference room for her and the other counselors. He was here in the break room today, sitting at the big kitchen table of pine wood, his legs crossed, sipping coffee from a huge mug that bore a crest and the name VanDeusen in gold script.
The psychiatrist was a tall, lanky man whose clothes looked too big for him, although they were in good taste and of good quality. Today he wore dress slacks, a long-sleeved, blue shirt and a tweed sports jacket. Bony wrists poked from his sleeves and the hands attached had long, thin fingers.
Doctor VanDeusen wore his salt and pepper hair short. A beard and moustache, also greying, hid part of his face. One of the therapists joked it must be his Freud disguise.
Allie thought his face lacked the refinement obvious in photos of Doctor Sigmund Freud. Some quality about Ralph’s sharp and uneven features prevented a description of attractive. He might claim distinguished except for a slight inward cast of his left eye. At times, it was barely noticeable. He had a way of minimizing the defect by turning his head so he never seemed to look at a person straight-on.
Allie greeted him, collected her mail, made a copy of some handouts she wanted to give Crystal, then poured her own cup of coffee and sat down at the table.
“How are you, Doctor V? Your wife tells me you’re flying back to Ohio for Thanksgiving.”
“Yes, Sherry’s family is there. It will be nice for her but I’m not looking forward to the nasty weather. How about you?”
“Probably stay here, do some sightseeing.” She briefly pondered Ralph VanDeusen. His practice of psychiatry was limited to prescribing and managing his patients’ regimen of psychoactive medications. Like most other psychiatrists, he had priced himself out of competition for counseling. That left psychotherapy to professional counselors and psychiatric social workers like Allie. For a fee, Doctor V had begun to provide licensing supervision for several therapists who worked in the building.
Among her peers, Allie had gained quite a reputation for her insights and ability to diagnose and problem solve difficult cases. She believed it was her intuition which enabled her to identify many core issues that bedeviled her clients, rather than expertise in psychology.
Dr. V intruded on her thoughts. “So how are you doing with our little borderline, Crystal?”
“Oh, she’s a little slow to open up, but I think we’re going to be able to work together.”
Doctor V shook his head. “Better you than me.”<
br />
It made Allie wonder again whether, in spite of all his psychiatric training, Doctor V understood women at all. He was especially judgmental of those with borderline personality disorder. It was a malady that rendered clients incapable of regulating their intense and sometimes extreme emotions. As a result, they struggled with relationships. Every aspect of their lives was disrupted.
The term 'borderline' signified that clients with the diagnosis were so compromised by emotional extremes they were at times on the edge of actual psychosis. The latest research indicated this particular mental illness might be a kind of posttraumatic stress disorder caused by severe physical or sexual abuse in early childhood. Doctor V didn’t know or didn’t care.
Allie remembered his comment about his experiences as a staff psychiatrist in a private psychiatric hospital. “I could always tell the borderlines. When they walked down the unit in their jammies and came into my office clutching their teddy bears, I knew I had another borderline on my hands.”
Allie thought about it now and mentally corrected him. Not a borderline, Doctor V, a person who suffers, with the emphasis on suffers, from borderline personality disorder.
Wanda, the receptionist, came in for her morning break and joined them at the table. She didn’t speak and Allie was glad. The woman had a way of saying or doing precisely the wrong thing at the wrong time. She turned when the door popped open as if from a sudden gust of wind.
“Oh my God I had a night!” Heidi Alarcon talked to no one or anyone within listening distance as she entered. Heidi was a young intern working toward her license in counseling. Sherry VanDeusen was her supervisor for licensure.
Heidi had a few individual therapy clients and also worked for the agency that provided mental health services to people in crisis. For the agency, she put in five nights and two weekends per month and was on call during the week. She had to sandwich her appointments here at the office between her other duties.
Heidi pressed a few keys on her android phone before she sat down at the table. Allie looked at the younger woman’s face, marveling at her firm, smooth complexion. It fairly glowed, her cheeks lit by the vivid pink flush characteristic of plump, energetic, fair-skinned. She looked like an excited child to Allie, who found her youth and enthusiasm endearing. Allie lifted her coffee cup at Heidi with a question on her face.
“No, I can’t drink coffee any more,” Heidi said. “Not since I started crisis work at the agency. I’m now addicted to kava-kava, l-tryptophan and anything else that’s legal and helps calm my nerves. Last night I had to do a Title Thirty-Six and a Tarasoff!”
Doctor V smiled. “Proud of yourself?”
“Not really,” Heidi shot back. “It was not fun and it kicked my butt. I’m exhausted!” She pushed her blond hair back from her face with both hands and smiled, as if to indicate the challenges of crisis work stressed her but certainly hadn't defeated her.
Title Thirty-Six refers to the Arizona law that permits involuntary evaluation and commitment of anyone deemed to be a danger to self or others. Additional provisions in the law allow the same seventy-two hour commitment of someone who is 'gravely disabled' or 'persistently and acutely disabled' by a treatable mental illness.
The latter criteria are narrower and less obvious, therefore less frequently used by mental health professionals, than the 'danger' definitions. Medical hospitals often do these assessments. There, the staff tests patients for drug use or other signs of medically induced mental deterioration.
Doctor V asked, “How did the hospital staff treat you?”
“Not bad.”
“You’re lucky,” he said, and leaned back in his chair to stretch his long arms toward the ceiling. “They don’t always welcome the attempted suicides or other 'crazies'. Look at it from their perspective. They spend all their time and energy trying to preserve and prolong life. Why would they want to waste that effort on someone who doesn’t want to live?”
“I guess I can understand that, but I also go there sometimes to evaluate clients for Tarasoff. You’d think they’d be happy to cooperate in preventing violence. Less trauma for them to treat later. So many of the mass shootings, even the shooting of President Reagan, were done by deranged souls.”
'Tarasoff' refers to Tarasoff v. Regents of the University of California, a precedent-setting legal case from the 1990's, still upheld nationwide. It mandates professionals to warn an intended victim of violence by a client of theirs if they believed the threat is immediate and real.
That caveat, 'imminent and real,' creates an ethical and practical dilemma that demands a judgment call. A wrong decision might cost a crisis worker her license, her career and all the worldly possessions a lawsuit could wring from her.
Doctor V lowered his chin and looked up sideways at Heidi, “Let me guess. The Title Thirty-Six was for a borderline.”
“She does have that diagnosis. She took a bunch of pills in a suicide attempt then changed her mind and called nine-one-one. She couldn’t convince me that she wouldn’t do it again tomorrow, and she was very depressed because she broke up with her boyfriend. She needed to get back on her antidepressants, the sooner the better. The psych hospital was the best option, the safest option.”
“I’m not questioning your clinical judgment,” Doctor V told her. “The final decision isn’t yours anyway. The crisis agency psychiatrist has the final say, and the final liability, I might add. What was the Tarasoff about?”
“Some people reported their neighbor was ranting and raving and acting strange. They were afraid of him. They did a petition for involuntary evaluation. He seemed pretty squirrelly, all right. When I went to talk to him, he said he was inspired by mass shootings. He wanted to make it clear he was not a terrorist, but he said so many people who didn't deserve to be alive were ruining things for him. Then he went on to describe how he would like to kill them.”
“Well, I guess that was a slam-dunk,” said Allie. The need to hospitalize the man was clear and unmistakable. By this time, Heidi had her full attention as well as that of Wanda.
“I’m not sure he could do it, as disorganized and psychotic as he was, but 'c-y-a' is my motto.”
“It’s a pity that has to be a factor, but you’re right,” said Allie.
“Sometimes it’s damned if you do and damned if you don’t,” added Doctor V “They can hail you as a hero one day and sue the pants off you the next for the same decision.”
Allie nodded and sipped her coffee. “The client who loves you today may hate you tomorrow, and in both cases, for actions that are clinically necessary.”
Heidi said, “Yeah. I’ve been in trouble more than once in situations that look like a slam-dunk but aren’t. Have I told you about my beach client?” She hesitated a second before she continued.
“The client was from San Diego and she was really, really homesick. She cried every time I saw her. She told me she loved the beach. It was the only place that made her feel calm and relaxed. I suggested she would feel less anxious if she made her apartment more like the beach. She loved the suggestion, and she just loved me. It was going so well. Then she came in one day mad as hell at me. Her landlord threatened to evict her. She said it was all my fault. Turns out, he came into her apartment to do some routine maintenance and found she had dumped two inches of sand all over the living room floor.”
Heidi jumped when a buzzing sound interrupted their laughter. She reached for her phone, which had been on vibrate.
“Great startle response,” Doctor V said. “A clear case of what we used to call pager anxiety.”
Heidi looked at her message. “For sure,” she agreed, without looking up. Then, her mind still on clients, “You’re right, Allie, they either love you or hate you and it has absolutely nothing to do with how good you are at your job.” Her voice had risen in volume and her face looked tense. Allie recognized the signs of an anxious attempt to gear herself up for another crisis call. The text message had been a summons from the crisis agency.
/> Heidi stood up and hooked the phone on her belt. “Oh, before I go,” she said, “I have to tell you about one of my first crisis evals last spring.” She drew a deep breath. “She was just sixteen years old, and her mother called the crisis line because the girl wouldn’t eat or drink; she was distraught for some reason.
“When I went out to see her, I got that she wasn’t suicidal, she was just very upset because she wanted to go to the prom and they had no money for a dress.
“You know how these kids go ape-shit about the prom. She didn’t want to tell her mother what had her so upset for fear she’d make her mom feel bad. I talked to the girl for a long time about self esteem, valuing herself for what she is instead of what she wears. I told her in the long run, clothes don’t make the man--the woman--she knew what I meant. I thought everything was fine. A few weeks later her mom called to tell me the girl showed up at the prom stark naked and got arrested.”
Allie and Doctor V laughed. Even Wanda looked amused.
Doctor V said, “They’re supposed to warn you in school to beware of unintended consequences.”
“Evidently I’m the queen of unintended consequences,” Heidi said.
“I might contest you for that title," Allie told her.
Heidi exited the room as abruptly as she had arrived, smiling at Allie over her shoulder.
Doctor V drained the last of his coffee and looked at the clock. “I thought Sherry would have an hour free to talk about our vacation plans, but I guess she got stuck with a client. What’s on your agenda for the day, Allie?”
“I’m seeing both Crystal and my anger management client later today. Not back to back. They live in the same general area and I think they might know each other, so I don’t want them to run into each other at the office.”
“Ah, our little borderline, Crystal,” said Doctor V, with a tilt of his head and a snide smile.
Wanda turned to Allie, “Have you noticed that whenever Doctor V talks about a borderline he goes cross eyed?”
The Well - Book One of the Arizona Thriller Trilogy Page 4
