My 3:00 appointment had been referred from the Hospice team. Their patient, a woman in her 40’s with a spouse and two children, was dying at the close of a long battle with cancer. The team was actively working with their patient along with her spouse and children, who were the primary family system. Their patient’s mother was an independent older adult living in the community, and the team was concerned for her and wanted me to see if she could benefit from individual counseling. The referral to me was a way to navigate the complexities of both insurance billing and family dynamics. I anticipated it to be a smooth, supportive session where we talked through many of the challenges of anticipatory grief as an augment to her Hospice team.
Not so much.
My first assessment meeting with her was superficially fine. In fact, everything was fine. Just fine. Her health was fine. Her mental health was fine. Her coping was fine. Her social support was fine. Her family was fine. We whipped through an assessment which can sometimes take 2 hours to complete in 15 minutes, including pleasantries. Everything was just fine. This means, of course, that it was not. I still had a few minutes of session time left, so I pushed a little harder. She had mentioned having a strong faith and a supportive church community. She came back to this repeatedly, actually. I brought this up as a strength, but turned things around a bit to try to open the dialogue, “in what ways do you think your faith may be challenged or changed right now as you care for your daughter, as you and your family face the possibility of her death?” I asked. She sat up in her chair and got a little ruffled, “dear, no one questions God in times like these. You cannot be angry with God”
Well, if that was true, I am fairly sure 99% of my clients (not to mention myself and my own friends) would be shocked at their abnormality. I kept my reaction to myself, but asked her if she would be willing to delve a little deeper into this topic during our next session.
I am a therapist, not a clergy person, so I consulted with my chaplain colleague before the next session. My intent wasn’t to pry open or challenge her faith, but to raise her awareness of the link between spirituality and emotion, and try to move through a stuck point that seemed to be preventing her from having the quality of relationship with her daughter and family that could be meaningful at this crucial time. My chaplain friend was encouraging of this approach, and since he knew my client, provided a specific message for me to take to her, and he was happy to let me deal with it from there. It seemed like an exceptional disciplinary arrangement for both of us.
My client came back for her next session. She likely didn’t want to, but she was compliant. I told her I had spoken with the Hospice chaplain, and that he had a message to relay; it wasn’t my message, but one that he wanted her to hear and that I wanted us to talk about after she heard it. That message was, “God is big enough to understand us and love us through everything. God is even big enough to understand and love us through our anger.”
This would have been a strong and powerful, positive message to many people. But, my client sat there in silence. I waited for her to take it in. She met my eye and said, “Dear, I hate to have to say this but I am going to: Get Thee Behind Me, Satan!”
Instantaneously, my clinical instincts were reaching out to schedule my next supervision session in preparation for malpractice litigation. I was also mentally paging the chaplain, since this was not territory where I wanted to tread alone. Nothing in my professional social work training ever prepared me to be called Satan. I sat there more in stunned silence than clinical intentionality. But something amazing happened, in spite of it all. Or, perhaps, because of it.
My client sat back down in her chair and sobbed. Tears streamed down her face. At one point, she held on to me as she allowed herself, for the first time, to actually feel her feelings. This was my realm again, the place where emotion and cognition meet. The place where we gain insight over our emotional experience and make choices that help us navigate our relationships. That visceral breakthrough changed everything.
We went on to work together throughout her daughter’s end stage illness. Mother and daughter (and partners and grand children) went on to have rich conversations that helped sustain them through grief and dying and mourning. My client grew both psychologically, and spiritually. When it was finally time for our last session, she told me that I had been an angel, not the devil. I told her I frankly didn’t want to be either one. I was simply pleased to be the catalyst for her own authenticity and growth, which transformed her final weeks with her daughter into deep and meaningful memories.
This story, which she has allowed me to share, has stuck with me as a small point of light. It transformed me, too. It spoke to my spirit and has revisited me during times of pain, struggle, and grief when I was tempted to put on a strong face and move forward.
If we can risk the authenticity and vulnerability of feeling our feelings, of being in the present moment as the human beings that we are, we will experience God in an entirely different way.