It is extremely rare for mental health workers to be killed by patients.
It happens about once a year in this country. In most instances, the victims have been young female caseworkers. The homicides most frequently occurred while the victims were visiting residential treatment facilities. And the most likely perpetrators were males with schizophrenia.
The majority of victims were killed by gunshot wounds.
Not that a psychiatrist who rarely sees inpatients is immune from such an attack. At any moment during a session, my patients could stand up, grab the letter opener off my desk, and jam it through my eye socket. But my risk is relatively low. Even though I see patients in my home, which people tell me is a mistake, I feel safe.
Also, I don’t actually keep a letter opener on my desk. That would be tempting fate.
And I take one other precaution. Every single patient I accept for treatment is vetted by me personally. I refuse to accept any patients with whom I do not feel comfortable.
With one exception. But that will resolve itself soon enough.
Right now, my mind isn’t on my patients as I sit at my computer, replying to messages via email. I’m currently composing a reply to a message I received yesterday from my former agent Paige.
Dear Adrienne,
I was shocked and saddened to hear that you wanted to work with another agent at the company for your next project. In addition to being an incredible writer, I have considered you one of my closest friends. I have worked extremely hard nurturing your talent these past years. Can you please let me know what I have done to offend you and I’ll do whatever I can to make it right?
Your friend,
Paige
It takes all my self-restraint not to roll my eyes at Paige’s email. She and I are not friends. Not even close. I am a trained psychiatrist and psychotherapist. Does she honestly believe that her insincere flattery and overfamiliarity will endear her to me? And how exactly has she nurtured my talent aside from taking fifteen percent of everything I’ve made?
But the best part of being a bestselling author is that I don’t have to answer to people like Paige. I get to call the shots—and my contract is with the agency, not with Paige herself. So my reply to my former agent is extremely succinct.
Paige,
I’m afraid that I just don’t feel that you are a good fit for me anymore. Best of luck to you.
Sincerely,
Adrienne Hale, MD, PhD
As I hit “send” on the email, I wonder how Paige will respond. Will she accept that I don’t want her to be my agent anymore and take the rejection gracefully, or will she haul her Audi back out to Westchester and beg on her knees for me to take her back? I suspect it will be the latter.
Human beings don’t deal well with rejection. Back when our ancestors were hunters and gatherers, being ostracized from a tribe was akin to a death sentence. For that reason, rejection is experienced by human beings as being incredibly painful. Studies using functional MRI have shown the same areas of the brain become activated both during rejection and during real physical pain.
Some people deal with rejection better than others. Paige won’t deal with it well. I can already see it unfold. But it doesn’t matter. Once I make a decision, I never go back on it.
A new message pops up in my inbox. The sender is a woman named Susan Jamison—a name I am very familiar with. I click on the new message, already aware of what it is likely to say.
Dr. Hale,
I appreciate the work you have attempted to do with my son, but I don’t feel like he’s making any progress. As I told you two months earlier, I will no longer be paying for his sessions. I’m sorry he has not been reimbursing you himself out of his allowance, but I must reiterate that I will no longer be financing any of these therapy sessions. I’m sorry if you assumed otherwise.
Best,
Susan
I look away from the computer screen to the tape recorder sitting on my desk. Ever since I started holding therapy sessions in my home, I have been recording every single one of them. I ask all patients for permission prior to recording the sessions, although even when they tell me no, I still record them.
I find the tape recordings of the therapy sessions to be extremely helpful. Yes, I could take notes as many therapists do, but those could be potentially inaccurate. Tape recordings don’t lie.
Right now, I use the tapes to refresh my memory, but I envision that someday, at the end of my career, I might listen to the tapes and write a memoir of my experiences.
But not now. Not for decades. I have many, many years left in my career.
On the cassette case for each patient, I write the patient’s initials, the number of the session, and the date. The case currently lying next to the tape recorder reads “EJ #136” and then yesterday’s date.
EJ is Susan’s son. She asked me to work with him about two years ago, stating that he had “no direction in life.” Within one session, I had diagnosed EJ with narcissistic personality disorder—the characteristics of this diagnosis include a long-term pattern of exaggerated feelings of self-importance, cravings for admiration, and impaired empathy.
I press play on the tape recorder and listen to the session from yesterday one more time:
“How did your job interview go?”
“Oh, it went great. They loved me. I’m sure they’ll be begging me to come work there. But honestly, I don’t think I could do it. Everyone at the company seems so stupid. I don’t think I could work in a place where I’m surrounded by stupidity all day.”
The moment I first met this man, I immediately disliked him. But I had already met Susan and agreed to see her son. I considered telling her no, but I had given her my word. And I did believe that I could help him.
Unfortunately, I do not believe it any longer. I cannot help this man. He has no insight into his shortcomings and he never will. He has no desire to change. And now that his mother is no longer paying me, I have ample excuse to terminate our sessions.
I will never have to see him again.
