The Supervision of Tears

I had an incredible internship at Elmcrest Psychiatric Institute.  I learned about people, psychotherapy and myself.   We learn about ourselves through our interaction with other people.  As a result, the place emphasized groups.  Everything was done in groups.  There was group therapy, family therapy, community meetings and multifamily therapy.  You couldn’t get your loved one into Elmcrest unless you agreed to attend family therapy and multifamily therapy weekly.  I tried to capture the spectacle of the community meeting in my novel Bedlam. 

The training I experienced was perfect for who I was at that time in my life.  I had been studying behavior modification in college and graduate school.  Behavior modification didn’t speak to me.  At Elmcrest, I was trained to look at the big picture, Systems Theory.  My mind wanted to think in the big picture and this gave me permission.  

Weekly, we participated in a psychotherapy seminar with Leo Berman, M.D.  Leo had originally trained as an M.S.W.  Then he went back and completed his medical degree.  He was a wise man.  In my blog Great Marriage Advice, the psychiatrist I refer to was Leo.  During the seminars our therapy was scutinized.  In addition, monthly, we were invited to the Medical Director’s Office.  Lou Fierman, M.D. was a brilliant psychiatrist.  He had studied with Helmuth Kaiser, M.D., who was a student of Sigmund Freud.  Since I found that out, I have always felt a legacy sent down to me from Freud.  This is purely fantasy, but I love thinking it.  We had amazing discussions with Lou about psychotherapy.  

Then there were the monthly workshops.  As an intern, I had the opportunity to attend workshops with Sal Minuchin, Virginia Satir, Alexander Lowen (the bioenergeticist), Bandler & Grindler (The Neurolinguistic Programming exponents) and Carl Whitaker.  Carl Whitaker later became my mentor.  These workshops had a huge impact on me and my psychotherapy.  

I had lots of supervision at Elmcrest.  My supervision is representative of some of the craziness of the place.  I started by being supervised by Steve.  Steve was down to earth and a terrific therapist.  However, half way through the internship, he stopped coming to work.  He eventually went into a substance abuse rehab.  It would be Wednesday morning and 15 minutes before clinical rounds and I would find out that Steve, the team leader wasn’t showing up.  As a totally green intern, it fell to me to discuss all eight cases with the team and the psychiatrist.  

The first psychiatrist I ever worked with was Joan.  It was like working with the earth-mother.  She was strong, intelligent, beautiful and a terrific shrink.  She was the most nurturing psychiatrist I have ever known.  I remember one time, receiving a call from my mother, just before the meeting started.  I don’t think I have ever felt safer as an adult.  I had my mother on the phone and the earth-mother sitting across from me.  

The second supervisor I had was from the admission service.  I had to meet with him, because he was the head of psychology.  Half way through the year, he stopped coming to work.  We found out that he had been admitted to a sister hospital for depression.  

The third supervisor I had was the director of the adolescent service.  Richard was often described as a big teddy bear.  He was a wonderful therapist and a great man.  He was amazing with adolescents.  But one morning when we were just starting the unit community meeting, I looked over at Richard and he was sobbing.  Again I had to take over the team and the meeting.  Later we found out that his wife had attempted suicide the night before. 

My fourth supervisor made up for the rest.  E. Bruce Bynum was a Doctoral Psychology Intern and I was a pre-Doctoral Psychology Intern.  As part of Bruce’s training, he was to supervise an intern:  me!  I met him the second day and when we shook hands, he smiled and asked: “So, Thursday night you want to split spaghetti?”  Then he winked.  From that moment on, he has been my brother, my best friend and my confidant.  Next to my wife, he has been my greatest support and I have done the same for him.  He is one of the great blessings of my life.  

The administrator of the hospital was a fascinating character.  He had been a New York City Policeman.  After that, he got his Masters in Social Work.  Finally, he had finished his Masters in Public Health.  He was smart, loud, bossy and a great therapist.  It is his supervision that I want to discuss. 

I was still new to the internship, maybe it was January.  I was working on the adolescent service.  One of the 17 year old patients was running out of insurance and being forced to leave.  He was still not ready to go to the community, so he was being transferred to the state psychiatric hospital.  From the perspective of working at Elmcrest, this was like being thrown into the snake pit.  Everyone on the unit was feeling very sad the day he was leaving.  I was not alone to have tears in my eyes.  At one of these moments, the administrator of the hospital walked by me.  

The next day I was summoned to his office.  “What was that about yesterday?  I saw you crying on the unit.”  I explained the effect of the boys situation.  “That’s ridiculous.  You are going to be a psychotherapist, a clinician.  You can’t be crying in front of your patients.  You need to be stronger than that.  That’s all.”  With that I was dismissed.  

I wrestled with that for years.  Something about what he said didn’t ring true for me.  Eventually, I realized he was wrong.  I wasn’t crying, I was tearing.  I hope that if I am a psychotherapist for 60 years, I’ll still be able to feel sadness in my office.  One of the worst things you can do as a psychotherapist is be a fake, or not connect.  

Now there is a difference between crying and tearing.  When I am in my office, I sometimes tear.  But I am in control of myself when I tear.  I can continue the discussion, react to what people are saying and be there with them.  Crying is not for my office.  When I cry, I let go, I fall into the sadness and am absorbed by it.  I relish these moments as a cleansing of my soul, but I don’t do it in my office.  

I have had tremendous supervision throughout my professional career.  I wouldn’t have accomplished what I have accomplished without all of them.  There lessons were invaluable.  But with each one of them, there reached a moment when I realized that what was right for them, wasn’t right for me.  Usually supervisors are right, but that doesn’t take the responsibility away from the therapist to make their own decision about what is right for them.