First Chapter
Session One
Monday, June 5
The light
slowly filtered in from the other room as I opened the door. This was the last
moment of the unknown, where two strangers meet and a life story begins.
Most
times, I've no idea which seat in the waiting room a new patient will choose.
Sometimes, though, I can make a good guess from the initial phone call.
Usually, the depressed patient, feeling weak with fatigue, sits in the first
seat available, whereas the anxious person, eager to feel relief, selects the
seat closest to the consultation room.
Not that
it really matters. There are only six chairs in my waiting room.
“Mr. Ferro?” I rolled my neck around the
waiting room. Then checked my watch. Eight o'clock on the dot. Seeing no
one, I pressed my lips together. Did I make the appointment for eight or eight fifteen?
I left
the door ajar, walked to my desk, and re-checked my schedule. I slid my finger
down the Monday, June 5th grid in my appointment book to the eight o’clock hour, and there was his name: Lucas Ferro. He’d be my last
appointment of the night.
Okay, it’s for eight o’clock.
Maybe he’s running late.
While I
waited, I reviewed my notes from my telephone conversation with Ferro. I opened
the crisp manila file and heard a shuffling, then a sputtering hiss of air in
the waiting room. I turned toward the sound, unsure of what it was. A magazine falling on the floor? The
air conditioning shutting off? I
listened for another moment or two and, hearing nothing more, went back to my
desk. My
office suite was a beautiful setting and one I didn’t mind spending so many
hours in. The waiting room, a spacious rectangle, was lined with several Ficus
trees and exotic plants, paintings from local artists, and burled wood
furniture contemporary in design. The thickly upholstered leather chairs were
caramel in color, and the teal-flecked carpet stretched from wall to wall. The
vaulted ceiling housed three skylights, flooding the room with an abundance of
natural light. My consultation office was just as large, and there was ample
room for my desk, two chairs, and the proverbial psychoanalyst's couch–and of
course, an etched nameplate on the door: Alicia Reese, Ph.D. Psychologist. Across
from the built-in bookcase was a long picture window overlooking Oyster Bay.
At this time of night, the evening sunset gleamed across the water, layering
the inlet with a silvery orange hue. I
turned my attention back to the Ferro file, and I heard it again.
Thumping
movements.
Hissing
sounds of air.
Then
silence.
“What is that?” I asked aloud with growing
curiosity.
I'd been working in this building fifteen years and knew
all its creaks, thuds, and mechanical whirrs. But I couldn’t decipher these
sounds. They weren’t familiar.
I tapped
my pocket, confirming the presence of my panic remote. In all the years I’d
been in practice, I never found a need to use it.
I got up
from my desk and moved toward the door that led to the waiting room. An
emerging sense of uneasiness took hold. I heard a hollow voice say something I
couldn’t catch and then trail off.
I jolted
forward, took out the panic alarm, and held my thumb on the button, ready to
send the signal. I entered the waiting room but saw no one.
Again it happened.
The bang of something hitting the ground.
Then a rush of air.
I focused
my vision on the sounds, turning my gaze toward the far right corner of the
reception room.
The darkened bathroom.
I walked
in willed steps toward the nearly closed door. Drawing in a deep breath, I
opened it all the way with a poke of my index finger.
There,
standing against the corner wall, was the shadow of Lucas Ferro having a panic
attack.
“The
tile...it’s cool,” Ferro said, breathing raggedly like a drowning swimmer.
Hissing
sounds of air.
“It’s
okay, Mr. Ferro.” I followed his frenzied movements with my eyes. “I’m gonna
step away and give you some room.”
I flicked
on the bathroom light as I moved away. As the room brightened, I saw Ferro's
face. It was sweaty and chalk white. His black hair flopped in wet patches
across his forehead, and his eyes were narrow slits of blue. His body moved in
spasms, halting and then starting again.
Ferro
tugged at his shirt collar as he drew in rapid breaths. Watching him, I felt
the anxiety leave my body and the return of my clinical posture. This was a
crisis, and I went into crisis mode.
“I want
you to listen to my voice as you take in a deep, slow breath.”
Ferro lifted his shoulders, straightening
himself from the stooped position against the wall. His knees bent several
times as if unable to bear his own weight. Then, all at once, his body buckled
toward the sink, but he anchored his two hands on the porcelain base to steady
himself. As he drew in a series of deep breaths and huffed them coarsely
through his mouth, his feet wobbled and slapped the tiled floor.
Thumping
movements.
“You’re
doing great,” I said. “You're gonna be just fine.”
Soon,
color began to return to his face.
“I want
you to slow your breathing even more. Like this.” I modeled the technique for
him.
Ferro
followed my instructions and formed a slower breathing pattern, ending the
hyperventilation that gripped him. Bit by bit, he raised himself to a solid
standing posture. A self-conscious impulse took over as he saw his reflection
in the mirror. Ferro slicked back his hair with his fingers, smoothed his
clothing, and blotted the sweat from his face with a swipe of his arm. Then he
smiled at me weakly.
The
crisis was over.
As he
found his way back from this acute attack, I realized there was no longer a
need for me to be holding the panic alarm. I tucked it back into my pocket. I
waited for what I thought was a good moment to ask my very first question.
“Can you
move out of the bathroom?”
Ferro
nodded his head and walked toward the reception area. Upon moving into the
waiting room, his eyes sought my approval to sit down.
“Yes, of
course,” I said.
He
slumped into the chair and tilted his head back against the wall. I moved a few
seats away and waited for him to find a sense of balance.
In the
long stretch of silence that followed, I studied him in sidelong glances,
trying not to be obvious. He was young, probably mid-to-late twenties, and his
dark blue eyes glowed with intensity. He was dressed in a green and white
Abercrombie & Fitch shirt. There was a moose logo on the left chest pocket.
His slacks were washed in a dark tan hue, and he wore no socks with his deck
shoes. On his wrist, a flash of gold—a watch with chunky links. He was
vulnerable right now, but as the panic faded, I noticed he was muscular in
build. And tall. Six feet or more.
We
remained quiet in the room for a while. I was always good with silence. It was
a comfortable experience.
“I’m
worried you won’t be able to help me,” Ferro said finally. His voice was dry,
cracking slightly.
“What
makes you say that?”
He was
silent as he regarded me. I wasn’t sure if he was trying to find the right
words or still seized by panic. The silence stretched as he continued looking
at the ceiling, occasionally rubbing his hands over his eyes and face. He
cleared his throat several times, fighting the dryness.
“Let me
get you some water,” I said, getting up. I filled a paper cup with cold tap
water in the bathroom.
Ferro
drank it down in one large gulp. He crumpled the cup and rolled the shapeless
form between his hand and fingers.
“Been in
therapy before. Nothing’s helped,” he spoke again.
“But
you’re here tonight. Something made you feel hopeful.”
Ferro
said nothing but shifted restlessly in his seat. I gave him a few moments
before leaning forward to talk again. Just then, he stopped moving altogether
and turned his gaze toward me. It was a searching look, and at that instant, it
was as if he was seeing me for the first time.
"I
guess... I’m hoping you can help me.”
“How
about we move into my office?”
A beat
later, Ferro nodded.
Wanting
him to find a level of comfort, I avoided unnecessary words or actions as he
made his way into the consultation room. He walked and sat in a nearby chair.
He drew in a few deep breaths trying to get comfortable, but it felt like he
could take flight at any moment—leaving the session altogether. “I’m
not exactly sure where to begin.” “Why
don’t you tell me how long you’ve had these attacks?” It seemed a good starting
point.
“About
two years.”
My eyes
widened. “A long time.”
“Yeah,”
Ferro replied.
“Any idea
why they happen?”
“It’s
–uh—it's complicated.”
“Complications
are my specialty.”
Ferro
laughed and sat back a little further in his chair.
"Tell
me about your work with Dr. Karne," I asked, giving him another place to
start. Dr. Paula Karne was a well-regarded psychologist who practiced cognitive
behavior therapy in Great Neck.
“Saw her
for a few months, y'know, trying to stop the anxiety."
"What
kinds of things did you work on?"
"Changing
how I think, replacing bad habits with better ones. Stuff like that."
"I
see."
Cognitive
behavior therapy focuses on in-the-moment issues and how to change them to find
greater well-being. Though I worked differently than Dr. Karne, my goal would
be the same: to help the patient feel better.
Ferro
cleared his throat and spoke again. "I wasn’t always totally honest with
her, though.”
“How do
you mean?”
“Didn’t
exactly tell her what was really bothering me. Thought I’d just go there and
learn how to control things. That’s all I really wanted anyway.”
“To control
the panic on your own,” I said, reframing his thoughts.
“Yeah.
But I know I gotta be more open. That’s why I decided to try again.”
“Being
honest is important in therapy.”
Silence
came down like a curtain, and we lingered in its folds for a while.
"Why
do you think it was hard to be more open with Dr. Karne?" I asked him.
"Well,
she doesn't really work like that."
"True,"
I eased back in my seat. "She works just with the behaviors you have. She
doesn't get into the nitty gritty things like emotions, memories."
Ferro
nodded in agreement.
“Well,
what’s honesty mean to you?” I asked when it was clear he wasn’t going to speak
again.
“Showing
all the cards, I guess. Talking about things I don’t wanna share.”
“And
feeling things."
Ferro
nodded. "Makes me feel weak.”
“How so?”
“I really
don’t like needing other people.”
“Dependency
makes you feel weak?”
“Yeah.”
"Have
there been times in the past where needing others wasn’t easy?” This was a
gentle probe to move him deeper into his thoughts. Ferro said nothing, shutting
down by looking away. Sensing I might be moving too quickly, I shifted my
approach. “We can talk about those kinds of things at a later time.” “It’s hard to just open up to someone you
meet.”
“I get
that.”
Keeping
track of time, I checked the clock on the end table where Ferro sat. The
session was nearing its end. So much occurred and yet so little was done to
obtain a formal clinical interview.
“We have
just a few more minutes. How about scheduling another appointment?”
“Uh,
okay,” he said, handing me the shapeless cup.
I took it
from him, wondering why he hadn’t placed it in the trashcan himself.
“How
about seeing me on Wednesday?”
“Twice a
week?”
“Actually,
I was thinking three times a week.”
Ferro glanced out the window and then raised his eyes to
mine. As he did this, he shrugged his shoulders. "All right." “We’ll look at why you're feeling anxiety, explore your
early childhood, your connections to others.” Ferro nodded. “Do you know much about Psychoanalysis?” “A little. Dr. Karne talked about it.” “We’re going to explore your thoughts, feelings, and
behaviors, but in a deeper way.” “The
unconscious.” “Yes,” I said, pleased he was familiar with the term. “These
techniques will help us kick your anxiety to the curb." “I'd like that.” “How does seven o’clock
work for you?” Ferro nodded. I picked up a pen and filled in the Wednesday, June 7th slot. Taking an
appointment card from the holder on my desk, I completed his name, the time,
and the date. His eyes seemed glued to my every movement. “Here you go,” I said as I held out the card. “We have to stop.” “That’s it, then?” “For now.”  The arc of the
session went from one extreme to the other. Lucas
Ferro walked into my office at his worst and left seemingly in control. “See you Wednesday, Dr. Reese.” Ferro paused, looked at me,
and extended his hand. nbsp; Many
classical analysts hold back from any form of touch in sessions. I was a modern analyst, and incidental touch wasn’t
something taboo to me. “See you Wednesday,” I said and met his hand with my own. His grip was firm and tight.
