Eva has been artfully nodding as the therapist presents all of the rules of confidentiality. Eva knows the therapy game; she knows all about confidentiality and HIPAA. Eva smiled at the appropriate times and gave her verbal agreement when needed, all the while sizing up the woman sitting in front of her based on the office and its contents. The books that sit on the shelves are eclectic and elementary; Eva has read them all. The diplomas displayed on the walls are all from state universities; they are no match for Eva’s inherent intellect, let alone her Ivy League education. The furniture is cheap and tired. Eva estimates that she probably makes fifteen to twenty times more annually than the therapist. Yes, they live in very different worlds. Before the therapist can even ask one question about why Eva was there, Eva knows she is not going to be good enough. Eva is already angry with herself for taking precious time out of her busy life and bothering to make this appointment. How could anyone who comes to this same office day in and day out even begin to relate to Eva’s frustrations and concerns, let alone her life?
“Pardon me?” Eva is not quite sure she heard the therapist correctly.
“I said, if you leave, that’s fine, but you will still have to pay for the session, as you already agreed to the cancellation policy when you made the appointment online.”
“Who said anything about leaving?” Eva responds firmly.
Jackie simply points with an open hand toward Eva. Eva takes a look down at herself and sees that she is on the edge of her seat with both feet on the ground and her purse strap wrapped around her hand. Eva is clearly in the position of someone about to walk out the door, not someone who is about to sit through a fifty-minute therapy session. Eva smiles. She unwraps her hand from her purse, sits back in her chair, and decides to stay for at least this session. Eva appreciates Jackie’s quick assessment, her business acumen, and, most importantly, her confidence.
Jackie is relieved to see Eva’s exit stance dissipate. She could tell by Eva’s half-completed self-assessment that if she even showed up today, Eva was going to be a challenge. And so far, after all of five minutes, Eva is living up to Jackie’s expectations.
“So, Eva, before we really begin today, I read what you completed of your self-assessment.”
Eva nods. She has been waiting patiently for the standard question on why she did not complete the assessment and the long-winded explanation on how valuable the self-assessment tool is for a new therapeutic relationship.
“As a therapist, I have to get some clarification on one question. With regard to ever feeling suicidal or having any suicidal ideation, you wrote that you do not have acute suicidal thoughts but are passively suicidal. Would you elaborate for me?”
Eva smiles. “Jackie, I am an Ivy League–educated woman in her forties who works eighty-plus hours per week, has at least one drink per day, and smokes. Some would call my habits avoidance; some would call my habits addictions. They may not kill me today, but I am well aware that one of those things or the combination of those things will eventually kill me. So, yes, I would say I am passively suicidal.”
Sarah E Stewart, MSW,CPC