Which is the most meaningful?
Jack, a forty-three-year-old insurance executive, was referred to me by his family doctor for help with his severe panic attacks that had a sudden onset for reasons that were completely unclear to both of them. Jack’s symptoms were disabling and resulted in his missing work for several days before his initial appointment with me.
In the first session, I listened to him describe his difficult breathing, chest pains, sleeplessness, occasional choking episodes, along with his fear of losing complete control and “going crazy.” He told me that he has always been an anxious person and had contemplated entering psychotherapy for several years, but never actually did… until now.
The initial consultation with Jack was, in my view, a mixed success. According to Jack, it was “an unbelievable success.” We were able to quickly identify the sources of his current anxiety symptoms which, almost immediately, provided him with some much-needed relief. We began to outline some of the likely goals of the ongoing therapy he was “very happy to be starting, finally” and for which he eagerly arranged his next appointment with me. As the session wore on, I began to feel concerned that the initial and speedy benefits of this first session might have implications for Jack’s ability to fully engage in the challenging, ongoing work of psychotherapy; something I believed he needed and from which he could derive greater benefit than symptom relief only. I became especially concerned when Jack described his first session as “maybe the best hour of my life!” and described me as, “undoubtedly, the best therapist in America!” That’s when I thought I probably will never see Jack again.
As it turned out, Jack did attend his second session, and a third, and described the continuing benefits of the work thus far. He was hardly symptomatic, felt “great,” no longer thought that he was “losing it,” and was wondering whether or not he really needed therapy after all. Somewhat surprisingly, he asked me to tell him what I thought he should do. In order to help Jack figure this out for himself as much as possible, I did what any therapist worth his stripes would likely do as a first response to such a question: I asked Jack to try and decide independently of my input, so that we could both learn something about his attitudes, thoughts, and feelings, rather than have him simply react to mine. My input followed and consisted of my ideas about the differences between relief and change with the latter, obviously, being the more ambitious pursuit and, perhaps, the more durable. I also was mindful, as always, that for some people, relief may be all they want or need. Not everyone wishes to or has the wherewithal to undertake a full course of psychotherapy, especially if they are not in active distress.
After a meaningful conversation about his dilemma, i.e., to stay or to go, Jack decided that he was quite happy with what had occurred and chose not to pursue further therapy at that time. He asked for and received assurance that my door would always be open and we both acknowledged that we may or may not ever see each other again. He left describing himself as the “three-session wonder.” I later heard from his physician that he was doing quite well with no further panic attacks. It led me to wonder whether or not I should revise my thinking to include the fact that sometimes and for some people, relief is change and not necessarily something less or less meaningful.