The vicissitudes of private practice -- over the course of a few months new people start work with me and some end. It's like that. A long term patient reaches an end and leaves. Of new people, some stay, some do not. I can usually tell in the first visit if a person is going to stick with the work. Something in how they make even the initial contact on the phone tells me that the basic commitment has already been made and that it is a matter of the two of us seeing if we are a good fit. And with those who feel iffy from the start -- wanting to be seen less frequently than weekly, or who locate the source of their problems outside themselves -- it's all there from the outset.
That first hour is critically important. I find out what they're wanting, what brings them to talk with me. And I have to strike a balance between just listening and beginning the process of going inside, of interpreting what I hear and making connections in their story while at the same time not going too deep too fast. A delicate process of carefully monitoring the depth of the conversation, because it is too soon to go too far.
And paying attention to how I feel with this person. What is going on in my body while I listen. What images the story calls to my mind. What associations.
And if it goes well, we agree on a time and a fee and the work begins.
Sometimes, the work takes them in directions they hadn't expected. The point is reached where the story they have told themselves about why things are not as they wish they were isn't holding up and to go further is to take on examining themselves and things they have pretty much avoided. And sometimes at this point, they leave. Because they aren't yet ready to go there. And may never be.
It is different every time. And there is a reassuring sameness as well. I never get tired of it.