I met Luke when he was about to turn 15. He was at the beginning of a growth spurt, thin and lanky, with sneakers that looked far too big for the rest of him. Polite but reserved, he made eye contact fleetingly and didn’t smile. He wasn’t attending school, had stopped playing baseball, and for the last eight months had spent most of his time alone in his room. When his best friend had moved across the country, he’d withdrawn even more. His social anxiety became so overwhelming and painful that he told his mother going to high school “felt like being shot.” He’d been in therapy before and had tried medication, but as his anxiety and depression deepened, he felt hopeless, and his parents were increasingly desperate.
This is a success story. Luke, now 17, is back in school full-time. He started taking drum lessons, and he and some new friends formed a band. He joined a baseball team and showed up to the first practice knowing no one. He missed a grounder that first day, but went back. I could spend hours describing the steps Luke and I took to manage his anxiety and get him to where he is now, two and a half years later. But this isn’t a story about that—it’s a story about connection and what happens when we therapists allow ourselves to be genuine and flawed and real.
Looking back, I think two conversations started us off down this path. The first took place during an early session, when he was wary of what I had to offer him. “How do you know what this is like?” he asked. “You’re not me. I can’t walk into school and not feel the anxiety. It’s awful.”
I told Luke that, for the first half of my life, I was held hostage by a powerful medical phobia. Actually, the term medical phobia is far too specific for what was really a fear of anything I considered even remotely “gross” in the realm of bodily function or dysfunction. Even the vague suggestion of something “medical” or “gross,” would cause me to have a full-on panic attack, a vasovagal reaction that came on slowly but quickly picked up speed. Once the symptoms started—always with a rushing in my ears—the panic and physical reactions spiraled. Ultimately, I’d lose consciousness.
I passed out frequently and in the most embarrassing situations imaginable. Although I worked hard to avoid any possible triggers, it didn’t take much to set me off. Once, as a swimmer after college, I developed an ear infection and went to the doctor. He looked into my ear and said rather dryly, “Wow, it’s red in there.” That was all it took. I fainted.
Luke was leaning forward in his seat, taking in every word as I told him this. I went on to say that my first job after graduate school was in a hospital, which, I reminded him, “is one of those big buildings where they keep all the gross medical stuff.” I was working on the inpatient psychiatry unit—as nonmedical an environment as I could hope for. But still, inside every elevator, around every corner, even in the cafeteria, lurked potential horrors that I might see or hear or imagine. I was determined that this fear wouldn’t rule me, but I had no skills or plan to back up my determination. I had to figure it out.
“And I did,” I told Luke. “I’m proof that this can be done. And in the last 18 years, I’ve only passed out twice. Both times were embarrassing, and both had to do with bones. Bones and dislocations can still get me every once in a while. But I’m much, much better. I’m on offense with this thing. I don’t avoid it. And I’ll teach you to do what I do.”
The second conversation took place about a year into treatment. As Luke was steadily moving back into his life, I asked what made him stick it out in therapy with me, way back when.
“One thing, I think, was that I knew you were funny,” he told me. “And I knew I was funny. I wanted to show you that. I wanted to make you laugh, and it made me mad that my anxiety didn’t let me do that. I wanted you to see who I was because I knew you’d appreciate it.”
This brings us up to the last few months. Luke was doing so well that we were meeting only every six weeks or so. At one visit, he began to tell me about recent events and successes, as had become the routine. “Oh, yeah,” he added, “and I have a girlfriend. Annie.” I beamed immediately, but then felt myself working to rein in my excitement. Instead, I did the therapist nod as he filled me in. She was a girl from school, also anxious, he told me. They’d become friends first, able to tell each other all sorts of things. “I like her,” Luke said, grinning in spite of himself. “So a few weeks ago, I asked her to be my girlfriend. She said yes.”
But there was a problem, and he was hoping I could help. “We’ve agreed to be boyfriend and girlfriend,” he said. “Except since then, nothing has happened that you’d consider ‘boyfriend and girlfriend.’” Luke looked down at his sneakers. “Do you know what I mean?”
I told him I did, and we talked about what he could do to take that next step. Should he hold Annie’s hand? Put his arm around her when they were watching TV? “How do you just do that?” he wanted to know.
“Take her to the movies,” I said, with more confidence than I felt. “Annie’s hand will be resting on the armrest or her lap. Then during the movie, tap the top of her hand like this, and offer your hand to her.” I acted it out. Finger tap. Offer hand with palm up.
The next week, Luke reported success. After they’d gotten over that hump, it was easy to hold hands and sit close while hanging out. “But now I want to kiss her,” he said. “Tell me how to do that.”
I asked Luke if he thought Annie wanted to kiss him. Yes, he thought so. “So ask her,” I said. “When you’re sitting together, turn to her and say something like, ‘Can I kiss you?’”
“Really?” said Luke. “Isn’t that weird? Is that what people do?”
I told him it was kind and polite and sweet. And, yes, that’s what kind and polite people do—even teenage boys. I predicted that Annie would say yes. I was almost sure of it.
“Okay, I’ll do it,” he said. “And can I come back next week? You’re the only one I can talk to about this.”
The following week, he sat down and made a few minutes of small talk. “Oh, and I kissed Annie,” he added, casual as can be. “Damn!” I said, laughing. “You buried the lead!”
“I did what you said,” he grinned. “We were watching a movie at my house and I turned to her and said, ‘Do you want to kiss me?’ She said yes. But then we realized we didn’t know what to do next.” So, he said, they took out his iPad and searched for “how to kiss a girl” on WikiHow. They figured it out, step by step. They laughed a lot. I assured Luke that kissing was something that improved with practice. He smiled. We talked about school and his thoughts about going away to college the following fall, and then scheduled another appointment.
His mom emailed a few days before his appointment to let me know that Luke had dislocated his shoulder while playing touch football. “All is well,” she wrote. “He’ll tell you about it when you see him.” I got nervous.
The last time I’d passed out, four years earlier, was the direct result of my friend Jim telling me about his dislocated shoulder. We were at a fancy fundraiser, and Jim was a bit drunk. In some detail, he described to me his fall while skiing, his subsequent belief that his shoulder was “just dislocated,” and his repeated attempts to shove it back into place. “I didn’t know it was broken,” he said. “While I was pushing on it, it got a bit gummy in there.” Gummy. Such a seemingly innocuous word, but I felt those familiar symptoms moving in fast.
The last thing I remember was excusing myself, saying I needed to take a trip to the bathroom. I regained consciousness about 15 feet from where I’d left Jim. I was flat on my back in the foyer. When I came to, the live music had stopped and several people were leaning over me.
The night before Luke’s appointment, I struggled to fall asleep, which is unusual for me. He was going to tell me about his dislocated shoulder. I’d taught him to step in to his worries, that avoiding triggers only made the anxiety stronger. He could handle it. But now, it was my turn. I felt responsible for the progress of both of us.
I reminded myself I could handle whatever happened. “If I faint, I faint” had been my liberating mantra for decades. I’d been humiliated in more scenarios than I could remember, and I’d survived. Bring it on, I told myself, and then stayed awake for another hour or two.
Luke arrived for his appointment the next afternoon. We chatted about school (he was finally catching up in math), Annie (the kissing was going well, and the need for coaching diminished at this point), and his dogs (his mother had added another rescue to the pack, much to his father’s dismay). “I dislocated my shoulder, did you hear?” he finally asked. I told him his mom had emailed, then he filled me in on the details.
After baseball practice he and his teammates were playing a little touch football that quickly came to include tackles. One boy took him down hard, and he immediately knew there was a problem. “I couldn’t move,” he said. “I was just on the ground groaning.” He didn’t tell me anything too graphic—and no mention of “gummy.” I focused on my breathing and was doing fine. Then Luke said, “I have the X-rays on my phone. Right here. Pictures of when my shoulder was out and then when they put it back in. I want you to see them.” He looked at me with anticipation.
“Sure!” I said, perhaps a little too enthusiastically. “In a few minutes.” The session was almost over, and I decided I’d look at the X-rays as he was heading out the door. That would be safe.
But Luke was having none of it. “You should look now. No avoiding. Let’s go.”
He was right. I needed to walk the walk. “Okay, let’s see them,” I said. Pressing my hands together and breathing as slowly and silently as I could, I felt my heart rate bump up a bit.
Luke found the X-rays on his phone and turned the screen toward me. “This one is when the shoulder was out,” he said. “See that? Look closely. And here it is back in. See?” He toggled back and forth several times. Then he looked at me. “How’re you doing?” he asked.
“I’m fine. I really am,” I said, hoping Luke could feel my confidence. My heart rate was evening out, and there was no telltale rush in my ears.
Luke told me I’d done a great job. He’d known I could do it, he said. He put away his phone and we talked some more. I don’t remember what we discussed, but he was making me laugh, probably by imitating his poodle’s nervous grimacing. Luke is funny.
When the hour was over, we scheduled several weeks out, back to our previous routine. “Thank you,” I said. “This was my lucky day, you dislocating your shoulder and then showing me the X-rays. You’ve helped me a lot.”
“It’s the least I could do,” he answered.
I felt my eyes well up as he left. This was a boy who came to my office barely able to look at me, wanting so desperately to find friends and connection, but terrified to show himself to the world. He left this day knowing, I’m quite sure, that connection happens when you take a bit of a risk and share a human, emotional experience.
When I was in graduate school, I was told not to self-disclose, to always be careful about how I reacted and what I said when I saw a client outside a session. As a 22-year-old social work intern, one of the many things I worried about was my ability to hide my “real” self from the families I was assigned to help.
Believe me, I like boundaries. My office is attached to the back of my house, and the rules surrounding that are made clear to my clients. But how can I teach my young worriers (and the older ones, too) to relish the uncertainty of human connection if I’m unwilling to connect genuinely with them? Now you know the truth: I’m funny, and I faint. When you specialize in anxiety disorders, these two qualities can come in handy as needed.
Lynn Lyons, LICSW, specializes in the treatment of anxious families and is the coauthor of Anxious Kids, Anxious Parents and Playing with Anxiety: Casey’s Guide for Teens and Kids. She’s the author of Using Hypnosis with Children: Creating and Delivering Effective Interventions.
This blog is excerpted from "I'm Funny and I Faint" by Lynn Lyons. The full version is available in the May/June 2017 issue, What Now? Five Therapists Face the Limits of What They Know.
Photo © Psychotherapy Networker
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