CW: Several references to trauma including child abuse, sexual assault, and COVID. Mentions to the first two are largely brief but they are present.

With Shrinking back for a second season, I looked back on my first season review before writing my second. And in revisiting the review, I started to look back on myself. Specifically, the me that was a therapist. Or is a therapist? I think, in many ways, being a therapist is like being an alcoholic or a Catholic. You might stop doing the rituals, but you never really stop being the thing. So, yeah, I guess I am a therapist and always will be, even if I never see another client.

A thing you get asked a lot when you stop doing the thing you’ve said you wanted to be since you were a teenager is, well, why? It happens less now that it’s been nearly three years since I left the field to write full-time, but it still comes up. I have a friend from grad school who seems to especially struggle with it. It makes sense. We took classes together, read each other’s papers, and reviewed each other’s testing. We met in line to get our campus ID photos. We became fast friends after he realized that despite my shaved head, I wasn’t actively a threat to him or any of the Chosen People. He only knew as a guy trying to be a therapist and then a guy being a therapist. When your buddy leaves the calling and you know what it took to get there, it’s natural to have questions.

Anyway, even though it happens less now, I have the patter down pretty well. I was a therapist at two group homes for adolescents who have spent most of their lives in the system. COVID hit, and they were locked down for more than a year. It was hard, and I could feel burnout coming. It was time for a change. I figured some other kind of therapy job, but then, lo and behold, I got a chance to be a full-time writer, a thing I had never actually believed would be something I could do.

It’s clean. It doesn’t quite fit on a t-shirt, but it wouldn’t fill up an index card either. And people get it. We’ve all felt overwhelmed at work. We’ve all wanted a change. We all have a thing we not so secretly would love to do but “know” we can’t.

But it isn’t the whole truth.

The truth is my last 18 or so months as a therapist were brutal. The limited social contacts, the little shreds of a web of support my clients had they couldn’t see in person for most of that time. The few who had parents or family members with visitation rights they actually exercised would have to sit on the porch or stand in the yard to be yelled at through closed windows. They didn’t go to school; they couldn’t go to work. It was brutal on them.

And it wasn’t much better on us. For months, I was utterly convinced that I would get COVID and bring it home. People were dying at rates that were unheard of in my lifetime, and I was sure that I was going to introduce that virus to my family. And then probably die. Thankfully, I did neither despite being “essential personnel” who went in to work 5 days a week the entire time. But I lived under that cloud for a long time. The truth is I wasn’t heading toward burnout. The truth is I was cooked. I was white-knuckling, and I knew it. As a therapist, I was surviving. I wasn’t thriving. I certainly wasn’t helping my clients thrive.

And I get I didn’t have it the worst. Grocery store employees and first responders and the nurses, my god, the nurses had me beat in every direction. Still, I’ll take this moment to model some positive behavior here.

I’m not sure if you’ve ever read it, but there’s this thing that goes around social media now and then. It talks about how traumatized people are always saying someone has it worse. Therefore, they shouldn’t complain.

In my experience, that’s true. I once had a client tell me that she didn’t feel entitled to feel traumatized by the time her ex got her drunk and had sex with her on the night of their prom because she had read about women who had gotten beaten in the course of their sexual assault. Imagine being violated so physically and emotionally by someone you loved and trusted and trying to argue that you didn’t have the right to that pain. Unfortunately, it’s too common.

So, yes, people had it worse, but it was still rough for me. I won’t try to pretend it wasn’t. Pain is pain, even if someone else is experiencing more.

The thing of it is even all that is kind of a general answer. I can still remember the specific day, the specific moment when I realized that I, for lack of a better way to put it, was in trouble.

To tableset a bit, the thing to understand about mental health care, especially when talking about a nonprofit organization funded by, in large part, by government contracts, is that it is all triage. There’s never enough personnel, money, or time to help everyone you want or should. Nearly everyone has a waiting list. That’s especially the case when you are talking in-patient care or, as in this case, group homes. So that’s part one to keep in mind.

Part two to remember is that kids in state care frequently go AWOL from group homes. It is an absolutely frustrating part of the work. Clients are receiving shelter, a team of trained staff including therapists and doctors, at least one state case worker, educational support, and other assorted support contacts. Objectively, they are better in care than on the run. And yet, there they go. It’s totally maladaptive. But most, if not all, learned from their lives before they ended up in care that running away was an excellent way to protect themselves. Mom was high and starting to yell? Run and hide. When she comes down, it’s safe to return. Dad’s drunk and breaking things? Run and hide. Uncle’s starting to get that look in his eye again? Run and hide. Their rational brain knows that staff won’t hit them or degrade them, but their body’s learned response and their subconscious are screaming, “GET THE HELL OUT OF THERE!”

When kids do run, staff have very few options to stop them and none once they’re off the property. They often follow an AWOL by car or walking behind them as the client proceeds on foot. I walked about 20 feet behind a client, in July, for two miles while dressed in a business casual ensemble and dress shoes. But if following a client puts the house out of ratio (for instance, a 3:1 group home must have at least one staff to every three clients at all times), the client gets picked up in a car (it’s usually a bad idea for law enforcement to engage in car chases… it’s a genuinely terrible idea to have mental health staff do so.), or the client goes into someone else’s home, there aren’t any more options. Also, clients will not infrequently lose staff by running, cutting through yards and hiding, going into busy shopping centers, and so on.

(Quick story, “best” AWOL ever. A young woman got into a huge screaming match with another resident. Staff had to step in and separate them. The young woman sits at the table, proceeds to light a cigarette. She breathes in a considerable puff; the staff tells her to stop. The client puts it out on the table, walks down two flights of stairs, and out the front door. Almost simultaneously, a car pulls up and opens the passenger side door. Client is in and gone before staff even hits the yard. A bad thing, but wow, you had to admire the planning and execution.)

The final bit is that youth in state care are required services until at least 18—and often can keep them longer if they work or continue to pursue schooling. They can also opt to just sign out at 18.

All that preamble squared away, we can get specific. At the tail end of COVID lockdowns, we had a client run. He had gotten caught breaking a variety of rules a few different times, including ones regarding substance use, and decided to take off. He wasn’t 18 yet, but he was close, and we didn’t have the resources to pursue him. We reported the AWOL to police and the state, as always, but a nearly 18-year-old taking off in the middle of a COVID lockdown wasn’t a priority. He didn’t return and neither the police nor the state found him before his birthday. When he turned 18, his AWOL became a relinquishing of the right to state support. It happens on occasion, and it always sucks.

The twist here is he did come back, some six months later, about four months after the state discontinued care. The house manager (I was responsible for all the mental health-related programming in the house; he was responsible for everything else) and I were standing on the front porch near the end of a shift. We were taking a breather and talking the events of the day to make sure we both knew everything the other person knew. At the end of our cul de sac, a car pulled up, and this former client popped out and made his way towards us as his ride pulled away.

He was clearly high, the kind of high where you aren’t so out of it you can feel regret about running from your group home but still high enough that you have the confidence to come back. He talked to us for maybe 10 minutes, reassuring us he was good while unable to provide much by way of details to “prove” that point of view. At some point, I glanced at my watch, saw the time, and decided to go inside to get my stuff so I could go home. He was gone by the time I got back. I don’t know how much longer he lingered talking to the manager, and I never asked.

When I was 8, the UConn men’s basketball team made it deeper into the NCAA tournament than they ever had before—the Elite Eight—thanks to a buzzer beater against Clemson. It was incredible, especially for an 8-year-old who loved basketball. But when I read the Sports section, (I read the newspaper as a kid. Yes, I’ve always been this flavor of insufferable), there was a column by Alan Greenberg. In it, he wrote about how UConn “looked in the mirror” for the first time against Clemson.

The point being, they had been unconscious all season, fearless and in the flow. But against Clemson, they seemed mortal again. They lost the next game to Duke. While I’ve never been a superstitious man, I confess part of me still blames that loss on Greenberg’s column. It’s unfair, of course, and yet, it is true. But the idea that “looked in the mirror” meant “in that moment they lost” stuck with me.

I was about halfway home when it clicked for me. I had just looked in the mirror. I had other clients run and never return. I had clients attempt suicide, once with me in the room. I’ve had clients who were so high on heroin that they fell asleep during sessions with me. On my first day as a case manager in a program for veterans with dual diagnoses at the VA, I had to discharge a client for testing positive for drugs. He overdosed in the parking lot that night. He wasn’t found til the next morning.

So, I’d known disappointment and failure as a therapist before this. But this was the one. This was my end of the line. He showed up, and I looked in the mirror.

It doesn’t mean I’ll never see a client as a therapist again. I might, I might not. I wasn’t, like, irrevocably broken. Or I don’t think so, at least. But the tank ran empty that evening and not in the usual way. There was no way to fill it back up. I had to leave for myself, my clients, my coworkers, and, not inconsequentially, my family. It’s hard to hit that moment where you know you have nothing left to give. If I didn’t, though, or if I pretended I hadn’t, well, I don’t like to think about how that would’ve gone for me or anyone else. So I looked in the mirror. I dropped my calling. And everything is better for it.