Other Consultations may be more aptly named, ‘Exploring Possibilities’. From time to time, and when deemed appropriate by client and therapist, during the course of Individual, Group, and/or Couples therapy, other therapeutic meetings with significant relations from the client’s life can be arranged to support the broad work of therapy in a very time defined and specific intervention. Typically, these sessions are scheduled only after thorough exploration of: 1) what it would mean for the client to alter the existing therapy; 2) what is sought by doing so; 3) what conflicts might present themselves; 4) as well as what solutions or unexpected magic might unfold or emerge? ‘Other Consultations’ are short-lived and I have yet to adapt such arrangements to any permanent therapy. The following are what I consider examples of consultations used to support a client’s therapy.
1) Brother (5 sessions over one year): For one client, the family chaos from his beginning to the present was extreme. There were many family members with addiction, acting out, poor decision making, and lots of cruelty. This particular client was high functioning, articulate, and sober. He had distanced himself from his family for over 10 years and had limited contact, usually for short periods of time, by himself, and in public places. He had embarked on an engagement to be married to his lovely girlfriend of 2.5 years and was perplexed and pained,( more the latter) about how to, or whether, he ought to involve his family in the celebration of his marriage. The client had one brother who had similarly pulled himself out of the downward swirl of the ‘family flush’ (my client’s quote!). My client felt a lot of love for and support from his younger brother, but the expression of love was truncated, tenuous, and not fully claimed. The advent of the wedding being planned spurred my client to explore connecting and claiming more fully the relationship with his brother. He eventually invited his brother to several sessions when his brother was in town for the holidays. The work consisted of reviewing and grieving what they had experienced and a deep exchange of love and affection. My client shared his engagement news (something he kept hidden from all of his family) with the brother. My client invited his younger brother to be part of the wedding in a very full sense….not simply to stand with him at the ceremony, but to stand as a part of his circle of deep connection and support for his marriage, as a part of his existing family.
2) Neurological History (3 sessions over two months): A female client (age 25) with an extensive history of depression, a few head injuries (one from a bike accident, the other from field hockey), and difficulty following through on goals with work and/or graduate school was making progress in building a trusting relationship in therapy, then in a therapy group. After about a year in the therapy group, several members firmly but respectfully confronted her about her history of such head injuries, what had been done in the past, what exactly were the injuries, when her last neurologic evaluations had taken place, .etc. The hope was to gain a clear picture of what had taken place, what had the client’s family done or remembered, and where might the history lead. The client heard the requests from the group in a defensive and then receptive manner. She agreed to meet with her parents, generally agreeable and nice folks, with me for a history of the family, head injuries, and other family challenges. The client and I gained mutual insight into the nature of the head trauma, a few over looked details, and she was sent for a current neurological evaluation. As important, she reported to the group, with my encouragement (and ‘pushiness) that her family was mostly supportive, and ‘not’ uninvolved. A myth she had constructed about their participation in her care. The group was more receptive to her more frequent requests for time to process her movement into more fulfilling work as well to take responsible steps for trying medications and structured support services.
3) Employee Assistance (3 letters written with two 30-minute phone consults over 10 months): A middle-age man with whom I worked for 4-5 years in individual therapy was caring for an aging father and his own child took ill. His child required intensive specialized treatment for several months. My client experienced the demands of his father and his ill child, in combination with his work stress by going further into a depression. He required an increase in his depression medication and after only slight gains, a second medication was added. Unfortunately, the addition of the second medication made the client more sluggish, more depressed, and far more ‘foggy’ regarding the details needed for his high level law firm position. He made a few uncharacteristic mistakes at work before we set to limit damages until he withdrew from the second and reduced the first medications. Several letters were written on his behalf and co-signed by myself and his psychiatrist requesting a reduction of work, and then, a short-term disability. These were successfully granted as he had been a very high functioning and successful employee for the firm. He was out of work for a few months, before he gradually returned to full time employment without issue. In the meantime, he, his wife and friends coordinated care for his child and his aging dad.
Again, these are a few ways that consultations outside of the therapy office and regiment can be seen to support the overall functioning of the clients with whom I work.