The Fourth Wall

My favorite time of the week is Mondays at 2:00pm. I get to facilitate a group supervision of our interns. Usually about four or five interns meet with me in the group room to talk about their experiences and their clients and we get to explore their newly acquired skills and clinical insights.

I would absolutely buy a ticket to this event! We have high expectations of transparency and emotional safety in this group. There’s no mocking or belittling going on here. A lot of respect and a ton of curiosity.

I lead the group from a position of curiosity: An intern presents a case, and then they tell the group what their clinical impressions are, followed by what they did for and with the client. Then I start asking a few questions.

Then the inevitable occurs: The intern feels insecure and they start talking like they are taking a test. They’re looking for the right answer. They get nervous (at first). But the interns with more experience bail them out with, “Hey, it’s just a question. Not a trick question!” For many, it’s their first experience with a treatment team approach to clinical care.

One intern shared about a case last week. After she was done I asked her, “Are you aware of your bias against the client’s community?” And so we embarked on a long and winding journey on how to identify and correct our blind spots. On another occasion an intern shared about a session and I asked, “Did you report that to the authorities?” Another long and detailed spelunking into the code of ethics and mandatory reporting. We try to have year long internships, so I get a front row seat to a pretty high trajectory of change.

We talk a lot about diversity, equity and inclusion. We talk a lot about blind spots and joining with the client. I’m open about a lot of my mistakes and what they taught me. Nobody is an expert in that room, least of all, me.

And while we talk a lot about counseling, I’m always wondering about each intern: Do they have it? “It” is the thing that can’t be taught. “It” is a gift that is born into them, maybe refined by their early experiences. I see glimpses of “It” from time to time, and it drives me to invest more in those interns than in those who seem to be mismatched for the vocation.

Rachel came to us a little over a year ago. She’s of rural origin, and her dialect announces that when you first meet her. My first impressions of her: She’s a little rigid. She’s a little insecure. She might have some trouble connecting with our clients, particularly those who have “seen some stuff.” Early in her internship, she measured her words and wanted to be right. She hates to be wrong and blushes easily. And due to her light complexion and her red hair, it shows up like a beacon.

I pushed her a little in the beginning, just wanting to see what the walls were made of. Sturdy stuff, but she surprised me with flexibility. The group made suggestions that seem to be implemented in the following weeks. She never missed group. She started to relax (a little) and talk more without fear. She stopped ending every sentence with a question. She stopped nonverbally polling the room after she shared a clinical experience. I really liked where this was heading with her.

This past week I was preparing for a tough assessment; I got a call from a local business asking me to do an assessment on an individual who may have an alcohol issue. One of the barriers was that the employee didn’t speak English. So I was looking for an interpreter for the session. Then I remembered Rachel said she knew Spanish, so I asked her if she felt comfortable interpreting for the session. I expected her to decline and maybe tell me she knew a little Spanish, but wasn’t fluent. She surprised me with an immediate, “Yes!”

We have a strong internship program in our agency. Daniel and I both believe in investing heavily in the next generation. Mainly because both of us are in the Autumn of our careers. But one experience we rarely offer is the opportunity to experience or observe individual therapy. The only thing we value more than the intern experience is the client experience. For us, the therapy room is a sacred space. I’m not sure if you’ve ever received therapy in a setting where someone was observing, but I think it hinders the process. So we offer a lot of group and case management experiences. And sometimes, not very often, we arrange an individual experience for the intern. Usually with another counselor. The last time I had an intern with me during a 1:1 with a client was 2009. And I regretted that. But this case was different; I needed a translator in the room.

I met the client in the waiting room. His HR manager was right. English was not his first language. English was not his second language. Now, I can get around in Spanish, but not to the degree I needed for something as specific as an assessment. I told him an interpreter was on her way and we made a little small talk until she arrived.

Rachel came into the room and the client looked at me with a nonverbal question (micro expressions transcend language and culture): “Who is this?” I told him, “This is the interpreter.” He looked at her, then looked back at me with another nonverbal question: “Are you serious?” I also responded nonverbally, “Well, let’s give it a try.” Rachel settled into her seat and smiled.

I started the session and told Rachel to jump in when the water got too deep, which happened pretty quickly. Then Rachel spoke to the client in perfect Spanish. Not only did she have the language down, she nailed the cultural nuance of the conversation. The client looked at me again and said, again nonverbally, “Holy shit! What about that?”

If you’d like to recreate the client’s reaction, go to Youtube and watch a little Lamont Landers sing R&B.

What happened next was quite a sight. Not only did Rachel have the language and the nuance down, she joined with the client in about 5 minutes. “Joining” is a term we use for connecting, but it’s a little deeper than that. It’s a skill that almost can’t be taught (IMO); rather it’s a trait that can be developed. Scott Miller has studied this trait and identifies it as the single greatest trait that sets apart what he calls Super Shrinks from the rest of us bush league therapists.

Joining with a client is made more difficult by the number of hurdles the therapist has to clear to get to the client. For instance, the client and I were close enough in age that age wasn’t a hurdle. We were both male, so no hurdle there. But he grew up in Mexico. That’s a hurdle. And we spoke different languages. Second hurdle. But I’ve been doing this a while; two hurdles isn’t a huge task for me.

When someone asks me about a time when I felt good about what I have done in therapy, I always think about the adolescent female from Japan that I joined with during the first session. Three hurdles, or walls, is some heavy lifting!

And so I was watching, with my own eyes, four walls coming down. Four hurdles cleared in minutes. Rachel and the client were separated by age, gender, race, and culture. And none of these hurdles were small either. I knew what the client’s cultural view of women was, particularly young women, especially young white women. And in the span of about five minutes these two chuckleheads were going on like they were at a reunión familiar. That’s “family reunion” for you gringos.

The result was I was unjoined. Immediately. And I was left as the observer. The guest. I was the third wheel on this therapeutic encounter. And I loved every second of it. A front row seat to a four wall joining that would have made Carl Rogers grab for a bag of popcorn.

I came away from that session with a couple of conclusions: First, maybe I should start bringing interns into the sacred space more often. Second, Rachel is going to get a job offer at the end of her internship.