On opening doors and therapeutic intervention

I've never given much thought about opening doors. It's just something I do. Perhaps it's the Midwestern boy in me: I was taught it was polite to open the door for another. When I was in college, before the days of remote locks in cars, I remember taking pride in unlocking and opening the passenger side door for whomever I was with. I always got such a smile from a friend--or a date--when I took the time to walk to the car door, unlock in, open it up, and gently close the door after my passenger settled into the seat.

I suppose no one really does that any more. A new generation of teenagers going on dates with their young loves won't have the opportunity for the gentle generous act of holding the car door open. 

I remember my first year of graduate school. New York City in 1992. Just barely 20 years old on my first day of classes, I stood outside the crowded CUNY building holding the door open. Silly me. First one person walked through, then another, and another, and another, and another... I might have spent the whole year standing outside holding the door open if I hadn't perfected the art of opening the door, letting one person through, and whisking myself through the door behind them. I just couldn't give up the tradition of holding the door open. I did, however, need to be smart about it.

So it wasn't a surprise when I became a therapist and opened and closed the door for my patients. I never considered not doing it (door opening, such a habit, wasn't a thing I considered even thinking about). For years I opened and door countless times a day for patients without thought. 

Finally during my practicum in the 2000-20001 academic year the door was mentioned. In fact, during that year Glenda Russell, my clinical supervisor, made mention of the door twice. In talking about an upcoming final appointment with a patient Glenda asked how I normally ended my time with a patient. I responded that I'll  tell my patient to call me if they need me, walk to the door, open it up, and then close it behind them. Glenda had asked me what it might be like to have a discussion about the final session and maybe invite the client to open the door themselves and walk out on their own. An interesting thought. 

Several months later Glenda talked about how sometimes she will gently, yet firmly, close her door when a patient who needs a little help with boundaries walks out. "It gently delivers the message that the appointment was over it and it is time to leave."

I noticed that when I walked out of her office that day she gently, yet firmly, closed the door behind me.

I remember years later being mystified by Debora Carmichael, one of my post-doctoral supervisors. We sat in two dark red Windsor chairs. When our supervision ended she would say goodbye and just sort of shut off. She would stay in her chair and look down. I was totally befuddled. It took my awhile before I finally figured out when she did that I was supposed to get up, open the door, and walk out. 

I thought that was strange. Who doesn't open up the door? Deb clearly must not be from the Midwest. I figured it was cultural.

None of this is really my point.

I've been opening and closing my door now for years--decades actually. Things area little different now. I have a dog. I'll send her out into the waiting room to retrieve my patients. She likes doing it, my patients like when she does it, and it is such a playful way for me to say hello. I still open and close the door. Maggie just gives me a little help.

I open and close my door with reason and intention. I want to greet my patients. I want to express care for them by the simple, gentle, and kind act of opening and closing the door. I want to express care for them by walking them to the door and seeing them off into the outside world.

That is my thing, and I do it with reason and intention. It never occurred to me that I would do something different. At least doing something differently didn't occur to me until this past week.

I've felt vaguely uncomfortable for several months now as I walk a particular patient to the door. The feeling was so vague I didn't notice it at first. I figured I was tired and clumsy as her bag gently brushed me. I thought maybe she was tired as she stumbled a bit and pressed against the wall opposite of me. I'd like to say that I spent time thinking about those things and came to insight. That's not really what happened. It was all very unconscious. 

This week what I've apparently been unconsciously thinking about burst to the surface. I realized that I felt uncomfortable as my patient walked out the door. I could think of no reason why I should be. I'm not uncomfortable at the end of appointments. Nothing this patient does makes me feel uncomfortable. Clearly there is something else going on here.

I did what any good therapist does: I used my experience to illuminate a conversation.

"Before you leave, I wanted to talk with you about how you leave. It always seems vaguely uncomfortable to me. I'm wondering if you feel uncomfortable too?"

With somewhat wide eyes (incredulous that I'm talking about the door?) my patient responded. "Yes."

I took a leap of faith and said what I thought here experience might be: I wanted to provide a little scaffolding to help her understand her experience (or give her some scaffolding to tell me I'm off my rocker). "Might it be that I get a little too close to your physical space when I open the door? It's a small space. I'm wondering if maybe you don't feel safe."

"Yes," she said. "I don't."

We talked more and came to the conclusion that she would open and close the door herself now.

This was a small interaction. Just a moment or two of time. I could have easily missed it: we miss these moments all the time in therapy and in life. When we can capture them and harness the energy of the moment for long enough we can illuminate important parts of our experience. The intervention arises from the moment. The intervention arises from the interaction between myself and my patient. Change comes from what is alive and real in the office. Change comes from closely observing what is alive in the moment and wondering together what it might mean.