Daily Excerpt: From Deep Within (Lewis) - The Cutting Group

 

excerpt from From Deep Within (Lewis) 

The Cutting Group 

The door to the outpatient clinic’s waiting room opened and flakes of snow swept in with a chilling cold. The room was shaped in a perfect square. Twelve chairs in total leaned on opposite walls. The upholstery had once been institutional grey, but now it had black marks throughout, with tears soaked into the fabric and yellow/brown filth embedded in the seams. The center of each chair had taken on a rounded contour from years of patients sitting in the same place. Footprint marks were embedded in the carpet in front of each chair, showing where hundreds of people had placed their feet over the years. The wear in the carpet reminded me of the worn yellow footprints millions of airport travelers step into every day when passing through X-ray machines at security. 

When the weather was damp, the clinic waiting room smelled like wet dirty diapers. At one end of the room was a sliding glass window with one side open. Anita, the receptionist, sat behind the glass. A sign taped to the inside of the window read, “Please check in with the receptionist. Co-pays are due at the time of service.” For twenty years Anita had sat inside that fortress. When a patient came in, she would peer over her red Prada glasses and greet the visitor before the outer door closed behind them 

“Whom do you see today, dear?” she would ask, a lilt in her voice.

Anita’s soft hazel eyes were comforting and when she smiled, her left brow lifted. The clients who came through the clinic greeted her enthusiastically. Familiarity and consistency were important to these individuals in allaying their anxiety.     

While some of the patients sat unfocused and staring into space, Anita would eye the waiting area and quip, “It’s been busy today, everyone is running a little late. But honeys, all appointments will be kept.”

Anita was the first contact for psychiatric patients at the outpatient clinic; the adhesive that kept it running. She knew the intricacies of the phone system, including how to transfer calls without losing anyone. She was also the stationary store, with pads, pens, paperclips, appointment books and take-out menus at the ready. When new psychology students arrived in August for their internship year with that deer in the headlights look, she guided them to their assigned offices and through the rules of the clinic. With a wave like the sword of Damocles she announced, “Rule one; Keep the kitchen spotless.

On Wednesday at 1:45, the waiting area was filling with patients. Six people had checked in with Anita and were calmly waiting for the meeting of their 2:00 group, a group I nicknamed “The Cutting Group.”

Cutting can be pretty bloody, and someone who has never encountered it before might be shocked by this behavior, but people who self-injure do so for various interesting reasons, at least in my experience. Cutting is sometimes misinterpreted as a failed suicide attempt, but death is not usually the end goal.

Self-injury can help people organize their thoughts and decrease the intensity of their emotions when they feel overwhelmed. The ritual can help release pent-up tension, albeit in an unhealthy way. These may be exaggerated responses to what may be perceived as a personal insult by someone even though that was not the intent. Like the escape of steam from an engine, the act of self-injury discharges pressure and restores a person’s equilibrium. This is not to say cutting is harmless. The injuries can be severe enough to require stitches, cause infection or deep scarring, or at the very worst, cause unintended death.

Self-injury can also serve to communicate intolerable emotional pain. It may result in euphoric feelings, and then intense relief. 

All the members of the cutting group had self-injured at some time in their lives. One member had made an almost lethal suicide attempt by hanging himself. 

The members were profoundly lonely and lost souls, yearning for relationships that appeared to be out of their reach. They didn’t understand the intimacy of relationships or friendships. Many of them were masters of manipulation and entitlement, explosive anger and self-pity. They lacked the feeling of being a whole integrated person. Their neediness for me could be overpowering, especially when I was tired or in need of support myself.  At those times, I felt like I was being suffocated with all the demands to take away bad feelings.

Many clinicians don’t like to work with patients with personality disorders because of the energy required to maintain a stable relationship with these volatile and unpredictable individuals. I would have liked to think they stood in awe of my task. On the other hand, they may have just thought my attempts would be futile.

Day after day, group members left lengthy messages on my answering machine, begging for help. “Susan, help me. I can’t take it anymore. Please call me. I need to talk to you.”

Clients came and went from the group. It often depended on their own level of tolerance for really looking at their emotional states. Each group member represented a unique set of problems and challenges.

Meredith, one client in the group, had just bought a new beige Toyota Corolla with a plush brown carpet and leather seats that matched the exterior. The whole group went out to admire it. Her car was her own private sanctuary. When she felt panicky and overwhelmed, her ritual was to drive to an emergency room parking lot with two towels in the backseat, one for her lap and another to hide the wound. When she reached the parking lot, she would lay her arm across one towel and repeatedly cut her arm in a horizontal motion. When the towel grew soggy and red, she would place it in a plastic bag, remove the clean towel, wrap her wound and walk into the ER saying, “I cut myself.”

That’s when she would call me. “Susan it’s me, Meredith. I cut myself and had twelve stitches. They want me to stay inpatient. I don’t want to. Besides, I didn’t try to kill myself.”

After knowing Meredith for some time, I knew she was trustworthy. She was never late for an appointment or a scheduled phone call, and she never canceled an appointment at the last minute. I knew what she told me was reliable.

“I’ll talk to the ER doctor,” I told her. I felt I stood on solid ground every time I requested she be released.

When Meredith first came to group, she was disheveled in dress, stuttered when she spoke and made little eye contact. The group became calming for her. She found a safe place to talk about her secret of self-harm. During group meetings, she spoke of her behaviors as if she were in control of her choices. When confronted about her impulsivity, she defended herself. Truthfully, she had very little insight at that time; it was hard for her to look at herself. She was, however, intrusive when it came to her suggestions for others in the group, not understanding how hurtful her comments could be. She once told a member to “get over their bad self.”

Meredith dressed like a bohemian from the 1970s. She wore long paisley skirts, and her shirts always matched some color of the design in the skirt. In group, her eyes were cloudy with sadness. She failed to accept feedback, often talking over the comments of others. It felt as if she always had one foot in the group and the other ready to flee.

Still, I was always confident that Meredith wasn’t in immediate danger of lethally injuring herself. That was not the case with Michael. Before coming to group, Michael had almost succeeded in killing himself. He had mounted a belt with a noose over the banister of his staircase, but the rope broke and he toppled to the ground. When his father found him, Michael’s face was blue and his tongue hung from his mouth. He looked dead, and his father was traumatized. His father immediately called the paramedics and Michael was taken to the hospital. After assessing multiple contusions obtained when he fell to the ground, he was determined to be medically stable and was involuntarily committed to a state psychiatric hospital where he remained for six months before being released to a group home.

Although Michael was alive, he continued to suffer from severe bouts of depression that lingered.  I don’t believe that involuntary hospitalization allows patients to get treatment. Its main function is giving patients time to adjust to medications. It is, however, one way to keep the individual and/or society safe from harm. At the very least, the hospitalizations kept Michael alive.

Michael’s internal life was fixated on the notion that his father didn’t love him. He complained about feeling abandoned and alone, and spoke of little else.

I had had several meetings with Michael’s parents (with his consent), and it quickly became clear that his parents had tried desperately to make Michael feel welcome by inviting him for meals, giving him money, and calling him each morning. No matter what they did, Michael could not take it in. Michael rejected their offers and, in his convoluted way of thinking, used their attempts to reach out as the irrefutable evidence of their lack of love.  He felt that if his parents sincerely loved and cared for him, they wouldn’t have to go to such lengths to try convincing him.

The severities of the wounds that Michael inflicted on himself were often proportional to his anger at his father. The more intense his feelings of disappointment, the deeper the wound. His father told me that Michael would sometimes phone and tell him he was going to cut himself. It was clear his father felt tortured by those calls.

He could be extremely obnoxious, constantly whining about his needs going unmet. Sometimes I wanted to shout, “Michael, get a grip! The world is not all about your needs!”  He had virtually no ability to stand outside himself and objectively perceive how others might experience him. Instead, I tried to be empathetic. The amount of emptiness he felt was sad, even if it was self-inflicted. 

Michael looked like the Michelin tire man. At 32, he was already balding. He spoke sarcastically, gesticulating with his arms. However, he was always well put together. He wore khaki Dockers and dark brown boat shoes, and his shirts all came from Ralph Lauren. The rainbow colors of the polo changed frequently. He was meticulously clean, and it was clear he paid attention to his outward presentation. It never ceased to amaze me when I met clients who were immaculately groomed and tastefully dressed and I discovered the pain or illness that they were hiding inside.

Latisha, another member of the group, had more trouble hiding her conditions from the outside world. Latisha believed she was an artist. She didn’t finish anything she started, from artwork, to cleaning up kitty litter, to showering and cooking. Although she obsessed about the subject matter of her paintings, she and her expensive canvases never met. She lived alone with her two cats, Raggedy and Andy. When she first came to group, juxtaposed with Michael’s neatness, I was shocked. Her fingernails were as long as legendary Howard Hughes’ were, jagged, filthy and yellow from constant smoking. She smelled acrid from perspiration and her clothes appeared askew. Her shirt buttons never closed directly in front and were always buttoned out of sequence. The collars were stained soupy brown. Her matted grey hair went uncombed and unwashed for months. On a monthly basis, a devoted caseworker would do Latisha’s dishes and laundry and would force her into the shower to excise those mats. To me, Latisha always looked frail, as if a brisk breeze might just snap her in two.

Latisha didn’t eat meals because she couldn’t plan them. Her thinking was too disorganized to plan and shop for the necessary ingredients. Once she put a steel bowl in her microwave, turned it on and walked away. It exploded, destroying itself and blowing the cabinet doors off their hinges. Thereafter, Meals-on-Wheels delivered her dinners, but after the caseworker left, Latisha would often forget where she put the food.

I constantly worried about Latisha taking care of her cats. Were they being fed? What about the kitty litter? I had to dig deep into my soul for empathy, and many times I just couldn’t find it. Caseworkers came to her home throughout her life. They were patient, kind individuals who understood the curse of chronic mental illness, but despite their efforts, Latisha never improved. Her life remained stagnant.

The group listened to her go on and on about painting efforts that never began, and I wondered how she could be so oblivious to the condition of her life. I never knew what experiences she had while in her adolescence or early adulthood. All I ever saw of her was the helpless old woman she had become. She was one of the saddest individuals I had ever worked with – pathetically hopeless.

Becky, on the other hand, was a decorated police officer. Police careers ran in her family, and Becky’s father was proud enough to burst when she followed in his footsteps and joined the force.

On a warm summer afternoon, a routine day for Becky and her fellow partner, someone fired a gun into their windshield. It broke the glass into shrapnel. They ducked, pushed open the doors and using them as shields, screamed to the passers-by to lie down. As Becky and her partner radioed for assistance, they heard another round of gunfire. Screeching sirens announced the arrival of police backup. Once on the scene, the backup officers fanned out in formation, but the shooter was never found.

As is customary after a shooting, Becky was sent home. She remained there for three days. When she returned to the precinct, she felt anxious. Her hands shook uncontrollably. She described the feeling of her heart pounding and noticed that her temples beat to the same rhythm. Becky was mandated to make an appointment with the police psychiatrist after the shooting, but Becky didn’t want to give her doctor any information. That was the code for most police officers.

Becky found herself hyperventilating and sweating. She started changing her sweat-drenched uniform often. When she drove to work, it was with trembling hands. She worried that others would notice her shaky voice, so she stopped all unnecessary conversations. She tried everything, but she couldn’t calm herself.

Becky’s trembling only got worse, and she worried that she wouldn’t be able to use her weapon safely. Eventually, she felt she no longer had a choice. She went on leave from the police force, giving the excuse that she was caring for her ill father.

Becky’s desk and workspace were in the basement, and she began hibernating there. She pulled the shades so no light could reach her. Perched on her wooden desk chair, she felt scared. She was so disappointed and angry with herself for being unable to cope, that she clenched her teeth and referred to her feelings as ‘primitive seething rage.’ She tried reading, but by the time she reached the end of a page she had forgotten the beginning. Her thoughts were scattered, flitting from one thought to another without any connection between the two. She busied herself with rearranging items in her home and waiting for each day to become night. 

One afternoon, Becky was killing time by cleaning out her desk when she reached into a drawer and accidently pricked her finger on an open safety pin. She yanked her hand away, worried that the pin was rusty, but then, a wave of relief and calm settled over her.

“I must be nuts,” she told herself.

Over the next several days, Becky began to purposely prick her skin, each time deeper and deeper. Every time a droplet of blood fell into the tissue she held under her finger, she felt like she was floating and free.

Reluctantly, Becky shared her thoughts with the group. She had wondered whether something was seriously wrong with her and whether she was heading toward a nervous breakdown.

“I went onto Google and used pin pricks as my search term, but not much came back. So I thought, ‘I’m a prick?’ If it didn’t hurt and I felt a sense of calm, maybe I need prick therapy,” she laughed. The group laughed with her.

Becky continued, “I was playing with my anchor words in Google and typed in ‘cutting injury.’ What flashed on the screen stunned me. Different descriptions of cutting and self-injury were described by websites from the Mayo Clinic to Mental Health America to WebMD. Chat rooms were filled with conversations about self-harm behaviors. All the stories had one theme in common – feelings of immense relief and calm attached to the bleeding. People described their use of razors, knives, metal strips and pins. What I was doing equated to self-injury. I was stunned by this. I spent the day reading narratives and rereading them until the words blurred on the screen.

Becky began to wonder whether a razor would increase her relief, as some people on the website claimed. Her thinking was, the deeper the cut, the more blood, and the more relief. 

Still, she resisted the urge to cut for months, thinking that increasing her use of the safety pin would help. It didn’t. Finally, she made a single, deep horizontal cut inside her right arm. The bright red blood dripped over her arm and fell onto her bare thighs. She exhaled with relief. 

Over time, she became an expert. She could gauge the depth of a wound. On occasions when she mistakenly cut too deep, she would simply butterfly the wound to avoid going to a hospital. Both arms soon began to look like railroad tracks. She hid the scars.

Then, suddenly, she began to have gaps in her memory. Once, she found herself on a train to Rhode Island. She didn’t know when she purchased a ticket, where she was traveling to, how she had reached the train station or, more importantly, why she was going. I believed that she also suffered from a dissociative fugue state (a blackout). 

Becky knew she needed help. Since she had no intention of going to her department psychologist, she came to the clinic. I worked with her individually, but I hoped that if Becky joined a group she might feel less isolated.

Meanwhile, Becky complained of being tired. Vivid dreams were keeping her awake.

“I have the same dream every night and wake up in a cold sweat. I’m in a basement. The walls are new white sheet rock. I am leaning on my side looking around. I try to twist and am stopped because my wrists are handcuffed to a tall grey pole. The steel rubs against my wrists and they are raw and hurt. I am naked except for socks, cold and shivering. I am a little girl.

“An unfamiliar face looms over me, but I can’t focus. I can smell rancid alcohol on his breath. The man is slapping my face and it stings. I cry out for him to stop but he continues like he doesn’t hear me.

“I hear the swoosh of air before his hand made contact. Jesus Christ, ouch. I can’t readjust my position because of the handcuffs and the wounds. He fidgets with his clothing, but I can’t see what he is doing. As I peek around, I see him holding his penis. My brother has one, but his is bigger. The man moves his hand, moans, and there is white gunk on my chest. He smears it in my hair. It smells funny, ick. Sometimes these images just settle on me even when I’m awake. If I cut myself, the terror disappears.”

I wondered if Becky’s nightmares were a true memory of events. Sometimes flashbacks of events return in memories, other times we create them, although they feel real. In the end, it doesn’t matter. If it is true to the person, it is their reality. The cutting seemed to help lessen Becky’s anxiety, and I suspected brought her back into the present rather than reliving this terror of the past. A police officer in uniform is the archetype of protection and safety for us, but this battered and broken officer was burdened with secrets that none of us could ever imagine.

Janice, another group member, broke the law by stalking her former psychiatrist. She lurked in full view of his family and peered into the windows of his home. He called the police, and they placed her under arrest. To avert a jail sentence, she was court mandated to get treatment, but the intensity of her fantasy love affair suggested a long, bumpy ride if she were to see a male  clinician again, so she was referred to the group. The thinking was that an interactive group minimized the chances of her becoming obsessed or fixated on any one person. 

On occasion, Janice made superficial cuts on her arms for relief, but they were not severe. She told the group she was frightened and feared cutting deeper because she thought might never stop and then kill herself.

Janice had no life with humans. Her life was work (she worked in food service for a local hospital) and her four chocolate Labrador Retrievers. The group tried to get her to talk by asking questions, but she remained stoically silent. When the topic was cutting and relief, she never participated. She was unresponsive to any topic besides her dogs. 

I suggested Janice bring her dogs to group and introduce them. Since those were the most important relationships in her life, why not? I had thought. I wasn’t sure if she heard me at first, but she acknowledged my invitation with a slight head nod.

At the next meeting, her magnificent creatures trotted in, single file. As Janice sat down, her hand moved almost imperceptibly and the dogs lay by her feet. I asked if she would introduce them to the members. She made a low guttural sound and each dog walked around the room, stopping at each person’s chair. Each dog was dark brown, slim and elegant, with hazel eyes. Whenever Janice waved her hand, they obeyed a language only she and they shared. 

The group was thrilled with the new members, and from then on, they came to each meeting, sitting at Janice’s feet awaiting a signal for their next move. Very slowly, she began to speak about the act of cutting as a secure friend. With the dogs in tow, Janice came to group and began to speak in a whisper. Over time, her voice grew to conversational strength. Maybe this symbolized her growing movement toward human relationships.          

Ruth, on the other hand, would screech non-stop without coming up for air, or give others useless advice in a colloquy. She was an obese thirty-seven-year-old woman who, honestly, I didn’t like, and although I tried desperately to make a connection with her, I failed. As a result, when she spoke, I resorted to nodding and keeping my mouth glued shut. I didn’t want anyone to detect my dislike for her.

Ruth, like Janice had no interpersonal contacts. She lived her entire life in a tiny house with her mother. She shared a bed with her mother as a thirty-seven-year-old. Her father had been dead since she was two, and she and her mother lived a sheltered life, never venturing beyond a four-block radius. In those blocks were a supermarket, bank, post office, hardware store and pharmacy. Even the school she attended and graduated from was two blocks away from her house.

I wondered what Ruth’s explanation might be for sharing a bed with a fragile, frail, elderly woman looming outside death’s door. Ruth was in denial about her mother’s condition. She bought food to fatten her up, vitamins to build her strength and calcium to strengthen her bones. Yet her mother was rapidly deteriorating. Ruth was so oblivious to this reality that when her mother died at home one evening, Ruth left her mother in bed until late the next morning, believing she was sleeping in.

Her story brought me back to the death of my own parents. How could a person not know when their parent had passed lying next to them? I believed I could feel my parent’s souls leave their body almost immediately. I felt angry with Ruth. While she was busying herself with false care, her mother was dying. Even though Ruth was there, her mother had died alone. I hated that thought. 

Ruth was inconsolable; sobbing, screaming and wailing. She had been referred to group in anticipation of her mother’s death and in the hopes of helping her understand her self-harming behaviors. Ruth was the only person in the group that I believed cut herself solely for attention. She would usually summon help from the police department, fire department or an ambulance afterwards. Her need for attention was insatiable. 

While in group, Ruth was also meeting weekly with a second-year psychiatric resident in individual therapy. He hung on each word she uttered and was overjoyed when she reported the development of a new personality. He diagnosed her with dissociative disorder, formerly known as multiple personality disorder, and met with her three times a week to try and uncover the other personalities that she told him were controlling her and would appear without warning. Curiously, the more he probed, the more personalities emerged. I believed he had been so fascinated seeing a patient with this diagnosis, he never realized he was being duped. 

Enjoying the attention, Ruth wove a wonderful tale. When she believed another personality was struggling to emerge, she made another appointment with the resident. She ended up seeing him four times a week as well as coming to the group. I thought Ruth was lying for attention. Rather than dealing with her extreme dependency, she nurtured it manipulatively. This was Ruth’s way of having relationships.

Don stood out when compared to most of the other group members. He was tall, blonde, and incredibly handsome, with a physique that left me breathless. He was a carpenter by trade and built houses. He lived with his girlfriend, Haley. They had a deep relationship and spent as much time together as they could. Don loved gardening, and in the summer, they would eat the vegetables he grew. 

Yet secretly, Don despised himself and engaged in a ritual only he knew about. He would lock the bathroom door, light candles at each corner of the bathtub, fill the tub with scalding water, take a razor and make cuts across his muscular chest. He watched the blood flow until the water around him was pink. Sometimes he cut a pentagram. Other times, he dunked his whole body under water to cleanse his skin and then forced more blood from his wounds. 

Although no one else knew what Don was doing, his black and white mixed lab, Dylan, knew. Dylan would lie on the bathroom rug waiting for playtime while Haley worked the overnight shift as a nurse. When she left their place at 10:00 pm, Don listened as the sound of the car engine grew fainter.

Somehow, Don had been able to hide his secret. He wore T-shirts all the time. One night while he was in the tub, engrossed in what he was doing, he didn’t hear the car returning early. Haley walked into the bathroom and saw him sitting in the pink water. She let out a scream and passed out. 

Night after night thereafter, the two stayed awake, talking, and Haley tried desperately to understand what Don was saying. She began having panic attacks on her way home from work. With his secret exposed and Haley’s distress, Don was forced to cut less. He became more anxious and short tempered. He felt he had no choice but to move out with Dylan. 

“I needed to give Haley some relief, and I was so tense I felt like I would explode,” he explained.

Don owned a small tract of land near the bridge that crosses the mainland to Cape Cod. It was still warm at the end of that summer, so he pitched a tent and purchased a propane camping stove and a sleeping bag. 

Don lived on his land with Dylan into the fall. Each morning they would go for a run in the woods. Don had contact with no one. His cutting ritual took place in the lake nearby. As winter set in and the weight of the snow threatened to level his tent, Don started to build his house. He had designed the house with all the basic necessities for he and Dylan. As each room was being built, it remained exposed to the elements. Don and Dylan slept in the open all winter. Dylan had his own sleeping bag. The arrangement afforded little warmth, although the makeshift roof protected them from the severity of the cold. Don cooked on a Hibachi and used the forest as his bathroom.

It was a hard, self-imposed exile, and the group members couldn’t grasp Don’s deep hatred for himself, his self-flagellation or why he didn’t shelter himself. He had joined the group out of desperation and had continuously thwarted his own suicidal thinking by not wanting to leave Dylan alone. As he felt his control weaken, he came to the clinic.

Knowing these individual’s stories so well now; it is bizarre to think back on the first couple meetings of our group. We spent weeks getting to know each other, re-introducing ourselves to each other. Recalling each other’s names was ephemeral, since human relationships were difficult for the members.

In general, one of the guidelines utilized in the group therapy format is that outside contact is not encouraged. Issues are reserved only for group discussion. I thought that exactly the opposite approach would be more helpful. The more contact they had among themselves, the more chance that relationships would develop.

Latisha wanted to hold meetings in her art studio. Don said he didn’t care if we met weekly or monthly. Meredith wanted to make connections with others. Michael joked that group was useless. Becky wept. Janice was quiet. Ruth babbled on about all her previous experiences in group therapy. When Meredith asked Becky why she was crying, she replied, “I can’t feel.”

Don stared at the carpet and said, “Me too.”

Meredith added, “I can feel when I cut myself.  Look at my arms.”

Then everyone would turn to me, expecting a profound statement. I would peer towards the group and often feel a lump in my throat. I thought about my professional liability if anyone committed suicide.

“Am I nuts or am I nuts to take this risk?” I thought to myself.  

I then said in one early group meeting, “I think it might be important to think about a group safety plan.” I wanted to create an atmosphere of care so that if an individual felt suicidal, they would be able to seek help from other members who might be willing to step in.

Meredith piped up, “I think our job is to help each other and pay attention to the relationships we develop here. Most of us have no one. I know people cut here, but it doesn’t mean they need to do it alone or have feelings alone.” 

The group came up with a plan to exchange phone numbers. If anyone felt suicidal, they were to call one member who would subsequently call another and so on. If the person felt they needed to go to the hospital for possible admission, all parties available would accompany the person to the ER. The members felt that they were better than most at distinguishing between behaviors seeking immediate relief and behaviors weighted with the actual desire to die. 

I thought the plan showed creativity. It was a commitment to the development of close relationships and to helping each other when help was needed. I wasn’t sure whether their plan would work, but I was hopeful. These were individuals who were still in their infancy in terms of developing relationships. Could each person be relied on? What if there was an accident and someone committed suicide on my watch? What if my risk assessment, or the group’s, was wrong?

Over the course of the next six months, group met each week at 2:00 p.m. and I spent a lot of time wondering if the members were being helped. There were lots of silences and complaints, and very little reflection. Invariably, different members would continue to cut themselves and then would come to group unable to self-reflect. Yet no one spoke of feeling suicidal. I had a commitment to work with the group, and onward we went for the next three years.

One afternoon while I was arduously and painfully writing notes, which I hated to do, I received a telephone call from an ER psychiatrist.  

“Dr. Lewis, this is the doctor on call today. Your entire therapy group is in the ER and one of the members is feeling suicidal. What would you like me to do?”

I froze, somewhere between concern for my patient and glee at the success of the group’s game plan. 

For more posts about Susan and her book, click HERE.

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