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Personal Accounts: A 35-Year Follow-up of Completed Psychotherapy
Stephen Rachlin, M.D.; Barbara Prach, B.A.
Psychiatric Services 2008; doi: 10.1176/appi.ps.59.6.609
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Dr. Rachlin has recently retired from full-time clinical practice. He may be reached at stephenrachlin@aol.com. Ms. Prach lives in Northern Virginia and may be reached at bprach77@msn.com. Jeffrey L. Geller, M.D., M.P.H., is editor of this column.

In this column a psychiatrist and a former patient remember their work together after a chance encounter 35 years later.

Early in 1970 I began part-time "moonlighting" work as a staff psychiatrist at the Lt. Joseph P. Kennedy Jr. Home, a rather large residential foster care facility in a quiet neighborhood in the Bronx. The predominantly adolescent population was there primarily because of parental neglect. The organization ran under the auspices of Catholic Charities and was administered by the Franciscan Sisters of Peekskill in New York.

Most of the teenagers were seen on referral from staff because of behavioral difficulties. It was unusual for someone to seek help on his or her own, because there was some stigma attached to seeing a psychiatrist, especially on campus. I was approached by Barbara, then a 16-year-old tenth grader, who was seeking assistance for various personal issues. By that time, she had already spent a total of ten years of her life in placement. Her father died when she was 12, and her mother was to pass away when she was 18. We began psychodynamically oriented supportive psychotherapy on a regular basis. No medication was prescribed.

After about a year of working together, it appeared to me that we were at an impasse. I indicated to her that it seemed that we had spent a good deal of time talking about the problems she had presented to me, but that I noted no changes in her behavior. Her response was unexpected, insightful, and memorable. She told me that she was just a youngster, that she had taken in all that we had discussed, and that it would be useful to her as she became more mature. In other words, this was not as valuable for the present as it would be for the future.

Over succeeding years, I used this story often as I supervised psychiatric residents' conduct of psychotherapy. When they were feeling the frustration of little perceived progress with their patients, I would recount this aspect of my experience. Although it may have been encouraging and instructive, the usual question was whether or not I had any follow-up to validate what I had told them. I did not, and so my reply could not go beyond the oft-repeated advice to pay careful attention to what your patient is telling you.

Because children could stay at the facility only until age 18, Barbara left in 1972, and therapy had to have concluded at that time. In July 2007 the facility held a reunion. Although this event was aimed at those who had lived there, several former staff members, including myself, also attended. As I was at the sign-in station, the person I was speaking with addressed the woman next to me by her last name, one that I recognized immediately. I turned to her, calling her by her first name. She did not recognize me; I would not have known her, either, if not for this serendipitous introduction.

Thirty-five years had passed. Just after we exchanged pleasantries, she repeated, in what was a déjà vu experience for me, her earlier words. Psychotherapy had remained of value to her as she went on with her life, and at times she did think back to, and remembered, our discussions. At various junctures, she utilized what she had learned to help her to make decisions.

Barbara was now in her early 50s. Sensing the value of structure to her personally, she had joined the Army. In her 26-year military career, she rose to the highest enlisted rank, that of sergeant major, one of the few women who could claim this achievement. She had also completed her college education. As a single mother, she raised her son. Now a civilian employee of a different branch of the armed services and living in the suburbs of Washington, D.C., she is also a proud grandmother. Her adult life has been rich and fulfilling, without any further need for psychiatric treatment.

In these first few moments that we spent together, I noticed that I was feeling a keen sense of satisfaction. My work with her had made a difference. It was a part of Barbara's success in overcoming the many disadvantages of her early years. What a rare privilege it is for any of us to have a 35-year follow-up after termination of psychotherapy. It was as though she had returned to me all that I had given her many years ago.

Practitioners of psychotherapy obviously believe that we are helping the people we serve. We take it as an article of faith that our words have an impact that should last and be of ongoing utility to the patient. This anecdote does not provide scientific proof but it is nonetheless a powerful demonstration of the value of a modality of treatment that must remain at the core of our professional skills.

Any parent or teacher of a 16-year-old girl will tell you it is a difficult time for all involved, and any 16-year-old girl will tell you that they know everything, don't want to hear any more, and will do what they darn well please—that was me.

I am the product of a dysfunctional family. As I have grown older, I realize that the world is full of dysfunctional families, but the difference in my case was that the state of New York labeled mine.

My journey was from an institutional lifestyle to a world I did not understand or trust. The help I had received at the age of 16 for an ever-so short period proved to be the catalyst to my successful life. I think at the time I knew that, but it was not until years later that the words and the advice I received all came back to me.

My journey was one of maturity, trust, and understanding—physically, emotionally, academically, and spiritually. The birth of my son was my epiphany, my "aha" moment. The wall that I had built around me, not allowing anyone in, was slowly getting knocked down. I began allowing myself to love and be loved. Trust was the most difficult thing for me, but now that I was raising a child, I had to teach him how to trust. But how could I teach something that was so difficult for me? I constantly went back and reflected on the sessions I had with Dr. Rachlin, which helped me to grow.

At the age of 16, I could not fathom opening up to another, truly sharing sorrows and joys, but with maturity, I realized that it is the root of any relationship. To be able to share means you open yourself up for the love of another but also risk a part of yourself. In doing so, you grow.

At 16, I did not appreciate who I was, let alone what I had to give. On reflection now, I realize that I am a loving mother and grandmother, a dedicated career soldier and government worker, and a woman of integrity, strength, and faith—a true friend.

I still have to work at opening up, but as I cry with others or smile with others, I realize how far I have come.

Closure with my mentor and doctor was an important part of my life puzzle. His words did not fall on deaf ears but were rather like the seeds in the Bible story; they fell on fertile soil and took time to germinate and grow, and grow they did.




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