The Sessions - 1. Visit #1

The Sessions - Visit #1

“Oh Josh, come in. You found me okay then?”

“Yeah, thanks for the text; I had to reread it, But, yeah, I pressed the right buzzer. Claire, right?”

”Yes, please follow me through.”

“Thanks.”

“And here we are, just let me close the door. Please go take a seat… make yourself comfortable. Would you like some water?”

“Thanks, and no I'm fine. Hmm, comfy sofa.”

“Ha, it’s probably older than you, but it’s comfortable. So let me grab my notebook, and we’ll get started. While I get that, are you warm enough, and would you like the blinds open or tilted?

“Thank you, I’m actually pretty warm, and open blinds is fine,”

“Excellent. So how are you? How was your journey?

“Uh, yes, it was fine, traffic was good, so no issues, and thank you. So yeah, I’m doing okay, just a bit nervous, I guess.”

“Oh, don’t be; I’m sure once we get talking, that will go. So here we are, I’m all ready, are you?”

“I think so.”

“So Josh, before we do anything, there is some legal information I need to let you know, and I'll also tell you a bit of what I do, okay?

“Yep”

“So I’m Claire Akins, and I’m a consultant psychiatrist. In simple terms, that means I am medically qualified, and a trained therapist rolled into one. I specialise in mental health disorders, So I cover depression, anxiety, PTSD and things like that, okay?

“Yep.

“Excellent. So I need to let you know that anything you tell me stays within this room, and I cannot discuss your sessions here with anyone. The only time I would release any information is if I thought you were an immediate danger to yourself or others. I would also be obliged to release information if you tell me something that indicates a crime has been committed. Barring that, you can speak with complete confidence.”

“Uh, right, okay.”

“That’s great; I try to keep that part as short as I can. So, Josh, your medical records have yet to be sent over to me, so I am awaiting those, I'm afraid, but thank you for signing the forms I sent you. It's always better that I have records to look at in conjunction with our conversations then I can better help you.”

“Okay,”

“So while we chat, anything to do with your medical side, I’m going to be guided by you, if that’s okay? And I will ask questions that might help me.”

“Yeah, sure... erm, I think I can answer most stuff.”

“So let's start by you telling me a bit about yourself and why you think you’re here?”

“Uh, okay, well I’m Josh... as you know, and uh, I’m 18. Erm… well I suppose I would say I’m here for all sorts of reasons... sort of mainly my mum, ha… sorry I’m a bit nervous. Yeah, my mum said I should see my Doctor.”

“So you were referred by your GP, yes. Oh, and please, take your jacket off if you like; I know it can get stuffy in here.”

“Thanks, I think I will. Erm, so yes, I went to my GP recently… sorry, I’m so nervous I don’t know why.? So yeah, I went to my GP because I was feeling down and my mum….”

“Go on.”

“Yeah, well, she said I should see my Doctor as I’ve been having some issues, you know? Feeling down and stuff, and uh, I keep getting these periods of horrible feelings? Like panicky and clammy, I had this one thing where I thought I would have a heart attack. It was so bad. Stupid, really, because I was fine after a while.”

“And what did your GP say?”

“Oh, you know, that I should exercise more and get good sleep, and he said to adjust my diet... cut down caffeine, asked if I smoked or used drugs. Nada nada nada!”

“And then?”

“Oh, erm, well, I tried to do that, and nothing really happened. But, I mean, I get exercise anyway. My uh… Dad. Well, I help on the farm, you see.”

“So your parents are farmers?”

“That's right, yeah. So I help with that, and… well, it's a family-run business. We all help.”

“Do you enjoy it?”

“Early starts… haha, uh, well sometimes I enjoy it, yeah. A very lonely job, I guess you could say.”

“You smiled there Josh, what was that?”

“Oh, just remembering something, that's all.”

“Keep that memory, and we’ll get into that in a while. So let's go back a bit. You say your GP didn’t help the first time? So you said you went back?”

“Yeah, and he sent me for a blood test and suggested some pills to take.... here.”

“Oh, thanks; I wondered if you’d bring them with you. So let me have a… ahh, yes Prozac.”

“So you know them?”

“Yes, Josh, very old drug. I’m surprised he put you on those really, there is more effective medication available. I think for your age, you might have been put on Citalopram. So anyway, how have you felt while taking them?”

“Hmm, a bit tired, I suppose. Hard to get up sometimes. I think a bit foggy as well, if I’m honest. But I don’t feel any happier.”

“Hmm, well, you are on a low dosage. And how long have you been on these… sorry, here you are, you can take them back.”

“Thanks, erm well about seven weeks now.”

“And you feel no difference and no anxiety reduction?”

“Not really.”

“Okay, Thank you. So just to add, we can pause at any moment or go back. So how’re those nerves now, feeling a little better?”

“Ha, yeah, sorry, I just get… well, I’m feeling better now, yes.”

“Good, Josh. So how long do you think you’ve felt down as you put it, can you remember?”

“I think for a long time now, maybe a year or so. But it's not been a steady thing. I mean, it started okay, and then got worse, because erm….”

“Take your time.”

“Sorry, it’s a bit embarrassing, erm. So. My God…”

“Josh, just take a moment. I have met many people, heard many stories that would make you blush for months. But, believe me, so don’t feel embarrassed. Remember, I’m here to help you.”

“Yeah, thanks, I just, well it’s hard to admit, you know? When things are hard to say, mum said I should just count to 10 in my head and say it, but… well anyway. I’ve been in a relationship, and, well, it didn’t go well. Like pretty violent.”

“Violent, and may I ask who was inflicting that violence?”

“Oh, uh, no, not me; I mean, they were doing it to me.”

“You slowed down at that last bit, Josh. Can I ask what form of violence this was?”

“Uh, well, they used to hit me… like, really badly.”

“They, Josh?”

“It’s uh… It's a him, and uh, well sorry, it’s just I’m not...”

“Josh, it’s fine. There see, you did it?”

“Yeah, ha, erm. So yeah, that may be part of the reason I'm here.”

“Josh, well done. That looked hard for you, and you said it, and guess what happened?”

“What?”

“Nothing, see?”

“Yeah, I guess. I think I’m just a bit embarrassed because I always thought I was strong, and I let him do that.”

“Strong as in physically or mentally?”

“Well, both really, I mean I’m six foot, I go to the gym, and he was still able to do those things. So I think I just felt….”

“Just say what’s in your head.”

“I felt weak, I suppose. But, I'm ashamed because he had beaten me up. I mean, I could have tried to fight back, but I didn’t.”

“So, is this a masculinity issue, do you think?”

“Maybe, I guess.”

“You shrugged there.”

“Okay, so yeah, I believe that was a part of it.”

“So before we explore any more, I just want to get an idea of your health first. You said earlier that you went for a blood test?”

“Yeah, I think that was maybe four weeks ago?”

“And what did your GP say?”

“Oh, right, erm well, everything is fine… like normal.”

“Well, that's a good start. So you work out at the gym and exercise too. Do you smoke?”

“No, why do you ask?”

“Well, nicotine is a powerful stimulant, and that can affect your mind and body, but it's good you don’t.”

“Yeah, no… most of my mates did at school, but I didn’t like it.”

“Are you taking any drugs at the moment for health reasons for recreation?”

“Uh, no, not at the moment.”

“But you do, is that it?”

“Well, occasionally I smoke a bit of pot, sorry.”

“Josh, don’t be silly, I’m not here to judge, but this information helps me. So any other drugs?”

“I tried some cocaine once or twice but nothing else.”

“Okay, so nothing that's going to kill you quickly, ha! That's great Josh, thanks for your honesty.”

“Uh-huh.”

“So tell me about family… Do you have any siblings?”

“Erm, yeah, I have four brothers, 31, 26, 22 and 21 and a sister who’s 13.”

“Goodness, a big family then, and you smile when you mention them. Are you close?”

“Yeah, we’re a close family. Life on the farm is hard work, and we all muck in, so we see each other all the time. Well, apart from my second oldest brother, he works for a software company. But the rest of us work for my Dad.”

“Your dad must be pleased with all that help. Any close friends?”

“I have a couple, but they’re more just people who go to the local pub and who I see in the village. So small place, you see... hard to make friends, and I work long hours so….”

“And this person… the one who was violent towards you, is it okay to talk about that?”

“Erm, yeah, sure,”

“So tell me how….”

“Kai… his name is Kai.”

“Kai, so tell me how Kai came into your life?”

“Well, in the summer we need extra help, and I just knew him from school, you know? And uh, he heard me talking to a friend about what help we would be getting this year and that my Dad said we’d be short. You see, we have people who normally come back every year, but uh, what with Brexit, it was hard to get people, my dad said. So yeah, Kai met me at my locker and said he’d overheard me talking and that he was interested in getting a summer job,”

“Okay, and you knew Kai well?”

“Not really, just in some of the same classes and all that. Maybe said hello, and played sports together in PE.”

“So what happens next?”

“Right, yeah, so uh, I asked my Dad, who was pleased and said yeah, hire him. So I invited him to the farm, and that was it really, he started on the first day of the summer holidays.”

“Hmm, okay, So may I ask Josh, and we need to be clear on this? Is the violence still happening?”

“No, no, he’s left for good now.”

“So just an observation, I can see you’re a little bit shaky at the moment. We can slow down or stop at any time, but you’re doing well so far.”

“No, It’s fine, you know, uh, it’s just I haven't spoken to anyone about him… us, and, and I… I dunno it’s just still really raw. But, strange as it sounds, I kind of miss him.”

“And that is more common than you think, Josh. It’s not strange at all. We can often still have desires for the ones that hurt us the most.”

“Hmm, well. I certainly do. But, he warped me.”

“Warped. Tell me why you chose that word?”

“Dunno, kinda like… well in my head he tricked me.”

“You think he was insincere towards you?”

“No, no, that’s not it. He was so persuasive, and... God, I don’t know; it’s hard to explain.”

“Okay, well, we can explore that. Sometimes the words come later after you have studied the thought. So let's talk about you for a moment. I picked up that nobody knows about Kai and you. Can I make an assumption?”

“That I’m in the closet, ha?”

“If that's the term that's comfortable with you.”

“Yeah, uh, well, no one knows about me. I mean. I’d like them to, and I’ve come close, like. But I think my dad would be really upset and my mum too, I think.”

“Recently?”

“Uh, yeah. Well, I almost told my mum at Christmas. I remember us having this intense conversation about how well Kai and I had connected, and she was telling me how pleased she was that I'd got a friend. But…”

“Take your time.”

“Well, it was Christmas, you know? And I almost said it, and then I bottled out because I thought I would ruin the best day of the year.”

“Understandable. And at that moment, how do you think your mum would have reacted if you could go back to that conversation and go through with the revelation?”

“Hmm, uh, well, that's a good question. In my head, I think right at that moment, it felt like she might be okay. But then my mind changes it to something else.”

“Something else?”

“Yeah, like one minute I can see her hugging me and saying everything will be okay, and the next… the next she is telling me to pack my things and go. That's what I go through every time I get close to doing it.”

“Right, I see. So it’s the fear of the unknown rather than the subject.”

“Huh? Oh, wow. I never thought of it like that. I guess so. I mean, if I had a place to go if it all went wrong, then….”

“Josh, let me ask you. You said you were a close family. You’ve indicated that you get on very well with your dad and that your siblings love you. Thinking about that, does it change what’s in your head?”

“The outcome?”

“Yes.”

“I guess.”

“Food for thought, Josh. So Kai, tell me about Kai?”

“What would you like to know?”

“Well, your story, Josh. Like how he ended up working on your farm to you sitting here in front of me?”

“He’s a big part of why I'm here, I've always been a kind of nervous person.”

“Wow, that was a big sigh. So start from the beginning. Tell me about him?”

“Uh, God, this is embarrassing.”

“We’ve done that bit, Josh, remember, haha.”

“Okay, he is… was, lovely. He is smart, funny, and has nice features. He’s fit, quite short, I think around 5, 7.”

“You’re smiling; go on.”

“Oh, wow, haha, erm, he’s got short dark hair, dark brown eyes, just something about him was… is really attractive and he has a way of communicating which I’ve never seen before. Mind you; I come from a tiny village, so that's not surprising, but yeah, he’s just, I dunno!”

“Sounds like a Dreamboy, by the look on your face.”

“Uh, yeah, sorry. Just remembering some of the good times.”

“Do you think his way of communicating affected you?”

“Oh, yeah, I think that's what kept me going back.”

“Back? Explain.”

“At first, it was just half chats, you know, here and there while we were working in the summer. We’d cross paths when he was moving our sheep, and I was out fixing fences. He’d stop, we’d chat, and it felt like anything he said was interesting.”

“Go on.”

“But then… then I got more intrigued and would start making excuses to do some work… or fix something in his vicinity. I mean, the farm is massive. It’s over 5000 acres, so sometimes, if you have a fence out or a stray Heifer somewhere, you might not see anyone. I mean, summertime is busy on the farm. We hire around sixty workers, usually from Eastern Europe, to harvest or pick crops, but it can get isolated even then. So when Kai was working, I would find myself being... weird.”

“You mean, interested.”

“I guess.”

“So you wanted to be near him… continue.”

“Yeah, so, uh… I remember one day him driving up to the farmhouse early in the morning. I can’t remember why he was starting that early? Perhaps my dad told him to. But anyway, I was on my way back from the VMS, and we caught up to...”

“Sorry Josh, I’m interested… VMS?”

“Oh, yeah, sorry. Farm lingo. It's where the cows get milked. It’s called the Voluntary Milking System.”

“Right, hmm, I see, so please, go on.”

“Yeah, so we kind of met by his car early in the morning and just got chatting. It must have been really early, around five in the morning, so it was just us. I remember him saying that he’d noticed I was around a lot more lately. I mean, I tried to laugh it off, but then he said something strange, and that's when I think I’d say we properly… I mean, I’d say when it all started with him.”

“Something strange?”'

“Yeah, he said, 'I tend to get less work done when you’re following me around' and winked at me. But, of course, at the time, I didn't think about the wink, just the words, and then he got back in his car and closed the door.”

“You were disappointed?”

“No, I was… dazed is all I can describe it as.”

“Sounds like you took an instant liking to this boy?”

“I did, and I wanted to chat to him more, but I took his closing of the car door as a….”

“Rejection?”

“Exactly.”

“Okay, so I think you’ve just described your first attachment to Kai. Would I be correct?”

“Yeah, I suppose you could say that. Well, anyway, that's where we properly talked.”

“So, what happened next?”

“Uh, well he… I mean, why is this relevant?”

“Why is it not?”

“Huh? I don’t understand?”

“Okay, so let me put it this way, Josh. If you think of Kai as a ball of string with a stick in the middle.”

“Okay,”

“And the ball of string is all tangled and knotted round this piece of wood in the middle. Suppose you think of yourself as that piece of wood and Kai as the tangled string. We need to go through your story so we can unpick this string…or rather Kai, from you. And the way we do that is for you to relive your story, so we know where to unpick. As you talk, there will be certain parts of your story that we’ll unpick from the string, and slowly we can release it. Kai will be a neatly wound piece of string in your mind to process, and you… the stick will be free.”

“Okay, fine. I get it.”

“You seem agitated; tell me why?”

“I’m okay, really; I just don’t want to drag up the past.”

“Read any Greek philosophy?Josh?”

“Can't say I do.”

“Well, Humans may seem complex, but Aristotle teaches us that all human actions have one or more of these seven causes: chance, nature, compulsions, habit, reason, passion, desire. Think about all of these as you tell your story. Even now, from the little you have started to tell me, I’d say you will tick all of this 2300-year-old guy’s causes. He might be ancient, but he was on to something.”

“I’ll bear that in mind.”

“Well, Josh, I'm afraid that is the end of our session today. However, I think we made some foundations, and you seem more relaxed now, which I find is always the main goal in my first session with my patients.”

“Yeah, it's been nice to talk… so uh, I see you, erm.”

“Next Thursday at 1:15 pm. It’s been great talking to you; I think we’ll have lots to discuss next week.”

“Yeah.”

“Right, let me get that door for you, and you have a safe drive back.”

“Thanks, Claire, see you.”

Patient notes: Claire Atkins, Consulting Psychiatrist.
1st session with Josh Fisher. 18-year-old male. Awaiting GP records. No reported medication apart from PZ. Recent full blood count - No issues. 6ft 1ins. Athletic build, no visible eating disorders. Physically very fit and of good weight. Slight bruising to neck and left wrist - Not discussed.
On the first meeting, Josh appears nervous with noticeable historic confidence issues. Josh appears of stable character. No signs of BPD. No ticks visible.
Patient seems suggestive and vulnerable although no cause for intervention. Visit due to acute anxiety and chronic depression brought on by domestic Violence and possible family pressure - needs further discussion. Patient also appears closed at times with mild agitation at trigger subjects. Possible codependency to be explored. Patient suggests not fully comfortable with Sexuality and family unit not aware - Needs further discussion. No signs of suicidal tendencies and is of sound mind. Josh is able to express emotion in the positive and negative.