Your new client arrives, and she appears older than her 39 years, haggard, and resigned. She makes it clear she doesn’t want to be there, but her husband gave her an ultimatum that she get therapy or move out. She is a destructive force as both a wife and mother, and she has hit bottom.
For the next hour she enumerates all of her problems dispassionately as if she were giving you a grocery list: drug addiction including cocaine, alcohol, and pills; reckless behaviors including a long standing affair with the husband of family friends (from whom she also gets drugs), sex with strangers, driving erratically, and raging against people important to her husband and children.
Actually, this isn’t your client at all, but the character Laney Brooks portrayed by Sarah Silverman (yes, THAT Sarah Silverman) from the film “I Smile Back” adapted from Amy Koppelman’s novel of the same name.
While we learn somewhere in the middle of the film that Laney was abandoned at the age of 9 by her father, we’re given little else to understand how she has become a woman with more than a dual diagnosis, more like a person with a triple or quadruple diagnosis. From the beginning of the movie, she is a self-destructive mess, written and portrayed in a less than pitiable light. Of course, we as the audience feel for her, but in her yo-yoing between rage and despair, she is not particularly likeable.
Back to the earlier premise that this is a client of yours, were she real, and not a character created from an author’s imagination, any one of us would have our own way of working with her. Sure there’s a lot we have in common as mental health providers, but our theoretical orientation, our training, our experience both as therapists and in our own lives, would have us all working differently. I believe we would all do honorable work, but some of us would be more effective than others. Some of us would have an easier time feeling compassion for Laney, and demonstrating unconditional regard from day one, and others of us would be slower to bond, and form an alliance.
While watching movies, plays, and well-written television, do you ever find yourself thinking if the characters were real, would I want to work with them? Conflict is present in every story, whether fiction or in real life. We all have goals, and there are obstacles along the way, and sometimes we can’t resolve all of the complexity on our own. So we wind up in a therapist’s office, and hope for professional help.
I could help Laney Brooks, but I know it wouldn’t be easy. No matter your philosophy of how change takes place, this woman has been through years of depression, addiction, and self-sabotage. As a post-modern narrative therapist, I would collaborate with her through generative conversations that would reveal her hopes and dreams, and together we would deconstruct and challenge the forces that have stood in the way of her showing up in life in her preferred way. We would excavate for the values she holds dearly which have been masked by compulsive behaviors, and I would assist her in uncovering and building on the strengths she needs to change. What would you do?
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I recommend you see the movie when available through a rental service since it’s not in the theaters any longer. It’s not an easy ride, but the acting is excellent, and much of the writing is strong. One of the film’s weaknesses is we don’t learn enough about how Laney came to be so ineffective at running her life, but you’ll find yourself filling in the too thinly described back story with your own theories and suppositions. Luckily in real life, we can get that information from our clients, just by asking.
Amy Gottlieb, MA, LMFT