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The number one thing which haunts me as a therapist

Updated: Jun 13, 2022

All that we see or seem Is but a dream within a dream -edgar allen poe


I have dreams about clients. From time to time tiny doppelgangers of clients roam around my head at night. It’s understandable. Because we’re working with clients all day therapist spend more time with clients than co workers, so naturally clients roam the hallways of our minds. Not to long ago I had a client, Kyla, roaming around my mind. I’d not seen Kyla for a few months. She’d discharged from the Medicaid funded treatment center where I worked and within in a week relapsed. Her dad found her in a car cradling a bottle of vodka. I had to go to a training the week she was discharged so I missed seeing her off. The week before she was discharged she and another client gave me a gift.

After I got the call from Kyla’s dad telling me what happened, I looked up Poe and the poem. Something about it haunts me.


I stand amid the roar on a surf-tormented shore and I hold within my hand grains of the golden sand how few, yet how they creep through my fingers to the deep. while I weep, while I weep. Oh god, can I not grasp them with a tighter clasp? oh god, can I not save one from the pitless wave is all that we see or seem but a dream within a dream?


After I’d heard about her cradling that bottle I was a man possessed by doubts. Maybe if I had been there working with her instead of at the training … maybe if I had requested an additional week of treatment from her insurance company…. maybe if I had known then what I know now… maybe if the Medicaid system wasn’t designed to fail…

There are many clients I have not helped. I’m not ashamed to say that. I feel guilty not being guilty, but that’s about it. I simply wast trained nor given the guidance to help certain people when I first became a therapist. So I don’t feel bad about the past because I couldn’t have done anything and I don’t feel bad about the present because I now know my limits. That helps me sleep at night. If clients I’ve failed are ghost, then most of them are of Casper’s brood — friendly.

Yet there are some that linger. There are some that haunt me.

I’m haunted by Jamiel. Jamiel was abused by his grandmother and deemed a lost cause by his elderly foster mother. I still remember that moment when I knew I was going to fail him. The image of Jamiel is forever frozen in a frame of him squatting outside in the summer heat, with a stick in hand poking at the dirt. Meanwhile foster mother sits inside and grumbles at me about how she’s sending him to a state home because at night Jamiel rummages in the dark recesses of the cupboard and devours whole boxes of Little Debbies delights.

That was the beginning of the end because foster mom did send him away to a group home where at best he’d be overlooked and forgotten. All because I couldn’t convince foster mom that him stealing food was not the problem.


how few, yet how they creep through my fingers to the deep while I weep, while I weep.


I’m haunted by Jamie. She was a little on the cousin of a client and a little on the slow side. In my mind the movie begins with me helping her with her homework. “What’s this?” I asked looking over a math problem with her. “I don’t know” Jamie answered. “Count it out.” I prompted. “1,2,3,4,5,” she started, “6, 7 ,8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, … 100?”

And suddenly I was very aware that this 8 year old couldn’t count past thirty, that that was not a very good sign for her future, and that I had neither the time nor the skill to help her make up the gap her public school had left her.


Oh god, can I not grasp them with a tighter clasp? oh god, can I not save one from the pitless wave


Some times in my daydreams these two come back to me. They are older now and I know in that dream like way where you just know, but have no idea how you know, that Jamiel is in jail. He’s been in solitary confinement several times for being violent. I also know that Jamie has several kids. She’s dropped out of high school and never went back. In the dream they just stare.

“I’m sorry!” I plead. “There was nothing I could do. I didn’t know how.” But they don’t respond. Their stare is conviction enough.

The thing about the failures is not that I failed. Failure in and off itself is painful but failure doesn’t haunt me. Failure is washed away with the next success. The thing about failure is the nagging feeling that because I failed, they will never have another opportunity. Because I couldn’t do it, the hopes they had for their future are now merely a dream.

Maybe to think this way is hubris or craziness. I don’t know. All I know is that life works because we make it work. Because we go out into the world and make change happen. If we don’t there is no guarantee someone else will come along and fix it for us. No, I am not the last hope for Kyla, Jamiel, or Jamie. But someone has to stand up for them, and there is no guarantee that someone else will.


All stories about clients are mixes of various clients with identifying details changed. No identifying client information is revealed in these stories.

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