ending treatment

I have been seeing Pauline for over three years. For almost two years she came every week, than it was every other week. Today we decided that we would meet once a month for the next three months, and that would be it.

She was a fascinating patient. She thought about things we said. She was a nurse, so she knew a lot about her own health and what to look for, and she wanted her life to get better.

Her problems were a combination of all the factors that affect how someone lives. She was a wound-up child who was crawling out of her crib at one-year old. Even then she hardly slept, and by the time she was three she was defiant.

Her father was over-bearing and tried to get her to behave by being loud and threatening. Her mother cried a lot. She married young and divorced early and was left raising two kids on her own. Along the way she developed an eating disorder and a drinking problem. By the time she reached me she had just bounced off the bottom of being frantic, drunk and suicidal. She had terrible panic attacks and had been isolated from the world. She had tried about eleven different medications, and an intensive group program. She is now on two medications that she agrees that she needs. They don't do wonders but without them she is awful.

During her time with me she got better, then got worse, and then slowly pulled herself together. And now we have reached a point when it seems to be enough for a while.

Her drinking has stopped. She is back working part-time. She had a terrible relationship with an older man, and now she is still sees him a lot, but they have learned how to deal with each other. Her being sober helps a lot and she is grateful that he stuck by her. He can still be selfish and irrational, but she has learned how to deal with him.

Her eating disorder lingers on. She won't go to a more intensive treatment program for it. She hardly even wants to talk about it. She finds ways to push it away sometimes, but it haunts her. I worry about how much it limits her, and so does she.

But over the last couple of months the tone of the sessions have changed and it is clear that we have reached a stable plateau, even if it isn't perfect. She is working, she has a relationship, she is out of debt, she is sober, and even enjoys herself once in a while.

She is a good example of how so many factors interact to make a life: genetics, family, environment, stress, health, other physiological factors, brain chemistry, as well as luck and random events.

We only have limited control of so many of these factors. We have to make the most of the leverage we have.