8:30 AM is generally not the best time for me to meet with clients. Many therapists recognize that they are "on" with their therapeutic skills at certain times of the day. I am an afternoon/evening person, so I generally do not hold office hours before 11 AM.
And then there was Helen. Helen had called early that morning begging for a first appointment "immediately!" and that an afternoon session would be "simply dreadful!" When I asked her if she could briefly describe the difficulty that required immediate attention, she paused, then whispered into the phone, "Relationship problems." She started to go into greater detail, but her voice was getting not only faster, but softer and unintelligible, so I simply told her to come in right away and we would discuss it then.
"Hello, Dr. Dobrenski!" she exclaimed in the waiting room with a gleeful and highly refined British accent. "I am Helen! And this" she swept her bejeweled left arm toward the floor, "is Farvesham!"
Staring up at me with big, round brown eyes, a tittering nose, and a small tail that beat ever so softly on the floor, was a white Maltese. Farvesham.
"Hello, Helen. I'm Rob Dobrenski."
"And?," she queried, darting her eyes down and to the left.
"Hello, Fa-vee-sham."
"No," she corrected, using an elongated "o". "It's FAR-ve-SHAM, Dr. Dobrenski. Just like the merry ole English town. Farvesham is, in fact, the 5th Farvesham I've owned over the course of my life, all sired by championship-caliber canines."
"You've used the same name for all of your dogs?"
"Indeed, Dr. Dobrenski. Loyalty and consistency are what make a person healthy."
"Well...that's...just wonderful." Then, remembering Helen's darting eyes, "Hello, Farvesham."
I do not consider myself a particularly rigid person. I've done therapy in people's homes, the Student Union at my graduate school, on the basketball court, in pubs and in the park to help a client overcome Agoraphobia. I'm generally flexible with clients' needs. However in my office, I am King of the Castle and there are certain elements that are simply unwelcome when I'm working, the major ones being alcohol, cigarettes, infants and pets. But before I had a chance to rule with an iron fist, Helen sauntered into the main area of the therapy room with Favresham in tow, attached to what looked like a diamond-studded leash. At approximately 70 years of age, impeccably dressed in almost regal attire, Helen gently lowered herself onto the therapy couch. She tapped her perfectly shaped pearl earnings and, as if on cue, Favresham immediately leapt up onto her lap, touching his nose to the matching necklace dangling across her neck. He lowered himself onto her, staring obediently at me as I reached for my clipboard to take some notes.
"Might I have a spot of tea? Two sugars and a dash of milk please."
Office Rule: While therapy is a conversation between two people, it is not a social setting. The therapist is not a host.
"I'm sorry, but I don't keep refreshments for clients in the office."
"Oh dear. I see. Might Favresham have a biscuit?"
"No Helen, I don't keep animal treats here either. Why don't you tell me what brings you in to see me?"
Helen sighed. "Well, it has been a time for acting strangely." Her eyes narrowed to slits. "You know, logy...depressive."
"Logy."
"Yes indeed, exactly. You can see the sadness...no joie de vive!"
"How long has this been going on?" When assessing for a Major Depressive Episode, a 2-week minimum time frame is required for diagnosis.
"Approximately one month. Terrible, terrible business."
"How about sleep?"
"Awful, horrible! Up all day and night."
"And appetite?" Like sleep, people suffering from depression often will have extreme eating habits, either gaining or losing a noteworthy amount of weight.
"Thanks to all the heavens, that has remained constant, good friend."
"Are there any medications being taken for the depression?"
"No, not at the moment. That's why I'm here."
"Well, I can recommend a few psychiatrists for you, but I don't prescribe medicine."
"Oh dear. My my, I was hoping that you could provide Prozac, but if it is a colleague who is decreed to help poor Favresham, so be it."
"To help Favresham?"
"Yes yes, of course. To ameliorate the depressive malady."
"Favresham is depressed?"
"Why yes, that's why I'm here, young man."
"You're not depressed?"
"Oh, Dr. Dobrenski, you are quite the card!" she giggled, scooping up Favresham under his two front legs so that he dangled listlessly. "Isn't Dr. Dobrenski such the entertainer, Favresham!"
"I'm sorry I've wasted your time, Helen, but I'm not a pet therapist or a veterinarian. Why didn't you tell me that this appointment was actually for your dog and for that matter, why did you say you were having relationship problems?"
"I did tell you this morning when I called, I said that my relationship with Favresham is completely compromised with him acting like such a pill and whatnot. Weren't you listening? You sounded a bit torpid I must say. Do I even look depressed, Dr. Dobrenski?"
"No, I suppose you don't."
"Indeed! You are probably quite a good therapist, but if you cannot focus in the morning, you might simply want to hold afternoon and evening hours."
"Thanks, I'll keep that in mind."
After the departure of Helen, I did some research on depression in canines, as well as on "Doggie Prozac." Apparently it is believed that dogs can become depressed for a variety of reasons: change of scenery, loss of a playmate, a chemical imbalance, or even the health of its master. Medicine can apparently be useful in many cases, although most veterinary behaviorists recommend it only when combined with behavior modification, which is a form of therapy used with people. This is, then, essentially what most psychiatrists recommend for depression in humans: medicine combined with some form of psychotherapy. Therapists educate patients by telling them that depression knows no gender, color, creed, or socio-economic status. Apparently it doesn't discriminate by species either.
A few weeks later, I saw Helen and Favresham on the lower east side of New York City. Helen approached gleefully, stating that she had found a prescribing practitioner for Favresham, and that he was working with a trainer to increase his activity level. This was, essentially, running around Central Park and chasing a Frisbee, or "the round discus item," according to Helen. I had to admit that Favresham seemed happier, whatever that means. He was much more frantic, jumping around with a friendly and excited bark and his tail was beating more rapidly. It crossed my mind that he might actually be manic, but I resisted working beyond my area of expertise. Helen told me that she recommended me to "all of her contemporaries," although I have no idea why. I do hope, though, that they call in the afternoon.
Posted by Rob Dobrenski at 3:24 PM