u/everyfruit

I just wanted to make this to help some people who are especially anxious about this. I started twitching right above my elbow at 14 years old, I remember it distinctly. I am 32 now and have twitched consistently and all over for the last 18 years.

It goes through phases where sometimes it's significantly more intense, but I am the strongest I've ever been and to my understanding in good health. The single best thing to manage them has been working on my mental health. I am a therapist, so having awareness around my nervous system states has helped to some extent.

That said, it's just annoying as hell now.

Another recent post inquiring about how people begin sessions really got me thinking. I was shocked by the rarity of silence as an answer! I have started intentionally beginning sessions with silence in the last 6 or so months and I thought it would be a cool exercise to note why I think this is important to me / my work. I’ll begin by saying I mostly operate from a lens of Existential Humanistic, Reality Therapy, and ACT. I’d love to hear your thoughts, disagreements, etc.

The way the patient engages with silence with another person will likely tell me much more about their daily interpersonal processes than their words. Perhaps they perform subordination to authority; they may look at me, expecting me to tell them what to do or to give them a suggestion. Maybe they spend their life in a whirlwind of stimulation and become visibly uncomfortable with stillness and silence, filling it with unbroken and ultimately distracting communication designed to soothe this feeling. Or maybe this silence reminds them of times at home when silence was weaponized and they become frustrated, upset, or scared of me. This is all rich information!

Descriptions of their weeks are just that, descriptions. They feel abstract to me and probably to the patient too. But direct interaction with the living moment can lead to enhanced ability to withstand discomfort and can foster intimacy. I find that while in a 53 minute session we may not get around to discussing a specific topic, but that clients typically experience feelings of lightness, openness, love, and confidence at the end anyway. These same mechanisms that contributed to whatever has been happening for them are now being made explicit, and are being handled with care, tenderness, and sometimes confrontation.

Lastly, questions or statements do ultimately influence the direction of session, which is by no means “bad”, but is at least partially inhibiting the idea of the patient doing their own work. This is a primary philosophical underpinning of my practice too!

To start- I'm not sure what I need right now. I feel extremely destabilized and it's bringing up a lot of difficult emotions that are all happening at the same time.

Essentially, I have been in a group PP for one year since graduating from grad school. I had a wonderful office, a number of amazing clients, and generally enjoyed my life a lot. I carved a little niche out for myself as someone who specialized in existential-humanistic therapy (a la James Bugental, Yalom) and really liked Reality Therapy. I am a man and have an addiction background (just over 5 years sober) and so my specialties naturally leaned toward substance use, compulsive sexual behaviors, relationship concerns.

I was let go by being told that they were not interested in renewing my contract, which is out of left field for me as I have slowly built up my case load and have a ton of folks who are on the up and up and I enjoy the diversity of client concerns. I am punctual, don't miss work, show up to supervision prepared, professional. The explanation was cryptic but boiled down to making people feel uncomfortable, both "clients and clinicians." I asked for any further information, and I was told that there was a perceived arrogance and ego that they considered to be a liability. Definitely feel deeply ashamed and confused about this, as I don't know specifically what's being referred to. My AA brain kicked in and all I did was acknowledge how I felt about this, rather than trying to convince this person to keep me on- I stated that I felt lost, really confused, and a bit betrayed because nothing was ever brought to my attention until I was being terminated.

Now I am wondering what is next for me. I was told I have 2 weeks, and in those 2 weeks I see 30 some odd clients, none of whom are expecting me to disappear. I've never had to have that conversation with anyone before, and have no idea where i'll end up or if I'll be able to see some of these folks again.

I am not someone who desires to speculate about specifics as I have a trauma background which has been pretty inflamed through this situation. What's important to me now is figuring out how to re-stabilize emotionally, determine the next step, ethically and gently handle these conversations with my clients. Have you been fired? What do you recall it being like, and how did you effectively manage it, especially in this field?