Psychotherapist Gets Punched In The Nose

Disclaimer: All characters appearing in this work are fictitious. Any resemblance to real persons, living or dead, is purely coincidental.

Chapter 1

Avenue of the Americas

Credit: Enrique Dans/CC License

Could you imagine punching your therapist in the nose?

By “punching” I mean the kind of blindsiding, staggering, nearly unconscious-rendering criticism that takes place at work and can go viral within hours. But what if a therapist could become more helpful after being “punched” in the nose? Let me explain…

People who seek therapy come to hold their therapist in high regard; they feel listened to and helped by an expert in the privacy of the therapist’s office. Many people I work with tell me they feel safer and happier in my office than they do in the outside world.

To be sure, this is a major accomplishment and arises out of hard work and a mutually respectful relationship.

But, in addition to being a psychotherapist in private practice, I wanted to consult with companies who deal with problematic employees and chaotic workplace situations.

I knew that working in my office all day, while certainly a privilege, was one step removed from the outside world.

I thought I could help people better if I spent time in the workplace where mud flies and noses get bloodied. I wanted to get a little mud and blood on my all-too-clean uniform.

As we all know, there are bullies out in the world and the workplace is filled of them.

What we sometimes forget is that bullies are people with strengths and weaknesses; they’re many shades of grey; they can be funny, charming, kind and smart — in addition to being cruel.

And, out of self-protection, we tend to deny the reality that bullies will pierce our perceived bubble of safety throughout our lives. Too often we maintain the stance that bullies happen to other people.

The bully I met when I stepped on to the field was creating a path of destruction under the guise of ferreting out incompetent employees. Beyond my wildest imagination, I became one of her targets.

And, this is the story of how I became a better therapist because of it.

Chapter 2

Within the glass towers that create an urban canyon along the Avenue of the Americas are hundreds and hundreds of offices. In one such office, in a big company that takes up several floors, sits a rising star, his weeping mother and a Vice President.

The rising star’s younger brother has been running amok in the Bronx since he was 14, committing “broken window” crimes and nipping from a bottle of vodka he keeps in his back pocket. His mother is terrified about what will become of him.

The VP arranged to find a job for him in the building’s basement. He’s did fine there, except he continued to nip vodka throughout the day. In her office, he agrees to accept alcohol treatment. His brother, the rising star, will take him to and from the program.

Case closed. A good deed has been done.

I’m called in to assess and refer him to an alcohol program. He agrees to everything I ask. I get the sense that he’s been lectured to a lot in his life and he’s learned that saying, “Yes” is the fastest way to get through these ordeals. Plus, sadly, it may also be a way to disguise his inability to understand the world around him.

I call the VP and leave a voicemail that the referral has been made. I add that while he’s alcohol dependent, I fear the program will question his motivation and ability to benefit from treatment, and might reject him as a result.

Within an hour, a fist slams into my nose.

It is clear to her that I have undermined getting this employee the help he needs. She’s in a total and complete rage. When someone with power is in a complete and total rage in the workplace, people assume there has to be a reason.

Object Relations theory, on the other hand, tells us that people with severe personality disorders have a pattern of splitting the world into good and bad “objects.” Good people. Bad people. The reason they get so mad is in fact, internal. They have a nearly insatiable need to find bad people to be angry at.

And now I’m on her radar. And then the worst possible thing happens.

I was right.

Chapter 3

When your boss calls you into his office, and the VP and her boss have just taken turns punching him in the nose, he has a look on his face you’ve never seen before. He feigns a “business as usual” tone, and we both ignore the wads of cotton stuffed in each nostril.

“Without discussing the legitimacy of the complaint, fix the problem.”

The treatment for people with severe personality disorders, according to the experts, is to confront their negative, often paranoid, distortions. Otherwise, their desire for omnipotent control goes unchecked, and the world for a time, views their distortions as reality, which only serves to justify the bully’s anger.

Try saying that to a boss with a strange look on his face and wads of cotton coming out his nose.

I tell him I said nothing to the program about the employee’s motivation and ability to benefit from treatment. I only told them about his drinking. His strange look remains strange. Then I tell him I can certainly make a referral to another program.

“Good,” he replies, as he looks down at his desk and shuffles papers. As I was leaving, he calls out, “This thing has gotten out of hand. It’d helpful if you’d apologize to her. “

When competent people who like each other suddenly act in ways that are unlike their usual selves, there’s a good chance a personality disorder has been added to the mix.

I call back and say I absolutely refuse.

I get to my office, call and arrange a referral to another program. This is a simple matter. But I find that I’ve become almost desperate to get this employee admitted, and surprised that my hands and voice were shaking when I made the call.

Now, I need to update the VP about the second referral. I dial the phone, hoping it goes into voicemail.

It does not.

The bully picks up my call.

Chapter 4

We tell ourselves we come to work to do the best job possible, give our honest opinions, then put work behind us and go home. We don’t go to work to feel threatened, nor to lie awake at night ruminating over mistakes we might’ve made during the day.

Therapists often give this “put work behind us” advice to their patients. It’s sane and soothing. But alas, it’s too clean. No, to belong to a group is to invite a sticky kind of insanity into our lives.

I tell the VP I’ve made a second referral. She says, “I want to know why a therapist would refuse to help an employee who’s asking for help?”

I say I didn’t. I say that the alcohol program came to their opinion independent of mine. She says, “We pay a lot of money for your program. Do you think we’re getting our money’s worth given how you’ve handled this employee?”

I say I’ll let her know how the second referral works out, trying to end the call. She corners me, “You didn’t answer my question.”

I say I’ll be in touch with her shortly. She says, “This is exactly the kind of ineptitude I’ve been talking about.” I realize now that she has me on speakerphone and someone else is in her office.

Given how I imagine this will play out with the higher ups, I should go back to my office, pack up my stuff and wait. I’m on occupational death row.

The experts say we must address the narcissism of people with severe personality disorders. When they talk about the needs of others, they’re often talking about their need to be admired.

In therapy, the experts say we must talk about what is true compassion and what is self-centeredness. In a good therapy relationship, this difficult conversation results in greater trust between therapists and the people they work with.

At work, such conversations can get you fired.

“Insubordination” can sometimes be defined as telling someone with more power than you a truth they don’t want to hear.

My boss calls me into his office. I walk down the corridor and step into his office.

Chapter 5

I’m not fired after all.

No, in fact, my boss has also become a “bad object.” His attempt to fix the problem blew up in his face, he says sourly. We’re not the first to be cited by the VP as useless. She has a track record of getting people fired, as she has the ear of senior management.

How could that be?

In addition to bullying, she has a history of being an effective executive and getting good work done, otherwise she would never have gotten promoted.

And, her bullying serves the needs of someone in a higher position. It’s essential for those at the top to have attack dogs. Gaining power and holding on to it is a savage business.

However, this VP is a brawler. A careful bully lays low. They act strategically different with different people. By doing so, they take advantage of the human tendency to put our own experiences ahead of everyone else’s.

Brawlers become famous and their fame becomes their undoing. Eventually they pick one too many fights and become a liability.

My boss tells me we’re not going to wait for the results of the second referral. We’ve hired an IME (Independent Medical Examiner) to assess the employee. To cut to the chase, for $1,500, our IME will write a report that we will send directly to the program’s medical director.

For reasons not defined, the IME’s report will all but guarantee his admission.

To really cut to the chase, the fix is on.

I’m told to meet face-to-face with the VP, bring along a colleague (a good friend) and smooth things over.

Sounds like a suicide mission to me, like my boss is saving his hide by offering mine.

No matter. My friend and I have a secret weapon.

We’re cockroaches.

Chapter 6

The employee is rejected from the second program by the admissions staff, accepted the next day by their medical director and then discharged three days later. His difficulty paying attention made it impossible for him to sit still in groups. The only time he did was when he showed up quietly drunk one morning and fell asleep.

My opinion, which I offer to anyone who will listen, is that AA is a much better fit for him. The looser, drop-in structure and warm fellowship might appeal to him — someday. In order to get help, you need to want help. People drop in and out of AA and then one day, they’re ready. Just because this employee isn’t today, doesn’t mean he won’t be in six months or a year or five years.

Unfortunately, since he can’t return to work unless he’s sober, he’s going to lose his job. Alas, consequences are a necessary part of the recovery process. You can’t lock people up, hold them down and force them to get sober.

The VP consents to a brief meeting with my colleague and me.

In her office, we peer up at her from the floor, our antlers twitching, aware by the expression on her face that she finds us disgusting to look at.

She has her shoe off, ready to pound.

“He needs to be in a hospital and his family agrees. Why haven’t you done so?”

“If he loses his job, I’ll make sure you lose yours. Everyone feels you and your program are complete waste of money.”

“I plan on reporting you to your licensing boards. Hope you have a good lawyer.”

As the heel of her shoe hammers down hard against the floor, we somehow manage to move just enough to the left, then just enough to the right, that she keeps missing. In frustration, she kneels on the floor, aims her shoe heel directly at us and hammers away.

We scamper across the room and hide underneath her desk.

My boss is not a cockroach. He wants to be liked. Having the need to be liked around an attack dog is not a great idea. Strange but true, in the workplace, having the social needs of an insect is sometimes best.

And what happens next tells us why.

About Thomas Moore

Thomas Moore, a licensed clinical social worker in private practice in Manhattan, a NASW approved Social Work Diplomate, is a graduate of two post-graduate training programs in psychotherapy. Tom treats highly reactive couples, anxiety, depression, addiction and overuse problems, alternative lifestyle issues, executive coaching and workplace difficulties. Tom is a fierce advocate of sexual, race and age diversity and equality; he's pretty fly for a straight white guy.

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