I can’t tell you what year it was. Maybe 1995 but it doesn’t really matter. I was in the first decade of my private practice, long enough to be established but short enough to still feel like a novice on occasion. “Sam” found me because he heard I was proficient in something called cognitive behavioral therapy or CBT. It isn’t that common for a client to ask a therapist about his therapeutic approach but in those days, if queried, that was my response.
I am like a musician who can play instruments but can’t read music. Since I started counseling people while I was still in high school, my approach was instinctive or intuitional, not theory-driven. I was nearly 30 years old and finishing up a post-doctoral fellowship at Shasta County Mental Health in 1985 before I even thought about what to call my treatment orientation. It wasn’t psychodynamic, existential, gestalt or behavioral. It might have been humanistic or Rogerian in the beginning but I had evolved. Usually I said I was “eclectic,” which is a technical term for mishmash. It merely meant I used whatever tool felt right at the moment with a particular client.
One of my supervisors was Dr. Charlie Cordes who was perplexed. He could tell I was getting good results and respected my work, but he couldn’t figure out what I was doing or how I was doing it. I can still see him scowling and trying to fit me into a box he never found. And I had no idea how to help him. I knew how to do what I did. But I didn’t know how I knew.
By the time Sam showed up in my office years later, I was a seasoned CBT practitioner, had trained with David Burns and was ready to help this new client change the cognitions that were causing him to feel depressed or anxious. And then he stumped me and explained that his problem was not depression or anxiety but tinnitus. His ears rang. Constantly. Every day and night, without ceasing, forever.
Sam was resigned to the constant alarm in his head; he’d been told there wasn’t a cure or a fix. He just had to learn to live with it. And so in desperation he looked to me to rescue him from his own private hell inside his brain because he had read that the only effective treatment was CBT. And I was the expert, you see.
Except I didn’t feel like one at that moment and instead, looked back at him in complete bewilderment. In those days – no kidding – when I was overwhelmed with a client’s issues, I would think, “This person really needs to see a therapist” before immediately realizing, “Oh yeah, I am one. Ooops.”
Sam hung in there with me for about three visits before he figured out what I had a hard time admitting: I had no clue how to help him “live with” tinnitus. After he stopped coming in, I was slightly relieved, but mostly guilt-ridden and (thanks to my own magical thinking) fearful that I would one day be punished for failing to help him. I actually had the intrusive thought or worry that one day I would be inflicted with tinnitus, which I imagined as one of the worst conditions a person could have.
It took another ten years or so, but my fearful prophecy came true in the midst of a particularly stressful period in my life. The reason for the stress is a separate tale but suffice it to say that one day the ringing came and never left.
My first reaction was, of course, panic. When the thing you dread shows up and moves into your brain like a permanent and unwanted guest that you can’t escape because it is inside your head and goes with you everywhere, what do you do? What do you think?
I don’t know what others do but I immediately and desperately consulted with a physician who taught me the correct pronunciation (accent on the first syllable) but otherwise just shook his head, smiled and said, “Good luck.” Millions of us suffer with this he said and there is no treatment or relief. “Learn to live with it,” he advised and of course I thought of Sam and the curse coming true.
I actually had suicidal thoughts after that and wondered how I would ever “learn to live” with a siren in my head that never shut up. Thankfully, I not only learned to tolerate the noise, I came up with a solution that has brought me great peace and comfort and, as I describe in my next column, helped make me a better therapist.