“Rising Stars” – From Fall 2007 Newsletter

“Rising Stars”

A “star” is not just a vibrant glow above us. It is not just a luminous, celestial being hundreds of miles in the air. I know this because I had the opportunity to come face to face with a star (one of the many blessings of being a provider). On that day, I received a frantic phone call from a teacher who was concerned about her 18-year-old student. The student was homeless and thinking about dropping out of school. For reasons you will soon see, we will call her Star. I called the student immediately, and it was true, Star was homeless. And, support-less. She was sleeping anywhere she could lay her head (hotels, cars, alleys).  Star was very reluctant to come in to talk with me, which I later learned was due to her mistrust of the system after years of receiving uncoordinated, fragmented services from providers who, in her eyes initially, were no different than this woman on the other line asking her to come in. I am not sure what convinced her, but the next day, she knocked on my door.

As she sat in front of me, I observed a young lady with a tough exterior. As we talked, I began to see that the toughness was her protection--her safety in what seemed like a very unsafe world. I learned that she had a long list of previous diagnoses, including Major Depression, Bipolar Disorder, Attention Deficit/Hyperactivity Disorder, Post-Traumatic Stress Disorder, and Conduct Disorder, just to name a few. No one had ever diagnosed her with a Substance Use Disorder despite the fact that she had been using alcohol and marijuana everyday since she was 10-years-old (and later experimented with cocaine and ecstasy). She was a drug dealer for several years (and also in a gang) before getting out of the game after her boyfriend was arrested and she witnessed her best friend being shot and killed in front of her eyes from drug-related activity. She said that this was not the life she wanted to live. She had lived on the streets since she was 11-years-old. And, like many young women on the streets, she often sold herself in order to survive.  I am not sure that I have ever been so impacted after a first session.

Because she told me that she had never gone to a therapist for more than two sessions, I continued to be surprised when she showed up each week like clockwork for over a year. In order to make sure that she did not quit, I regularly checked in with her to see how she thought things were going and to gather information on techniques that she liked and did not like in the therapeutic process. For a young woman who had virtually no control in her life so far, having a say in her treatment seemed refreshing to her. It was something that she said she had never experienced before despite seeing multiple providers for over nine years across four states.

I learned that she had experienced traumas that seem almost unreal. You name it, she experienced it. Repeated rape, physical abuse, sexual abuse, emotional abuse, homelessness, death of a parent, witnessing murders---all of this while being completely and totally isolated from positive supports. She had no parental figures in her life (all previous parental figures were either dead or addicted to crack). The streets were her family, and so, substances became her coping mechanism. It was her way to escape from a world that she (and I imagine no one) would want to be in.

With that backdrop, it might be hard to believe her life now. Statistics would tell us that she would be in jail, or in rehab, or on the streets. Instead, she is in college, living with a roommate, and working part-time to make her way through. She has decreased her substance use significantly. She is volunteering when she can as part of her college experience. Of course, she still has many challenges and room to continue to grow, but she is working toward peeling back the layers of her traumas while building more effective coping strategies. She is bright. She is determined. She is strong. In my mind, she is a Star.

I asked myself, “What was it that made her keep coming back?” As I pondered this question, I came to the conclusion that it was not a specific evidence-based practice (although these are important in treatment). It was not the homework or the practice activities that she completed outside of our sessions. It certainly was not anything mind-blowing or life-changing that I said.  In my heart, I believe that it was the fact that she did not feel judged when she shared her experiences and the things she did to make it through.  She knew that she could count on me to listen to her each week. She knew that, for at least this point in her life, someone cared. In sum, what made the difference for this rising Star was the therapeutic relationship. The relationship was the therapy.

Stars begin to form from collapsing clouds of material. The Star that I knew began in a similar way given the multitude of collapsing and traumatic events she experienced. But, like the stars above, the Star that I knew began to sift through that material to show the world her brightness. We terminated therapy because she moved, but I think about her when ever I look up.

~Submitted by Kelly Graves, Ph.D.

References on Building Therapeutic Relationships
Hardy, G., & Barkham, M. (2007). Active ingredients of the therapeutic relationship that promote client change: A research perspective. In P. Gilbert & R. Leahy (Eds.), The therapeutic relationship in the cognitive behavioral psychotherapies (pp. 24-42). New York: Routlege/Taylor & Francis Group.

Ritter, A., Bowden, S., Murray, T., Ross, P., et al. (2002). The influence of the therapeutic relationship in treatment for alcohol dependency. Drug and Alcohol Review, 21, 261-268.