Hendrix Revisited: Joe’s Final Psychotherapy Session

[[{"type":"media","view_mode":"media_crop","fid":"57113","attributes":{"alt":"© GUALTIERO BOFFI/SHUTTERSTOCK.COM","class":"media-image media-image-right","id":"media_crop_3351751132695","media_crop_h":"304","media_crop_image_style":"-1","media_crop_instance":"7206","media_crop_rotate":"0","media_crop_scale_h":"195","media_crop_scale_w":"200","media_crop_w":"312","media_crop_x":"31","media_crop_y":"23","style":"font-size: 13.008px; float: right;","title":"© GUALTIERO BOFFI/SHUTTERSTOCK.COM","typeof":"foaf:Image"}}]]Joe was a musician in his forties with a history of alcoholism who had recently resumed treatment in the context of his wife’s suspected infidelity and his subsequent relapse. He arrived approximately 14 minutes late for what would end up being his final psychotherapy session. He smelled of alcohol and his speech was slurred, suggesting that he was acutely intoxicated. This was in violation of our previously discussed treatment agreement.

Joe sat down in the chair and began the session by apologizing for having arrived late for his appointment. After a brief discourse regarding his frustration with the $25 co-pay, he abruptly stood up and pulled his hand out of his coat pocket to reveal a handgun. At this point, I attempted to remain calm and asked him about his intentions regarding the firearm he had surprisingly brought to the office. Caressing his weapon, Joe responded, “I’m going down to shoot my old lady; you know I caught her messin’ ’round with another man.”

Joe then sat down and started crying. I asked him to put away his firearm and secretly pushed the hidden safety switch under my desk to summon hospital police officers for a code gray. Joe muttered something unintelligible that sounded like, “And that ain’t too cool.” I asked him if everyone was safe, given how upset he appeared and the fact that he was wielding a firearm. At this point he put his head between his legs and cried, “Yes I did, I shot her; you know I caught her messin’ ’round town, messin’ ’round town.” When I asked him if his wife was still alive, Joe stood up and yelled, “I gave her the gun and I shot her!”

The momentary silence that followed was shattered as police officers arrived and kicked open my office door to find Joe pacing angrily while I sat in my chair trying to remain calm. Pointing their handguns at him, Joe suddenly dropped his weapon and ran toward the window on the other side of my office. The officers urged him not to jump out of the window -something that Joe may or may not have been considering -and I distinctly recall the larger policeman yelling, “Where you goin’ to run to now??!?!”

In his intoxicated state, Joe initially muttered something about “Mexico,” then yelled, “I’m going way down South where I can be free!” The policemen, assuming Joe was going to make a break for it, lunged at him and Joe began to struggle before falling to the floor. In the scuffle that followed, Joe was escorted out of the office in handcuffs screaming, “Ain’t no hangman gonna, he ain’t gonna put a rope around me!”

In discussing the events with my clinic supervisor, it became clear that Joe’s case was handled as best as it could have been. Luckily, there weren’t any casualties beyond the murder that had presumably occurred before Joe’s final psychotherapy visit. A chart review of recent therapy sessions showed that Joe’s risk assessment -notably his substance abuse and access to firearms -had been clearly documented and discussed with local authorities as well as with Joe’s wife before the incident. This allowed our hospital lawyers to stop hyperventilating.

Moving forward, it was clear to me that no matter one’s training, only such fundamental moments can enable one to answer affirmatively when asked, Are you experienced?

Disclosures:

Dr. Freedman is a psychiatrist in Boston, MA, and in Israel, where he serves as medical director of the English-Speaking program at Bayit Cham in Jerusalem. He also works as a business consultant and serves in both leadership and advisory roles with healthcare and technology companies. Dr. Freedman can be reached at drjacoblfreedman.com.