A Case Study or A Psychotherapy Story

Raunak met her first while she was still at 'Aastha', the halfway home. He was a visiting psychiatrist there, and once a week he met with some of their patients. She sat beside the sick dog, caring for it and devoting her entire attention to its slightest wheeze and whine. He sat with them in silent communion, she barely noticed him. At the end of ten minutes or so he stroked the dog gently, got up and left. She just about registered him then, but made no acknowledgement. In any case she was an extremely quiet, rather timid, slip of a girl, who had been diagnosed a schizophrenic, but was not one of his patients.
The next time they met he had been asked to look her up, since she was in one of her catatonic phases and had not responded to anyone or anything for over a week. He went to her, observed her for a little while, then sat with her in a similar posture and paced her breathing. He did not do this as a conscious technique but it just came to him. He sat with her sharing her outer silence, allowing it, and allowing also the inner storm of thoughts and feelings that she was unconsciously trying to control by being absolutely still. After half an hour he got up and very lightly and briefly touched her forearm with his finger. For a split second she opened up then returned firmly to her rigidity. He prescribed the usual narcotic injection and life went on as usual.
A young man, her brother, brought her a month later into his clinic. He said her term at 'Aastha' had come to an end, and the family didn't quite know what to do with her. They didn't want to put her in any of the mental hospitals, as conditions there were worse than pathetic. They couldn't keep her at home without some professional guidance and help. Shreya herself had suggested that they consult him. He said he was honored that she thought he might be able to help them. The brother, Shailesh found such an admission from the doctor rather strange, but he had observed that his sister had nodded and acknowledged the doctor. This was more than any interaction she ever had with anyone outside the closest family. More importantly, they seemed to have some kind of rapport between them and so he was prepared to give it a shot.
In private, Raunak asked Shreya what she thought he might do for her. Shreya replied outright that he could listen to her silences. Raunak acknowledged that he would be willing to do that. All other queries of how often she would like to meet him, for how long, what she thought might be the goal/outcome of these meetings etc. were met only with silence. After further consultations with her brother it was decided she would come to him 4 times in a week to begin with and later they might bring it down to 3 or 2, when she was adjusted to her new surroundings at her brother's home.
Her history revealed that she had gone through a series of hospitalizations. She had always been a rather quiet and withdrawn child prone to sitting around by herself, reading or secretly drawing in her sketchbook, which she kept hidden or caring for her pet dog. Her first catatonic phase occurred when was still a child. They felled an old tree in their garden. She cried non-stop for almost half a day, her father got exasperated and yelled at her to stop the crying. She did, but she also stopped all her other responses, for almost a whole day. A year later a similar thing happened when her dog died. In the ninth standard, they were discussing ecology and environment, and how science and technology had contributed to if not created much of the damage. She shrieked, ran into the chemistry laboratory and broke all the test tubes, jars and other apparatus including acid bottles, thus inadvertently causing a fire. That was her first and most major outburst. As soon as people started inquisitioning her about what had happened she became catatonic. The more they tried to get her out of it, to shake her with a sense of the wrong she had done and the damage and harm she had caused, the more she went into herself and rigidly closed off from the outer world. After that there was no returning to a normal life. Various doctors/healers/hospitals were tried, but the relapse always occurred sooner or later. The family had just about given up and were contemplating sending her to an ashram, when she had, probably daunted at the thought of facing such an eventuality, shyly and hesitatingly suggested Raunak as a last option prior to the ashram. The others might have disregarded this but her brother felt they should follow up on it since it was the first time she had taken even that much of an initiative. So they worked out the logistics of keeping her at home and visiting Raunak for an hour every other day.
With Raunak all sessions in the first fortnight followed the same pattern. She would come in, he would greet her, she would say nothing, and she would go and sit on the edge of the couch or chair and become resolutely still. He would sit facing her and simply being with her. His keen but gentle eyes were always on her. He gave her his entire attention in as loving and accepting a manner as he could. He asked nothing of her, and held no expectations also within himself. This was his discipline, his meditation, his work. At the end of the therapy hour, he would gently tell her that her time was up, and take her hand to bid her farewell. She would get up rather reluctantly and slowly leave. Once or twice he came out of his clinic at the end of the day and found her standing apparently immobile, at he head of the stairs, or just outside the building. He would gently touch her and remind her that it was time to go home.
Slowly, little by little, his unconditional acceptance reached her. She would be sitting in the chair opposite him and to her horror would find that tears were rolling down her cheeks. But she did nothing to stop them or wipe them away, nor did he. Now and then she would steal glances at him to check if he were still with her, when she found him looking at her, seeing her, she would get flustered and look away angrily or smile shyly. She also began to relax her posture a little, to lean back occasionally and sit easy. After two months of this slow increase in emotional responsiveness, one day she came in visibly disturbed and agitated. He asked her what the matter was and she struggled with herself for a while, then let out a loud and angry and almost animalistic cry. She hollered for a long while and then became absolutely quiet. He asked her again what she was angry about and prodded her a bit, once again she hollered. This went on for almost the whole session. At the end he said he could see she was very angry about something and if she didn't want to tell him what it was about that was okay too, but if she did want to at any point, she could call him or write to him or draw for him. The last appealed to her and she left somewhat appeased.
But that night he got a call from her brother saying she was creating a ruckus and no one could sleep. He prescribed a mild sedative and spoke to her on the phone and asked her to come again tomorrow and to go to sleep now.
The next day she came and almost immediately began hollering. He let her for a while, then placed some drawing paper and colours around her and said that though he could see she was enjoying the hollering, he was getting a little tired of it, and perhaps she might consider expressing her anger through sketching. She was enraged, picked up the paper and tore it to pieces and flung all the colours around, and continued to scream even louder. He realized he needed to once again settle in himself and listen to her, to her hollering and shouting as he had to her silences, with acceptance and without judgement. As he did that more and more she too became more settled and less angry and agitated, till finally she quieted. And then the words came tumbling out, that they were cutting down all the trees along the block and that it made her ever so mad, that she loved those trees, all trees and animals especially dogs and she hated it when anyone willfully destroyed them, and that at such times all she could do was either cry or scream and shout. Since she knew neither of these responses was acceptable she had to hold herself back. She kept saying this over and over again. Raunak too began to talk along with her, saying the same thing reaffirming her assertions, substituting "I" for "You" till once again she acknowledged his presence.
He commended her for articulating her feelings and also pointed out to her that though crying and shouting might ease her for a while, they were not a very effective means of communication. Also that if she verbalized what was going on in her, perhaps they could find some way of dealing with the situation. Once again she became quiet and recalcitrant.
And thus the therapy went on for a year with a very slow and gradual growth of trust. She began to show him her sketches. They were very artistic but colourless, always and only stark black and white. She never drew in front of him. Little by little she voiced her concerns and brought her inner world out, yet she stopped short of any direct action in the outer world. He did not push her, it was enough for the moment that she was expressing herself, that she was adapting at her brother's home without falling into her catatonic phases and without creating too much inconvenience through some wild or unpredictable behaviour.
Then one day she came into a therapy session looking very different from her usual self, with a painted face, pointy shoes and a becoming dress. Her manner toward him was very seductive and flirtatious. In fact she was so different from her previous self that he wondered if she had been misdiagnosed and he was meeting one of her other personalities. He observed her closely and realized that this was a charade. After some flirtatious moves when she could not draw the desired response out of him, she would briefly relapse into her silence, then again perk up and make more advances at him. In one of these silences he asked her what was going on. She immediately turned it into a seductive retort. This seduction game went on for a while but without any response from Raunak. At one point she came and sat on his lap, he let her do what she was doing and watched her without desire and without judgement. At another point she asked him point bank if he would like to sleep with her. He replied that no he would not and that he could see that she was trying to convert their intimacy into a physical one. It reassured her to hear him speak to her in his usual considerate tone of voice, and to acknowledge that they did share some intimacy. She went back to her chair and feeling his unconditional acceptance broke down and recalled the incidences of molestation and sexual abuse that she had suffered in hospitals. She was also not sure if she could call it molestation since she had acquiesced. They had lured her with the promise of a permanent cure and she had been willing to surrender her all. But later she had always felt betrayed and hurt and angry and helpless and guilty and secretive about the entire incident. He let her express her pent up emotions for a while and commiserated with her. He was sorry that this had happened to her, he could understand the burden of such a secret and at the same time he was glad that she had allowed herself to express it, to let it out so that it would not weigh on her so heavily now, that she could grieve over it and let it go. He pointed out that having sex with him or anyone else would not transform her overnight, although it might offer her some release, it would be short lived. He added that he was willing to share her dreams of transformation and to help her realize them to whatever extent he could.
This was her second and major breakthrough. From then on her therapy became more grounded, a process of communication, of interchange of ideas also always connected to feelings. Slowly her vibrancy emerged and spilt over into her home as well. Colours entered her pictures. She joined a course in commercial art, she began dating a neighbourhood boy. Life began to live itself in her, through her.

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