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I overheard someone telling one of our students that she loved her.  40 of us were packed into a room at a transition ceremony. We had formed a big circle, standing up, and the graduating student was going from person to person, hugging each one goodbye. As the student approached my right, she hugged my friend (staff) and my friend said, “I love you.”  The student, crying, said, “I love you too.”  Their hug lasted about 10 seconds.  Was this appropriate?  What would I say when it was my turn to say goodbye?  After all, I was a 30-plus-year-old man and she was a 16-year-old young woman.

Why does the word “love” carry such a taboo in treatment?  Do we really think that we can wall-off our hearts to those we serve? Do we really think that we can remain unaffected by their journeys, their stories?

As a relationship progresses, I believe it’s important to define what is happening.  It’s especially important because many young women in treatment have had inappropriate, unhealthy relationships and they become confused about what they are feeling. Particularly as a male therapist, I have to be constantly aware that the intensity of the emotions shared during healing process can be confusing to young women. So I am constantly defining what I mean and why I choose to use the words I do.

For example, if I tell a client, “I care about you very much,” I will immediately clarify that statement.  ”You realize that this is not a sexual kind of caring,” I’ll say.  ”The feelings I’m expressing are like those I might feel for my own daughter.”  Usually, the girl will become uncomfortable:  ”I know it’s not sexual!  Why do you even have to say that?!”

I’ll press forward.  ”You’ve certainly noticed where my eyes look.”  ”Yes,” she’ll usually say . “Your eyes never leave my face.”

“Why is that?” I’ll ask.  And we’ll talk about how my feelings toward her are fatherly, as if she were a daughter.  We’ll define the differences between platonic love and amorous love.  We’ll dissect the friendship that is developing.

I tell her that I am okay with the conversation being uncomfortable as long as we can take use that moment to be clear with each other about what kind of relationship is developing between us.  I submit that this is good therapy.

One student I worked with years ago had had a boyfriend ten years older than I.  It was difficult for her to reconcile her growing feelings of love for me with what she’d experienced with her perpetrator boyfriend.  As we grew closer, it was vital that I teach her the differences between what she’d felt for him and what she was beginning to feel towards me.

At times the conversations were painfully direct.  ”I am not aroused by you,” I recall saying when she provocatively suggested that there might be more to her feelings than would be appropriate. Whenever I noticed confusion in her eyes during a group where a male staff member might have expressed compassion for her situation, we would take a moment to define what was going on for her and for him.

Years after treatment she came to an alumni reunion.  We had a few quiet moments to catch up on her life and she said, “You’re about the only man I trust.”  I was taken off-guard by that statement.  She explained that she’d caught her father looking at pornography, that she’d been “used” in every intimate relationship she’d had since treatment, and that she just couldn’t look at men without feeling sexually unsafe.  ”But not you,” she said.  I attribute that to the hours and hours we spent working at understanding the difference between appropriate and inappropriate love.

All of this and more flashed through my mind as I stood in that circle during that transition ceremony and anticipated how I would say goodbye to one of my favorite students.  It only took a few seconds for her to hug the person at my right and then be standing directly in front of me, but I relived every moment we’d shared during treatment.  I felt my heart swell in my chest.  I felt my eyes sting.  This was a student who would have been dead, had she not received care.  I thought back to the day she had arrived.  Images of her – angry, bitter, depressed – flashed in my mind:  her dark clothing, her darker countenance; her fear of connecting, her fear of others never wanting to connect to her.

I thought of the arguments we’d had, the times she’d screamed at me until she was hoarse.  I thought of the quiet moments when she’d trusted me enough to tell me something she’d never told anyone before.

The feelings within me burned stronger as I reminisced about the magical moment when something had seemed to “click” for her. I remembered her change of heart. I recalled the light that shone in her eyes that I hadn’t seen before, but which her mother said had been there up until only a few years ago.  Her face and demeanor had relaxed and she had become gentler with others – and with herself.

And so, as she stepped in front of me and reached up to hug my neck, without shame or pretense I wrapped my arms around her back and pulled her tight to my shoulder and said, “I love you.”  There was nothing sexual about me using that word, and she knew it.  ”I love you too,” she said.  There was no confusion in my mind about what she meant. For five seconds we enjoyed the connection of that hug.  We felt the bond of friendship forged in the heat generated by months and months of intensive psychological and emotional healing.

Then she pulled away and moved on to the person at my left.  I’m pretty sure I overheard them use the word “love” as well, but I can’t be sure.  I was distracted with trying not to cry.

“I messed up,” the text message began, “and I just wanted you to know that I cut myself today.  But I’m back on track.”

Is this a relapse?  She’d been free from self-harm for over 13 months.  How would you have responded to her?

In my mind, there is a big difference between a momentary lapse and a full-blown relapse.  I had the following conversation with parents at a Family Weekend years ago, an event we hold for three intense days every other month of the year.  All of the parents in my group that weekend had girls who were coming home soon.

“I can’t wait for my daughter to come home,” one father said.  “New Haven has been wonderful!  All of her problems are fixed.”  I find that all too often parents expect their kids to be “fixed” when they return home.  Even after spending time at New Haven, arguably the most systems-focused residential treatment center in the country, they still believed that treatment is an event and when it’s over, they were done working.  “Oh, no,” I told him.  “Your journey has just begun!”

“What happens when your daughter returns home and you find her spending hours on the internet? What happens when she skips her curfew?  What happens when you find pot in her backpack?”  He began to sweat.  He stewed.  Finally, he couldn’t take it anymore.  He lunged across the room at me, red-faced and yelling.  “What is the point of this?  I came here to feel better about my daughter!”  He accused me of doing “poor therapy”, then sat down.

“I’m trying to prepare you for the inevitable,” I said.  And we had a robust discussion about how his daughter, in particular, was going to bring home a young man he didn’t like, was going to accelerate into sexual behavior faster than he would be comfortable, and they would have to deal with it.

“I’ll kick her out on the street!” he said.  “I won’t tolerate it.”

“But what if it’s not a relapse?  What if it’s a one-time screw up?  I doubt you’d kick her out if you knew it was an honest mistake.  She might ‘lapse’ but not ‘relapse’. So how will you define the difference between a ‘lapse’ and a ‘relapse’?” I asked.

In the end, the group decided together that a lapse is a one-time event which is reminiscent of past behavior.   A relapse, on the other hand, is a persistent pattern of the behavior we thought we left behind.

It’s easy to recover from a lapse.  Yet it’s also easy to allow a lapse to become a relapse.

So, what stops a lapse from becoming a relapse?  They wanted to know!

Two things will keep a lapse from becoming a relapse:  #1) consistent, healthy relationships with parents and friends; #2) parents unified and consistent about implementing rules and structure in accordance with established family values.

We spent the balance of that Family Weekend session outlining ways  to keep their relationships with their daughters fresh and alive.  We outlined rational rules and boundaries which were neither too permissive nor too restrictive.

About ten months later at another Family Weekend, the angry father returned.  He sought me out during a parent group and apologized for his attitude.  “You were right,” he said .  Turning to the other parents in the room, he laid out his daughter’s lapses and how he’d helped her keep them from becoming relapses. He never “kicked her out on the street” and she was doing reasonably well.

He’d realized the truth:  our journey does not stop with the end of treatment.  We continue on, we fall down, we scrape our knees.  It’s how fast we get back up that matters.

So here’s how I responded to the text I mentioned at the beginning of this post:  “Thanks for staying connected.  As long as you are back on track, that’s what matters.  Call if you need to talk.”  After all, it was just a lapse.