Therapy on the Fly

I have a small number of regrets about not going to medical school: prestige, money, being able to call myself a “doctor” without people laughing at me, that cool silver circle to wear on your head, the extensive golf-playing, and getting to yell “clear!!!” in the operating room before hitting the defibrillator. These are things I could have enjoyed but were just not meant to be. I can accept that.

What I truly crave however is that ability to help a sufferer outside of the office in an emergency situation. Much like the doctor who performs the impromptu tracheotomy on a man in the street using only a # 2 pencil and an alcohol wipe, I too would relish performing a psychological service to one truly in need: a sociopathic killer holding a damsel in distress on the George Washington Bridge who is talked down from his maniacal plan by the soothing and sagacious words of Dr. Rob. This of course would be followed by the cheers of a gathering crowd who hoist me onto its shoulders and whisk me away to the nearest ale house. That would be nice.

I had decided that such heroism would never occur and that I would have a simpler career with quality therapy delivered in healthy doses to those who seek out my services. Strangely it was after I came to that conclusion that my professional life got just a bit more interesting.

I had left Dr.Pete’s apartment after a peer supervision session where the focus had annoyingly shifted from discussing important cases and therapy styles to Dr. Jane and Dr. Allison debating who was better looking: Freud or Rorschach (yes, Rorschach was a real man). I should have just followed MILF-loving colleague Dr. John’s modus operandi and not attended at all (“Supervision is for pussies. Real shrinks don’t need help.”) but was at least smart enough to bail before they started talking about which male clients they would like to sleep with. Getting into the elevator on the 35th floor I came face to face with a middle-aged woman who was teary-eyed and panting.

“Are…are you alright?” I asked. I always hate when people ask that question when the person is clearly not alright but nothing immediately came to mind. I’m a sharp thinker that way.

She wheezed in and out. “I…think I’m…having a panic…attack.”

“Are you sure? Have you had these before?” When people present with symptoms of Panic Disorder it’s important to ensure that they are not suffering from a more serious problem such as a heart condition.

“Yes” she said, breathing basically into my face. “I get…them a…lot.”

True panic attacks can be psychologically debilitating. Although there are a lot of erroneous beliefs surrounding panic (e.g., I might pass out, I’m going to lose my mind, I’m having a heart attack) the sheer terror that patients report during panic make it a crippling condition.

“I usually…take Xanax,” she said. “But I left…them at…home.”

“Can I help you with this? I’m a Psychologist.”


When people are having episodes of panic their breathing becomes labored. They don’t take in enough oxygen. Their heart rate speeds up causing more labored breathing and thus beginning a vicious cycle that can lead to beliefs about a heart attack or fainting.

I extended my arm out and up and beginning wiggling my fingers. “Look at my hand and try to focus on my fingers.” Distraction can be a useful way for clients to get through the initial stages of panic. She looked up at it, still breathing heavily, slightly bent over from the fatigue of inefficient breathing.

“Everything is going to be fine,” I reassured her. “You’re just breathing poorly right now. “I’m going to put my hand on your belly. Is that alright?”

Therapist Rule: Rarely is it necessary to physically touch a client (or elevator partner). If you plan to do so ask beforehand so there are no misunderstandings.

She nodded her approval.

“Okay, keep looking at my fingers. Breathe in through your nose and slowly start to push your belly out. Picture your stomach pushing my hand off of it while breathing slowly through your nose. Keep your eyes on my fingers.” This is diaphragmatic breathing and, while ideally done laying down, it can be successfully completed in any position with enough practice. Fortunately this woman seemed naturally talented and was successful right away.

She seemed to be a little calmer after about 10 seconds of this which was timed well with our arrival at the lobby of the building. “I think I…might pass out,” she said. “I’m so tired now.”

“You won’t faint because your blood pressure is through the roof right now and that needs to drop for you to pass out but I don’t doubt you’re exhausted.” I led her to a seat in the lobby.

“How about you continue to breathe like I showed you and I’ll get you some water?”

I went over to the doorman of the building, Samuel, according to his name tag. Pointing to the woman he asked, like any caring New Yorker would do, “What the fuck is wrong with that one?”

“She had a panic attack. Could you please get me some water?”

He rolled his eyes in annoyance, clearly pissed that I was taking him away from the Gossip section of the New York Post and walked off. He came back with a cone-shaped cup of water. “There’s no loitering here so hurry the hell up and get out of the lobby.”


Formal panic attacks rarely last more than a few minutes and by the time I got back to the woman she seemed pretty much recovered. She drank the water, thanking me between sips. I told her that she would probably have felt better fairly soon without my help but that treatment is available beyond simply medicating yourself. She was excited to hear that and I gave her Dr. Pete’s phone number for a consultation.

I left the building and felt fantastic. The psychological equivalent of a Sidewalk Appendectomy! At that point I was ready to help anyone I could find and began looking around for a distressed person to counsel. Then I remembered that I live in New York City and everyone here is distressed pretty much all the time. I guess I won’t be out of work soon.

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14 Responses to “Therapy on the Fly”

  1. PurpleMonkeyDishwasher says:

    Fascinating as always Dr Rob. I hope you gave the Doorman a dirty look as you walked out.

  2. Jen says:

    Aww, Dr. Rob, you’re a hero! I bet that baby face was grinning all night.

  3. Rosie says:

    I’m curious Dr. Rob… What’s your opinion of Barlow’s Panic Control Therapy? (Education about the physiology of panic, followed by a deliberately induced panic attack in a controlled setting.) He claims that 80% of people who complete it are basically cured. Have you ever seen it in action?

  4. Anonymous says:

    Great story Dr. Rob!

  5. Jorge A. says:

    My only question is why you referred her to Dr. Pete instead of giving her your number seeing how you already showed her you’re capable of helping her?
    Dr. Rob Note: Complicated but in part due to her need for office location.

  6. Jenna says:

    Petey boy owes you one.

  7. Nicole says:

    Where are you when I need you? Maybe I can time my panic attacks to your appointments outside the office????????????? Elevator therapy…love it!

  8. Mary says:

    This is a great is a good thing you were at the elevator at that time to help her

  9. BorderlineBetty says:

    Way cool, Doc Rob, way cool! (I wonder if she’d even need her meds if she could start a mindful breathing program? Not that I want to make light of her attacks). Pretty funny and vivid column, as always! I really enjoy your writing, even as I disagree w/some things pretty strongly. For instance, I think supervision is important for therapists, if done well. (Also: I think Carl Jung tops those two other guys in looks and in all other ways, too. Looks-wise, The young Jung – heehee – was pretty hot.:)

  10. Wayland says:

    Pretty freakin’ cool man.

  11. Amber says:

    Kudos to you Dr. Rob. This one made me smile.

  12. Colleen says:

    When I did an undergraduate internship at a mental health hospital I used to plan out what I would do if one of the paranoid schizophrenics got violent and took hostages. In reality most of them were properly medicated and far from violent, and I’d be more likely to lock myself in the supply closet and call 911 than be a hero, but it was fun to fantasize. It’s cool that you were able to help someone having a minor crisis. The satisfaction of having an immediate, positive effect on someone’s life can’t be beat :).

  13. Nancy Drew says:

    Just curious: do you change in a phone booth or do you wear the cape and tights all day?

  14. s says:

    Great story! And I wish I didn’t stay in the liberal arts.