*Names are changed and certain details are left intentionally vague in order to protect people's privacy
Recently, I was in a local cafe doing my daily Italian lesson on Duolingo. The exercise involved one of Italian's little quirks, in which it uses the masculine article lo instead of il before nouns that begin with "s" or "z." Initially, I had to consciously consider which article to use each time I encountered a masculine noun, but lately I didn't have to think about it. I was feeling good about how quickly this mental adjustment had become automatic. Also automatic was the thought that I would excitedly relate this development in my next session with Oren, my psychotherapist of the past nine years.
But then I felt the familiar pressure behind my eyes, the crushing weight in my chest, and the dull ache in my stomach. I had already lost count of the number of times over the past two weeks that I had to reorient myself to the painful reality: Oren was dead. In these situations, I either fought back tears or cascaded into a full-blown crying episode. Although I didn't cry on that particular occasion, I still ached with the reminder that the person I trusted the most to help me work through such intense grief was gone.
Oren's death was sudden. Although he was definitely in the category most consider "old age," he was not old enough that I ever dwelled for long on the idea that death, rather than retirement, could end things. At each of our sessions, he was sharp, alert, and engaged. When he contacted me a few weeks ago to cancel our weekly session, saying that he was feeling sick, he ended his email with, "See you next week." I wrote back, "OK, feel better!", to which Oren replied, "Thank you, Julie!"
A few days later, I received another email. Although it originated from Oren's account, it was signed "Jeremy (on behalf of Oren)." It took me a few seconds to register that Jeremy was Oren's son-- and that he was informing me that his father had died.
"Oh my God. No!" I said aloud. I immediately hit "reply," typed what I had just articulated, and added, "He was the best therapist I ever had. What happened?"
To keep Oren as anonymous as possible and to respect his family's privacy, I won't even repeat the vague explanation that Jeremy provided. But I will say this: hindsight is 20/20, and although I was shocked by Oren's death, it is now clear that he was dealing with serious health issues that I wasn't aware of. He had told me a little bit when it was relevant, but I didn't know the full extent. And why would I have known? There was no reason to tell me unless, perhaps, I had suspected something and asked directly. My therapist did not expect to die soon, and he was clearly trying to avoid scaring me and saddling me with an unnecessary emotional burden. Although it's the kind of professionalism one should expect in a therapeutic relationship, it also illustrates how Oren always prioritized the well-being of his clients. Additionally, now that I realize he continued to work despite serious health problems, I see with even greater clarity what an exceptional therapist-- and human being-- he was.
On and off for the past 33 1/2 years (since age eleven), I have seen a number of psychotherapists and, as I told Jeremy, Oren is by far the best I ever had. Only two others came close, but even they didn't have the nuanced and thorough understanding of autism as Oren did, let alone how it presented in me. A few others that I tried both before and after my diagnosis were terrible; most were just okay. To my continuing frustration, most of these people only recognized that I was autistic after working with me for several months because of my non-stereotyped presentation that didn't include sensory issues, trouble with understanding sarcasm, or being male.
Oren was different. At our first appointment in 2016, he told me that after about a minute of listening to me talk, it was obvious to him I was neuroatypical and that he didn't find it difficult to believe that I was autistic. He said that something about the inflection in my voice-- which I guess was too subtle for most people to pick up on but obvious to him-- tipped him off. In addition, during that first session, he listened attentively. I liked him immediately, and with time I developed a deep sense of trust. I continued to meet with Oren at his Boston-area office for the next four years until COVID forced us to move to Zoom; it stayed that way when he moved out of state shortly after.
Overall, Oren saw autism as a valid neurological variation to understand and affirm, not a mental defect. Rather than approach me like I was someone to be managed, a problem to solve, or even a patient to treat, he validated my internal reality and worked with it. He never dismissed emotional distress with, "You're overreacting," but might comment, "You're someone who feels things deeply" or "You have a lot of emotional vulnerability because of repeatedly being misunderstood." In lieu of the approach of many other therapists who offered neurotypical-standard advice and feedback such as "Just let it go," "You should have done this," "You can't do that," or "You're overreacting," he encouraged me to reevaluate how I approached or thought about certain social interactions and internal conflicts. He asked disarming questions such as, "What does this mean to you?" or "What is the outcome you are hoping for by doing it this way?" He gently reframed my frustrated declarations of "abnormal" with "atypical" when talking about my social missteps. At the end of our most emotionally-charged sessions, he would remind me, "Be kind to yourself."
Most importantly, Oren understood me better than damn near anybody I have ever known. One could say that he spoke my language with the fluency of a native speaker. Whenever I came to him with a problem, he always knew why it bothered me as much as it did without my having to go into a deep explanation. Unlike many therapists who seemingly view their clients as someone to scrutinize based on preconceived notions rooted in popular theories in psychoanalysis, Oren listened. He never claimed to know me better than I knew myself, and his ability to listen and learn helped him achieve that "fluency" in my language.
Oren also had a remarkable ability to get to the heart of whatever social or internal conflict I was dealing with, succinctly summarizing complex issues in one or two sentences. He might say, for example, "The reason you two had this conflict is because you were both operating in completely different mindsets." He also helped me to reframe socially traumatic memories that resurfaced from my middle and high school years in which I had blamed myself. "You were a neuroatypical kid who was not given appropriate support," he might say. "People in your life only looked at surface behavior, and did not consider the underlying thought processes. The reactions you got were based in ignorance, and you were perceived through a distorted lens."
Talking to Oren about my personal issues was only one part of our relationship. In the nine years that I worked with him, I began to see therapy as an ongoing process, not something only to engage in when there's a crisis or when a painful memory from childhood reasserts itself. For him to help me during difficult moments in my life, it was important to put these events in context of me as a complete person with a range of emotional states, which included laughter, joy, and excitement, all of which I was delighted to share because I completely trusted him.
Many of my "good" sessions with Oren began with me declaring, "Something interesting happened this week." He would listen in fascination as I excitedly told him about my different passion projects and hyperfocused interests, such as learning Greek, using DNA evidence to solve a nearly-100-year-old mystery in my family tree, or watching Back to the Future for the millionth time. Oren always affirmed this common-but-often-pathologized autistic trait. "When you get into something, you really get into it, and I think that's cool," he often said. He read and appreciated many of my blog posts, and also enjoyed my artwork. Since he always knew what I was interested in, sometimes this awareness followed him outside of sessions. One time, he told me that he had seen a movie on television with Alan Arkin, my favorite actor, and thought of me.
And on some of my other good days, Oren and I just had fun laughing together. He enjoyed my twisted sense of humor; hearing stories about the antics of my cat, Neptune; and laughing at the surreal dreams I had that I often joked would make Salvador Dali cringe.
I also know that Oren genuinely cared about me, and not just because he said it more than once. A couple years ago, when I was going through a particularly difficult time, I emailed him the day before my regular morning time slot, saying I felt like I was at the end of my rope and asking if he could talk that night. He was unable to, so I grudgingly accepted that I would have to wait until the next morning. Unfortunately, my alarm didn't go off, and when I realized I'd missed my appointment, I opened up my email to apologize to Oren. But he had already emailed me-- not to chastise me, but to ask me if I was okay. I let him know what happened, and he saw me later that morning.
When I got on the Zoom call with Oren, he looked and sounded profoundly relieved, saying, "I was really concerned when you didn't show up." I assured him that while I was overwhelmed emotionally, I never would have done what his concern implied. He didn't charge me for the missed appointment.
Oren also showed how much he cared through his exceptional generosity. One time, when I was forced to switch insurance companies to a policy he didn't already accept, he signed up for it. I only learned recently what a significant gesture this was, with the amount of paperwork and negotiations involved. While he waited to be approved for this new insurance, he continued to see me. I had to pay out of pocket, but together we agreed on an appropriate rate that I could afford. Last year, after I got laid off from my job and couldn't find a new one, it looked like I would have to move in with my parents in my hometown in Pennsylvania. I asked Oren if I would be able to continue seeing him. He said he didn't have a license in Pennsylvania, but that he would look into getting one. That, too, involves a lot of work and bureaucratic interactions. Fortunately, he never had to do it, as I found another job and was able to stay in Massachusetts.
Every week for almost a decade, Oren remained a constant in my life. He was a person I shared my complex inner world with, someone I brought what was confusing, painful, joyful, or simply interesting. After exchanging greetings, he often began our sessions with a smile, asking, "What can I do for you?" and ended them with "Let's stick a pin in it," if a conversation was left unfinished. In a variation of his typical closing, he ended our final session with "Let's put a flag in it"; in hindsight, this seems oddly prescient.
Although I genuinely liked and trusted Oren and could not imagine anybody else as my therapist, I never could have anticipated how much losing him would affect me. In the weeks since his death, I have thought intensely about how much I missed his kind eyes, his warm smile, and his joyous laugh. That is, I found myself missing Oren on a personal level. I have cried multiple times and fought back tears almost every day, and also found myself deeply worried about what his final moments were like.
Was Oren asleep when it happened, or was it painful? Was he scared? Did he know what was happening? It deeply hurts to imagine this warm, kind, and generous man possibly dying in a horrific way. That Oren's death has affected me in such a visceral manner made me realize something important: I loved him.
Of course I loved him. How could I not have loved someone who knew, understood, and respected my inner world so well? Initially, I couldn't comprehend why this reality had never crossed my mind when Oren was alive. However, love in this particular context is not always obvious, as it develops quietly and subtly within the appropriate bounds of a therapist/client bond, and only crystallizes when the connection comes to an abrupt end. It has neither the electric spark of romantic attachment nor the unbridled altruism of a familial bond, but it is a type of love nonetheless. I am confident that the feeling was mutual, and I will always treasure our relationship.
Oren was a rare human being. He had an acute sense of compassion and was warm, kind, open-minded, knowledgeable, deeply philosophical, brilliant, and principled to the very end. For nine years, I trusted him profoundly. I laughed with him on my good days, I cried in front of him during difficult times, and now I cry for him alone. I will deeply miss him.
My one solace is knowing that the world is better for having had Oren in it.
