I met Luke when he was about to turn 15. He was at the beginning of a growth spurt, thin and lanky, with sneakers that looked far too big for the rest of him. Polite but reserved, he made eye contact fleetingly and didn’t smile. He wasn’t attending school, had stopped playing baseball, and for the last eight months had spent most of his time alone in his room. When his best friend had moved across the country, he’d withdrawn even more. His social anxiety became so overwhelming and painful that he told his mother that going to high school “felt like being shot.” He’d been in therapy before and had tried medication, but as his anxiety and depression deepened, he felt hopeless, and his parents were increasingly desperate.

This is a success story. Luke, now 17, is back in school full-time. He started taking drum lessons, and he and some new friends formed a band. He joined a baseball team and showed up to the first practice knowing no one. He missed a grounder that first day, but went back. I could spend hours describing the steps Luke and I took to manage his anxiety and get him to where he is now, two and a half years later. But this isn’t a story about that—it’s a story about connection and what happens when we therapists allow ourselves to be genuine and flawed and real.

Looking back, I think two conversations started us off down this path. The first took place during an early session, when he was wary of what I had to offer him. “How do you know what this is like?” he asked. “You’re not me. I can’t walk into school and not feel the anxiety. It’s awful.”

I told Luke that, for the first half of my life, I was held hostage by a powerful medical phobia. Actually, the term medical phobia is far too specific for what was really a fear of anything I considered even remotely “gross” in the realm of bodily function or dysfunction. Even the vague suggestion of something “medical” or “gross,” would cause me to have a full-on panic attack, a vasovagal reaction that came on slowly but quickly picked up speed. Once the symptoms started—always with a rushing in my ears—the panic and physical reactions spiraled. Ultimately, I’d lose consciousness.

I passed out frequently and in the most embarrassing situations imaginable. Although I worked hard to avoid any possible triggers, it didn’t take much to set me off. Once, as a swimmer after college, I developed an ear infection and went to the doctor. He looked into my ear and said rather dryly, “Wow, it’s red in there.” That was all it took. I fainted.

Luke was leaning forward in his seat, taking in every word as I told him this. I went on to say that my first job after graduate school was in a hospital, which, I reminded him, “is one of those big buildings where they keep all the gross medical stuff.” I was working on the inpatient psychiatry unit—as nonmedical an environment as I could hope for. But still, inside every elevator, around every corner, even in the cafeteria, lurked potential horrors that I might see or hear or imagine. I was determined that this fear wouldn’t rule me, but I had no skills or plan to back up my determination. I had to figure it out.

“And I did,” I told Luke. “I’m proof that this can be done. And in the last 18 years, I’ve only passed out twice. Both times were embarrassing, and both had to do with bones. Bones and dislocations can still get me every once in a while. But I’m much, much better. I’m on offense with this thing. I don’t avoid it. And I’ll teach you to do what I do.”

The second conversation took place about a year into treatment. As Luke was steadily moving back into his life, I asked what made him stick it out in therapy with me, way back when.

“One thing, I think, was that I knew you were funny,” he told me. “And I knew I was funny. I wanted to show you that. I wanted to make you laugh, and it made me mad that my anxiety didn’t let me do that. I wanted you to see who I was because I knew you’d appreciate it.”

This brings us up to the last few months. Luke was doing so well that we were meeting only every six weeks or so. At one visit, he began to tell me about recent events and successes, as had become the routine. “Oh, yeah,” he added, “and I have a girlfriend. Annie.” I beamed immediately, but then felt myself working to rein in my excitement. Instead, I did the therapist nod as he filled me in. She was a girl from school, also anxious, he told me. They’d become friends first, able to tell each other all sorts of things. “I like her,” Luke said, grinning in spite of himself. “So a few weeks ago, I asked her to be my girlfriend. She said yes.”

But there was a problem, and he was hoping I could help. “We’ve agreed to be boyfriend and girlfriend,” he said. “Except since then, nothing has happened that you’d consider ‘boyfriend and girlfriend.’” Luke looked down at his sneakers. “Do you know what I mean?”

I told him I did, and we talked about what he could do to take that next step. Should he hold Annie’s hand? Put his arm around her when they were watching TV? “How do you just do that?” he wanted to know.

“Take her to the movies,” I said, with more confidence than I felt. “Annie’s hand will be resting on the armrest or her lap. Then during the movie, tap the top of her hand like this, and offer your hand to her.” I acted it out. Finger tap. Offer hand with palm up.

The next week, Luke reported success. After they’d gotten over that hump, it was easy to hold hands and sit close while hanging out. “But now I want to kiss her,” he said. “Tell me how to do that.”

I asked Luke if he thought Annie wanted to kiss him. Yes, he thought so. “So ask her,” I said. “When you’re sitting together, turn to her and say something like, ‘Can I kiss you?’”

“Really?” said Luke. “Isn’t that weird? Is that what people do?”

I told him it was kind and polite and sweet. And, yes, that’s what kind and polite people do—even teenage boys. I predicted that Annie would say yes. I was almost sure of it.

“Okay, I’ll do it,” he said. “And can I come back next week? You’re the only one I can talk to about this.”

The following week, he sat down and made a few minutes of small talk. “Oh, and I kissed Annie,” he added, casual as can be.“Damn!” I said, laughing. “You buried the lead!”

“I did what you said,” he grinned. “We were watching a movie at my house and I turned to her and said, ‘Do you want to kiss me?’ She said yes. But then we realized we didn’t know what to do next.” So, he said, they took out his iPad and searched for “how to kiss a girl” on wikiHow. They figured it out, step by step. They laughed a lot. I assured Luke that kissing was something that improved with practice. He smiled. We talked about school and his thoughts about going away to college the following fall, and then scheduled another appointment.

His mom emailed a few days before his appointment to let me know that Luke had dislocated his shoulder while playing touch football. “All is well,” she wrote. “He’ll tell you about it when you see him.” I got nervous.

The last time I’d passed out, four years earlier, was the direct result of my friend Jim telling me about his dislocated shoulder. We were at a fancy fundraiser, and Jim was a bit drunk. In some detail, he described to me his fall while skiing, his subsequent belief that his shoulder was “just dislocated,” and his repeated attempts to shove it back into place. “I didn’t know it was broken,” he said. “While I was pushing on it, it got a bit gummy in there.” Gummy. Such a seemingly innocuous word, but I felt those familiar symptoms moving in fast.

The last thing I remember was excusing myself, saying I needed to take a trip to the bathroom. I regained consciousness about 15 feet from where I’d left Jim. I was flat on my back in the foyer. When I came to, the live music had stopped and several people were leaning over me.

The night before Luke’s appointment, I struggled to fall asleep, which is unusual for me. He was going to tell me about his dislocated shoulder. I’d taught him to step in to his worries, that avoiding triggers only made the anxiety stronger. He could handle it. But now, it was my turn. I felt responsible for the progress of both of us.

I reminded myself I could handle whatever happened. “If I faint, I faint” had been my liberating mantra for decades. I’d been humiliated in more scenarios than I could remember, and I’d survived. Bring it on, I told myself, and then stayed awake for another hour or two.

Luke arrived for his appointment the next afternoon. We chatted about school (he was finally catching up in math), Annie (the kissing was going well, and the need for coaching diminished at this point), and his dogs (his mother had added another rescue to the pack, much to his father’s dismay). “I dislocated my shoulder, did you hear?” he finally asked. I told him his mom had emailed, then he filled me in on the details.

After baseball practice he and his teammates were playing a little touch football that quickly came to include tackles. One boy took him down hard, and he immediately knew there was a problem. “I couldn’t move,” he said. “I was just on the ground groaning.” He didn’t tell me anything too graphic—and no mention of “gummy.” I focused on my breathing and was doing fine. Then Luke said, “I have the X-rays on my phone. Right here. Pictures of when my shoulder was out and then when they put it back in. I want you to see them.” He looked at me with anticipation.

“Sure!” I said, perhaps a little too enthusiastically. “In a few minutes.” The session was almost over, and I decided I’d look at the X-rays as he was heading out the door. That would be safe.

But Luke was having none of it. “You should look now. No avoiding. Let’s go.”

He was right. I needed to walk the walk. “Okay, let’s see them,” I said. Pressing my hands together and breathing as slowly and silently as I could, I felt my heart rate bump up a bit.

Luke found the X-rays on his phone and turned the screen toward me. “This one is when the shoulder was out,” he said. “See that? Look closely. And here it is back in. See?” He toggled back and forth several times. Then he looked at me. “How’re you doing?” he asked.

“I’m fine. I really am,” I said, hoping Luke could feel my confidence. My heart rate was evening out, and there was no telltale rush in my ears.

Luke told me I’d done a great job. He’d known I could do it, he said. He put away his phone and we talked some more. I don’t remember what we discussed, but he was making me laugh, probably by imitating his poodle’s nervous grimacing. Luke is funny.

When the hour was over, we scheduled several weeks out, back to our previous routine. “Thank you,” I said. “This was my lucky day, you dislocating your shoulder and then showing me the X-rays. You’ve helped me a lot.”

“It’s the least I could do,” he answered.

I felt my eyes well up as he left. This was a boy who came to my office barely able to look at me, wanting so desperately to find friends and connection, but terrified to show himself to the world. He left this day knowing, I’m quite sure, that connection happens when you take a bit of a risk and share a human, emotional experience.

When I was in graduate school, I was told not to self-disclose, to always be careful about how I reacted and what I said when I saw a client outside a session. As a 22-year-old social work intern, one of the many things I worried about was my ability to hide my “real” self from the families I was assigned to help.

Believe me, I like boundaries. My office is attached to the back of my house, and the rules surrounding that are made clear to my clients. But how can I teach my young worriers (and the older ones, too) to relish the uncertainty of human connection if I’m unwilling to connect genuinely with them? Now you know the truth: I’m funny, and I faint. When you specialize in anxiety disorders, these two qualities can come in handy as needed.

Michael swaggered into my office, his flannel shirt flapping and his faded jeans threatening to rip at the knee. Before sitting down, he glanced at my footwear and looked up with a smirk. “I see you’re wearing new boots today,” he said. “Is that what you do with the money from our sessions? Or are you wearing those boots because you think you’re going to kick my butt with your psycho mumbo-jumbo?”

I was used to getting this kind of challenge from Michael, who liked to spar and use sarcasm as a defense. Graduate school hadn’t prepared me for this, but growing up with two obnoxious brothers had. Over the three months I’d been seeing him, I’d learned that the only way to soften his sneering was to playfully razz him right back. So channeling my best Albert Ellis, I teased, “Yeah, I know you want to test me to see if I know what I’m doing and whether or not therapy has been worth your while. So I’ve got a challenge for you.”

He folded his arms across his broad chest. “Okay, lady, bring it on,” he jeered. “Give me your best shot!”

For all the arrogance emanating from his six-foot, two-inch frame, Michael was a fragile 32-year-old guy, who struggled with depression, alcoholism, and a fear of crowded places, along with his terror of crossing bridges.

A bridge phobia poses an especially big problem in our town of Chattanooga, Tennessee. It’s actually nicknamed Bridge City because it’s hard to go anywhere without driving over a lake or the Tennessee River, which meanders right through the center of town. Michael’s bridge phobia was locking him into a prison of despair and isolation.

He never admitted to a suicidal plan, but all the elements were there: major depression, loneliness, uncontrolled drinking, and a firearm in his house. For all the cheeky games he played, I knew that therapy was a last resort for him. We’d been preparing him to face his fear of bridges for several weeks now, and I knew we needed a breakthrough soon or he’d give up on therapy. Even worse, I feared he’d give up on himself.

At this point, I sat up straight, looked him in the eye, and said, “I think you’re ready to cross a bridge. Since it’s a beautiful day, we could go to the park and start with the wooden footbridge that crosses Chickamauga Creek.” Michael began to chew on his lip. “You don’t have to cross the whole thing today,” I continued. “But we could start and see how you’re feeling around it. I’ll even meet you there in my kickass boots, if you’d like.”

In a flash, Michael resumed the role of disdainful cool guy. Rolling his eyes, he said, “No, Miss Courtney, I don’t need you to hold my hand. I can do it all by my wittle self.”

Part of me wanted to slap the snarky smile off his face, but I was delighted that he was even considering this challenge. Realizing that he was motivated by the chance to prove me wrong, I winked at him and prodded, “I know you can do it, but I bet you won’t.”

“I bet I will!” he shot back. “In fact, I’ll do it right after I leave here.” Leaning forward, he added, “And I’ll take a picture on my phone to prove it to you, Miss Smarty Pants.”

Quick as a flash, I retorted, “I don’t believe it. I bet $50 you won’t do it!”

Oh, no. Had I just said that? I wondered. The challenge had popped out of my mouth before common sense could run interference. What kind of therapist makes a wager with a client, with actual money involved? But I’d thrown down the gauntlet, and it was too late to pick it up.

Michael raised his eyebrows in disbelief. “Are you serious?” He was laughing now. “If I do it, you’ll give me $50?”

Hiding behind what little pride I had left, I said, “Yes, sir, I will. But I don’t have to worry about it because you’re so stubborn. I know you won’t do it.”

Michael shook his fist at me and leapt from the sofa. “You’re on, lady! And I don’t need you to come along and babysit me. I’ll go do it right now and show you. I want my $50!” He pivoted toward the door and strode out.

Alone in my office, I took a shaky breath. My stomach churned with excitement and dread. I was thrilled that Michael was finally facing his fear, but a series of disastrous consequences flashed before my eyes. What if he gets over there and has a panic attack? Should I follow him and lurk behind a tree, to be on standby if he needs support? What if he does do it and I have to give him $50? Will he expect me to give him $50 every time he achieves a goal? Which one of my countertransference issues had triggered this incredibly dumb idea? Do I need to go back into therapy?

Just then, my phone vibrated. Michael had texted me a picture. He was standing tall on the other side of the bridge with his tongue sticking out. The caption read “Never make a bet with a crazy person.”

Phew! He’d done it. I breathed a sigh of relief and figured it was worth $50 if this experiment boosted my client’s confidence and helped us get on a new, productive track. Michael returned to the office 10 minutes later, grinning from ear to ear. Since we had a little time left in the session, I invited him in, reached into my purse, and handed him the cash. As he reached out to take it, his hands trembled and his face grew red. His lips quivered. Then he bowed his head and began to cry.

I placed my hand on his shoulder. “That was a big step, Michael,” I said. “You did great. You did it, man.”

He wiped his eyes and took a shaky breath. “Thank you,” he said in the softest tone I’d ever heard from him. “I can’t believe you got me all caught up in that. But I really did it. I can do this.”

Smiling, I said, “Yes, Michael, you absolutely can. We just had to find something more compelling than your fear to get you to take a risk.”

After this success, we continued to do experiments outside the office that got more and more interesting. No more wagers. But one time, he drove downtown with me to cross the narrow Market Street Bridge that towers 70 feet above the Tennessee River. At the stoplight before the bridge, I noticed that his hands were shaking as he gripped the steering wheel. “Are you okay?” I asked.

When he looked at me I realized that he was laughing, not panicking. With a noisy snort, he asked, “Have you seen who’s driving the car next to us?” I turned my head to see a grown man dressed as Smokey the Bear driving a yellow Volkswagen. We roared with laughter. In the throes of his giggle fit, Michael proceeded to drive across the bridge with ease. Elated by that triumph, he managed to drive across the bridge several times in the succeeding weeks. There was no Smokey to the rescue now, but Michael had tasted fearlessness, and something inside him had shifted.

In another experiment, we met at a Starbucks to help him overcome his fear of crowds. Before we entered, he looked pale. He paced up and down the sidewalk a few times, flicking his wrists in an effort to dispel his nervousness. When I offered to walk with him, he looked down at my shoes and smirked, “Nah. I see you’re wearing your kickass boots again. We better go on in.”

As we approached the counter, I did a double-take. The woman in line in front of us was wearing jeans that were two sizes too small and, without a trace of self-consciousness, exposing half of her rear end. I was so thrown off by the spectacle that I tripped over a chair and knocked over a whole container of straws on the counter. Once again, Michael doubled over with laughter. Later, he teased, “I suppose if you and that lady can go out in public without being embarrassed, I can too.” And after that, he did, visiting a grocery store, a shopping mall, and then Walmart—a store whose mega size even makes me anxious.

As Michael gained the courage to face his own fears, he mustered the nerve to enter a 12-step recovery program. He worked diligently in our sessions to heal the pain of growing up with a distant, alcoholic father, a major source of his anxiety and depression. He even invited his dad to a session to begin the process of repairing their relationship—another bridge he’d long feared to cross. Getting on speaking terms with his dad was vital to his healing. Recently, he wrote me to say that he was maintaining his sobriety, continuing to work things out with his father, and even playing in a rock-and-roll band on the weekends. Toward the end, he wrote, “You’ve got a strange way of doing therapy, but you saved my life.”

I treasured that appreciation, of course. I was thrilled and relieved to find out how well Michael was doing. As it turned out, the help was mutual. While I’d prodded my client to face his fears, he’d nudged me to face my own. Before meeting with Michael, I was timid about confronting tough clients, doing sessions outside the office, and taking therapeutic risks for fear I’d offend my client or make a mistake. How often do we hold back, believing that therapy can only happen in the confines of our office as we maintain a reserved, composed presence, squelching the feelings and impulses that well up inside us?

Mind you, making bets with clients hasn’t become one of my standard interventions! But Michael helped me realize that clients can benefit from seeing our raggedy humanness. They watch our willingness to take risks—or even make fools of ourselves—in the hope of moving forward, of supporting growth. We need to take care not to hurt our clients, of course. Yet often our own leaps of faith can empower them to muster the courage to try something different and keep going in the face of the unknown.

I had no idea that making that bet would open a gate for me, for Michael, and even for his father, but I’m glad I took the leap. I’m grateful that I crossed that bridge.

This article was adapted The Therapeutic “Aha!”: 10 Strategies for Getting Your Clients Unstuck and Transforming Traumatic Grief, © 2015 by Courtney Armstrong. Used with permission of the publisher, W. W. Norton & Company, Inc.

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