Doorknob Communications

In our last supervision, my student told me one of her patients surprised her with a “doorknob communication.” It was their last visit and the patient chose that moment to confess some secrets she had been holding in from everyone. My student was startled but also proud, I think, to bear witness to the darkness this woman had been keeping inside. We talked about termination and what it can mean for a client. Another social worker is going to replace my student in this case so we talked about how to communicate everything to the new social worker while also respecting how difficult it was for the patient to divulge.

Photo by  Nick Tiemeyer  on  Unsplash

Photo by Nick Tiemeyer on Unsplash

The phrase doorknob communication was new to me; I understood what she meant from context but I had never heard the phrase before. Because I kept thinking about it long after our supervision was over, I went immediately to Google for answers. (How anyone did social work before the internet is an ongoing mystery to me. I’m told there were rolodexes and calls from pay phones). According to the good old search engine, it’s just what it sounds like: a client sometimes reveals a huge piece of information to the clinician while they are leaving a final session, with their hand on the proverbial or literal doorknob.

So why do clients do this? There is a safety, I think, in knowing that you won’t be seeing your therapist again. There’s little risk involved in laying out your deepest secrets while you’re walking out the door. The therapeutic relationship can build a deep trust but still, we all keep some parts of ourselves hidden. I think sometimes it’s simply too hard to divulge everything, even in a long-standing relationship. Dropping bombshells while walking out the door must feel liberating in a way: here, hold this; we don’t have to talk about it again.

I wonder more about what we as clinicians do when we are faced with the doorknob communication or, perhaps more aptly, confession. Termination is supposed to feel like a nice, neat bow on the end of a therapeutic relationship: we’ve reached our goal together and the client should feel better somehow. Does it feel like a failure if someone has a sort of breakthrough on the way out? Should we look back on our practice and try to figure out if we could have elicited it sooner? Should we not terminate after all?

I don’t necessarily have the answers to these questions. For what it’s worth (and if she’s reading) I don’t think my student failed this patient at all. I think she opened the door for this woman to release some deep sadness that she was carrying with her. And the patient couldn’t do that until their very last minute together. Those last minutes are a theme in my work in hospice. They carry a lot of meaning for the survivors and for the dying as well. That patient gave my student something precious to hold; in that way, this doorknob communication, confession, whatever you call it, was a gift.

What are your thoughts? Better yet, what doorknob confessions are you holding on to?