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I bet you are asking yourselves: Doorknob bombshells? Doorknob bombshells in therapy? What is that?
A doorknob bombshell, also known as a doorknob moment, is a clinical phenomenon that occurs in a wide variety of settings. That’s when a patient drops distressing personal information critical to the treatment on their way out the door, hand on the doorknob, and breaks down.
What should a caring clinician do when a patient does that? It’s a near universal dilemma for clinicians. Should we process the material with the patient right then, and run over? Possibly making ourselves late for the next patient? Or, should we end on time? And possibly cause the patient more suffering?
When the patient is distraught, it’s a tough judgment call to make under time pressure.
I was taught as resident that ending on time is therapeutic for the patient, but not why. For most of my working life, I’ve dreaded doorknob moments because I’ve had no confidence that it really is helpful to the patient to end as scheduled.
Then—Eureka! The solution came to me. It is therapeutic to end on time! Even if the patient is weeping wretchedly.
Let me explain. It has to do with how the brain works. The brain has two hemispheres, the right and the left. They function differently from each other and have very different agendas in the world.
The right hemisphere deals with anything new. It is comfortable with uncertainty, the unknown, and what it hasn’t seen before.
The right is creative. It generates anything with a narrative arc—a beginning, middle and end. Things like novels, symphonies, dances, science experiments, this post.
It has no words. I repeat, the right has no words. It thinks in images and sensation. My Eureka! is a great example of how the right hemisphere thinks and delivers new ideas to us. They arrive in a flash, fully formed, and without words.
The left hemisphere is very uncomfortable with what it doesn’t recognize. It ignores or rejects what it hasn’t seen before. But, it does home in on what is familiar, and translates that bit into words. Words live on the left side only.
The left cannot create. I’ll say it again. The left cannot create. Its strengths are focus, logic, and analysis, with a heaping side of criticism.
You know that negative, critical voice we hear in our heads? That’s our left brain. It is a genius at telling us what will go wrong, why we’ll fail, the project has been done before and better, yadda yadda yadda. So, if you want to create or do something new, the left will try to inhibit you in one of two ways (or both).
1. It’ll try to stop you from starting.
2. It’ll inhibit you from finishing.
Creative people who regularly produce and deliver original, new work to the public understand this and use a deadline to bypass the roadblocks the left throws up. As Duke Ellington said: I don’t need time. I need a deadline.
A deadline helps you get things done in two ways.
1. It helps you birth newborn work, the first draft.
2. It helps stop you from falling down the rabbit hole of endless, perfectionistic tweaking that prevents you from finishing.
Somehow, a deadline helps the right power ahead and deliver against the left’s doom-and-glooming.
We’ve all had the experience of being pulled in opposite directions as if we have two minds…. Well, we do have two minds!
Now let’s look at the treatment relationship. Imagine the patient functions as the right hemisphere and the therapist as the left. Just as a writer’s right and left hemispheres work together to create a novel, so too both patient and clinician work together to create the treatment.
Notice that the appointment time period is a narrative arc. It has a clear beginning, middle, and end. That makes the session’s end point a deadline.
The patient, functioning as right hemisphere, delivers new material over the course— or arc— of the session. They choose (whether consciously or unconsciously) how to end, one option being the doorknob bombshell.
Don’t forget that sharing new and vulnerable information is not a straightforward process for the patient. Their right hemisphere wants, no, needs to give the therapist new information. But their left hemisphere does not.
In order to drop a doorknob bombshell, the patient has to trust—follow me closely here—that the therapist will end on time, will hold the deadline. Somehow, the impending end of the session, the deadline, empowers the patient’s right hemisphere to over-ride their left’s nay-saying to say what needs saying.
And, in the wake of a doorknob bombshell, we clinicians, functioning as left hemisphere, need the session to end on time too. Why? Our left hemispheres, like everyone’s, can’t deal with anything new. We need the time between sessions to think things through. Otherwise, we are at risk to respond unhelpfully in the moment.
Friends, the doorknob bombshell is actually extremely useful to me as a clinician. It serves as a bridge. It ends the current session and opens the next one, thus beginning a new chapter in the ongoing epic drama that is the treatment.
I no longer dread doorknob bombshells. And, whether you are a therapist or a patient—neither should you!
If you are a clinician, this post barely scratches the surface of useful clinical information contained in my soon-to-be-published book. If you are a patient—aren’t we all patients at one time or another?—now you know why you blurt at the last minute and bolt. Rest assured that in doing so, you have helped your clinician help you!