Thank you sir, may I have another?

Sometimes, you just have to fire your patient. Oh, rarely of course, and for cause. But it does happen. You find yourself clearing your throat, placing a gentle hand on their forearm after you've taken their vital signs and reviewed their chart, and saying those three little words, "Let's be frank." Because, you see, they just won't LEAN IN.

I'm talking here about participation, showing up, bringing something to the party. Like a shy or indifferent party guest, they just sort of hang around the corners of their therapy, without ever fully committing to it. It's very frustrating for the therapist. Give me the patient who will get down, get messy, fling it out there, make eye contact. Those who will laugh, cry, air their dirty laundry in public, send you off with a cupcake with too much frosting, scream, pound the mat, introduce you to their cat, and then work. And work some more. Spare me the patient who can't put down their remote long enough to commit to themselves or their therapy. Really? I'll just leave you two alone, shall I? Someone here needs a little discipline, and when you are ready, here's my card.

It's definitely true I am not everyone's cup of tea as a therapist, and that's okay. I can usually tell in the first five minutes which it is going to be, and the patients I bond with (many) are true devotees of my brand of therapy. In fact, they joke about it with me. They call me calm but tough, fun but focused, and joke that I never let them get away with anything. Those who want to lie to themselves will dislike me almost immediately. My only real requirement is that they show up for themselves, commit to themselves. I want them to lean in, and the sooner the better.

The fencing fleche is all about leaning in. The whole maneuver requires you to lean so far forward that you fling yourself into your opponent and run past them on the strip. You overbalance your body weight at a forward angle and fall forward very fast. It's a move I have not yet mastered, and don't try to use very often. I know that when I use it I feel off balance, which is disconcerting. I can see the same thing in my patient's eyes when I gently but frankly have to talk to them about their commitment to their own recovery. Some of them are just not there yet, like I'm just not there with the fleche. The only way to get comfortable with it is with regular practice. And now if you'll excuse me, I need to go practice falling forward with a sword in my hand.