The Space Between Clinician and Human

Developing boundaries as a therapist needs to happen before it is too late.

Lex E Santí, LCSW, Clinical Director, A Key Therapy

It was Halloween. Six, maybe seven years ago. I was driving home on Perry City Road, about three miles from my house, coming off a shift at Family and Children's of Ithaca. It might have been my first year working there, before A Key Therapy, this private practice, before the novel, before most of what has since become my life. I was learning something about living the work and clocking out when I left that building. I have always been a therapist, and in becoming a therapist, I was learning the hard fight to learn boundaries and stop giving myself away to everyone on the street. That day, I think I learned that if I gave too much of myself outside of the therapy room, I might never help anyone else.

The sky was starting to go that particular Halloween orange, and I was thinking about nothing in particular as I drove home. I had a VW Jetta at the time, a car I loved to drive and push it into gears, lunging forward with the sunroof open. Fall was creeping in, but the last dregs of summer can still bathe Central NY in an Indian summer in October. I turned up Perry City Road from Route 96.

Not Perry City Road, but very much one of my photos.

Then I saw them.

Two cats in the middle of the road—a tabby and a black one, intermingling right on the center line. The road bends and rises there, a slight hill and incline that always makes me ease off the gas. A car was coming in the opposite lane, fast. Too fast. I honked. Both cats froze, the way cats do, as if the sound had turned them to stone instead of moving them. The oncoming car never had time to brake. I felt the impact in my heart.

I kept driving. But I decided I was going to my house two miles up the road, getting a shovel, letting Pago out, and going right back. I did, my dog was happy to see me, but not thrilled to go back to the house.

Then I turned around and went back. I drove full of what I would call later a

I’ve thought about those two miles many times since. The moment between something happening and the moment you decide it matters and you are going to do something outside of the norm. That day, it was about burying a cat that I felt responsible for.

The Figure in the Road

When I arrived again, I thought maybe I’d be putting the cat on the side of the road. I thought maybe no one would be there. When I pulled back up, there was a figure sitting and crouched next to the road—I couldn’t determine much about them, didn’t fully register gender or age at first. They had gathered the cat and were carrying it to the garden beside a dilapidated house on the shoulder. They sat down in the dirt with it.

They had gathered the cat and were carrying it to the garden beside a dilapidated house on the shoulder.

I instinctively went back to my car for my phone. I don’t know fully why. I put the shovel back in the back seat. Perhaps I was preparing for something without knowing what. Perhaps I already felt the edges of something I couldn’t name.

When I came within earshot, they shouted:

“Were you the one who killed my cat?”

I raised my hands, open.

"No," I said. I was the one who honked. I walked two more steps and thought about getting back in my car. "I tried to startle them away. The car came, and they didn’t run. I watched it happen. I’m here to pay my respects and to say I’m sorry I couldn’t do more."

The word respects seemed to register something. They went quieter. I approached and then sat in the grass.

Then their life began to spill out.

...there was a figure sitting and crouched next to the road—I couldn’t determine much about them, didn’t fully register gender or age at first.

I have met, in my life, a handful of people who stopped me cold—not through any threat or explicit danger, but through something emanating from them that my body recognized before my mind did. Once, a man in a downtown scene told me, quietly and with total authority, not to park in his spot. Three words. "Mind moving it?" And I knew, with the kind of knowing you can’t justify to a jury, that this person had crossed lines most people don’t cross. There was also a woman in Santo Domingo, DR, dressed in red who urged me into the ocean, and the wound on my leg became infected almost immediately after. I will write about her one day. I looked for her ten minutes later. She was gone. I have never resolved those moments, and I don’t fully try to.

Standing on Perry City Road, as the Halloween sky deepened toward orange and black, I began to feel some version of that. The grief in front of me was real. I didn’t doubt that for a second. But the grief kept escalating in a way that felt less like mourning a cat and more like something much larger pressing against a door that had been there a long time. They told me this might be over for them. They said it wasn’t that bad, and then doubled down into something darker. The stakes kept rising.

"Why do people drive like that," they said. "I can't take this and bury her, where am I supposed to do that, how?" Their face, in the darkness looked up into the orange sky and I felt out of my body.

"Do you have housemates that could help? Family?" I said.

"No one helps. NO ONE." They shouted and they poked the dead body between us.

I gently suggested a helpline. I mentioned that I knew people they could call. I held the space as best I could—not yet as a clinician, but as a human being standing at the edge of someone else’s pain.

Won’t You Come Inside

Then came the invitation. Won’t you come inside. We can keep talking. I have tea. The voice was both needy and something else—a sharpness underneath it, almost an anger in the asking, like a demand wearing the clothes of a question.

I felt the pull of it. I had a dog at home. Friends expecting me that night. And yet here was a person in genuine grief—or something that wore grief’s face—and I had come back. I’d turned the car around. Didn’t that mean something? Wasn’t I now obligated to follow it all the way?

This is the question I return to. What does it mean to take responsibility for something? And at what point does that responsibility become a kind of martyrdom—not caregiving but self-erasure dressed up as virtue? There is a line, somewhere, between the person who helps and the person who uses helping as a reason to ignore the signal their body is sending them. I have thought about that line in clinical contexts many times since. On that road, I was standing right on it.

They asked again. Louder this time, the need and the anger fused together. Almost a shout.

I said: There’s nothing more I can do. I wish you a good night.

I walked back to my car. Got in. Turned around. Left.

What I Keep Coming Back To

I still don’t know the full story of who that person was, or what their life held beyond that garden on Perry City Road. I have driven by that house hundreds of times since. I know when I got home that night I was so scared I locked all the doors and turned on all the lights.

What I do know, is that I trusted something—a current of awareness running below the level of thought—and that trusting it felt, in that moment, like the harder choice rather than the easier one. It would have been easier, in a strange way, to go inside. To keep being useful. To tell myself I was still helping and allow myself to be consumed by the forces of their life.

I say to clients, often: humans are the only animals that don’t trust their instincts. That day, I trusted mine. As a helper, as someone who knows this is my process of getting free in life, I love helping but there is a limit. There are boundaries but I know, in my heart--that if I would have entered into that home and there would be no going back.

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Lex Enrico Santí is a licensed clinical social worker, novelist, and founder of A Key Therapy PLLC in the Finger Lakes of New York. His debut novel, The Song of the Midnight Rider, is available now at akeytherapy.co/somr