She let her thumb drag across the red lines as she unrolled the tape measure. One inch, two inches, three, four… All the way to sixty, and her thumb pressed against the metal tab at the end. She pinched the tab between her index finger and thumb and rolled the tape measure up.

Carolyn watched her repeat the process over and over, dragging out the tape measure and rolling it back up again. “Elise, is something wrong?”

“One, two, three, four…” Elise’s voice was barely audible.

Carolyn leaned forward in her chair. “Elise, honey, can you answer my question?”

Still no response from the girl. Carolyn exhaled and then sat back. She pressed the butt of her pen against her legal pad and the pen clicked open. Right beneath the date and Elise’s name, Carolyn wrote, in dark blue ink, Unresponsive; patient has adopted habitual coping mechanism.

Carolyn looked up. Elise was staring back at her, the tape measure rolled up in a tight cylinder. “Would you like to talk?” Carolyn asked.

Elise stood. She dragged her scuffed red sneakers across the dark green carpet as she slowly approached Carolyn. The older woman fought off the urge to stand and confront her patient.

When Elise was directly in front of Carolyn, she stopped. For a moment, they locked gazes; Elise stared with her pale blue eyes, and Carolyn tried to keep from blinking. Then, with one red fingernail, Elise reached down and lightly scratched the back of her therapist’s hand. In an instant, Carolyn’s hand was open, and Elise had placed the tape measure into the woman’s palm.

“Thank you, Elise,” Carolyn said.

The blonde girl shook her head. “You need it more than I do.”

There was a knock on the door. Carolyn stood and shoved past her patient. She pulled the door open, face to face with her secretary. “Yes?”

The secretary frowned. “I thought I heard your voice. Are you okay?”

Carolyn smiled. “Why yes, we were just—” she turned to gesture toward Elise, but her patient was not there.

“Are you okay, ma’am? You seem, well…”

“I’m fine,” Carolyn whispered. “Just fine.” She pushed the door shut and looked down at her hand. The tape measure was still there. With her other hand, she pulled the metal tab at the beginning of the tape measure, and let her thumb run across the red lines as she unrolled it. One, two, three, four… All the way to sixty.For