Southeast Florida Association for Psychoanalytic Psychology Blog

Unrelenting Grief | by Linda Sherby, Ph. D, ABPP

Tue, 19 Mar 2024 23:58:55 GMT

In today's blog, "Unrelenting Grief," a patient mourns the profound loss of his safe space, while his therapist reflects upon her own similar loss.

“I just can’t get over this,” Scott says his head buried in his hands, a tall, dark-haired man who looks like he’s in his mid-thirties. “He was 98 years old. Did I expect him to live forever? I loved him so much. And he was always, always there for me. When he and my Grandma decided they couldn’t handle the Kansas farm anymore they moved right next door to us. Actually giving up the farm was pretty hard for me too. I guess I’ve always been a softie. My Dad made fun of me, called me a wuss, a ‘girl,’ too sensitive for my own good. He was always trying to toughen me up. But I loved that farm. It was my safe space. I spent summers there, got to be rid of my Dad and just be loved by my Gram and Gramps. I’m sorry, I’m just rambling all over the place”

“Not at all,” I say. “I can feel how much you’re grieving.” I am near tears myself, remembering the pain of losing first my grandmother and then, three years later, my grandfather. Remembering too, although my grandparents lived not on a farm but in a three room apartment in the Bronx, I knew what it was to have and lose a safe space. “You’re talking about loss. Most people have a terrible time with loss. Doesn’t mean you’re a wuss. Loss of the farm, loss of the days of feeling safe and protected, now the loss of your Grandpa. Is your Grandma still with you?”

“Yes, she’s only 90,” he says with a slight smile. “In my family that’s almost young. But the last month has been really hard on her,” he says sobbing. “I guess it’s been really hard on all of us, taking turns sitting by his bedside, holding his hand, first all those machines and tubes and God knows what else. Then, nothing. I don’t know which was worse, hoping for a miracle, or letting go of hope,” he says breaking down in gut-wrenching sobs.

Several minutes pass.

“I can’t go on like this. It’s over a month. I have a wife, a precious daughter, a job. I can’t just keep crying.”

“A month isn’t a long time, but I understand you’re saying you’re feeling his death too intensely, like it’s entirely consuming you.”

“Exactly! And I keep asking the same thing my father did, ‘What’s wrong with me?’”

“I suspect there’s nothing wrong with you, but perhaps we can try to understand the intensity of your feelings. Whose Dad was he, your mother or father’s?”

“My mother’s. I never really knew my father’s parents. They were very old and lived across the country so we almost never saw them. I don’t think I even went to their funerals – my Mom probably wouldn’t have wanted me to.”

“Because?”

“She was over protective like that, wouldn’t have wanted me to get too close to death.” Pause. “I had an older brother who died before I was born. I’m not sure my mother ever got over that loss. And she spent a lot of time making sure I wasn’t going to die like he did.”

“How did he die?”

“I guess he was a real dare-devil kid from the moment he was born. Putting things into electrical sockets when he was like two, riding his bike in traffic, climbing taller and taller trees. That’s how he died, fell out of a tree. My Mom was going to have none of that with me.”

“Are you saying your Dad pushed you to be more like your brother and your Mom pushed you to be anything but?”

“I never thought about it that way, but that’s exactly right.”

“And your grandparents?”

“I was fine however I was.”

“Wow, that’s quite a contrast. Your grandparents loved and accepted you for just being you. You didn’t have to do or not do anything. That’s an amazing gift. No wonder your grief is so profound.”

Scott weeps. After a while he says, “But I have to stop crying. Why can’t I stop crying?”

“Because you’ve lost one of the two people who were most able to love you.”

Scott shakes his head. “I think there’s more.”

“I’m sure there is. None of our behavior is so simply explained. Do you have any thoughts?”

“I think I’m afraid. I’m afraid of my father. I’ve always been afraid of my father. My Grandpa kept me safe from my father. Now that he’s gone I don’t know if I’ll be safe. I don’t know if I can keep myself safe. And my Grandma’s too depleted. Anyway she wasn’t the one who kept me safe from my father. It was Gramps, Gramps,” Scott says sobbing. “I’m such a baby. I’m a 36 year old man, how can I be so afraid of my father?”

“I guess that is the question, Scott. What went on between you and your father when you were little that made you so afraid of him? We already know that he was very critical of what he saw as your ‘weakness.’ But perhaps there was more. Our time is up for today, but perhaps we can continue with this next time.”

Inside/Outside | by Linda Sherby, Ph. D, ABPP

Thu, 18 Jan 2024 23:55:33 GMT

a therapist reflects on and uses her angry feelings towards her patient to work more effectively with that patient and to help her patient understand her use of anger as a defense.

Not Again

As Cynthia sits scowling from the chair diagonally across from me, I remember why I was both surprised and less than thrilled to have her call and ask to return to treatment.

After several minutes of us staring at each other I say, “What prompted your wanting to return to therapy with me?”

“The New Year,” she says curtly, as if that provides an adequate explanation.

“And…?” I ask, prodding.

“What the fuck! You know people make resolutions about what they’re going to do to improve their lives. As if January 1 was the magic date.”

“That would imply there were things in your life you wanted to improve.”

“Of course! You know anyone who doesn’t want to improve their life!”

“This all feels very familiar Cynthia. You say you want to improve your life, you asked to come back into therapy with me, yet you’re immediately attacking everything I say.”

“What? You can’t take somebody challenging you?”

“Okay,” I say, hoping I’m hiding my desire to strangle her. “Let’s look at that last comment: You can’t take somebody challenging you. What impelled you to make that particular statement?”

“What? How should I know. It seemed like a good response to your dumb ass comment.”

Silently counting to 10, I reflect on how uncomfortable it is to be angry and to have to contain it. “Okay,” I say. “We already know you’re angry. And we know you have good reason to be angry. But would I be making a wild guess to say that perhaps one of the ways you’d like to make your life better is to be less angry?”

She shrugs.

We again sit in silence, but this silence feels a bit more comfortable, not as raw, not as challenging.

She mumbles something.

“I’m sorry,” I say, “I didn’t hear you.”

“It’s not a good way to make friends,” she says, barely over a whisper.

“True. In fact I think that sometimes you use your anger to keep people away.”

“Why would I want to do that?” she asks, the edge back in her voice.

“I wasn’t criticizing you when I said you use your anger to keep people away. I was making a comment that, if correct, might help you to think about when and why you try to keep people away and when you you’d like a person to be closer.”

“I never know,” Cynthia says, again barely above a whisper. “I do want more people in my life. But when they come at me, I don’t know, I just can’t take it.”

“Interesting choice of words, Cynthia – when they come at me – like when your parents came at you to punish you, beat you, hurt you.”

She nods, dropping her head. “Yeah.” Pause. “People aren’t safe.”

“Some people are safe.”

“You can always get them mad.”

“I guess you’re saying YOU can always get them mad by prodding and poking and challenging. Or by running away.”

“Who says I run away?!”

“There’s that edge again, Cynthia. I say you run away. If you didn’t run away you’d have more people in your life. You’d be less lonely.”

“I never said I was lonely!”

“You didn’t imply it?” I ask gently.

She shrugs. Pause. “I guess.” Pause. “I don’t want people getting too close. I could get hurt.”

“I understand that, but I wonder if you’re also saying it feels really scary to want people, to need them. Like it feels really scary to need me, to say you want to be here, that you need to be here.”

“Go fu…” Pause. “I was just going to tell you to go fuck yourself, but then that seemed like exactly what you were saying, that I use my anger to keep people away and maybe it’s because I don’t want to need any of those fucking people who are just going to hurt me again and again.”

“I’m impressed, Cynthia, that you were able to catch that yourself, reflect on it and keep yourself from giving an automatic angry response.”

“Yeah. I guess that was pretty good.”

I smile. “I’m glad you were able to take in a positive comment about yourself and accept it.”

“I guess.”

“Now don’t get too enthusiastic,” I say teasingly.

“I… I’m glad I came back.”

“Thank you, Cynthia,” I say. “I’m really, really glad you came back too.”

Unexpected Fear | by Linda Sherby, Ph. D, ABPP

Sat, 09 Dec 2023 01:15:40 GMT

Unexpected Fear, a therapist helps her patient to explore the possible underlying reasons for her sudden fear of flying.

“I’m so terribly nervous I can’t stand myself,” Kaleigh begins wringing her hands, jiggling her right foot. “I thought I was going to be so excited about going back to Chicago after my first semester at school. But I’m not! I’m suddenly terrified of flying. I was never afraid of flying before. Maybe it’s because of the Israeli-Palestinian war and I’m afraid of terrorism, like of my plane being shot down. I don’t know.”

“Are you afraid of your plane being shot down?” I ask.

“I don’t know. It sounds ridiculous. But there was 9/11. Of course I wasn’t even born then, but still… It feels like anything can happen.”

“Anything can happen, but it is interesting to wonder why you suddenly developed a fear you never had before. Do you feel especially frightened because you’re Jewish?”

“I asked myself that. I guess someone could bomb the plane because they thought there’d be lots of Jews on it, but it’s not like I think someone’s specifically coming to get me because I’m Jewish.”

“Any other thoughts come to mind?”

“I just had a flash of my older sister. She’s not supposed to be there this holiday… But what if she is? That would be pretty scary.” Pause. “Oh God! It would be so terrible if she’s there. She ruins everything. She ruined my whole childhood! She ruined my family,” Kaleigh says crying. Pause. “I’m pretty sure my father told her not to come. But that doesn’t mean she won’t. And then everything would be ruined! All there would be is screaming and more screaming and tantrums and threats!! I can’t stand it.” Pause. “Do you think that’s why I developed a fear of flying? Like maybe I really don’t want to go home. Like maybe I’m afraid of what’s waiting for me.”

“Have you asked your parents if she’ll be there.”

“No, I haven’t. I feel scared about that too. Scared there will be this big scene about my even asking.”

“Why?”

“My mother will immediately get mad at me for being so afraid of my sister. And she’ll be mad that I might bring up the abuse again. She’s never believed me about the sexual abuse. She knows my sister used to beat the shit out of me, but she always dismissed the sexual abuse as two kids just playing around,” Kaleigh says crying. “I don’t know what’s more painful, the abuse or my mother just dismissing it. No, that’s not true. The sexual abuse was way more painful. I haven’t even told you all of it.”

“Maybe it would be helpful if you did,” I say gently.

“She used to take things, mostly sticks, sometimes a vase or whatever else she found around and put it inside me. A few times she even threatened to use a knife, but she never did.” Pause. “Usually she put it in… in my vagina, but sometimes she’d put it in the other place. That really hurt,” she says crying.

“That’s so awful Kaleigh. I’m so sorry you had to endure that, it sounds like torture. No wonder you’re scared to go home. And I’m so sorry your mother doesn’t believe you. What your sister did is certainly not just ‘playing doctor.’ What about your Dad?”

“I’m so glad you believe me! I was afraid you wouldn’t. Afraid you’d think I was just making it up.”

“Of course I believe you Kaleigh. I can’t imagine why you’d want to make up something like that.”

“I’m so ashamed of it. I even lied to my boyfriend and said I’d had sex with one guy before him. It was better than telling him about what my sister did to me!”

“Shame is a very common in sexual abuse victims, but that doesn’t mean you have anything to be ashamed of. You were the victim. She was bigger and stronger and abused you.”

“I know. But that’s not how I feel.”

“I understand. And we’ll have lots of time to deal with those feelings. I notice you didn’t say anything about your Dad.”

“I’m pretty sure he believes me, but he’s not about to argue with my mother. It was hard enough for him to tell my sister that she wasn’t welcome in their house anymore after she hit him and trashed the entire living room.”

“I am so sorry, Kaleigh. Are you sure you do want to go home? Or maybe there’s someplace you can go where you can feel safe if your sister is there?”

“I can’t imagine announcing that I’m leaving to stay with Brad or even with one of my girlfriends. That would create an uproar in itself.”

“I know we don’t have time to discuss this further today, but we do need to work on you’re not being so afraid of your fear that you’re willing to sacrifice yourself. Obviously you have good reason to be afraid, but you do need to first and foremost take care of yourself.”

Missed Sessions | by Linda Sherby, Ph. D, ABPP

Thu, 16 Nov 2023 01:36:24 GMT

a therapist struggles with her countertransference feelings when her patient announces he's taking some time off from therapy.

Jeremy, the prototype of a man who is tall, dark, and handsome, and just beginning to enter middle-age, begins his session by saying, “I won’t be here for the next three weeks. I’ll come back in December.”

“Are you going out of town?” I ask, surprised. He hadn’t mentioned an upcoming vacation. And I don’t recall him making such an announcement in the two or so years we’ve worked together.

He squirms in his chair. “Umm, no. No, I just figured I could do with a little break.”

“Because?”

He crosses his legs, uncrosses them, then crosses them again. “It’s just beginning to be a bit too much.”

“What’s the ‘it?’”

“This,” he says, gesturing around my office.

“And what’s making it too much?”

“That,” he says brusquely, gesturing toward me with his chin.

“I’m too much.”

More squirming. “Not you exactly, just this, this questioning, probing, always searching for something more, something deeper.”

I try to think what might have occurred in our last few sessions that may have brought about Jeremy’s desire to flee. “Is there something that happened that made you feel I’m too overbearing, too intrusive?”

“I knew you’d say this was about my mother!” Jeremy says angrily.

Although I hadn’t been thinking about his mother, I remain silent, waiting to see what might develop.

“It’s not about my mother. I haven’t spoken to my mother in weeks. I decided to take a break from her too!” He pauses, taking in what he’s just said. “Shit!! I just agreed with you, didn’t I? This could come straight out of a Woody Allen movie!”

I smile. “And like in a Woody Allen movie, I’m going to continue digging. Is it that I’m feeling like your mother or have you experienced me as being more intrusive lately? Or did something happen with your mother?”

“I don’t want to. I don’t want to keep thinking and thinking and trying to figure things out. It’s enough already. I need a break!”

I feel frustrated and annoyed and find myself unable to stop. “Can you at least humor me and help me understand why this has come up right now?” As he is about to respond, I realize that I am indeed duplicating his relationship with his mother and say, “Wait! Let me pull back. First, I realize I am repeating exactly the relationship you have with your mother. I’m coming after you more and more. And the more I come after you the more you resist and the more you resist, the more I come after you. But, and maybe this is the piece you need to own. You’re the one who has put up an unbreakable wall. You’ve said ‘no matter what you say or do, I’m not telling you.’ You may have very good reasons for erecting that wall in the past, but now it feels more like a two-year-old who’s having a tantrum. Which doesn’t excuse my behavior of coming after you. I need to look at that myself and figure out why I couldn’t just pull back and let you tell me in your own time.”

“That’s a lot to take in.” Pause. “I do appreciate your saying that last part, that it’s not all me, that something got kicked up in you as well. It helps break the cycle you were referring to – chased after, run away; run away, get chased after.”

Long pause.

“I think I know what happened,” he continues. “I did have a
conversation with my mother. But before that I broke up with Charlene. I broke up with Charlene for exactly the reason we’re talking about. I told her I was going out with some friends and she asked where we were going. I wouldn’t tell her. We were only going out drinking, although Charlene did think I drank too much. Anyway, I wouldn’t tell her and she came up with more and more preposterous guesses – going to a strip club, hiring prostitutes, etc. It was ridiculous. The more she came at me, the more intransient I became until I finally said, ‘That’s it, we’re done!’ My mother called the next day and began right away bugging me about what had happened with Charlene and when was I going to settle down and give her grandchildren. I hung up on her.”

“So you were tired of all these pushy women, myself included.”

“Exactly!”

“I wonder if you’re so afraid of all these pushy women that you erect barriers to protect yourself or whether you erect those barriers so that women WILL come after you so that you can be ‘justified’ in rejecting them.”

“Why would I do that?”

“We’re almost out of time and you’ll need to tell me whether you’ll be here next week or not, but I think you might want to reject them so you never have to deal with the need for genuine connection that exists within you.”

“Wow! That’s a lot to digest”

“Yes, it is. And if you want to take some time to digest it, that’s fine and if you want to come in next week that’s also fine.”

“Can I think about it and call you?”

“Yes.”

Pretending | by Linda Sherby, Ph. D, ABPP

Wed, 16 Aug 2023 05:48:53 GMT

“I did it!” Charlotte says, gleefully.

“Congratulations,” I say enthusiastically, “And welcome back.”

“I’m not talking about going by myself to Italy.”

“Oh! What did you mean?”

“I did go by myself to Italy. It was hard. And all you’ve heard about Italian men, don’t believe a word of it. No one gave me a second glance. Oh course, why look at a middle-aged woman when you have all these gorgeous young, half-dressed I might add, girls running around. But seriously, don’t you remember what we talked about our last session?”

“I thought I did but… Oh, Charlotte, you really didn’t…”

She smiles broadly nodding at me.

“You pretended you were sick,” I state matter-of-factly.

“Correct! You see, not even you can remember me unless I do something daring, outrageous.”

“Of course I remember you. I didn’t remember that you were considering presenting yourself as someone who was ill, but I remember …”

“It doesn’t matter. I figured out how to get the attention I wanted. The more outrageous I made the story the more attention I got. It’s amazing how solicitous flight attendants can be when you tell them you’re dying of cancer or that you just had a chemo treatment.”

“And is that whose attention you wanted?”

“Anyone is better than no one, but no, that’s not whose attention I wanted. But it was fun trying out different stories and seeing what provoked the most sympathy or what made people the most uncomfortable.”

“What did make people the most uncomfortable?”

“If they thought I was going to throw up all over them. That was a good one, especially on a plane with the person sitting next to me.”

“Sounds like you took a lot of pleasure making people uncomfortable.”

“Yes, I did. Felt like I was getting back at all the people who’ve made me uncomfortable, people who look at me like I’m ugly or don’t look at me at all, as if I don’t exist.

“What do you feel as you tell me all this?”

“First word that came to me? Triumphant!”

“And since you’ve been home?”

“It’s back to the same boring life. Biller in an ophthalmologist’s office. Real exciting. A great place to not be seen.” Pause. “But I am thinking about bringing my little pretense back home. Maybe in grocery stores or gas stations – I can go someplace I don’t usually shop. I’ve even considered taking it to work. Who’s to say I couldn’t start telling my co-workers I haven’t been feeling well, that I’ve gone to the doctor, that I have some kind of cancer, etc., etc.”

“Charlotte, when you first started talking today I felt annoyed with you, annoyed for the people you were duping and angry that you felt you had to stoop to subterfuge to get people to pay attention to you. But as you’ve kept talking, I find myself feeling sadder and sadder. And I suspect you also feel both angry and sad. You’re such a bright, insightful person. You could do so much more with your life.”

“Except that I’m ugly.”

“I know you feel ugly, and this is something you and I constantly disagree about, but you don’t have to be the most beautiful woman in the room to have friends, to have lovers, to have a job that fulfills you.”

“You mean billing doesn’t fulfill me?” she asks sarcastically.

I sigh. “I know your mother didn’t value you. I know you feel your older sisters were prettier and smarter than you. And given all that, it is still possible to have a meaningful life.” Pause. “You’ve always talked about writing. You certainly demonstrated that you can be creative with your storytelling about yourself. Put the stories down on paper instead of acting them out.” Pause. “I’m sorry. I’m preaching. I know I can’t decide your life for you.”

“I’m 55 years old. Don’t you think it’s too late for me? How do I change now?”

“You went to Italy.”

“And my most fun was spinning a death fantasy about myself.”

“What was your fantasy about what the trip would be like before you left?”

Charlotte drops her head. “I thought I’d meet the love of my life. I know, that’s stupid, ridiculous. I feel like an idiot even saying it.”

“It’s not stupid, Charlotte, it’s a wish. But maybe it would have been good if we had talked more about your imaginings about the trip before you went so that you could have anticipated several scenarios, thought of the good things that might have happened, as well as the disappointing things. And I know that although many people like it, traveling alone can be very hard.”

Charlotte starts to cry. “It was very hard.”

Lying Part II | by Linda Sherby, Ph. D, ABPP

Fri, 05 May 2023 02:56:23 GMT

This blog looks at one consequence of lying, as a therapist's good guess leads to her patient becoming suspicious of her.

“When I left your office last time I was thinking that I’d go home and confess to my Mom that I really hadn’t wanted to kill myself,” David begins immediately. “But that’s not what happened. My Mom had called my Dad and he was there when I got home. He wasn’t happy. He asked me what kind of shit I was pulling, why I had to scare my Mom, that he knew I was just bullshitting and I better knock it off and he wasn’t paying for any wimpy therapy. My Mom jumped in and said she would pay for it, that if her son even had a fleeting notion of killing himself, she was going to be sure he got help. My father exploded. Told her she was an idiot. That she was making me a Momma’s boy and that he didn’t want anything to do with either of us. Then he stormed out of the house.”

“Wow! I’m sorry David.”

“I was shaking. I did tell her I liked you and that I promised I wouldn’t kill myself. I asked if she’d really pay for therapy, even if Dad refused and screamed and yelled. She said she would, but I was scared all week it wouldn’t happen. But I’m here!” he says with an almost-smile. “My Mom gave my father the cold shoulder all week and my father hardly said a word to me, but something must’ve worked.”

“And how did all that make you feel?”

“Scared, really scared.”

“I certainly can understand that. But I imagine you must have felt really angry with your father. And how did you feel about your Mom sticking up for you?”

“I was surprised.” Pause. “I guess I really scared her last week,” he says with a sly grin.

“So you’re pleased that you scared her, helped get her in your corner.”

“Oh no, I wouldn’t say that. I don’t want to scare my Mom.”

“Maybe part of you doesn’t want to scare your Mom, David, but I wonder if that’s completely true of all of you. You said last week you were angry at your Mom for always going over to your Dad’s side. But this was one time she didn’t. You won. You told her you wanted to kill yourself and that did it! She was staying on your side.”

“Yeah, I guess that’s true.” Pause. “But that makes me feel bad.”

“I think you do feel bad about being angry, David, particularly at your Mom. That’s why I said last time that I thought your lying was a way for you to express your anger. It’s a way of getting back at her for not always being in your corner.”

“Oh! Now I get it.” Pause. “But it’s not like I feel angry and then deliberately decide I’m going to lie to my Mom to get back at her. Usually I lie to make her feel better.”

“But is that really genuinely making her feel better, David? If you got an A+ on a paper and told her you got an A+ on a paper that would be genuinely making her feel better. But if you got a C on a paper and told her you got an A+ that would be putting one over on her, telling her she can’t make you study more or do better than you want to and that you resent the pressure she puts on you.”

“How did you know that? How did you know that I resent the pressure she puts on me?”

I smile. “I didn’t know that, David. I was actually just making it up but I think it’s pretty common for adolescents to resent the pressure their parents put on them.”

“I guess,” he says, sullenly.

“What’s going on David?”

“What?”

“I don’t know, you sounded unsure.”

Silence.

“Oh. Do you think I’m lying to you? You think what? That your mother told me that she put pressure on you to do better in school?”

Silence.

“I guess that’s a problem with lying, David, you end up assuming that everyone lies to you too. I promise you, I will never, ever lie to you, even if telling the truth is difficult or hurtful. Therapy necessitates openness and honesty and that’s hugely important to me.”

“Okay.”

“Sounds like that means ‘okay, I’ll try to believe you.’ Let me also say, David, that if your Mom or Dad ever contacts me I will tell you that they did and will tell you what they said. And I’d tell them I was going to tell you before they spoke to me.”

“Really? That sounds pretty good. So there would be no secrets?”

“No, no secrets. Oh, I should say if you told me you were going to hurt yourself and I believed that was a real possibility, I would contact your Mom.”

“I get that. That’s okay. I’m not going to kill myself.”

“I’m very glad to hear that.”

Please Help Me | by Linda Sherby, Ph. D, ABPP

Tue, 14 Feb 2023 01:48:33 GMT

In today's blog, "Please Help Me," I explore the difficulties that can arise when patient and therapist have different ideas of what kind of help is possible.

“My name is Lisa Henry. I’m forty. And I’m desperate. If you can’t help me I don’t know what I’ll do,” says this clearly anxious woman whose appearance reminds me of the stereotypical 50s housewife, page boy hair style, pink dress gathered at the waist, flaring outward. “Can you help me?”

“I think you’ll first need to tell me what you need help with.”

“My son.”

Silence.

“He… he just told me that he’s … that he’s gay,” she says taking a deep breath. “There, I said it!”

“I gather that’s a problem for you?”

She looks startled. “Of course it’s a problem. How could it not be!”

“Is it a problem for your son?”

“He says it isn’t, but that’s impossible. He was a normal boy. He played baseball. He was always popular.” Pause. “And he grew up in our family.”

“And what was it like growing up in your family?”

“We’re a Christian family. My husband is always praying and reading the Bible. And of course we pray as a family before every meal. We eat together. There are seven of us. My son – the one I’m talking about – he’s my eldest. My husband will never, ever accept this. I’m afraid he’d disown my son, but that’s not going to be necessary because you’re going to help me, right?”

“Mrs. Henry, exactly what do you want me to help you with?”

“Telling me how to convince my son he’s not gay.”

“I’m sorry, but there’s no way I can do that. I can’t convince anyone that he isn’t gay and I can’t help anyone to change in any way who isn’t in my office and who doesn’t want to change.”

“That’s the first thing we need to do. We need to convince him he does want to change, that he isn’t gay and if he needs to see you that’s fine.”

“I’m sorry, Mrs. Henry. I can’t do that. I can help you try to come to terms with your son being gay…”

“No way,” she interrupts. “You have no idea what you’re saying! I could never accept such a thing. And even if I could … could … I don’t know, … pretend it’s not happening, my husband would never, ever be able to even look at my son again.”

I realize I have been so taken aback by this woman’s request, that I have been debating with her, rather than dealing with her underlying feelings. “That’s really sad, Mrs. Henry. You must be feeling very sad and scared that there’s going to be this tremendous breach in your family and that you might even lose your son.”

“No, no, no. That’s not going to happen. It can’t happen again. It can’t,” she says, starting to cry.

“I’m sorry, what do you mean it can’t happen again?”

“That’s what happened to me.”

I look at her, totally bewildered.

“I lost my family,” she says in a whisper. “My family were orthodox Jews. When I married outside the religion my family sat shiva for me. I haven’t seen any of them since.”

“I’m so sorry. That must be terribly painful.”

She nods, as tears fall down her face. “But I thought I put it behind me. I made my own family. And I was always going to have that family, the family I have now. You see, that’s why you have to help me, you have to help me not lose another family.”

“I understand why you feel so desperate, but there are some things I can help you with and some things I can’t help you with. I can help you to grieve the family you lost, your family of origin. I can perhaps help you to accept your son’s gayness. And I might even be able to help you find a way to talk with your husband about your son…”

She shakes her head vigorously.

“I understand that seems impossible to you now and it may be impossible, but I can help you to maintain a relationship with your son regardless of how your husband feels…”

“No, that’s not possible either. He would never allow it.”

“Do you love your husband, Mrs. Henry?”

“Yes, of course, what kind of question is that?”

“Does he love you?”

She hesitates for a moment but says, “Yes, yes of course.”

“So your relationship is important to both of you. Perhaps that means you could talk, negotiate…”

“No. My husband makes all the decisions.”

“And did your father make all the decisions?”

“Yes, yes he did. How did you know that?”

“Different religion, but similar way of being in the world.”

“Yes, that’s true.”

“Mrs. Henry, our time is almost up for today and I don’t know if you want to continue working with me or not. I can’t help your son be not gay. I can help you deal with the very painful situation you’re in now, which also brings up a very painful loss in the past. But you’ll have to decide if that’s the kind of work you want to do before you decide whether or not to work with me.”

“I don’t know.” Pause. “Can I think about it?”

“Of course. Just call and let me know what you decide. And know that regardless I wish you the best.”

Another Year | by Linda Sherby, Ph. D, ABPP

Wed, 25 Jan 2023 02:00:21 GMT

I wish you and those you love a Happy New Year filled with health, peace, love and fulfillment.

In today's blog, "Another Year," in an initial sessions a therapist must navigate not only her patient's ambivalence about treatment, but his conflict about closeness and distancing as well.

“I’m here because of my wife,” Kevin begins. He’s a good-looking man who I judge to be in his early 50s, wavy brown hair beginning to be streaked with just a hint of gray. “She gave me a really nice Christmas present – a trip to St. Barts, just the two of us. Our kids decided they wanted to spend the holidays with their boyfriends’ families, so we were on our own, two lovebirds.” Pause. “But turns out she had an agenda.” He sighs. “It was all a plot to get me into therapy. Said it was a new year, time to press the reset key. She says I’m uptight and angry all the time. And of course as soon as she said that I got angry which only proved her point.”

“So do you see yourself as angry and uptight?”

“I can get angry, but I always think I have a good reason.”

“Like when your wife said you were uptight and angry all the time?”

“Yeah,” he says, with an edge to his voice. “Like you’re telling me that’s not a good reason to get angry! She blind-sided me. Here I think we’re going on this romantic trip and actually she just wants to get me into therapy. It’s not right!”

I feel as though Kevin is daring me to prove his anger isn’t legitimate and I struggle to not engage with him on that level. “So what do you feel right now, right at this moment?”

“That’s a typical therapist question, at least from what I see on TV, not from personal knowledge.”

Silence.

“Oh yeah, that’s another therapist trick, silence.”

I again struggle to not pick up the gauntlet he’s thrown down. “I’m wondering why you decided to come into therapy, to do as your wife asked.”

“I just told her I’d try it out.”

“So is this a trial session?”

“I suppose.”

“Do you feel invested in not having it work? Because it feels like we’re almost in a fencing match. Or maybe there’s a part of you that really wants to be here.”

He sighs. “Actually my sister saw you. She said you were really good, that you helped her a lot.”

“Wait, I saw your sister?”

“Yes, Alison Bentley. Different last name. Quite a long time ago. You helped her deal with the sudden death of her husband.”

“If I’d known you were related to someone I’d seen, I would have referred you to someone else.”

“Why? Allison’s fine with it. She doesn’t even live here anymore, moved to Texas with her new husband. She’s good.”

“I’m glad to hear Allison is good. But it strikes me as really interesting that first you come in today and are unsure whether you want to be here and then you tell me I saw your sister and now I’m unsure of whether we can work together.”

“But why? You have a head start on me. You know the backstory, my insane family of origin, which should make our work quicker.”

“I’m just taking a stab here, but is it your experience that if someone moves closer to you, you pull away and if they move away, you move closer? Sort of like the fencing match I mentioned.”

“Definitely! You are good! How’d you come up with that?”

“Well, first you’re angry at being here and only doing it for your wife, but when I express reservations, you suddenly want to be here. Seems like you want to create distance, unless the other person – in this instance, me – pulls back.”

“I get it.”

“But I don’t know where that leaves us. I’m truly not sure I’d be the best therapist for you even though, yes, I know some about your family of origin. But I know about it from your sister’s perspective, not from yours. That’s not always helpful. Your subjective experience has to be different than her subjective experience.”

“That sounds like psychobabble.”

“Are you getting angry right now?”

“A little.”

“So this time I’m backing away and you’re still getting angry. Is it that you’re not getting what at least a part of you wants, namely me?”

“Yeah. I hate not to get what I want. Makes me mad and frustrated and all around pissed. Just like my father. And it especially makes me mad if the reason I’m being rejected … I mean the reason I’m not getting what I want makes no sense.”

“I don’t know about you, Kevin, but I found this to be a complicated session. I’m not sure what I think would be best for you and I’m not really sure what you want. Our time is almost up, but what if we agree to make another appointment and each think about it during the week and discuss it next session?”

“I guess.”

“You still sound pissed off.”

“I just don’t get what the big deal would be your seeing me after you saw my sister.”

“Well maybe during the week you can think about what you’d like to get out of therapy and we can talk some more about it.”

“Okay,” he says, half-heartedly.

A White Lie | by Linda Sherby, Ph. D, ABPP

Fri, 11 Nov 2022 00:21:30 GMT

"A White Lie," a therapist struggles to absorb her patient's deception, while trying to understand its meaning and remain in to with the patient.

“It was my birthday this past Saturday,” MaryAnn begins smiling, combing her fingers through her long, silky hair.

“Congratulations,” I respond enthusiastically, “Twenty, right?”

MaryAnn pauses, drops her head, then raises it again to look

directly at me. “Not exactly. I turned 18.”

I stare at her, startled. “But we’ve been working together for two years. You told me you were 18 when we started.”

“Yes, I did. I lied. But that’s the only thing I’ve lied about.”

“But you were a minor when we began working together,” I say, quite distressed. “I would have needed your parents’ permission to see you.”

“Exactly! That’s why I told you I was 18. Could you imagine my parents allowing me to see you and air all their dirty secrets. It’s no big deal, just a little white lie.”

I’m stunned. MaryAnn and I had what I thought was a close, intense bond, with a heated transference/countertransference relationship. I quickly became the mother she wished she had, not the socialite who left her daughter to be raised by a series of nannies while she spent her husband’s money throwing elaborate parties or meeting a series of lovers somewhere in the world. For my part, I usually felt motherly and protective towards her, unless her excessive demands made me pull back in either anger or self-defense. Her “little white lie” feels like a betrayal and I struggle to make sense of it.

“Come on!” MaryAnn says. “You look like I’ve committed some terrible sin! Why is it such a big deal?”

“Well, first you made me complicit in breaking the law – seeing you without parental consent.”

“But you didn’t know!!” she interrupts.

“Second, this is a tremendous breach of trust, of what I assumed was a good faith relationship between us.”

“It is.”

“Is it?”

“Yes, I don’t know why you’re making such a big deal about it. I lied so I could see you. What’s wrong with that?”

“How did you pay me every month?” I ask.

“You know money isn’t an issue. There are huge amounts of cash lying around, or signed checks. Neither of my parents cares how much money I spend. They never check up on me.”

“So you were stealing money to pay me?”

“I wasn’t stealing. I told you. I can spend money on whatever I want. They never ask.”

Through what feels like my foggy mind, some thoughts vaguely occur to me. “You know, MaryAnn, one of your complaints about your parents is that they’ve always had relationships with other people, while continuing on with what feels to you like their sham marriage.”

“That’s not the same thing!”

“You’ve grown up in a household where lying and deceit was second nature. It’s not so hard to imagine you’d also lie to get what you want.”

“I told you, I had no choice!”

“Perhaps your parents would say the same thing. And, besides, if your parents are so indifferent to what you do or don’t do, how do you know they wouldn’t be fine about your being in therapy.”

“I told you, because they don’t want all their secrets out there! Maybe I shouldn’t have told you. Maybe I should have just said yes, I’m 20.”

“So that brings me to another issue, MaryAnn, maybe the most important issue in terms of our relationship.”

She sighs, exasperatedly.

I continue. “A lie keeps distance. Your lie kept distance between us, just as your parents’ lies keeps distance between them and between the three of you. Maybe, unconsciously, it was important that you keep a distance between us, maybe you couldn’t risk being closer to me than to your parents.”

“But that doesn’t make sense. I’ve always wanted more from you, wanted you to take care of me, had fantasies of your being at my wedding one day, meeting my children, all that.”

“That’s what you’ve wanted consciously, but I wonder if unconsciously it would have felt very risky to be closer to me than to your parents, maybe it would have felt like I was replacing them, doing away with them. However not ideal they’ve been as parents, they’re the only parents you’ve ever had or will have.”

“I don’t know, maybe. But what now? What happens between us?”

“What would you like to happen?”

“I’d like you to forgive me and for us to go on as before.”

“Now that I have what feels to me like a psychological understanding of what prompted your lying, I’m no longer so shocked or angry. As far as us going on as before, if that means do I still care about you and want us to continue working together, the answer is certainly yes. But relationships always change, MaryAnn, and this relationship will definitely be impacted by what occurred between us today. For sure I’ll be looking to see if there are other ways you create distance in our relationship.”

“I am sorry. But I’m still not sure I would have done anything differently.”

“I hear you.”

Beyond Afraid | by Linda Sherby, Ph. D, ABPP

Wed, 21 Sep 2022 23:34:45 GMT

Beyond Afraid," concerns a man who begins therapy because of his overwhelming anxiety about his mother dying, while his therapist sees a man who is terrified of separation.

I open my waiting room door to a mid-thirtyish man pacing back and forth in front of the couch. “Frank?” I ask.

He startles and turns to face me. “Oh, I’m so sorry. Did I frighten you? I didn’t mean to frighten you. I just can’t sit still. I’m so jittery. I just…”

I note that he’s afraid of having frightened me when he’s clearly the one who’s terrified. “It’s all right,” I interrupt. “Why don’t we go into my office and sit down.”

He sits, but perches at the edge of the chair, as though posed for flight.

“What has you so frightened?” I ask.

“My, my, mother,” he stammers. “I’m afraid she’s going to die. My father died a year ago. He was fine, came home from work, went upstairs and died. Doctors said something about his heart. I couldn’t understand it. My Mom started screaming and screaming. I guess I did too. It still all a blur. But now I’m worried about my Mom. They say she has something in her uterus. I’m afraid she’s going to die. I couldn’t make it if she died. I couldn’t make it,” he says starting to cry.

“What does she have in her uterus? Are her doctors concerned? Is she concerned?”

“She’s a wreck. Her doctors say it’s nothing, just something to watch. I don’t know, fibrosus?”

“Fibroids?” I ask.

“That’s it! Can that kill you?”

“I’m not a medical doctor, but my understanding is that fibroids aren’t usually a problem.”

“Are you sure?”

“Frank, do you think anyone can sufficiently reassure you?”

Still crying, he says, “I’ve always been this way. Everything scares me. Mom’s like that too. Dad was also kind of anxious. Only my sister isn’t. She’s the opposite. She’s in something like the Peace Corps. In India. My parents flipped out when she joined. But she was determined. And now she married an Indian guy so I guess she’s never coming home. I worry about her dying too, but it’s not as bad as with my Mom.”

“Can you tell me a little about your growing up, Frank. What was it like being a kid in your family?”

“It was great. I didn’t worry about anyone dying then.” Pause. “But I was always afraid. Hard not to be. My Mom worried about everything, about us being kidnapped, about us driving. I didn’t drive ‘til I was 20 or something. She’d take us to the doctor for the least little sniffle. Make us stay home from school.” Pause. “That was okay with me. I didn’t like school. I mean it wasn’t school I minded. I just didn’t like being away from home. I always felt scared being away from home. The other kids made fun of me, called me a Momma’s boy. I guess I was. Guess I still am.”

“Have you ever lived away from home?”

“I tried. Went away to college, but didn’t last a semester. I came home, got a degree in accounting. Dad was an accountant. But I’m an assistant accountant. I didn’t want all that responsibility. I didn’t want the work to kill me like it killed Dad. I work mostly from home, especially since Covid, and especially since my Dad died. I want to be around for my Mom. She’s my responsibility now that he’s gone.”

“Have you been in therapy before?”

“I may have gone awhile when I was a little kid. But not really, no, not since I’m grown.”

“How do you feel about being in therapy? And how do you feel being with me?”

“I guess I need it. I’d like to not be so scared all the time.” Pause. “And I like you. You’re nice. Sort of like my Mom, except not as nervous.” Pause. “Can you help me be less scared?”

“I certainly hope so. But I do want to say, Frank, that you may not always think I’m so nice. There are times therapy can be hard and painful. Like one of the things I suspect you and I are going to look at is your relationship with your mother.”

“Why? I have a great relationship with my mother.”

“Except it’s hard for you to have a life apart from her.”

“Are you going to take Mom away from me?” Frank asks, panic seeping into his voice.

“No, Frank. I don’t have the power to do that nor would I want to. But having part of your life be separate from your mother seems like something an adult child might want.”

“I guess.”

“You can always disagree with me, Frank. My saying something doesn’t make it so.”

“That’s not like my mother! She always wants me to think the same way as her.”

“Well, maybe that’s one thing we’ll get to look at together, how you feel about always needing to think like your Mom.”

Fearing the Past | by Linda Sherby, Ph. D, ABPP

Wed, 24 Aug 2022 23:58:59 GMT

a therapist helps her pregnant patient deal with her and her husband's fears of her raising a child given her past history.

Katie barely smiles as I greet her in the waiting room. She walks slowly to my office and gingerly lowers herself into the chair. Oh no, I think to myself, did something happen with her pregnancy? Just last week she was radiant, bubbling with joy, thrilled that she’d be giving birth to a little girl.

“What’s wrong, Katie?” I ask.

Silent tears stream down her face.

“Did something happen to the baby?”

She shakes her head, cradling her stomach. “On Monday,” she says hesitantly, “Patrick woke up and right away he seemed different. He didn’t kiss my stomach and listen for the baby as he usually does. He just got up and started getting ready for work. I asked what was wrong, but he said he was just tired. I tried to connect with him, but he just ate breakfast and left. He texted me a couple of times during the day so I thought maybe everything was fine. But when he came home he was still distant, preoccupied. I told him he had to talk to me, that we weren’t having dinner until I knew what was bothering him.

“And then he asked me, he asked me if I was ever afraid I’d hurt our baby. I couldn’t believe it. I felt as though he’d slapped me. I started crying. He said he’d had a dream that I was shaking our baby and screaming at her. He said I must have thought about it, that I couldn’t have not thought about it given my history. I couldn’t stop crying. I just couldn’t stop. Like I can’t stop now.”

“I understand you’re in a tremendous amount of pain,” I say softly, “And this might seem like a ridiculous question, but can you say what you are crying about? Is seems like there’s many things you could be crying about right now and maybe it would be helpful if we tried to understand them.”

“I’m crying about Patrick even questioning that I could possibly, possibly ever hurt our child.”

“I understand that Katie. But you’ve questioned yourself too. We spent many sessions talking about your fears about your past, about whether you’d repeat your history.”

“And you told me not everyone who’s abused becomes an abuser!” Katie says, practically yelling at me.

“That’s absolutely true.”

“So?”

“And did my saying that take away all your fears?”

Katie covers her face with her hands, sobbing and shaking her head. “Why couldn’t he have faith in me? Why does he have to doubt me?”

“So you feel abandoned by Patrick.”

“Yes, yes!! He’s always been my biggest champion. He was always the one who said I could overcome anything, do anything.” Pause. “I would never, ever have agreed to have a child if I thought he didn’t believe in me!”

“I wonder if you’re saying that if Patrick doesn’t believe in you, you can’t believe in you either.”

Katie stops crying and looks at me. “That’s right. That’s absolutely right! That’s why Patrick’s question devastated me. I can’t lose my biggest champion just as I’m about to undertake the scariest step of my life.”

“So you do know it’s scary, scary for you and scary for Patrick. It’s sound like it would help if both of you talked about your fears, not to make accusations, but to provide each other with support and understanding.”

Silence.

“Where did you go, Katie?”

“Ever since Monday I’ve been re-living the horrible things my mother did to me, how she’d slap me around, take a belt to me, drag me around the floor by my hair, make me eat dog food, spit at me. She hated me. I know she wanted me dead.” Katie’s voice gets flatter and flatter as she recounts the abuse.

“Katie, you can feel about all these horrible things your mother did to you. You don’t have to shut down. You can hate her back.”

“I don’t want to hate her back. I just don’t want her to affect my life in any way.”

“It would be good to be indifferent to your mother, but it’s impossible that she not affect your life. She’s your mother. And she was your mother when you were a helpless, vulnerable, dependent child. But your life doesn’t have to be determined by her.”

“So you don’t think I’ll abuse my child?”

“No, I don’t think you’ll abuse your child. You’re a great aunt to your brother’s kids. You love your animals.”

“My brother’s kids are boys. Will that make a difference?”

“It sounds like that’s something you’re concerned about.”

Katie nods. “It crossed my mind when I knew I’d be having a girl. But I also thought, good, I get to do a do-over with my little girl. I just know it will be different.”

“You mean you and Patrick will make it different.”

“Yes, that’s exactly right. And Patrick and I are going to be doing some heavy talking. Thank you so much. Helpful, as always.”

“My pleasure,” I say smiling.

Unsure | by Linda Sherby, Ph. D, ABPP

Wed, 03 Aug 2022 23:45:30 GMT

"Unsure," a young woman enters therapy to decide whether or not to marry and quickly discovers that there are many old issues influencing her decision.

“I feel ridiculous going into therapy because I can’t decide whether or not to get married,” Nina, a slender young woman with shiny dark hair and large brown eyes, begins. “I mean I’ve been in therapy before, lots of times. It’s been a lifesaver sometimes, but going into therapy because I can’t decide whether or not to marry Sam seems silly. Either I want to marry Sam or I don’t. I don’t know what makes it so hard to decide.”

“What does make it so hard to decide?”

“I guess because I don’t know if I love him. But is it even necessary that I love him? I’ve loved other guys and they all turned out like shit. I don’t know. I keep going round and around in my head.”

“Nina, I hear that you feel a lot of pressure to decide right now, but it would be helpful if you told me something about you, your background, why you’ve been in therapy before, maybe something about the shit guys.”

Nina sighs. “I knew I’d have to go through the whole thing again. It’s so tedious. Okay, here goes. When I was a kid, my life was pretty normal until I was six. Then my mother was hit by a car. She lived on a ventilator for a year or so until my Dad won the court battle with my Mom’s parents and had her disconnected. My Dad didn’t let me see my grandparents for quite a while, but then I got to see them and that was hard too because they talked such shit about my Dad. That’s when therapy was really helpful. Things got better after that until my Dad started dating and dating and dating. I guess he was trying to drown his sorrow in women, at least that’s what my therapist said. Fast forward, I now have my fourth step-mother except of course I don’t live at home any more so I don’t really care who he’s with. End of story.”

“That’s an overwhelming story, Nina, yet you told it like you were reading from a book, like it happened to someone else.”

“I just can’t feel about it anymore. I don’t want to feel about it anymore. I want it over.”

“But maybe it isn’t over.”

“What do you mean?”

“Well, that’s a tremendous amount of loss and trauma for anyone to go through, let alone a young child. You lost your Mom, your grandparents and your Dad.”

“My Dad’s not dead.”

“No, but it sounds as though once he started dating you felt as though you’d lost him.”

“Yep! But that was just me being jealous. That was another therapist’s opinion.”

“And what’s your opinion?”

“I don’t know. It felt too soon. It felt like he forgot about my Mom. It made me wonder if my grandparents weren’t right about him. It made me sad. I missed him. I missed them all,” Nina says, her voice breaking a bit.

“I’m sorry Nina.”

Her eyes fill with tears which she blinks back. “But what does this have to do with my not being able to decide whether or not to marry Sam?”

“First tell me whether the previous guys you loved were unfaithful to you or otherwise unavailable.”

She snorts. “You mean like married? Yeah, I had my share of those. And my share of womanizers too. So you think I have an Oedipal thing, right? You think I want my father just for me.”

“Is that what you think?”

“Maybe. I just don’t know any more.” Pause. “For sure Sam isn’t anything like my father. He’s kind and generous and faithful. I know he loves me. I just don’t know if I love him.” Pause. “So you’d say I have to give up on my Dad in order to allow a different kind of man into my life.”

I smile. “You’re certainly no stranger to therapy.”

She nods. “Too true.”

“But I wonder if, as you said, it’s only an ‘Oedipal thing.’ You’ve had so many early losses, Nina, losses that had to have a huge affect on your life. I wonder if you’ve walled yourself off from ever allowing yourself to be really close to anyone for fear that the pain of losing them would be too much. If you choose unavailable guys, they maintain the distance. If you choose a guy who is available, maybe that’s just too scary. What if you come to rely on him like you did your Mom or your Dad? What if he leaves or is in an accident? What if he dies? Maybe your six year old self doesn’t feel like she could cope with that.”

“But I’m not six.”

“The unconscious is timeless, Nina. We’re all whatever age we are today as well as six and ten and fifteen. That’s how we’re made.”

“But what do I do?”

“I’d say we have to go back so that you can feel the tremendous pain and loss and fear you felt as a child and help that child mourn and grow so that you can allow yourself to love and to know that however painful it might be you could again survive loss.”

“Sounds charming.” Pause. “When do we start?”

Being Bad Part II| by Linda Sherby, Ph. D, ABPP

Wed, 18 May 2022 23:45:29 GMT

"Being Bad Part II," a therapist helps her patient to understand the feelings behind her compulsion to act-out by damaging cars.

“I’ve been thinking about what we talked about last time,” Brenda says, beginning immediately. “About my being angry. I suppose I could be, but I don’t know what I’d have to be angry about. I have this great life, a family who’d do anything for me, a nice condo, great weather. What else do I need? Well, I guess I’d like to find a man, but I’m not angry about that. It will happen eventually.”

“You mentioned last time that when you felt angry you stopped eating. What was that about?”

“Mostly I was just mad at myself. Mad that I let myself get too fat.”

“You said that when that didn’t work, you’d eat and throw up, what did you mean by that?”

“When my Mom got mad at me for not eating. Or more like when she kept asking if I didn’t like her food, or if I could tell her what she could make me that I’d like,” she says rolling her eyes. “It got annoying so I’d eat and throw up later.”

“You were annoyed at your mother?”

“Yeah. She can get pretty annoying. She thinks my skirt is too short or my hair is too long or I wear too much make-up, whatever.”

“So you can feel angry with her.”

“Yeah, I guess. My Dad’s not like that, pretty much everything I do is okay, but I don’t know, it’s almost like it doesn’t matter what I do, almost like he’s not interested. Yeah, I guess that’s right. I’m the afterthought. My brother’s the boy, my sister’s the smart one and I’m just me. I mean, he does like it that I do well selling houses. That he cares about.”

“So you feel criticized by your mother and ignored by your father except at his business.”

“That pretty much sums it up.”

“Don’t you think that’s something to be angry about?”

“I suppose. But it’s not like I’m being abused or beaten up or neglected.”

“That’s true. But you’re entitled to have whatever feelings you have. You don’t have to be beaten up to feel hurt and angry.”

“No one gets angry in my family. We’re polite and respectful, except when we were little kids of course. But like I’ve never heard my parents fight. They never scream at each other.”

“And do you think they have a good marriage, a close marriage.”

“I wouldn’t say that. They kind of exist in the same house and are pleasant enough to each other, but I wouldn’t say they’re close. I’m not sure anyone in my family is close to anyone else.”

“Sounds lonely. And sad.”

“I guess. I’m not sure I know anything else.”

“It sounds like you know something else when you batter cars.”

“That’s not being close!”

“No, but you were feeling something intensely. I think you said you felt free, that you were showing them you couldn’t be pushed around.”

“Yes, that’s right, but I’m not sure how that’s related to my parents or to closeness.”

“As you said, everyone in your family is proper and respectful. Everyone is good. But there’s an absence of feelings, any feelings, angry feelings, loving feelings. It kind of sounds like you’re living in a doll’s house.”

“Funny you should say that. I’ve had friends tell me my parent’s house reminds them of a doll’s house. I always thought they meant because it was super done by an interior designer, but maybe they meant more than that.” Pause. “So you think it’s good for me to be ramming cars because it gives me a chance to express my feelings?”

“I wouldn’t say that. It does give you a chance to let loose with feelings you’ve kept bottled up, but you’re acting out the feelings against inanimate objects, not really letting yourself know what or who you’re angry at. I suspect you’ve been carrying around lots of feelings for a long time.”

Silence.

“So what should I do about my obsession about ramming cars?”

“Well, when you first have the thought or the impulse, I’d try asking yourself what you’re feeling right then. What made you have that impulse right at that moment?”

“But can I still do it?”

“Perhaps it would be better to ask if you can not do it. If you can not do it, that would be best, but I don’t know if you can stop quite that easily.”

Silence.

“I just had the desire to do it, to do it as soon as I leave your office.”

“And do you know why that is?”

She shakes her head.

“You sure?”

Brenda drops her head. Very quietly she says, “Maybe because I felt you were taking something away from me.”

“Which made you feel…?”

“I guess annoyed.”

“So it felt like I was telling you what to do – or what not to do – and depriving you of something you enjoy. That made you angry and wanting to act out that anger by ramming cars.”

“I guess.”

“I think we made a lot of progress today.”

“But what if I still want to ram cars?”

“No one changes overnight, Brenda.”

Being Bad| by Linda Sherby, Ph. D, ABPP

Thu, 14 Apr 2022 00:13:56 GMT

"Being Bad," concerns a young woman who seeks therapy to help her stop a seemingly inexplicable destructive behavior.

I open my waiting room door to a slender young woman who looks up at me as though startled. With perfect posture she follows me into my office and sits gingerly on the chair I designate. She stares at me expectantly.

“How can I help you?” I ask, smiling.

“This is all confidential, right?” she asks quietly.

“Yes,” I say, immediately on guard.

“I’ve done something terrible.”

I say nothing, my anxiety increasing.

Silence.

“Do you want to tell me what that terrible thing was or would you prefer to give me some background information first?” I ask, trying to make us both more comfortable.

“Well, I’m Brenda Masters. I’m 29, a real estate broker. I work in my father’s company. I do pretty well,” she adds, smiling for the first time. “I like it. I did graduate from college because my parents wanted me to, but I kind of always wanted to go into the business. My older brother’s in the business too. My older sister is studying to be a doctor. She was always the brain. I own my condo – my Dad bought it for me – although I’d like to own a house one day. I date, but there’s no one special, not for a while.”

Pause.

“My life’s pretty good. That’s what makes this all the more strange.”

“Perhaps you need to tell me what “this” is.”

Taking a deep breath, she says, “About a month ago I parked downtown and went to do some shopping. I’m not sure how long I was gone, but when I got back there was a BMW convertible behind me and some fancy Porsche in front. They penned me in. I couldn’t move. Made me mad. I stood there a while hoping one of them would come back. No such luck. Finally I got into my car and tried to more a few inches up and back, up and back. But it was ridiculous. I couldn’t get anywhere.”

Pause.

“So then I stepped on the gas to see if I could move one of the cars a

little. And then I gave it more gas and before long I was ramming first one car and then the other. Bang! Bang!! Up and back, up and back. Crunch, crunch, crunch. I was obviously damaging my car too, but I didn’t care. I liked the feeling, the power. I liked showing them they couldn’t just push me around!” she says, quite animated at this point. “This time I was the one doing the pushing! And then I was out! I was free! It was a great feeling. I showed them!”

She pauses, seemingly trying to return to her previous calm and controlled state. “I guess I was lucky there weren’t many people around that day, maybe because it was raining. I told my Dad someone messed up my bumper and he had it fixed. No biggie.”

“And does it feel like ‘no biggie?’”

“Well, I guess I felt both thrilled and guilty. I decided not think about it. But I couldn’t. That’s the problem,” she says, lowering her head. “I’ve done it again. More than once. I look for the right place and the right day and I do it again. I know that’s not good. I know it’s wrong. And I know I’ll get in trouble. But it’s become like an obsession. Can you help me?”

“I think so, but first we have to understand why it’s become an obsession, why you feel so stimulated battering someone’s car. Do you have any thoughts?”

“I don’t know. I’ve never seen myself as an angry person. I was always the good girl. My brother used to tease me for being so good, said it made him look bad.”

“Do you know why you were so good?”

“I don’t know. Maybe because my brother was the boy and my sister was the smart one and I had to do something to distinguish myself, so I was good.”

“And what happened when you felt angry?”

“I didn’t get angry.”

“You never felt angry?”

“I never expressed it.”

“So what did you do with your anger?”

She hesitates. “I didn’t eat. And when that wasn’t okay, I ate and threw up.”

“Do you still do that?”

“Sometimes, but not much.”

“What’s going on in your life today when you eat and throw up.”

“I don’t know. I guess I feel fat.”

“Has your throwing up increased or decreased since you’ve been ramming cars?”

“Hmm. I might not have thrown up since that first time. Wow! You think there’s a connection?”

“Could be. You know, Brenda, you immediately struck me as a person very much in control, holding yourself back, reining yourself in. I wonder if both throwing up and ramming cars is a way for you to let go, to release some of the anger you’ve been sitting on your whole life.”

“But what do I have to feel angry about?”

“I guess that’s one of the things we’ll need to figure out.”

Undecided Part II | by Linda Sherby, Ph. D, ABPP

Mon, 07 Mar 2022 05:30:37 GMT

Undecided Part II, continues to explore a patient's conflicts around his sexuality identity and illustrates how fear can lead to paranoid thoughts about his therapist.

“It’s not good,” Stan says, shaking his head from side to side. “You have to tell me what to do! I can’t stand it! All I do is think about this day in and day out. Should I stay with Paulette and my family or should I throw it all up in the air and be with Frank?”

Silence.

“Tell me.”

“You know I can’t tell you Stan. No one can make that decision but you.”

He drops his head into his hands. “I can’t. I can’t make the decision.”

“If I told you what to do – which I wouldn’t – what would you hope I’d say?

“That I should follow my heart and be with Frank.”

“So is that what you want?”

“Yes. Yes. It is what I want. But is what I want enough? Is what I want always what matters most? If I want to go murder my boss, should I go murder my boss? No, obviously not. Sometimes you can’t have what you want. Sometimes you shouldn’t hurt other people to get what you want.”

“That’s a very good point. Let me ask you something, why would my telling you to follow your heart and be with Frank, change what you just said about not hurting Paulette and your children?”

“And my parents. And the rest of my family”

“And why would my telling you to be with Frank change how you felt about hurting those people?”

“I guess because you’d be giving me permission. Because you’d be saying being gay isn’t bad, isn’t a perversion.”

“So now you’ve introduced something else. It’s not only about hurting people, it’s about whether you think being gay is bad.”

“Is it?”

“No. But it’s not about what I believe, it’s about what you feel. If you tell me you want to work on the negative feelings you have about homosexuality, I’m happy to do that, but you’ll still have to decide whether or not you want to leave your marriage. And I suppose there’s also the question of whether if you stay in your marriage and feel as though you’re accepting second best, are you making Paulette accept second best as well? Are you depriving her of feeling with someone else the same way you feel with Frank?”

“Oh no! You’ve just made this even more complicated!” Stan stares at me intently. “Wait a minute, are you a lesbian? Do you feel I should be with Frank? That’s it’s better to be homosexual than heterosexual?”

I’m startled. “Now I’m confused,” I say. “I thought you wanted me to tell you to be with Frank which I certainly haven’t done, but now you wonder if I’m a lesbian because I raise the question of whether staying with Paulette is the only way to not hurt her?

“Wow!” Pause. “I guess it wouldn’t have been all right with me if you’d told me to be with Frank. Even giving me a possible reason to leave Paulette, like it would be kinder to leave her to find someone who was really into her, it… I don’t know. I guess it really scared me.” Pause. “I guess it’s that I don’t want to be gay. I don’t want to be rejected by my family. I don’t want all the hassles gay people have to go through. I just want to be normal, to have things be how they were.”

“And is that possible, Stan?”

“That scared me again. And again made me wonder if you really are gay.”

“I think you are very frightened. And when you feel as scared as you feel right now, it’s easy to think that there’s someone outside of you who’s frightening you, and right now that someone is me.”

“So you’re saying I’m being paranoid?”

“I’m saying right now you feel me as dangerous. And that’s okay. We can deal with that. We can explore what makes you so frightened both inside your head and outside in the world.”

“So you could think that homosexuality was okay and not be homosexual yourself?”

“Yes,” I say, concerned about how much less adult Stan feels to me right now. “Stan, you told me that you came from a Christian, conservative background. I assume the message was that homosexuality was bad, a sin?”

“Definitely.”

“And do you think that’s what’s scaring you now, that you’re afraid if you’re gay you’ll go to hell?”

“But maybe if I give up Frank and stay with Paulette I could go back to having a normal life and be redeemed.”

“I guess you’ve added a whole new dimension to your conflict. It’s not only figuring out what you want and not only trying not to hurt anyone, it’s also wrestling with a difficult religious question.”

“And can you help me with that?”

“Well, I can help you explore your thoughts and feelings, but I can’t answer the religious question for you any more than I could answer whether or not to be with Frank.”

“Thanks. I don’t know why, or how, but somehow I think this helped.”

“I’m not sure why either, but perhaps it was parsing out the different pieces of your conflict so that your feelings don’t seem so overwhelming.”

Undecided | by Linda Sherby, Ph. D, ABPP

Sat, 05 Feb 2022 00:01:30 GMT

"Undecided," a patient looks to his therapist to help him make what could be a life-changing decision.

“I appreciate your willingness to see me, even virtually,” Stan begins. He’s a nice looking man who seems anxious, unsure, fidgeting with his fingers, moving in his seat.

“How can I help you?” I ask.

“I just hope you can help me. I want to leave my wife. No, no, that’s not exactly true. I don’t want to leave my wife. I love Paulette. But I have to leave her. I love her and I love my two boys, but I just can’t go on like this. I’m sorry, I know I’m not making any sense.”

“You can say whatever you need to say, however you need to say it.”

“I’m in love with someone else. A man! I can’t believe it. I don’t even know how this happened. I’ve never been attracted to a man before. Or, or maybe I have. I don’t know. But all I know is that I love Frank. I never expected to love Frank, I mean I don’t know if I even liked Frank at first, but then, there it was, he kissed me and I don’t know if I ever felt anything so powerful in my life. So that’s it. I love Frank and I love Paulette. But I can’t keep lying to Paulette. I don’t even know how she hasn’t figured it out. I do everything I can to avoid having sex with her. Not that I mind having sex with her, but it feels like I’m being unfaithful to Frank! Which I know is completely crazy”’ Stan takes a breath. “So that’s the story. Do you think I’m awful?”

“No, of course not. I think you’re in a lot of pain. Can you to tell me a little more about yourself?”

“I’m 38. I’ve been married for 12 years. I have two boys, six and ten. I was supposed to be a physical therapist, but I ended up selling solar panels. I like it. Makes me feel I’m helping people. And the environment. That’s how I ended up in Florida. It’s a good place to sell solar panels. My wife and I are actually from a small town in Ohio west of Cleveland, conservative, Christian area. South Florida was an adjustment, but we’ve learned to love it.” Pause. “‘We’ve learned to love it.’ That’s the problem, ‘we’ has always meant me and my wife. I don’t know. I don’t know if I can leave that ‘we,’ break up my family, have to explain all this to my wife. And to my parents. I don’t even want to think about them.”

“And if you do think about your parents…?”“They’ll never accept it. I don’t think they’d say they didn’t want to see me again, but I know my mother would cry hysterically and my father would preach endlessly about my going to hell.” Pause. “This whole thing is such a mess. What would I tell my kids? Would my wife keep me from seeing them? No, I don’t think she’d do that. You know, the more I talk about this the more I wonder if I should just leave things as they are, keep lying, keep seeing Frank on the side. Maybe this thing with Frank will just burn itself out. Maybe it’s not love, maybe it’s just lust.”

“Can we talk a little about your sexuality? You said Frank was the first man you’d been attracted to and then you didn’t seem sure of that.”

“I played football in high school. And you know, we’d all be in the locker room, showering, trying to see whose was bigger while pretending we weren’t looking. Sometimes there would be a guy and, I don’t know, I guess you could say I might have been attracted to him, but I didn’t think much about it. I dated girls. I had sex with girls. I met my wife in college, we had sex, we dated a while, we got married and here we are.”

“And how was the sex with girls? With your wife?”

“Good. Good. It was good.”

“But not as good as with Frank?”
“Nowhere near. I never had sex like with Frank. I can see with across the room and all I want to do is jump into bed with him. He was my customer, buying solar panels for his house. At first I thought he was stuck-up, arrogant. Seemed like an awfully big house for one person. When I came by he started asking me to have a glass a wine. And that led to lunch. And that led to sex and where I am today.” Pause. “What do you think I should do?”

“I can’t possibly answer that…”

“What would you say if I was your son?” Stan asks, interrupting.

“What makes you ask that?”

“I don’t know. I guess you’re probably about my parent’s age.”

“It sounds as though your concern about what others think makes it hard for you to sort out what you want for you.”

“That’s definitely true.”

“I know you feel a lot of pressure to try and make a decision right now, but I’d suggest that you give yourself some time and that you give us some time to figure out what you really want.”

I Can't Stand It! | by Linda Sherby, Ph. D, ABPP

Fri, 04 Feb 2022 23:52:02 GMT

"I Can't Stand It!" starts with a patient's anger and despair about covid19 and ends with a surprise for the therapist.

“I can’t stand this anymore!” Karen shrieks. On my video screen I watch a usually attractive 35 year old woman grimace and pull at her hair. “When, when is it going to end?”

“I don’t know the answer to that, Karen. It’s a pandemic and the virus will do what it’s going to do.”

“But we can’t plan anything. We don’t know from one moment to the next what’s going to be happening. How many times have we gone back and forth from being in the office and back on video? I can’t stand it! I feel as though I’m going crazy.”

“The uncertainty is difficult for everyone, Karen. And I do understand that going back on video after a few weeks in the office is very disconcerting.”

“And then there’s your vacation! How could you leave in the middle of all this?! What if you got sick? What if you died? Would I even know? Would anyone tell me?”

“I understand your feeling angry with me for abandoning you.”

“But answer my question. Would anyone tell me if you died or would I just be wondering forever?”

“Yes, a colleague would contact you if I died. But I wonder if your worrying about my dying came from your feeling so unsafe without me. My absence has always been understandably frightening to you and certainly with Covid raising everyone’s anxiety, it’s easy to see how you’d fear losing me forever.”

“You mean like when I was a kid and my mother went away leaving me with my insane father?” Pause. “Yes, that was terrifying. It was always terrifying, even when she was there, but when she was gone that was really, really terrifying. I never knew what to expect. Truthfully, my mother was useless at preventing my father’s explosions, but it still felt a bit safer when she was there. He was so unpredictable. You just never knew what would set him off: a book left on the kitchen table, the dog barking, my clattering a dish. It was so scary. And I could never understand why she had to go away. What was so much more important than me?!”

“The pandemic replicates your childhood experience in so many ways: you never know what’s going to happen next and, just like your mother, even when I’m here I’m pretty ‘useless’ to change the reality of the pandemic, just like she couldn’t prevent your father’s explosions.”

“But why did you have to go away? She went away for business, although as a kid I never knew what that meant. She went away to see her parents, but I didn’t understand why she couldn’t take me with her. I guess my Dad would say we couldn’t afford it, but I didn’t understand that either.”

“I don’t think, Karen, anything your Mom told you about why she went away would have felt like a good enough reason to you and I’m sure that’s true of me as well. You’d always feel you weren’t important enough, that you were being left for something more important than you.”

“You’re not going to tell me, are you? You’re not going to tell me why you went away.”

“I don’t think the reason I went away would make any difference to you. As I said, it wouldn’t make you feel any less left or abandoned.”

“But it might make me feel like I mattered enough for you to tell me.”

“Did you have any thoughts, ideas of why I went away?”

“Well that’s an obvious therapist trick! I won’t play!”

“What I think is happening now is that you’re finding something to fight with me about, as opposed to us dealing with your anger about my leaving, and perhaps also the fear and sadness you felt underneath.”

“Why won’t you tell me?!”

“Because no matter what I say, I will have left you for someone or something else and it’s those feelings we need to deal with, not the specifics of where I went or why. Your mother told you why she went away and it never made a difference to you.”

“Tell me.”

I struggle to decide how to respond. I’m beginning to feel angry, which I know is also what Karen feels. I don’t think an endless power struggle between us will be helpful. And I also don’t think my telling her will change her feelings. I finally say, “I went to attend a friend’s special birthday.”

“You told me! I won!”

I’m startled.

“Yay!! You didn’t expect me to react like that. This was great. I feel powerful! And way less scared.”

“That’s true, Karen, that’s not how I expected you to react. You feel as though you won and therefore you’re no longer the scared child, but rather the powerful adult.”

“Yes.” Pause. “And you’re right, I still feel you put someone else above me. But it doesn’t hurt nearly as much.”

“There’s a lot to process here. We’ll have to continue next session.”

The Outsider| by Linda Sherby, Ph. D, ABPP

Fri, 04 Feb 2022 23:47:47 GMT

The Outsider, a young man who felt different and defective in his family, experiences and appreciates his therapist's validation and encouragement.

“I told my Mom I wasn’t coming come for Christmas,” Doug says, adopting a calm, matter-of-fact tone. “It didn’t go over well. She kept telling me I couldn’t split the family over politics, that family was more important. And I kept telling her nothing was more important than what’s happening to our country and, besides, as she might have noticed at Thanksgiving, our family was already split. Then she told me she didn’t know how I got so brainwashed, that I was brought up in a good, solid Republican family and how did I end up being so liberal. Unlike my brother’s reaction, she didn’t call me crazy or a Communist, so at least she hasn’t painted me as evil incarnate.”

“So how do you feel, Doug? How do you feel not going home for Christmas? How do you feel being the odd person out in your family?”

“Hmm. I didn’t think I was feeling much about it, but when you just asked, I don’t know, I guess it made me feel sad, like maybe even lonely. I mean my girlfriend and most of my friends think like I do, but still, my family is my family. I wouldn’t want to lose them. That’s really why I came to see you to begin with, feeling separate, apart, isolated even when I’m with a bunch of people.”

“Yes, you said you didn’t know why you should feel so alienated, when so many people obviously cared about you.”

“Yeah.” Pause. “But maybe I never felt really cared about in my own family.” Pause. “I mean, I was always different. My family is really into sports, group games, tossing around a football. That’s never been me. I was always the stereotypical shy kid who had my head in a book or, which I loved most of all, drawing, painting, looking to see how I could capture the essence of the world on a piece of paper.”

“No wonder you’re an artist,” I say, smiling.

“Well, I’m trying. But meanwhile I’m sort of making a living giving art lessons.” Pause. “My father keeps trying to talk me into being a financial planner like him, going into his firm, but that’s absolutely the last thing I want to do. I can’t imagine staring at numbers all day and trying to make more and more money. There’s so much more beauty in life.” Pause. “But that’s the problem, I’m different, always have been.”

“I guess my question is, why is being different a problem? Are you saying that in your family being different was automatically seen as bad?”

“Defective. I think that’s the word. There was something wrong with me. There was something wrong that I’d want to try to draw a perfect rose, to get the color absolutely right, rather than screaming at a football game. My Dad used to call me a sissy. I think he worried I’d turn out gay. That would have been a nightmare, gay in my family! When I was younger, I worried about it a bit too, but once I hit adolescence there was no question I was into girls. It was a relief actually. And I never had problems with girls. Girls liked me. Probably because I was sensitive and cared about them. And all that helped. But it still didn’t take away the feeling of being different.”

“Feeling different and feeling defective aren’t the same.”

“That’s true. I guess sometimes I feel one and sometimes the other. But the defective feeling doesn’t go away.”

“What about your mother? How did she see you?”

“Hmm. This might sound strange, but I guess kind of neutrally. I mean I know my mother loves me, and she never saw me as negatively as my Dad, but I don’t know. I think I was just sort of there for her and she knew she had to take care of me and she did what she had to do.” Pause. “This is a little embarrassing, but you know earlier when you smiled at me and said, ‘no wonder you’re an artist,’?”

I nod.

“Well, that’s not a response I ever would have gotten from my Mom. It’s like you were pleased with me, validating me. I never felt that in my family.”

“That’s really sad, Doug,” I say, feeling both his sadness and my own. “Thank you for telling me.”

Tears fill his eyes. “There you go again, giving me something I would never have received in my family.”

I smile. “It sounds as though you’re going to be able to take in my validating words and, as you do, I suspect you’ll come to feel less defective and less lonely.”

Emptiness | by Linda Sherby, Ph.D, ABPP

Tue, 23 Nov 2021 05:06:50 GMT

In today's blog, "Emptiness," a therapist helps her patient explore her feelings of despair about her husband's terminal illness and his decision to stop all treatment.

“I can’t understand it,” Valerie says sobbing. “Why would he want to leave me? We said it was forever. He’s breaking his promise! It’s not fair!! This should have been the best time of our lives. Approaching retirement, soon able to travel wherever we wanted. And now I’m just going to be alone.”

“Valerie, is Dave really choosing to leave you?” I ask gently.

“Of course he is. The doctor said there were several other chemo options he could try.”

I am more than familiar with the pain of losing a life partner, so I know to tread carefully in this most difficult of life experiences. “Can you understand Dave’s decision to stop further treatment?”

“No. Definitely not.”

“Do you have a living will, Valerie?”

“Yes, of course. I wouldn’t want to be kept alive if I was in a vegetative state, or if my mind was totally gone. But that’s not where Dave’s at.”

“Where is Dave at? What’s his quality of life? How does he spend his days?”

“He’s in bed a lot. He’s always tired. He sleeps. I know it’s partly from the lung cancer and partly the pain medication. But we still have conversations. We still sleep in the same bed. Sometimes we watch TV together. He coughs all the time, sometimes says he can’t catch his breath. Tells me he has a lot of empathy for Covid patients but he also says…” Valerie breaks off, puts her head in her hands and sobs.

When she composes herself she continues, “He says at least they have vaccines for Covid now and new medications and that at least Covid patients have the chance to get better and live normal lives. He no longer has hope. But I have hope. He could try some of these other drugs, these other regimens.”

“It sounds as though Dave is very tired, Valerie.”

She sobs again. “You think I should let him go?”

“Sounds like he’s saying he’s had enough.”

She sobs. “I’m so scared. I’m going to miss him so much. I’m not saying our marriage
was perfect, no marriage is perfect I know that. But we’ve been together for over 30 years. I don’t know what it’s like to live alone. I’ve never lived alone. I lived with my parents then roommates and then Dave. I just see myself locked in that house rotting away.”

“Rotting away? That’s a very graphic image. What makes you think you’ll rot away?”

“I don’t know. I guess like old food in the refrigerator that is left and forgotten about and just rots away. Like no one would know whether I’m alive or dead.”

“I don’t in any way doubt that you’re describing your feelings, but it’s surprising to me that you picture yourself so desolately. Before your husband’s illness you seemed to have a very active social life, to be involved with lots of people, in lots of different ways.”

“All meaningless. And besides, it was my husband who was the social one. Left on my own I just rot.” Pause “There’s that word again, rot.”

“Do you feel as though you’re rotten, Valerie? Rotten as in bad?”

“No, I don’t think I’m bad.” Pause. “I just think I’m not much of anything. Kind of a blob. My husband brought life into our home. Left to my own devices I’m afraid I’ll be swallowed by the emptiness.”

“I know depression can put a pall over everything, but this sounds like something more, like you’re literally afraid of disappearing into the void.”

“That’s it exactly. No Dave, no me, just an empty blob.”

Feeling more and more of Valerie’s despair, I ask, “And you felt that way as a child as well and as a young adult, like in college?”

“Well, there were my parents to tell me what I was supposed to do and then, as I said, I had roommates and sort of followed along with the crowd.”

“It sounds, Valerie, as though you’ve spent your life following along with whomever you’ve been with. And now, with Dave’s decision to stop treatment, you’re confronted with the terrifying feeling of not knowing who you are apart from him, and perhaps of never knowing who you were.”

“I’m terrified. I think you’re absolutely right and that makes me need Dave even more. Do you think I can persuade him to continue treatment until you and I can work this out? Until you can fix me?”

“Right this minute you may feel that you need Dave more, but nothing has actually changed. We definitely do need to work on your feeling more your own sense of self, but whether Dave will stay around until we accomplish that I can’t say.”

“I’m not sure I can survive. I want to survive but I’m not sure I can.”

“You just said something very important. You said you want to survive. That’s you, Valerie, knowing what you want.”

Self = Bad | by Linda Sherby, Ph.D, ABPP

Tue, 19 Oct 2021 00:21:52 GMT

Self = Bad, describes a challenging se4ssion for a therapist whose patient is determined to see herself as bad.

“So I’ve been thinking about where we ended last time,” Paula says, starting right in from our previous session. “You said we’d need to figure out why I can’t forgive myself for not being more attentive to my mother when she was dying. I’ve thought about it and I don’t see why I SHOULD forgive myself. I know I was a teen-ager, but I was old enough to know better. I did know better. I was being cruel and nasty and just plain BAD.”

“So what made you bad?”

“I suppose I was just born that way – selfish, self-centered, only caring about myself. And that’s how I was being when my mother was dying, paying attention to me not her.”

Convinced of the futility of arguing with Paula’s view of herself, I pursue an alternative approach. “How does it feel for you to see yourself as selfish and self-centered?”

“It feels …” Pause. “It feels accurate and true and I guess kind of shitty….” Pause. “And familiar.”

“Familiar?”

“Yeah, like I’ve always seen myself like that.” Pause. “And I guess my parents, especially my mother, always told me I was selfish, like ‘why can’t Monica go with you to the movies?’ My mother was always trying to get me to take my sister along with me and my friends.” Pause. “I hated Monica. I hated her from the moment she was born. Everyone fussing over the baby. I didn’t see anything so special about her. She just lay there and stared. And then when she turned out to be autistic, well that just made everything worse. All the attention went to poor Monica, understanding Monica, making allowances for Monica. But you see, you see how selfish I am, wanting all the attention, wanting Monica and all her problems to just disappear.”

Here again I feel the pull to reassure Paula, to tell her she was just a child who of course had angry, rejecting feelings towards her younger, challenging sister. Yet I know that Paula will only dispute what I say. “Paula, if I were to try and reassure you, to tell you all children have negative feelings towards their siblings, you’d tell me that your feelings were worse, stronger, more heartless, right?”

“Yes. Because it’s true. And you’re only trying to make me feel better. But I don’t deserve to feel better.”

“Why don’t you deserve to feel better?”

“Because I’m bad, very bad.”

“It sounds as though being bad is almost like a core sense of who you are. Being Paula equals being bad.”

“Yes. I’m bad because I hated my sister and didn’t want to be there for my mother.”

“I wonder if you had fantasies about killing your sister.”

She nods. “See, I told you I was bad, worse than bad, evil.”

“It’s not unusual for children – or adults for that matter – to have fantasies of killing a sibling, or a parent, or boss or whomever. But I suspect my saying that isn’t going to make you feel any less bad.”

“I’m bad. I’ve always been bad. My grandma used to tell me that I was like that girl in an old movie, “The Bad Seed,” I think she called it.”

“Why did your grandma think you were bad?”

“She never liked me. She thought I was mean to both my mother and sister. And she doted on Monica. The sun rose and set on Monica.” Pause. “I think grandma might have been on the spectrum too, but of course no one talked about that.”

“Paula, do you have a sense of who you’d be if you weren’t ‘bad?’”

“But I am bad.”

“I understand that’s your view of yourself. But I’m asking if you can imagine you as someone who isn’t bad.”

“No, that’s impossible.”

“So that’s one of the big problems we have here. Being ‘bad’ is such a core sense of yourself that to imagine anything else is destabilizing. It’s like you said, being ‘bad’ feels familiar.”

“It’s familiar because it’s accurate.”

“Do you want me to dispute that with you right now?”

“What do you mean?”

“Well, it feels as though you’re almost asking me to say ‘no, that’s not so.’ But If I disagree with you, does that give you the hope that you might in fact not be bad or does it just help you shore up your argument when you counter me?”

“I’ve never thought of that.” Pause. “I wouldn’t want you to think I’m as bad as I think I am.” Pause. “So I guess maybe I am hoping that I could eventually see myself as you see me. It makes me sad when I say that.”

“I understand that. If you see yourself through my eyes, it means giving up seeing yourself through the eyes of your parents and your grandma, which means leaving them behind and bringing up feelings of loss and sadness.”

An Apology | by Linda Sherby, Ph.D, ABPP

Tue, 14 Sep 2021 23:33:26 GMT

"An Apology" presents a session in which a patient and her therapist seek to understand the patient's depression after her previous session, as well as her reaction to her therapist's apology.

“I’ve been depressed since our session this past Monday,” Paula begins. “I’m not exactly sure why.” Pause. “I guess it’s because we were talking about my mother’s death – for a change – and that always makes me depressed. It’s been almost 20 years for God’s sake, I don’t see why I can’t let it go.”

“I know you get depressed when we talk about your mother’s death, Paula, but I thought about our last session too. I feel as though I was pushing you too hard and I want to apologize for that.”

“That’s what you get to do. If you didn’t push me, I’d be even more stuck than I am already.”

“I don’t know. You were talking about your guilt about your mother’s death and although it’s true that from my perspective you have nothing to feel guilty about, what matters is your perspective. I don’t think I gave you enough of a chance to talk about your feelings, including your guilt feelings.”

“My mother died of cancer. I get that I was a teen-ager, more preoccupied with my own life. But I could have gone to the hospital more. I could have spent more time with her. I could have just sat holding her hand.” Pause. “Besides, why would I get depressed if you were pushing me to not feel guilty? You’d think I’d appreciate it.”

“Well, what is one of the big problems you had with your mother even before she got sick?”

“She was always in my face, always on top of me, telling me what to do, telling me what I should think, what I should feel … Oh! I get it! You think you were being like my mother, intrusive like my mother”

“Yes.”

“Hmm. I guess that’s a good point.” Pause. “But I still don’t know why that would get me depressed.”

“Well, what did you feel when I was pushing you to not feel guilty”

“I don’t know if I felt it then or whether I’m feeling it now that we’re talking about it, but right now I guess I do feel, hey, isn’t this where I get to talk about my feelings? How come you’re not letting me feel what I feel? I thought that’s what I get to do here!” Paula pauses. On my video screen I watch as she drops her head, her straight brown hair falling forward over her face. “I’m sorry,” she mumbles, “I didn’t mean to get annoyed.”

“Paula, what just happened? You seemed to go from a person expressing her feelings and her right to be heard, to what seemed to be a scared, apologetic little girl?”

“I felt guilty for being ang… annoyed at you.”

“So you can’t even say you’re angry at me.”

“I’m afraid to be angry at you.”

“Because?”

“I don’t know,” she says in a barely audible voice.

Silence.

“Your anger feels dangerous?” I ask.

She nods. “I was angry at my Mom and look what happened to her. It’s much better to keep it tucked safely away.”

“Except it’s never ‘safely away.’ It’s turned inward on yourself so that you end up feeling depressed.”

“So you’re saying I was depressed after last session because I was angry at you and turned it on myself, not because my mother died? That makes me sound even more selfish and self-centered!”

I feel the urge to argue against Paula’s interpretation of her depressed feelings and wonder if her way of being self-deprecating, tends to elicit a reassuring, albeit intrusive, response from me. Do I feel a similar pull with other patients? Does Paula unconsciously set up this dynamic?” I’ll have to think about all that, but right now I need to respond to Paula.

“I think you can be depressed for more than one reason, but it sounds as though you’re saying you should feel depressed about your mother’s death.”

“Yes, of course I should feel depressed about my mother’s death. She’s dead!”

“You can certainly feel sad about your mother’s death, but I don’t know that carrying depression around as a heavy weight that burdens all aspects of your life is at all helpful.”

Paula sighs. “I guess after almost 20 years I should be able to cut myself some slack.”

I nod, smiling.

“But why is that so difficult for me?”

“I guess because you still feel the need to punish yourself.”

“I think you’re right.” Pause. “But what can I do about that?”

“I guess we’ll need to talk more about why you can’t forgive yourself for what you see as your adolescent ‘sins.’”

Good-bye Again | by Linda Sherby, Ph.D, ABPP

Sun, 15 Aug 2021 18:49:03 GMT

Today's blog, "Good-bye Again," deals with the spike in Covid cases necessitating a return to virtual treatment yet again, leaving both patient and therapist to deal with a myriad of feelings.

Although it is not my norm, today I begin Laurie’s session. “I need to tell you, Laurie, that starting next week I’m going back to working from home.”

“What?!” she shrieks. “You’ve got to be shitting me! We just came back to your office! You know how much I need to see you. You can’t do this to me. You can’t, you can’t,” she says sobbing, her face buried in her hands.

“I knew this would be very difficult for you, Laurie, but you know how Covid cases are tearing through Florida. I can’t risk your health, mine or anyone else’s.”

“I hate you! I hate you!! You’re like a big tease. ‘Here I am and now I’m gone!’ I can never rely on you. I can’t rely on you any more than I could rely on anyone else.”

Although I know it’s very unlikely to help Laurie to feel better, I feel compelled to say, “Remember when you felt just seeing me once would be reassuring to you, would convince you that I was indeed alive and not a figure of your imaginings.”

Laurie looks at me scornfully. “You’re joking, right? What does it matter what I was feeling then? This is now and I feel like crap and it’s your fault.” Pause. “What if we wore masks?”

“You know the answer to that, Laurie. I wouldn’t be able to hear you and it’s impossible to do therapy if I can’t hear you. We can do therapy without seeing each other, but it’s impossible to do therapy without hearing each other.”

“So there’s no compromise?”

“I don’t know if it’s a compromise, but you now know that we will see each other at some point, we will be back in the office as soon as it’s safe.”

“As soon as YOU say it’s safe!”

“Yes, that’s true. It is my call. And that is part of what I do, Laurie, keep us both as safe as possible.”

“You’re talking about my mother, right?”

“Yes. She didn’t keep you as the six-year-old child safe when she killed herself and she certainly wasn’t keeping herself safe.”

“But I don’t see how that helps me now!”

“Well, I may be mistaken, but it seems to be that you are feeling a little calmer right this minute.”

“I’m feeling depressed. I’m feeling I have to deal with yet another loss, the loss of you. Makes me very sad.”

“Do you feel depressed or sad?”

“You always ask me that. I can never tell the difference.”

“Depression is more a feeling of numbness, of nothingness. And it’s often a result of anger turned inward, like turning your anger at me in on yourself. Sadness is more acute, more intense and is often about mourning.”

“I’m feeling both. I don’t want to be angry at you. It scares me. What if I’m angry at you and then you get Covid? I’d feel horrible, guilty. I wouldn’t want that to be the last thing you remembered of me. But I also feel this huge loss. I know, you’ll say I’m still mourning my mother, and maybe I am. But it’s also about you. I need you so much and it is so good to see you in person and it just feels like this huge emptiness, again.”

“I do understand, Laurie. It’s a loss for me too. It’s been wonderful seeing you in person, actually having you as a real, live person in my office. But it’s not forever, unlike with your mother.”

“I wish you wouldn’t keep bringing her up.”

“Because…?”

“Well, what first jumped in my head, is that it feels like you’re trying to pass the buck, trying to get me to talk about her rather than you.”

“That’s a really good point, Laurie. Maybe you’re right. Maybe I also was trying to move away from the sadness between us.”

“Really! Wow, I’m surprised. I’m surprised that you’d feel that and, truthfully, surprised that you’d admit it.”

I smile. “Therapy is a place I get to be truthful too, it’s a place I get to reflect on myself just as you do.”

Tears fall down Laurie’s cheeks. “You see, that’s why I love you so much, that’s why I miss you, you’re such an amazing special person. There’s no one in the whole world like you.”

“Remember how much you hated me at the beginning of the session? I’m neither a horrible, evil person nor a saintly one. I’m both. And it’s important that you try and hold onto both parts of me.”

“But now I have to say good-bye again and that makes me really, really sad.”

“Yes, it is sad, but we’ll talk to each other next week and we’ll both be very much real and alive.”

Too Close | by Linda Sherby, Ph. D, ABPP

Sun, 18 Jul 2021 05:48:23 GMT

Today's blog is entitled "Too Close." In it a therapist helps her patient explore her reluctance to get close to others, including her resistance to returning to in-person treatment.

“I went out with Charles again last night,” Ashley begins. “You know the guy I met on Match who I’ve been out with a few times.”

“I remember,” I say, nodding at the computer screen. “You kind of liked him.”

“I guess, but he was a little too much last night.”

“Meaning?”

“I don’t know. Like he started telling me all about his childhood, which was pretty terrible. He was physically abused by his mother, like really bad. And he wanted to know all about me. I’m not sure I was ready for that.”

“What made you uncomfortable?”

“What if we don’t work out? Why should I tell him all about me? Does he really need to know that my mother died of cancer when I was four and that my father wanted nothing to do with me?”

“I’d say there would be no reason for him not to know.”

“I never understand why you feel I should be blabbing my whole life to anyone and everyone.”

“Well, if you’re not presenting who you are to people it’s kind of impossible to get close to them and it takes a lot of energy to be play acting through a large part of your life.”

“Aren’t you play acting? Isn’t being a therapist all play acting?”

“In what way?”

“You could be in terrible pain right now, physical or emotional, and you wouldn’t tell me about it, right?”

“That’s true. We do all have roles that we inhabit in our lives and…”

“See, I told you! So I’m no different than you or anyone else!”

“We all have roles that we inhabit. Being a therapist is one

role, just as being an attorney is another. And, no, in our professional roles we’re not telling everyone everything about us. You’re not going to be in front of a judge and say, “Your Honor I can’t try this case today because I had to put my dog down yesterday and I’m a total basket case. But yesterday, when you put your dog down – obviously I’m just using that as an example – would you have been able to call a friend and say I need to talk?”

“I don’t have a dog,” Ashley says matter-of-factly. “I don’t want a dog.” Pause. “Actually, dogs are kind of like that guy last night. They want too much. They’re always there, always begging. I guess you’ll say that’s my need to keep my distance.”

“Yes, I would. And there’s the question of why that distance feels so necessary for you.”

“It just popped in my head that we’re back in your office next week. I don’t like that idea either. This is much more convenient. I don’t have to drive to and from your office. I don’t have to waste time sitting in your waiting room. I just turn on my computer screen and here you are.”

“So I assume by bringing that up right now, you’re making the connection that returning to my office feels closer – literally and figuratively - than virtual therapy.”

“Right. And I’d prefer continuing just as we are.”

“So do you have any thoughts about what makes closeness so uncomfortable?”

“It’s messy. People are just so needy. They want so much. Just like a dog.”

“Are you needy, Ashley? Do you want so much?”

“Me? No way! I can take care of myself.”

“I think you learnt that early on. If there’s no one really there for you, you learn that you have to take care of yourself.”

“Right!”

“But there’s a problem with that, Ashley. When you were four years old you couldn’t take care of yourself. You were a helpless, dependent little girl who just lost the most important person in your life. That little girl is still inside you. She still wants and needs and longs for someone to care for her…”

“Ugh! That’s disgusting. I hope that’s not true. And if it is true I want her gone, poof! Like she never existed.”

“I wonder, Ashley, if that’s exactly the reason you didn’t like the man you saw last night and the reason you don’t want to return to in office visits and the reason you don’t want a dog, all of that brings you closer to that dependent, childhood part of yourself.”

“So what should I do about it?”

“Well, first we’ll resume in office visits and we’ll talk about how that feels for you. And when you’re with someone and feel the need to get away, maybe you can try to pay attention to what you’re really trying to get away from. I suspect it might be the needy part of yourself.”

“What if I just avoided people?”

“Well, what do you feel when you avoid people? What did you feel when we were locked down in the pandemic?”

“Lonely. Like something was missing.”

“I guess that’s your answer.”

Endless Despair| by Linda Sherby, Ph. D, ABPP

Wed, 09 Jun 2021 01:02:09 GMT

Endless Despair, a therapist attempts to help her patient understand how her tie to her critical mother fuels her recurring feelings of sadness and depression.

“I don’t understand,” Amber wails over the phone. “I was doing fine. I had a good day. I took my dog for a long walk. And then with one phone call I’m a wreck. I can’t stop crying. I feel as though I want to beat my head against the wall,” she says sobbing.

“Can you tell me what happened during the phone call?”

“Nothing! I mean nothing that would lead me to feel awful. I don’t understand. Why doesn’t it stop? Why do I always, always feel so awful?”

Having seen Amber for several years, I realize nothing I say at this point is likely to be of help. Still, I reply, “You don’t always feel awful. You were just telling me you were having a really good day.”

“But it always comes back! Why does it always come back?”

“Part of the problem for you is that when you feel awful, the feeling takes you over completely and you can’t remember that you felt really good yesterday or the day before.”

“But why does it always come back?”

“What’s the ‘it’ that always comes back?”

“The bad feelings. They always come back.”

“You know, that’s a really good question. Why do your bad feelings always come back? Like today, you said you didn’t think the phone call should have triggered your bad feelings, but it did. And perhaps I should ask what specifically you mean by bad feelings.”

“Sad feelings. Depression. Feeling everything’s pointless.”

“Okay. So why do your sad, depressed feelings always come back?”

“I don’t know!”

“Well, what did happen on the phone call?”

“My boss told me I did a really good job on the marketing project. She had a few minor corrections, but basically complimented me on a job well done.”

“And you felt how about that?”

“While I was on the phone with her I felt good, pleased. But then, I don’t know. It just washed over me and I felt like shit.”

“What washed over you?”

“Despair. Like what does it matter anyway. It’s just a stupid marketing job, for some stupid liquor company that’s just going to turn people into alcoholics.”

“Whose voice is that, Amber?”

“It’s mine.”

“Yes, but isn’t it also someone else’s voice? You’ve certainly told me that your mother was always critical of you, always telling you what a failure you were, how you couldn’t do anything right.”

She sighs. “Yup. That’s my mother.”

“So when you were talking to your boss you could take in your her voice, you could take in the compliment. But when you got off the phone, your mother’s voice returned with a vengeance.”

“I guess so.” Pause. “But why?”

“What are your thoughts?”

“I certainly heard her voice a lot longer. It’s louder, telling me how stupid I was and that I’d never amount to anything. And she still does. Why did I go into marketing? Why couldn’t at least have been a teacher? Why aren’t I married? Why am I such a bad daughter, etc., etc.”

“Yes, her voice is louder. And I also wonder if you’re invested in staying attached to your mother’s negative voice.”

“Why?”

“If you move away from your mother’s voice, maybe it’s like moving away from her, leaving her behind. And she is, after all, the only mother you ever had.”

Amber starts sobbing. “I can’t leave her. I can’t. I’d feel way too guilty.”

“Plus, if you take in more positive voices and leave your mother behind, you’d also have to mourn never having the mother you wanted or deserved, not as a child and not as an adult.”

Amber continues sobbing. “I can’t! I can’t! You can’t make me! Oh my God, I’m being swallowed up by those bad feelings again!”

“No, Amber, I can’t make you. I neither could nor would force you to do anything. But I think you can see how terrifying the thought is for you, the thought of moving away from your mother, of mourning who she isn’t and wasn’t.”

More sobbing. “But maybe she’s right. Maybe I am bad and stupid and incompetent, maybe that’s why she couldn’t be nice to me.”

Softly I say, “I understand that it feels safer to take the badness inside you, to take it away from your mother, so that as long as it’s inside you you can hold onto the hope that if only you were different she would treat you differently, would love you more.”

“Wouldn’t she?”

“Only you can answer that, Amber, but from what you’ve said, it sounds as though your mother was rejecting of you from the moment you were born, for her own reasons, stemming from her own problems, but extraordinarily destructive and painful for you.”

“I can’t. I just can’t.”

“I understand. You can only do what you can do. And we’ll keep working, working at a pace that you can tolerate, that isn’t unbearable to you.”

A Dream| by Linda Sherby, Ph. D, ABPP

Wed, 12 May 2021 01:18:52 GMT

"A Dream," a patient and therapist work together to understand and detoxify the patient's dream.

“I’m so glad I’m talking with you today,” Rose stays, starting immediately. “I had this awful dream last night and it’s haunting me. The specifics are kind of vague at this point, but the feeling it left me with is very clear - horror. And it was like a horror movie or something out of a scary sci-fi movie, neither of which I ever watch. So it was like this force, not sure what the force was – people, aliens, I don’t know. I don’t know that I ever saw any particular thing or person, I guess that’s why I call it a force - that was going around and doing something to people so that they looked like their whole body had been burned and like instantly turned to ash and dissolved. Ugh! It makes me shudder just to think about it. And I guess I was going around trying to avoid this thing, but also to warn people, people I knew and cared about, that they were in danger. I think I had a better idea when I first woke up who some of those people were, but now I’d just be making it up. I keep shaking my head wanting that image of people dissolving into ash to go away.” She takes a breath. “So what do you think?”

“I can certainly understand how disturbing a dream it was,” I say, impressed with how Rose has managed to convey her horror so well over the telephone. “What are your thoughts?”

“I don’t know. I was watching this TV show that had a cancer patient in it last night and it struck me how he seemed to be being eaten up from the inside out.”

Silence.

“I just keep feeling the horror.”

“Where does that feeling take you?”

“The horror? I guess the horror of the pandemic, of how many people have died. Oh! I guess that could be the force, the unseen virus, killing all these millions of people.” Pause. “But I wonder why I’d have the dream now. Things do seem to be getting better, at least for us. I’m vaccinated, most of the people I love and care about are vaccinated. Why now?”

“You said you thought there were specific people you were trying to save. Even if you have to make it up, who do you think some or one of those people were?”

“My mother comes to mind. She’s been dead for over 10 years now. She had a long life, almost 100 and she was pretty good until the last few years. She was ready to go. That made it easier for me, although it was still hard losing her. Painful, but not horrifying.”

Silence.

“What are you thinking about?”

“First I was thinking about this article I read about how deaths to overdose have skyrocketed during the past year. That feels like another force taking over people, especially young people. But then I ended up

someplace entirely different. I was thinking of the horror of growing up in my house, of my parents screaming and screaming at each other, of us cowering in the corner waiting for my father to start beating up on my mother or turning on one of us. He was definitely a force to be reckoned with, although he was a specific person, a tangible force, not a sci-fi character.”

“Maybe that made him even more scary. You couldn’t just turn off the TV.”

“That would explain why I was trying to save my mother. I was always trying to save my mother and feeling awful that I couldn’t.” Pause. “But still, I don’t know why I’d be dreaming about this now. This is an old story. Why now?”

Silence.

“Any thoughts about people being turned to ash and dissolving?”

“Cremation. Lots of cremations during the pandemic.” Pause. “The Holocaust. That was certainly a force of evil. Hitler, the gas chambers. But it doesn’t seem to be about that either. It felt more contemporary, like right now.”

“All right. Right now, what’s horrifying you, scaring you, threatening you?”

“Aging. I turn 65 next month. I know that’s not old these days, but I worry about aging, about who will take care of me if I’m ill or incapacitated in some way. And I suppose death itself feels frightening, the unknown, the aloneness. Death is a pretty scary, menacing figure. You think that’s what the dream’s about?”

“It’s certainly possible. And it’s also possible that it’s about all the things you’ve talked about today.”

“I suppose.”

“What are you feeling now?”

“Definitely not as horrified. Talking about it made it less scary. I feel more removed from it, like it’s something to look at and to figure out.”

From Father to Son| by Linda Sherby, Ph. D, ABPP

Mon, 15 Mar 2021 23:38:30 GMT

"From Father to Son," a therapist helps her patient see how his relationship with his father affects his feelings about his own son.

“My son’s home on Spring break,” Craig says, looking forlorn.

I wait.

“I know I should be happy, glad to see him. He’s a good kid, getting great grades in college, actually thinking about becoming a psychologist,” he says with a wry smile.

“But you’re not happy.”

He shakes his head. “And I hate myself for it!” Pause. “You know, I told you my father was an ass, always criticizing me, always telling me all the things I’d done wrong. He was the perfect one, I was the incompetent fool. Made me the anxious, insecure mess you see now.” Pause. “It’s not that I’m like that with my son Daniel. I’d kill myself if I was like that. I swore to myself I’d never be like that with my kids and I haven’t been. It’s more what I feel inside. And I’m so ashamed, how could I be such an awful person? It’s not like that with Britany, my daughter. We have a great relationship, so easy to spend time with, so easy to talk to.”

“So what is it that you feel about your son?” I ask.

“Jealous. Jesus, I hate that about me, what an awful thing to feel about your own son.”

“Beating yourself up for your feelings isn’t helpful to you. Or to your son for that matter. It would be better if we could understand your feelings. What do you feel jealous about?”

“It’s so embarrassing, but I’m jealous about everything. I’m jealous of his relationship with my wife. I’m jealous about his ease in the world. I’m jealous he has all these friends. I’m jealous that he already has a sense of purpose. I’m jealous, I’m jealous and I’m sick of myself.”

“It sounds like you’re saying you’re jealous of Daniel because he’s had a much easier time in himself and in the world than you had.”

“And what kind of father is that?! Fathers are supposed to want more for their children, want their kids to do better than them. And me, I’m a despicable jealous fool!”

“You certainly still carry your father’s critical voice with you inside your head, condemning yourself for who you are and what you feel.”

“But I should condemn myself. How else could I feel?”

“Well, you might feel compassion for yourself and, again, try to understand where your feelings come from.”

“It’s not only how I feel, it’s how I act! It’s not that I’m critical of Daniel but I’m – I’m not sure what to say – I’m distant, reserved and I worry how he interprets my coolness.”

“Do you think your father felt jealous of you?”

“What?! No. I told you, he thought I was an incompetent jerk.”

“But maybe he needed you to be a, quote, ‘incompetent jerk.’ Maybe he needed you to be less than him so he kept you down by being critical and demeaning. I don’t mean he knew all that consciously, but unconsciously he might have experienced you as a dangerous competitor.”

“I don’t know what to say to that. It’s like turning my world on its

head.” Pause. “And what would that mean in relation to Daniel?”

“Well first, as I said, you carry your father’s critical voice with you in your head. That critical voice certainly gets turned against you, but it sounds like you’ve also been afraid you’d turn it against Daniel and rather than do that, you’ve withdrawn from him.”

“Wow, that makes sense. I’m not sure what I do with it, but it makes sense.” Pause. “What about Barb, my wife?”

“What are your thoughts?”

“Barb always doted on Daniel. Britany was our first born, but I thought Barb always favored Daniel. I don’t know why, maybe because he was a boy and she lost her father shortly before Daniel was born. I guess I was jealous then, jealous of their bond and I worried that she was indulging the boy. Wow! I do sound like my father when I say that. My father was always telling my mother she was spoiling me, but unlike Barb my mother would immediately stop however she was being to me and side with my father.”

“So you lost your mother to your father. Are you saying you feel as though you lose Barb to your son?”

“I don’t know. Maybe. Especially since we’ve gotten older, you know, as the passion dims.” Pause. “I feel as though my heads spinning.”

“We have dealt with a lot today. Some of it might make sense intellectually, some not, but there are certainly a lot of feelings to work through on an emotional level. For sure, your relationship with your father has affected your being a father and that’s pretty much true for everyone.”

“So I’m not a freak?”

“That’s you father’s voice again, Craig. And, no, you’re definitely not a freak.”

Being Vaccinated| by Linda Sherby, Ph. D, ABPP

Fri, 12 Feb 2021 16:44:00 GMT

"Being Vaccinated," as a therapist deals with her patient's aversion to receiving the Covid19 vaccine, the patient-therapist relationship comes to the fore, as does the question of caring and being cared for.

“So I know I’m locked in the house like everyone else and hating it and ready to strangle my husband, but I really need to talk to you about my daughter. She’s driving me crazy,” Paula says, barely stopping for a breath. “She just doesn’t stop. ‘Mom, did you get the vaccine? Have you tried getting the vaccine? Have you signed up through the Department of Health? Did you try your local grocery store? What about Dad?’ She doesn’t stop. You have to tell me what to do.”

Paula, who I’ve only ‘seen’ for a few sessions via the telephone, is a seemingly headstrong, stubborn, opinionated 67 year old woman. “What should you do about…? I ask.

“About her of course! What should I do about my daughter constantly bugging me?”

“What have you done?”

“Nothing.”

“Nothing? But what do you say to your daughter when she asks you about being vaccinated?”

“I just put her off, you know, like saying ‘not yet’ or ‘it’s not in the area yet.’”

“Do you plan to get the vaccine?”

“Not if I can help it!”

“Because…?”

“I’m not into being a guinea pig! Who knows what the government is putting into those vaccines? How do we know they’re safe? They’re so new. Maybe they’re giving it to all us old folks first because they think we’re disposable. Who cares if some old people die! I didn’t trust Trump and I don’t trust Biden any more.”

Although I knew that Paula was distrustful of others, I hadn’t recognized the extent of her suspiciousness. I tread carefully. “So why haven’t you told that to your daughter?”

She scoffs. “My daughter’s a doctor. She’ll laugh at me and tell me I’m crazy.”

Although I find myself agreeing with my patient’s daughter, I stall for time by asking an inane question. “What does your husband think?”

“He doesn’t care. He’ll do whatever I say. We’re both healthy. I mean I know we’re both over 65, but we’re in good health. Why take any chances?”

“And yet you’re comfortable taking your chances with Covid?”

“Maybe.”

“I’m sorry. I’m not sure what you mean.”

“How do we know the whole thing isn’t a hoax? Maybe there is no Covid. Maybe it’s all just a big scam.”

“And what would be the purpose of this scam?”

“I don’t know. Maybe to try out these experimental drugs for some future disease, some other virus that strikes 25, 100 years from now. Who knows.”

I sit with my anxiety for a moment until what I hope is aninspiration strikes me. “You know, Paula, since you’re so reluctant to share your reservations about the Covid vaccines with your daughter, I’m impressed that you feel comfortable telling me about them.”

Silence. The silence continues.

“Paula, are you there?”

“I’m here.”

“Okay. Good.”

Silence.

“I’m supposed to tell the truth here, right?”

“Yes. That’s definitely helpful.”

“Well I know this sounds terrible, but I can tell you because you don’t matter. My daughter matters to me. What she thinks of me matters to me. What you think of me doesn’t matter because you don’t matter to me. I pay you to give me a service. Beyond that you’re irrelevant. Does that sound terrible?”

“Well,” I say cautiously, “it’s definitely honest.” I pause, trying to gather my thoughts and think of an appropriate response. Speaking softly, I say, “I wonder what it means that I don’t matter to you, that you can so easily dismiss me as irrelevant. I wonder who in your life has made you feel you don’t matter. I wonder if you yourself feel you don’t matter. And I wonder if one of the reasons you’re so suspicious about the virus or the vaccines is that it’s hard to believe that anyone could feel you’re important enough to care about.”

“Are you saying I should care about you?” Paula responds, understandably not able to take in what was a long, complicated interpretation.

“Only you can answer that.”

“Well, I don’t know if I can or if I should care about you.”

“I understand. I think perhaps our first questions should be whether you’re able to care about you and whether you’ve felt cared about by important people in your life.”

“You mean like my parents?”

“Yes. As well as others.”

“I told myself I wasn’t going back, that I wasn’t going to dredge all that stuff up.”

“Yet you chose to see me, a psychoanalyst, so perhaps part of you wants to dredge all that stuff up.”

“Nonsense!”

“But we’re meeting again next week, right?”

“I suppose,” Paula responds grudgingly.

“I’m glad to hear that. I’ll talk to you then.”

What's the Big Deal| by Linda Sherby, Ph. D, ABPP

Tue, 09 Feb 2021 00:11:09 GMT

a patient and therapist as they work to understand how the patient's past led to her blunted response to the storming of the Capitol.

I don’t get it,” Marlene begins, her face appearing tense and puzzled on my screen. “Every time I talk to one of my friends or even exchange an email, they’re talking about how devastated they still feel about the storming of the Capitol. I agree, go along with it, so they don’t think I’m some sort of a weirdo, but I don’t get it. It was a building for God’s sake. Yes, 5 people died and I’m sorry about that, but I see people dying of Covid every day in the hospital, people who are scared and alone and broken. We’ve lost way more than 300,000 people to Covid and people are so distressed about a building! What’s the big deal?”

I’ve had many patients who were very distressed by the events of January 6, others who, not surprisingly to me, didn’t even mention it. But I am surprised by Marlene’s lack of emotional response. As a nurse she has been on the front line of the pandemic, so perhaps, I think to myself, she can’t allow herself to feel any more pain. Still, politics matters to her. She usually has very definite opinions, often accompanied by intense affect.

“It sounds as though you’re uncomfortable with your not experiencing it as a big deal,” I suggest.

“I suppose. I don’t know, it just makes me feel different. Which is certainly not a new feeling for me.” She sighs. “Poor white trash, daring to want to make something different of myself. That got me beaten at home for thinking I was better than them and bullied at school because those kids sure as hell didn’t think I was as good as them. Shitty beginning.”

“And you’ve taken yourself far from those beginnings.”

“Yes. And I haven’t told you, but I’ve been thinking of applying to school to be a Physicians’ Assistant.”

“That’s wonderful, Marlene. I’m so pleased for you.”

“You don’t think it’s crazy? I’m already over 40. And PA school is very competitive.”

“You know, Marlene, I think you just asked me if I think you’re being too uppity, going too far from ‘home,’” I say.

She chuckles. “I think you’re right.”

“So do you think it’s weird that I don’t feel more about the storming of the Capitol?”

“I don’t think it’s weird, Marlene, but I do think it’s unlike you.”

“So you had strong feelings about it.”

“I did. But I’m wondering right now why you are asking me all these questions rather than telling me more about what you’re thinking, what you’re feeling.”

“I guess I’m feeling weird, which takes me back to my childhood.”

“What specifically in your childhood?”

“All of us living in that three room house. All the screaming. All the violence. My Dad beating the shit out of me if he found me reading a book. All the kids at school circling me, jeering at my clothes.” Marlene’s eyes fill with tears. “Will those images ever go away? I want them to go away.”

“Let me ask you something, what brought those images back so vividly?”

Marlene’s eyes widen. “Oh my God, seeing those people storm the Capitol! That’s what brought those images back. Those were quote, unquote, ‘my people.’ Oh my God,” Marlene says sobbing. “Oh my God! It’s so awful! Of course I couldn’t take it in. It’s way too close, way too close. It makes me sick. I don’t want to be like them, I don’t, I don’t.”

“You’re not like them, Marlene. You’ve grown a long way from there.”

Marlene continues crying, tears streaming down her face as she stares at me on the screen. “I wish I was in your office right now. I wish I could feel your presence, like your presence would erase the awfulness of those images.”

“I wish that too, Marlene. But I do hope you can feel that I’m here for you.”

She nods. Grabbing a tissue, she blows her nose and wipes her eyes.

“So I couldn’t take in the horror of the mob attacking the Capitol because it brought me too close to my childhood experience? So I did what, I shut down, and didn’t allow the horror to penetrate?”

“I’d say that’s exactly what you did, Marlene. At first I thought you’d shut down because of all the months of dealing with the stress of Covid meant you couldn’t take in one more horror. But I’d say, you got way closer to the real reason you shut down, the need to distance yourself from the horrors of your childhood.”

Tag words: Psychotherapy, mental health, defense, patient-therapist relationship, childhood, violence, growth, ambition, numbness, shutting down.

I Feel Well | by Linda Sherby, Ph. D, ABPP

Tue, 15 Dec 2020 00:06:03 GMT

a patient and her therapist seek to understand why this troubled, depressed patient is faring better than usual during Covid and its restrictions.

“I realized the oddest thing this week,” Anne begins, her voice fairly upbeat as she speaks into the telephone. “I’ve been feeling okay.”

“That’s terrific, Anne,” I say excitedly.

“Yeah, I’ve been talking to you for how many years? And this is probably the first time I’ve ever said I feel okay. I can’t figure out why. Nothing has changed. I’m stuck indoors like everyone else. Our Covid numbers are spiking, I’m as terrified as ever of getting the virus and yet I’m okay.”

Anne is correct. I have been speaking with her for a number of years and this is probably the first time she has not described herself as depressed, anxious and isolated. We began working in person when she relocated to Florida to take care of her aging and always demanding mother, a long and arduous process that called upon all the strength Anne could muster and all the support I could give. After her mother died, Anne returned to New York, saying it felt like home, although she had neither friends nor career to return to. She did, however, now have sufficient money to live comfortably whether or not she could find a career path commensurate with her intelligence and education, leaving behind her unsuccessful attempts in retail or restaurants.

“What are your thoughts?” I ask.

“I don’t know. I’ve done the same thing these past several weeks as I’ve done for months, or even years, and I feel strangely content. No despair, no pressure. Of course I haven’t had any pressure for a while, not since my Mom died.”

“Except for the pressure you put on yourself.”

“That’s true.” Pause. “I still feel I should figure out what to do with the rest of my life. I should be looking at various career possibilities, seeing what piques my interest. But I guess I know what the reality is with Covid. New York is decimated. There are thousands and thousands of people unemployed, stores are boarded up. No one is going to hire a 52 year old woman who has probably never held a job for more than a year. I also feel I should go back to my painting. I was pretty good at it. Why don’t I spend my very excessive amount of free time painting again? I should. But I don’t.”

“So you’re still putting pressure on yourself.”

“Yes” Pause. “And I do still hear your voice telling me I should be spending more time with people. But of course everyone is told not to spend time with people these days. But I know you’d still be telling me I should at least reach out to my sort-of friends by phone.”

“You still feel pressure from both yourself and me, but you feel different, calmer, less despairing.”

“Yes.”

“And you don’t feel isolated?”

“Everyone feels isolated.

“Maybe that’s comforting.”

“What’s comforting?”

“That everyone feels isolated.”

“That’s a good point. I don’t have to feel like such a freak.” Pause. “Yeah, that’s right. Usually this time of year would be the worst. Thanksgiving in November, Christmas and New Year’s in December. Everyone running around buying food and presents and looking forward to seeing family and friends. And then there’s me. Sitting at home stuffing myself with junk food and wondering if I should kill myself. But not this year, this year everyone’s in the same boat as me. I know they still have these ridiculous TV commercials with people sitting around a big table together or drinking themselves sick at parties, but now they look exactly like that – ridiculous. No one should be doing that this year. Everyone should be doing exactly what I’m doing, sitting home alone, no one else there. Yes, it’s a tremendous relief. That’s exactly why I feel okay.”

“Where do I fit in?” I ask.

“You’re my one exception. You’re here. But of course you’re not here. You’re thousands of miles away.”

“And that means what for you?”

“Actually makes me feel a little sad. But not too much, because I know even if you were next door we’d be meeting just as we are now, on the telephone. Yes, that makes me feel better immediately. So I guess that’s another thing Covid has done for me – made me feel less like a freak and made our distance feel less significance. No wonder I feel better.”

Anne may feel better, but I’m left feeling sad, both for the sadness she likely feels underneath her “better,” as well as for the isolation she wears as a protective shield, unable to breach the chasm between herself and others. Covid will eventually end and unless we are able to breach that chasm she will return to feeling like a freak, the forever outsider longing to be part of the lives she only imagines.

Tag words: Psychotherapy, mental health, patient-therapist relationship, projective identification, isolation, sadness, despair, aloneness, Covid19.

In Mourning | by Linda Sherby, Ph. D, ABPP

Wed, 18 Nov 2020 23:27:05 GMT

"In Mourning," a patient returns to therapy after the death of his mother, struggling with a depression he cannot shake.

“Well, I’m back,” David says morosely. “I thought I could at least make it a couple of years without seeing you, but there’s no way. I can’t stand myself any more. I knew I’d have to see you virtually too, which only makes it worse, but I just can’t get myself out of this depression.”

“Do you know what’s gotten you so depressed?”

“Yeah, my mother died of Covid in April.”

“I’m so sorry, David. Yet another victim of the pandemic.”

“Yup! I mean, I know my mother was 92, and her health wasn’t the best, but she still had all her marbles. And of course, just like in the news, she died alone in the facility.” Pause. “I feel so incredibly depressed. And you must think I’m nuts since I had such a difficult relationship with my mother. You’d think I’d be, I don’t know, relieved, or something.”

“What do you feel?”

“Lost.” Pause. “That sounds crazy when I say it. My mother was so suffocating. I was always trying to get away from her. And now I feel lost without her?”

“But when you were a little boy, you felt your mother as the only loving presence in your house. And she was a huge protector. She protected you against your father, she protected you against your older brothers.”

“But I’m not a little boy any more.”

“Except that you carry that little boy inside you as an adult, just as we all carry our child selves with us.”

“So you think that’s why I’m depressed?”

“I think you’re in mourning so it’s not surprising you’d be sad, but the depression seems as though it’s more than that.”

“So what it is?”

“You know, David, it’s interesting that you look to me to tell you what your depression is about. That may be another indication of how lost you’re feeling, looking to me for answers that reside in you.”

“That’s true.” Pause. “I want you to tell me what’s wrong and make it go away. I know therapy doesn’t work like that. But it’s like I’m too depressed to even do the work I know I have to do.” Pause. “Please help me.” Pause. “I sound like a sniveling baby!”

“Well right then, you sounded like your Dad berating you, rather than being able to have compassion for yourself.”

“That’s true!”

“So you’re mad at yourself for feeling depressed.”

“Definitely. I thought we fixed me. That my depression would be gone forever.”

“So, David, do you think you’re also mad at me? Mad that I didn’t fix you.”

Hanging his head, he nods. “Yeah. When my depression came back, I started questioning whether therapy had made any difference at all. When Covid first hit I felt very different. I felt that as was coping with all the stress and insanity and that I was a good support for both my wife and daughters. In the beginning we were all living together. My daughters came back from college, my wife was teaching from home, and I was doing my accounting from home too. It was kind of crazy, but sort of fun too. Felt like we were whole, a big, happy family again. And I wasn’t allowed to see my mother so that took away my worry about whether too much time had passed and whether I had to go see her. Now my daughters are back at college, although they’re still doing most of their courses virtually, my wife is back teaching and I’m back in my office although I still meet with clients virtually. And obviously my mother is dead so I don’t have to worry about seeing her.”

“Sounds like you are feeling a lot of loss, not only of your mother, but also your big, happy family.”

“Yeah, that’s true. Like there’s this void.” Pause. “And I turned 60. That didn’t feel good at all. Made me feel old. The time I have left in my life is getting shorter and shorter.” Pause, “I guess my mother’s death added to that feeling.”

“So there’s loss everywhere.”

“Definitely.”

“I notice though, that as soon as you acknowledged your anger at me and your lack of compassion towards yourself, you were able to start doing to the work, start looking at what was going on in your life that’s been contributing to your depression.”

“That’s true.” Pause. “I just wanted to ask you if that means I’ll stop being depressed.”

I smile. “I think with the loss of your mother, it’s easy for you to want to put me in the place of the mother who can make everything all right. I’m sure you have lots of feelings about your mother’s death, as well as issues about the inevitable passage of time.”

“Just hearing you say that made me depressed again.”

“I’m sorry. But sounds like that’s an issue we’ll definitely have to address.”

In A Quandary | by Linda Sherby, Ph. D, ABPP

Tue, 13 Oct 2020 23:20:57 GMT

Today's blog, "In A Quandary," focuses on a patient who returns to treatment to deal with the stresses imposed by Covid19, stresses that necessarily tap into past conflicts and issues.

“It’s kind of weird starting therapy on FaceTime,” my new patient, Leah, begins. “But I’m a therapist myself, getting used to working virtually, so I figured it was time to get myself back into treatment. I certainly could use the help.”

“And how can I help you?”

“I guess the big push for me to start treatment again is my father, but of course like everyone else in the world, I have problems and problems and more problems.” She sighs. “I’m 45. I’m married, my husband, Ed, is an IT guy working from home. I have two kids, girls, 12 and 14, who are in school virtually. So there we all are at home, each in a separate room, learning, seeing patients and solving computer problems. Sometimes it works, sometimes it doesn’t. It’s a problem if one of my girls doesn’t understand something she’s being taught and thinks she can just interrupt me in a middle of a session. I’ve tried to explain she can’t just do that, but if she goes to Ed, well, he just doesn’t have the patience, so she’ll end up interrupting me anyway. I’ve tried locking my door, but Elisa – she’s my youngest – gets really scared if I do that, so that doesn’t work either.”

“Sounds like you’re being pulled in every direction.”

“That’s for sure. And then there’s my father. My Mom died three years ago and at first I thought my Dad would be okay but now I can see he’s starting on the road to dementia – actually getting worse faster than I would have expected - and I’m worried about him being alone. Sometimes he calls again and again to ask the same question. He told me he’s burned a couple of pots forgetting he had the fire on. He’ll sometimes forget which apartment is his. And, of course, like many people during Covid, he’s lonely and, because he’s who he is, he’s angry. So I’m trying to decide if I should move him into the house with us.”

“Wow! Sounds like you have a tremendous amount on your plate.”

“Yeah. And the added problem is that I don’t like my Dad. I mean I love him – I guess – but I don’t like him. He’s angry, opinionated, narcissistic, dogmatic and intrusive. And that was all my life, not just since my Mom died or since the dementia.”

“So what was it like for you growing up?”

“Well, I’m a therapist, that should give you a big hint,” she says with a small smile. “It was hard. I was the oldest of three girls. My Mom was this really sweet person who didn’t have a backbone. She accepted anything and everything my father did, worshipped him really, and left us to fend for ourselves. Which usually meant I was the one arguing with him. My middle sister was the good girl, kind of like my mother, and my youngest sister just sort of floated through life, which is kind of what she’s still doing. I think she just ended marriage number three and career number … I don’t know. Too many to remember.”

“So what do you think it would be like with your father in the house?”

“Awful. I know it would. My youngest daughter is scared of him, always has been; and my oldest, at 14, she’d probably be arguing with him just like I used to. But I don’t know how they’d do with his dementia.”

“You haven’t said much about your husband.”

“I know,” Leah says sighing. “It’s hard. I mean I love Ed and I know he loves me, but even after all my previous therapy, I still think I married my father. No, that’s not really fair. Ed isn’t an angry bully like my father. But he is self-centered and not inclined to go out of his way to be patient or helpful, like I was saying before about his not helping my youngest with her schoolwork.”

“I notice you keep referring to your children as ‘yours’ rather than ‘ours.’

“That’s true. They’re very much my responsibility. I mean he loves them and he’s great about playing with them as long as it’s something he enjoys. But he’s definitely the fun parent and I’m the one who keeps after them to do their homework, pick of their rooms and so forth.”

“So you always end up in the role of the responsible one. Any idea why?”

“First response, I was the oldest. Second, it’s the only way I’m sure things will get done.” Pause. “Maybe it’s the only way I feel safe.”

“There’s certainly a lot there for us to explore there.”

“I want to ask you before we stop if I should take my father in, but I know you can’t answer that.”

“Maybe we first need to look at why you only feel safe when you carry all the weight of responsibility.”

Doomed | by Linda Sherby, Ph. D, ABPP

Thu, 17 Sep 2020 23:43:03 GMT

The convergence of 9/11 and Covid-19 and illustrates how a therapist tries to help her patient understand how the terrors of his childhood contribute to his fear in the present.

“Is it all right that we’re meeting on FaceTime today?” Jason asks.

“Of course,” I reply.

“You didn’t mind that I called and asked if we could?”

“No. But why are you sounding so tentative, scared.”

Jason drops his eyes. “It was 19 years ago today,” he says softly. “I was 25 years old. Seems impossible I was ever that young. But it also seems impossible that 19 years have passed. All I accomplished was that I got out of New York. But I’m as terrified today as I was then. At least then it felt as though there was an escape – get out of New York and your chances are way better. Now, now it doesn’t matter where you are, you’re doomed, subject to the whim of a virus. I’m tired, tired of feeling frightened.”

“I believe you, Jason. You were terrified during the 9/11 attacks and you’re terrified again. And, of course, we can’t forget that you were terrified your entire childhood.”

“I know you keep saying that and it’s true, but this is real! There

is this deadly disease out there that can strike anyone at anytime and there are a bunch of idiots who don’t think they should be wearing masks. Who wouldn’t be frightened?”

“Do you feel your childhood terrors weren’t real? An explosive, alcoholic mother who would beat you with a strap. I’d say that’s pretty real.”

“But that was then. That’s not what I’m living through now.”

“You may not be living through that now, but you are living with it. Those memories, those experiences are always with you.”

“I suppose.”

“Jason, why do you think you were so tentative about asking me to meet on FaceTime, why you had to check to see if it had been okay to call?”

“But you said it was all right,” he responds, tremulously.

“What are you feeling right now?” I ask softly.

“I just want to be sure it was okay to call, okay to ask for something different,” he replies, staring at me intently.

“Are you frightened of me right now?”

“I… I don’t know.” Pause. “Can you just tell me I didn’t do anything wrong?”

“Of course you didn’t do anything wrong. What you’re showing both of us is how easy it is for you to become frightened. You’ve put your mother’s face on me and are afraid I’ll be just as scary and irrational as her.”

Silence.

“I was thinking of that time I was, I don’t know, maybe 12, and my sister had a bunch of her friends over. My mother got mad at me for something, I don’t remember what. She started to throw out my comic book collection. I was really into comic books. She took one bunch of comic books after another and took them to the dumpster. I was hanging unto her leg and crying and begging her to stop. Right in front of those girls. Then she took the belt and started beating me. She was like a crazy woman. I begged and cried and screamed. I was so humiliated.”

“Oh Jason, that’s such a sad story. I’d just want to hug that little boy and tell him it will be all right. I wish you could hug that little boy and feel for the terrorized child in you.” Pause. “Your mother is like the 9/11 attacks and the virus rolled into one.”

“So you’re saying that’s why I feel so frightened.”

“Yes, just like you became instantly frightened of me when you thought I might just possibly be angry that you’d asked for a change in how we meet.”

“I get that in terms of you, but the virus is real, it’s scary. Shouldn’t everyone be frightened?”

"Certainly everyone should be concerned with their safety and the safety of others. But beyond that, and I’m not talking about the politics surrounding the virus, beyond that, how people feel about the virus depends a lot on what they bring with them from their childhoods. If children grew up in a basically safe and loving environment they’re more likely to feel things will work out okay, that they won’t be harmed. That doesn’t mean they won’t be harmed, but they don’t feel terrified every minute of every day. On the other hand, if a child grew up in an environment where one or the other parent was anxious all the time about some unknown danger, that person is likely to be a more anxious and frightened adult. And growing up as you did, where anything really bad could happen at any moment, well that’s going to lead to where you are today, scared and waiting for catastrophe to strike.”

“But what do I do about all that? I can’t redo my childhood.”

“What we have to do is allow you to feel all the terror you felt as a child and then get to a point where you can take in that you’re no longer a child, that you no longer have to be afraid of your mother, not the real one nor the one that walks around in your head.”

Tag words: psychotherapy, mental health, patient-therapist relationship, transference, Covid, fear, terror, childhood.

Stalked by DeathI| by Linda Sherby, Ph. D, ABPP

Fri, 04 Sep 2020 20:17:24 GMT

“I know I keep saying the same thing over and over,” David says, his despair and anxiety apparent even over the telephone, as all our therapy sessions are conducted these days. “I feel scared all the time. I’m sure Covid is going to get me. I’m sure I’m going to die. Yet it helps me to tell you. I mean I know you can’t keep the virus from killing me, but telling you makes me feel at least a little better.”

“Do you know why telling me helps?”

“You’re the only person I can tell. My wife doesn’t want to hear it any more. She says I’m a 48 year old man who rarely leaves the house, so how likely am I to get Covid. She’s just fed up with me. And I try not to talk about it in front of the kids. I don’t want to scare them. But I’m so glad they’re not going back to in-person school. I don’t know if I could have tolerated having them go into a classroom every day and then came back home.”

“So is it that you feel less alone when you talk with me?”

“Definitely.” Pause. “I’ve always been afraid of dying. Even when I was a kid. If I saw a dead bird, I’d cry and cry and not be able to sleep for days. I was sure that would be me. And when my cousin enlisted in the army, I was in shock. I couldn’t imagine how anyone would volunteer to be killed. But this, this is the worst it’s ever been. There’s this disease that’s killing hundreds of thousands of people. It makes complete sense that I’ll be one of them.”

“It makes complete sense because…?”

“Because I know I’m going to die.”

“And what does knowing you’re going to die mean to you?”

“What!?”

“What does knowing you’re going to die mean to you?” I repeat. “We are, after all, all going to die.”

“You say that so calmly.” Pause. “Of course I know we’re all going to die, but that terrifies me. And it removes all meaning from life. Why bother being in a marriage, having kids, being successful? In the end it all goes away.” Pause. “I know we always go back to my father’s heart attack when I was seven, but even then I was amazed that he was able to come back from that and throw himself back into the business as if he hadn’t been on death’s door.”

“But that wasn’t your mother’s reaction.”

“Oh no, not at all. She hovered around him like he was about to die at any second.”

“Just like she hovered around you when you were sick,” I add.

“That’s for sure. She was an anxious mess. All I had to do is run a slight fever and you’d think I was dying.” Pause. “I know we’ve talked about this before. You think that my mother’s over-reaction to my being sick is why I always think I’m going to die.”

“Well, maybe it’s not quite that simple. How did you feel about your mother’s reaction to your being sick?”

“I don’t know. I guess I kind of liked it. Made me feel like she really loved me.” Pause. “Especially after my father’s heart attack, she paid way less attention to me, so it was nice having her focus on me again. And actually it drove my father crazy. He’d say that she was babying me, that all I had was a cold or a sore throat or whatever and that I’d be fine. I remember, he’d say, ‘Stop treating him like a baby.’”

“So when your wife doesn’t want you to talk about your fears, what do you feel?”

“Ignored, I guess.”

“Unloved?” I ask.

“I suppose. But I’m not really sure how much my wife loves me. Ever since we’ve had kids, she’s way more focused on them than on me.”

“So you felt you lost your mother to your father and now you feel you’re losing your wife to your kids.”

“Yeah! That’s right.”

“And what about me?”

“You?”

“Um hmm. You said I’m the only person you can talk with about your fears.”

“Certainly the only person who will listen.”

“And that makes you feel how?”

“I guess it makes me feel like you care.”

“So maybe you learned early on that the only way to feel loved was to be sick.”

“But I could be sick without dying.”

Silence.

“I just thought of something,” David says. “Maybe dying is my punishment, my punishment for being such a baby and wanting Mommy’s attention.”

“That’s a great insight, David. We’ll talk about that more next time.”

I Have to See You| by Linda Sherby, Ph. D, ABPP

Thu, 20 Aug 2020 23:24:25 GMT

A patient's early loss makes working remotely painful, creating a yearning for in-person contact with her therapist.

“I’m sitting in your parking lot,” Laurie says barely whispering into the telephone.

I consider asking her why, but I know the answer. Instead I say, “I’m sorry.”

“Not even your car is here. I thought maybe I’d at least see your car.”

“You know I’m working from home, Laurie.”

“I know. But I thought maybe I’d get lucky.” Pause. “How long is this going to go on?” she asks, plaintively.

“I don’t know. No one knows the answer to that.”

“But you could see me. We’re not under lockdown. I can eat in restaurants. I can have my hair done.”

“That’s all true, Laurie, but it doesn’t feel safe to me for us to be behind a closed door in a small space without a mask.”

“I know. I know. We’ve been through this a hundred times before. But I have to see you! I have to! I have to know you’re really here!”

“We did try FaceTime.”

“That’s worse. That’s like you’re here and not here. I don’t know. That totally spooked me. Then you really aren’t real. It’s almost like you’re a figment of my imagination. Like I willed you onto my phone. Flat. Way too flat.”

“Flat or dead?”

“I know you keep going back to that.” Pause. “Maybe. I don’t know. I went off to school, came home and my mother was dead. I’m sure that did a number on me. Oh yes, and by the way, she killed herself.”

“You’re talking about that horrible time almost like it happened to someone else.”

“I don’t want to feel that now! I’m too sad, way too sad, why would I want to start feeling about my mother offing herself?”

“Maybe because you are feeling it. Maybe because every time you pour over the statistics about how many people have died and how old they were and where they lived, you’re actually mourning your mother again and again.”

“Don’t I ever get to have mourned enough?”

“I think there are always times that losses in the present trigger past losses, especially when that loss was so primal.”

“How about if I met you in the parking lot for a session? At least that way I could see you.”

“And what? We’d both sit in our cars and …” I stop myself. Giving Laurie the practical reasons why her suggestion won’t work is not what’s needed here. “You know, Laurie, it strikes me that you’re trying to undo your mother’s death. It’s as though if you figure out a way to see me, to erase the missing, to erase the absence, then that will magically make everything all right including bringing your mother back to life.”

Silence.

“What do you feel if you accept that we’re not going to see each other for some indefinite period of time?” I ask.

“Angry!! Angry, angry, angry! Because it’s only an indefinite period of time because you’re making it an indefinite period of time. It’s you, you, you!! You’re doing this.”

“Just like your mother killed herself.”

“Right! Who the fuck has the right to kill themselves and leave behind a six year old child? It’s not right! It’s not fair,” Laurie says sobbing.

“No, Laurie, it’s definitely not fair,” I say softly.

“Okay, so I’m mourning now, are you happy?”

“I’m definitely not happy you’re in pain, but you know I always think it’s best for you to feel whatever it is you’re feeling.”

“I want to see you! I want to see you! That’s what I’m feeling.”

“I’m sure that’s true. And I’m sure that’s what you were feeling as a child as well.”

“Fuck you! Leave me alone.”

Silence.

The silence continues.

I hear Laurie crying.

“I’m here Laurie,” I say quietly.

“You sure?” she whispers.

“I’m positive.”

“I used to make believe that I was talking to my mother on the phone, like she’d taken a trip somewhere and was missing me and couldn’t wait to get home to see me. Isn’t that pathetic?”

“No, Laurie, that’s not pathetic at all. It’s totally understandable and very, very sad. Don’t you feel for the little girl who was you who wanted her Mommy to come home?”

“I guess. Sometimes.” Pause. “And sometimes I just want her to stop being such a baby. I guess like I should stop being a baby when it comes to wanting to see you.”

“You’re not being a baby. You’re yearning for what your mother took away from you and what you feel I’m taking away from you too.”

“But you’re really here, right? I’m not just imagining you and I will get to see you again sometime?”

“Yes. I’m here. And we will see each other again.”

Starting Therapy Remotely| by Linda Sherby, Ph. D, ABPP

Thu, 02 Jul 2020 00:21:02 GMT

The problem many therapists face as the pandemic continues to rage and patients seek relief from their anxiety, depression and isolation.

Hello,” I say to an attractive, dark-haired woman who appears before me on FaceTime. “I’m glad to meet you.” And so begins my first experience beginning therapy remotely.

I practice in Florida, one of the states that is seeing a sharp uptick in Covid-19. Although I have toyed with the idea of returning to in-office sessions, I continue to find myself reluctant to do so. During the initial phase of the pandemic, I turned away new referrals, uncomfortable starting treatment with anyone I could not meet at least once in person. But as my time away from the office continues, I decide I need to go beyond my comfort zone.

“Hi,” Jennifer replies. “This already feels weird. I’ve been in a lot of therapy, but obviously in person. I kept thinking I’d wait until I could go to your office, but who knows when that will be, and I’m having a really hard time.”

“It feels strange to me too,” I say, “But why don’t you tell me how I can help you.”

I watch her take a deep breath. “I’m 49, I’m alone, I’m terrified of the virus and I just found out that my ex-husband has lung cancer. And that he hasn’t told our daughter yet. I’m so anxious I can’t stand myself.”

“That is a lot.”

“I’ve always been afraid of being alone and now I’m alone all the time. I mean, I talk to my daughter, but she’s in New York and she’s had a really hard time so I don’t want to lay all my stuff on her. And I worry about how she’ll respond to the news about Greg, that’s my ex.”

“Lots of people have been struggling with their aloneness during the pandemic, can you talk about what it’s like for you.”

“I’ve always hated being alone, ever since I was a little girl. I was the kid who was afraid of monsters under the bed, always had to have a light on, and would run into my parent’s room in the middle of the night. That’s why it took me so long to leave Greg, even though I knew about his affairs for years. And when he moved out I put way too much pressure on my daughter to be my companion, just as my Mom did to me. I mean, my parents stayed married, but they had a lousy relationship and I was my mother’s confidant. My Mom’s still alive. She remarried after my father died and she’s much happier now. We’re close, but not like it was when I was a kid.”

“Are you saying you miss your childhood relationship with your Mom or that you’re relieved?”

“I don’t know. Maybe both. When I’m happy, I’m relieved. But now that I’m so anxious, I guess I want my Mommy. I know that sounds silly.”

“Not at all. I totally understand.”

“I did tell my Mom about Greg, but she didn’t get it at all, thought I’d be happy that something really bad happened to him.”

“And is a part of you happy?”

“Oh no! I mean he certainly wasn’t a good husband but I could never be glad he got cancer.”

“So you’d feel guilty if you felt glad?”

“Definitely. I was brought up to be the good girl and the good girl I remain.”

“Can I ask you how this is feeling to you right now?”

“I guess it still feels weird. And I’m still anxious. I’m used to having my anxiety get better when I’m in

a therapist’s office. But I guess I’m not in your office. It’s like you’re here and not here. It’s similar to how I feel talking to my New York friends on the phone. They don’t feel really present to me so I’ve pretty much let most of those relationships kind of peter out.”

“Oh oh,” I say. “Does that mean you’re likely to do the same thing with us?”

She shrugs. “I don’t know.”

“Maybe you yearn for relationships that duplicate the early connection you felt with your mother, perhaps that’s the connection that reduces your anxiety, makes you feel safe, and that without that kind of connection you feel afraid.”

“I guess that’s true. But I thought I wanted to get away from my mother.”

“I suspect that a part of you does want to get away, but the scared little girl part of you still yearns for what you experience as safe.”

“I suppose.”

“I feel as though you’re less engaged with me right now.”

“Yeah. It’s not you. I just don’t know if this is going to work.”

“I suppose the question is whether you’re willing to give it a chance. We’ve actually talked about quite a bit today: anxiety, guilt, your need to be a good girl and, I suspect, although we haven’t talked about it, your difficulty allowing yourself to feel angry.”

Jennifer brightens. “That’s right! I feel really bad when I get angry.” Pause. “But right this minute I feel a little less anxious.”

“Maybe it helped that I figured something out about you, and that made you feel more connected, less alone.”

“Could be.”

“I can’t guarantee I’ll do that every session, but if you’re willing to give this a try, maybe our work together could be helpful, despite not being in person.”

Loss: Past, Present or Future? | by Linda Sherby, Ph. D, ABPP

Sat, 13 Jun 2020 18:21:07 GMT

In this month's blog, teletherapy diminishes the feeling of connection between patient and therapist restimulating old losses and increasing the dread of new ones.

Chelsea, a relatively new social worker, is talking about her work at the local hospital. “It’s scary being there right now, even though there isn’t all that much to do since our census is so low. Still, having to deal with families who are deciding where to place their elderly relatives is hard, even harder than usual. Who would want to put someone in a nursing home right now? But some families just can’t take them home – small kids, home schooling. It’s a challenge. And it’s worse since I have to do it all by phone or video conferencing.”

“Interesting, Chelsea, since that’s how we have to work too.” I have been seeing Chelsea for several years now, beginning when she was in college, through her Master’s program in Social Work and now as a beginning professional. We have a strong, caring bond. But switching to teletherapy has been difficult for us. Something is definitely missing. I even suggested we switch to FaceBook, hoping that might recapture our connection. But it’s still not the same.

She sighs. “Yeah. But the problem I have with the families isn’t the same as the one I’m having with you. I don’t know the families, so not seeing them in person makes it harder for me to have a sense of who they are as people. I mean if someone is sobbing about the thought of putting their mother in a nursing home, I certainly get how they feel. But if they’re more neutral, is it because they don’t care or because they’re just trying to hold it together. I can’t tell.”

“But that’s not true for us?”

“Not at all. I most definitely know who you are.” She smiles. “You’re my savior. I don’t know where I’d
be if it wasn’t for you. I mean I know I have a mother transference to you. How could I not, with my mother dead by the time I was nine and no one else really caring about me? But this not in person stuff just isn’t working for me. I even considered asking you if we could take a break from our sessions until we could meet in person again.”

“Really? I’m surprised.”

“Yeah, I know. But I chickened out. It would feel like too much of a loss.”

It would feel like a loss to me too, but I keep that feeling to myself.

“Maybe it would be helpful, Chelsea, if we really tried to figure out what the difference is for us, because I agree with you, something is different, something is missing.”

“I just don’t know,” she says shrugging. “I have wondered whether it’s somehow related to my mother’s death, but I’m not sure exactly how. Sort of like how she faded away from cancer and whether us not being in person makes me feel as though you’re fading away too.”

“That’s a really good thought.”

“But you know, just saying that made me really anxious. Like, my God, are you fading away? Are you leaving me? Are you dying? That’s so terrifying to me I can hardly stand to think of it. I mean, here we are in the middle of a pandemic and you have to be in the age group that’s most at risk. But I never thought of that. I never thought I might actually lose you!” Chelsea says bursting into tears.

“I understand that would be really scary. And sad. And of course I can’t tell you I won’t get Covid, although I’m trying my best not to.”

Still crying, Chelsea looks up at me, stricken, shaking her head. “So many thoughts just went through my head. I think I’ve been mad at you. I think I’ve been mad that you weren’t seeing me in person, like you were rejecting me. But that’s not true at all. You weren’t rejecting me, you were taking care of me, trying to stay here for me. I mean not just me, for yourself and for your other patients too. But I think I’ve been mad and scared and sad and I didn’t know about any of it! What’s wrong with me!?”

“Nothing’s wrong with you, Chelsea,” I say smiling. “This is a scary, unknowing time for us all, including not always knowing what’s going on inside of us. And death is all around us. It’s hard not to worry about loss, or to defend against acknowledging it.”

“I feel so incredibly sad. I truly don’t know how I’d deal with losing you.”

“I understand. And I hope you won’t have to deal with it for a very long time.”

“You know what, though? I feel closer to you right now.”

“I agree. Defending against fears of loss meant we lost each other in the present. And that’s even worse than losing each other in the future.”

Alone Together|by Linda Sherby, Ph. D, ABPP

Wed, 13 May 2020 00:29:20 GMT

Alone Together, when a married patient talks about her feelings of aloneness during the stay-at-home orders, her therapist helps her to see how these feelings are related to her long-standing fear of both knowing and expressing her own needs.

“I’m feeling so horribly sad,” Marion says, her sadness apparent from her voice which I hear remotely on my cell phone. “I feel sad for the country, sad for the world, sad for all the people who are losing their lives every day.”

Pause. “But mostly, I must admit, I feel sad for me. I mean, I’m grateful that everyone I know personally is well, that I haven’t had to deal with a loved one dying without being able to say good-bye… But I feel so alone, which is ridiculous. I know I’m not alone. Arnie is here with me as always. I get to FaceTime with my daughter and grandchildren almost every day – although how they’re all surviving in that apartment I have no idea. And with my son and his husband at least once a week. They’re actually doing very well, working from home and enjoying what they call a second honeymoon.”

Silence.

If I were I in my office with Marion I know I would wait for her to continue before I speak. But remotely I’m concerned that the silence will increase her feeling of aloneness. “And you feel sad because…?” I ask.

She sighs. “Arnie and I have no relationship. None. I mean I know we’ve been together for 30 years. I don’t expect us to be falling over each other like my son and his husband. But something, something…” Pause. “We sleep in the same bed. We get up in the morning, have breakfast, each of us focused on our iPads, barely speaking. Then he goes into the living room to watch endless news shows about the virus. I sometimes take a walk, then head for the bedroom to watch old movies or read or sometimes talk on the phone. I wish we at least had a dog, but of course they don’t allow them in our condo.”

Pause.

“Before at least I got to get out, had a change of scenery. I played cards, had lunch with my girlfriends, went to a movie. When I worked that was entirely different. You know, it’s sometimes hard to believe that Arnie and I were both teachers, that we had interesting lives, interesting things to say to each other. Now there’s nothing. Nothing. Emptiness.”

“And feeling alone with someone feels worse than being alone by yourself.”

“That’s definitely true.”

“You said that you and Arnie sleep in the same bed. Do you ever have sex?”

“I’d be hard pressed to remember the last time we had sex.”

“Do you miss it?”

“Sex has been so perfunctory for so many years it’s hard to say I miss it. I do miss cuddling. I miss the occasional kiss, holding hands, caring about each other. Now there’s literally nothing. The absence feels so bleak. And it’s mirrored in all those pictures of cities without people. Or even here – shuttered tennis courts, golf courses, emptiness.”

“Have you talked with Arnie about your feelings?”

“I’ve tried, maybe not enough, but I’ve tried. I tried sitting next to him on the couch, putting my hand on his knee, asking him something about what’s on the TV. Nothing.”

“But have you told him about your feeling of emptiness, of aloneness?”

“I can’t do that.”

“Why?” I ask.

Pause. “You know what I thought of? I thought of being a child, maybe 10, 11 I’m not sure. It was a rainy, dreary day. Must have been a weekend since I wasn’t in school. I was bored. I went to my mother to see if she wanted to play a game, but she was on the phone and put her finger on her lips and motioned me away. So I went to my father just to be with him. I knew he wouldn’t want to play a game. But he was reading the paper, looked at me annoyed and shooed me away. I learned never to ask, just to wait and see if someone will be there for me.”

“We’ve talked previously, Marion, about your unconsciously choosing a man like your father, but today I’m wondering about something else. What is it that you feel, you, the adult Marion, if you think about telling Arnie what you’re feeling?”

“I can’t.”

“But what is it that you feel?”

“Uncomfortable. Vulnerable. Maybe embarrassed. Like I’m not supposed to have feelings. Maybe like I shouldn’t need anything from anyone.”

“Like you shouldn’t need anything from anyone. I think that’s a very important statement, Marion. I think you’re saying that a long time ago you withdrew from your own needs, that you walled off those needs and locked them in a room somewhere deep inside you. And what you’re left with is a feeling of profound aloneness.”

“That feels right. But what do I do about it?”

“I think we have to start looking for the keys that will help us unlock that door, so we can find the sad, vulnerable child who reached out to her parents that dreary day.”

Why|by Linda Sherby, Ph. D, ABPP

Tue, 07 Apr 2020 00:37:48 GMT

Today, as I send this blog, I know that we are all in an alternative universe, overwhelmed by fear, locked in our homes, trying to get by the best we can. When I say I hope you are all well that hackneyed phrase takes on a whole other meaning. And I do wish you are well, with special thoughts to the New Yorkers on this list who are particularly under siege.

My blog, "Why," is unsurprisingly about the coronavirus, illustrating a patient's terror and her unrealistic demands of her therapist.

“I can’t stand it!” Marilyn yells into the telephone. “Why did this have to happen? I can’t stand being all by myself. There’s no one here, no one. I’m totally and completely alone.”

“I’m here,” I say quietly.

“No, you’re not! You’re not here. I don’t even know where you are but I know I’m not with you. I have to be near you. I have to imagine being able to touch you, even though we never do! And that’s what I want right now. I want you to touch me! I want you to hold me!”

Like most therapists these days, I am ‘seeing’ my patients remotely from home. Since for most of my career I have used the telephone when patients cannot be in my office, I am more comfortable using this modality than facetime or video conferencing. Most patients have been able to adapt to this new reality.

“Sounds like you’re feeling alone and desperate and wanting me to take care of you.”

“Now there’s a therapist response if I ever heard one! What good are you? You’re just a disembodied voice floating out there somewhere in space. You can’t give me what I need.”

“I understand that you’re feeling alone and uncared for, just as you felt as a child,” I say. “I understand that you want me or someone to save you, just as you did as a child. We’re all scared, Marilyn. We’re all in the same frighteningly unknown scary position.”

“But not everyone’s alone.”

“No, not everyone’s alone,” I agree. I want to add that many people are alone. I want to suggest that she call friends, reach out to family. I want to suggest that she start some of the projects she’s been wanting to do around her house, anything that will help her to feel more adult. But I know Marilyn will not, at this point, be able to hear such suggestions. She feels far too scared, back to being a child with an explosive, alcoholic father and a depressed, absent mother.

“Is there someway I can be helpful to you, Marilyn,” I ask.

“You can tell me when this is going to end! You can tell me why this is happening to me! You can tell me why only bad things have happened to me my entire life! It’s not fair!! I hate it!! I hate it!!”

Although I can feel my patience fraying, I try to retain my image of Marilyn as the frightened and vulnerable child. “I hear you, Marilyn. And I’m sorry you’re in so much pain.” I refrain from saying that this isn’t only happening to her and that she has known good times in her life. I know the futility of such word.

“I know,” she says suddenly. “I know how you can help me. You can tell me your address and I can come by and give you a hug and we can sit in your living room and visit.”

I am taken aback by the outlandishness of her request. At first I begin to respond directly, “You know that’s not something…” Then a thought comes to me and I stop myself. “Marilyn, have you just set yourself up? Have you just asked for something you know I won’t do so that you can continue to feel that I’m just one more of the long list of people who aren’t there for you, who don’t care about you, who can’t save you?”

She bursts into tears. “But you don’t!! You don’t care. Why can’t I come see you? Why can’t I come hug you?”

“Marilyn, can you try to answer those questions yourself,” I ask gently.

She sobs on the other end of the telephone. “You don’t care about me! I’m just a patient to you.”

I again consider responding directly and then decide against it. “What if you allowed in that I do care about you? What if you allowed in that I care about you and still can’t tell you when this will be over or why it’s happening? What if you allow in that I can care about you without being able to save you?”

Marilyn is sobbing uncontrollably on the other end of the line. “That can’t be! That can’t be!” she says between sobs.

I am silent and then say quietly, “It’s very hard to give up the hope of being saved, of being saved in the present and of being saved in the past.”

“I want you to hold me, I want you to hold me.”

I imagine Marilyn hugging herself and rocking back and forth in her chair. “I know, Marilyn,” I say, “I know.”

Denial|by Linda Sherby, Ph. D, ABPP

Tue, 10 Mar 2020 23:53:47 GMT

In this month's blog, Denial, a patient explores her inability to face the painful reality of infidelity.

As soon as I open the door I know that a different Rita is waiting for me today. Instead of her usual bubbly, sometimes false cheery self, I see a woman on the verge of tears who looks up at me beseechingly.

Seated in my office, Rita begins. “I don’t know what’s wrong with me. I know I’m not stupid and I know I’m a 52 year old woman, so I don’t know why this is hitting me so hard. But I had no idea, absolutely no idea.”

I first thought Rita was referring to her husband Henry’s infidelity, but since it has been several months since she found out about his long-term affair, I assume she is referring to a more recent event. I wait.

“My parents are getting a divorce. They’re in their seventies! I couldn’t believe it.”

“I can understand being shocked about a decision that came out of the blue.”

“But that’s just it. It didn’t come out of the blue! My mother couldn’t believe I hadn’t known. She told me my father was unfaithful to her their entire marriage, that they fought about it constantly.”

Now it’s my turn to be surprised. Rita had always described her parent’s marriage as idyllic. She said that’s what made Henry’s betrayal even more disturbing. She’d never been personally close to anyone who dealt with infidelity.

“I feel like I’m going crazy. I called my sister – my sister who’s younger than me - and she knew! She said they always fought about it! I asked her why we never talked about it. She said we’d literally put our blankets over our heads and guessed we did that figuratively too, like we didn’t want to think about it.”

“That’s a lot to take in. Maybe we should start with what you find the most disturbing about all these new revelations.”

“I don’t know. All of it. That I had no idea. How did I do that? Did I do that in my marriage too? Was I blind to my husband’s affair? Did he have other affairs I have no idea about? I feel as though I’m going in circles. My head feels like mush.”

“I guess one thing we know is that you have a striking ability to not know, to not see what you don’t want to see.”

“But why? Why can’t I know?”

“I guess it felt too intolerable to know.”

“But I can’t live my life like that! It’s a tremendous handicap. It’s like being divorced from reality.”

“I agree, but I think the question we need to ask ourselves is why you felt the need to deny what was right in front of you. You need to understand, not to beat yourself up.”

She sighs, but remains silent, looking dazed and confused.

I think about denial as a defense. It works as long as it works, but when it breaks, reality smacks you in the face, hard.

“What do you feel about your Dad’s infidelity now? How do you feel about them divorcing?”

“I don’t know. I haven’t gotten there yet.”

“Okay, so tell me where you have gotten.”

“Trying to remember the past. Trying to remember them arguing, trying to remember putting my head under the covers.”

“What would you have felt if your parents divorced then, when you were a child?”

“That wasn’t possible! It’s couldn’t happen!”

“So let’s assume for a moment it was possible. What would you have felt?”

Rita stares at me wide-eyed, shaking her head, repeating, “It couldn’t happen, it couldn’t happen.”

“Rita, see if you can find your feelings,” I say gently.

She continues to stare at me until she starts sobbing. Then she buries her face in her hands.

“No, no,” she moans. “I’m all alone, left. I won’t make it. I can’t make it.”

I remain silent, respectful of her feelings as the scared, vulnerable child.

“A family, a unit,” she says between her sobs. “We were one or nothing. Lost, adrift, floating, nothing.”

“Sounds pretty scary. I can certainly understand not wanting to know something that would lead to such catastophe.”

“But it’s not rational,” she says, quickly shaking her head as if trying to wake from a nightmare.

“No, it’s not rational, but that doesn’t mean it’s not how you felt and it’s how you felt that matters.”

Silence.

“I suddenly started thinking of my husband. Do I feel the same way about him? Do I feel there’d be nothing if I left him? Is that why I’m not leaving him?”

“Those are really good questions and I’m sure we’ll return to them next hour and for some time to come,” I reply, while thinking of the power of the unconscious, about Rita choosing a womanizer like her father without even consciously remembering that he was a womanizer.

Compassion|by Linda Sherby, Ph. D, ABPP

Tue, 18 Feb 2020 21:17:06 GMT

"Compassion" addresses the difficulty a therapist has moving her patient beyond self-hatred to a place of compassion where she can mourn the mother she always wanted but never had.

“You don’t understand!” Morgan screams at me through clenched teeth, hitting the sides of her head with her fists. “I hate myself! I hate myself! I’m stupid and ugly and awful. Bad! Bad! Bad!”

“Stop it, Morgan,” I say raising my voice. “You know you’re not allowed to hurt yourself in my office. Stop and try to calm down.”

Morgan brings her fists in front of her eyes and bursts into tears. I silently breathe a sigh of relief. She continues to sob.

“I’m here, Morgan,” I say gently.

She nods, still crying.

“She’s such a bitch,” Morgan manages to say through her tears. “But why am I such a mess? I should know it by now. She’s the golden child. Everything good comes to her. And me? I’m just bad and deserve everything I get.”

“Morgan, is there even a little part of you that knows that’s not true, that knows you were a small, helpless child who deserved to be cherished, not beaten?”

“Nope! You just said it. I was small and helpless, by definition that made me bad.”

“But all children are small and helpless, Morgan.”

“But not all children are illegitimate.”

“That was hardly your doing.”

“Tell that to my mother. I was born, ergo it’s my fault. And then Prince Charming comes into the picture and the golden child is born and I’m even more worthless than before. And now not only does Mom get to beat up on me, but my sister does too. You should have heard her gloating. Gloating! I mean I get it. She’s happy she’s pregnant. I should be happy for her. But gloating. Like it was a contest. I can’t even get a relationship and she and Rob are going to be the ‘happiest people in the world. You’ll know what I mean when it happens to you.’ Gag! I thought I’d throw up. But that’s because I’m bad. Because I can’t love my sister, because I can’t be happy for her.”

“It’s very hard to be happy for someone who smiled sweetly after she got you in trouble and watched you be beaten.”

“But I deserved it! I did pull her hair, or steal her doll, or punch her. I hated her! I still do. And that makes me really, really bad.”

“Does it?”

“Doesn’t it? Aren’t you supposed to love your sister? Aren’t you supposed to turn the other cheek?”

“Your rage at your mother had to go somewhere.”

“See, that’s exactly what I mean. I was a rageful brat. And if I couldn’t rage at my mother, I turned it on my sister. Charming!”

I sigh. “I always feel as though I’m arguing with you, Morgan, always trying to convince you that you need to have compassion for yourself…”

Morgan interrupts me, snorting her disdain. I continue talking.

“…that you need to have compassion for yourself as the scared, helpless child you were and understanding for yourself as the angry adult who keeps turning that anger on yourself.”

“Compassion doesn’t exist is my vocabulary, let alone in my experience.”

“If you read about a child who was beaten with a belt, who was locked in a closet, who was repeatedly sent to bed without food, wouldn’t you feel compassion for that child?”

“Maybe. But for me, for me I feel only hatred. I was bad. My mother was trying to beat the badness out of me. If my mother was bad she would have beaten my sister too. But it was only me, only me who needed to be beaten.”

“I do understand, Morgan, that you have to hold on to the belief that you were the bad one because as long as you’re the bad one you still have hope you can be different and win your mother’s love. But if she can never love you – perhaps because of the circumstances of your birth, perhaps because you reminded her too much of her – then the hope of her loving you is gone and you’re left in mourning, without the only mother you ever had. And that’s sad, Morgan. Very sad. And you need to find compassion for yourself.”

“There’s that word again. You don’t get it. There’s no word like that for me. It’s as though you were speaking Chinese.”

“I do understand that compassion feels entirely foreign to you. But you need to find your compassion for yourself, perhaps by first taking in my compassion for you. Your life has been terribly painful and unfair and you need to be able to feel sad for you.”

Fallout|by Linda Sherby, Ph. D, ABPP

Sat, 25 Jan 2020 23:10:41 GMT

This blog deals with the "Fallout" of a broken relationship. After a patient's girlfriend breaks up with him, he and his therapist deal with his need to continually choose women who give him less than he wants.

“This has been one shit week,” 35 year old Adam says, staring down at his hands. “Chelsea broke up with me. I mean, it was kind of mutual, but really it was her. She said I’d never be happy with her. She’s convinced she doesn’t ever want children. She’s way too into her career – I think she even fantasizes about being President one day – and then her own background was so awful. Drug addicted mother, alcoholic father. If it wasn’t for her grandmother she would never have made it.”

“I’m sorry, Adam. I know you loved her and hoped it would work,” I say.

“But she was right. I always hoped she’d change her mind about children, that as her biological clock started to run out she’d want a have a child.”

“And did she hope you’d change your mind?”

“Maybe. But I think our relationship was always more important to me than to her. I know it’s supposed to be the other way around with men and women, but it doesn’t seem to work that way for me. Anyway, there’s another part. Since I didn’t see my parents over the holidays they decided to come down this past weekend. I thought that would be good. They’d support me, be a shoulder to cry on. So I waited until we got to their hotel and suggested we have a drink. As soon as I told them, and they could tell I was pretty broken up, my mother’s first response was, ‘Well, I hope you’re able to take an important lesson away from this.’

“I just stared at her. I couldn’t believe it. ‘What’s that supposed to mean?’ I asked. ‘You know,’ she said, ‘such a different background, how could you expect it work out, especially in the long run. I mean I know she was white, but wasn’t she Cuban or something? I’m sure there are many nice Jewish girls you can choose from.’ This is my Democratic, college education mother talking. I really got mad. It’s a good thing we were in a public place or I know I would have started screaming. As it was, I had this deliberate, icy voice, telling her she was the biggest hypocrite I knew and that she must have forgotten that Chelsea who, in fact, had been born in the States, had a Ph.D. in political science. She didn’t give an inch, just kept saying it didn’t matter, that one’s background always made the difference. At that point I just got up and left. I was done.”

“Did you see them again?”

“Yeah, my father called and convinced me to go to dinner with them. It didn’t go well. My mother and I hardly said a word to each other; my father kept asking me inane questions about work, IT stuff he doesn’t understand and clients I can’t talk about. It was ridiculous. And the next day wasn’t better. She just wouldn’t move from her super-prejudiced position.”

“I’m sorry. It must feel as though you lost both Chelsea and your mother.”

“Yeah, and in the end unless I play nice I’ll lose my father too. He always ends up siding with her.”

“So how are you doing now?” I ask.

“Interesting you ask that. I was wondering where you stand. What you would feel if it was your son who was dating someone from a shitty background or another culture?”

As Adam was speaking I had been thinking about my first serious boyfriend who had, in fact, been from a shitty background and a different culture and, much like Adam, I was surprised to see how negatively my extremely liberal parents reacted. But Adam doesn’t need to hear my story.

“So how do you think I’d feel?” I respond.

Adam rolls his eyes. “Are you really going to fall back on that therapist routine?”

“You’re angry. Who’s to say you’d believe whatever I said?”

“Just answer the goddamn question,” Adam says raising his voice.

“I’d like us to look at a few things first. We’ve talked about how you keep trying to win with your mother, trying to get her to love you for who you are as opposed to who she wants you to be. I think that’s why you choose women, like Chelsea, who are less into you than you’re into them. You keep hoping to win them over.”

“Makes sense.”

“And I think deep down you weren’t at all surprised by your mother’s reaction, just as you weren’t surprised that Chelsea would break up with you. You have to be able to give up hope of winning the unwinnable woman.”

Pause.

I continue, “And even demanding that I answer your question. I could answer it, but perhaps it would be better if I didn’t so we can bring right into this room your feeling of loss and longing.”

“Great! So now I feel as though I’ve lost you too.”

“Do you?”

“A bit. But I also understand what you’re saying. And I’d like to stop picking women who I’m always chasing after.”

Losses|by Linda Sherby, Ph.D, ABPP

Thu, 19 Dec 2019 21:37:13 GMT

Losses," focuses on the experience of absence many feel, particularly during the holidays. It also highlights the importance of the relationship between therapist and patient.

“I couldn’t wait to get here today,” Carol says, practically breathless. “I had the most awful dream. It’s not as though anything so awful happened in the dream, but it felt awful.”

I have been seeing Carol in intensive treatment for many years. She entered therapy her mid-40s, terrified of being depressed and non-functional like her mother. She felt overly anxious and unsure of herself and although by all external appearances she had a successful life, inside she felt like a scared little girl.

“In the dream,” she says, “I was back in the apartment I grew up in as a child, which of course was awful in itself. I was sitting at the same shabby kitchen table I sat at as a child. We were having dinner. It was just me and my parents. I don’t know where my sister was. Maybe she had a fight with my father and stormed out. My mother was her usual depressed self, beaten down, defeated. My father was stuffing his mouth, but I had the feeling he was fuming. Of course he was always fuming, so that’s no surprise. I felt terrified. I don’t know if I was waiting for my father to explode. I don’t know, but I hated it! I hated that I was dreaming of that place again.”

“What comes to mind about the dream?” I ask.

“I don’t know. It seemed to come out of nowhere. You know I’ve been feeling really sad since Thanksgiving. I would have thought I’d be dreaming about that, all the losses. You remember, sitting around my daughter’s table and thinking of all the people who weren’t there.”

I did indeed remember. Thanksgiving brought up similar feelings for me, an awareness of all the absences, all the people who had died.

She continues. “My husband dead of pancreatic cancer, my son killed in Iraq, so many of my friends. I’m only 50, how can there be so many people in my life already dead. I mean I love my daughter and she made a beautiful Thanksgiving, but the losses, the losses overwhelm everything.”

She pauses, dabbing tears from her eyes. “So what am I doing dreaming about my childhood apartment? That’s one thing I don’t mind having lost. I guess I felt sad when my mother died, but in many ways I thought she welcomed death. Now at least she could be at peace. And my father, I know it’s terrible, but truthfully his death was a relief.”

“So why do you think you’re dreaming of your childhood apartment at this time?” I ask, a thought forming in my mind. I also used to dream of having to leave my idyllic home and adult life and return to the apartment of my childhood. For me those dreams were about my fear of loss, of losing what I so cherished in my present, adult life. For Carol many of the losses have already happened.

“I wish I knew.”

“Is there a connection between the losses you felt so acutely at Thanksgiving and the dream of returning to your parent’s apartment?”

“What I just thought is, maybe there’ll be no one left, maybe everyone will die, maybe there’ll be no place to go. If there’s no one left, maybe the only place I can go is to go back to them! I mean I know that doesn’t make logical sense because they’re dead too, but maybe that’s how it feels. If everyone leaves me, I’m back to being an abandoned child, a helpless, dependent child who has to go back to my parents.” She starts sobbing. “No,” she whispers. “No, that won’t happen. I have you. And as long as I have you, I don’t ever have to worry about going back there. You’ll remind me I’m not that helpless, dependent child. And if I do slip into that helpless place, you’ll be here to help me back up.”

I hesitate. We’re near the end of the hour. This has been a difficult session for Carol. But… “Carol, I wonder if you realize how much you’ve been your own therapist this hour, how much of me you’ve taken in over the years…”

“You’re not leaving are you?” she interrupts, panicked. “You’re not retiring? You’re not dying?” Her fear is palpable.

“I have no plans to go anywhere. But as you well know, we never know what life has in store for us. I do know I won’t live forever. And I also know that you’ve taken in so much of me. Did you recognize, even just in this session, how much you were able to do your own therapeutic work?”

“But…” she begins.

“We’re not ending, Carol. I’m not going anywhere. And it is also important that you recognize your own strengths. They don’t reside in me. They live in you.”

Removed|by Linda Sherby, Ph.D, ABPP

Fri, 15 Nov 2019 01:07:53 GMT

Removed, a patient's difficulty in connecting to others is unsurprisingly replicated in the therapeutic relationship.

“I’m thinking of breaking up with the girl I’ve been dating,” Andrew begins.

If I’m not mistaken, this is the third woman he’s broken up with in the several months I’ve been seeing him. Tall, with curly brown hair, 35 year old Andrew could be described as a handsome man, except that he feels too flat, too disengaged.

“I know,” he continues, “I just said I thought she might be the one. I don’t know, we just don’t seem to click. I mean, we’re okay sexually, it’s not that. Maybe she’s too eager, too needy. I need her to back off. But that’s pretty crazy,” he says, half laughing at himself. “You’d think with my parents being so disconnected, I’d be dying to have a woman who’s really into me.”

“Can you say what she does that makes you feel she’s too needy and what goes on inside you?”

“I don’t know. Well, like she’s constantly texting me.” Pause. “But that’s not really true. She might text me in the morning and then once maybe after she’s done teaching for the day.”

“But it feels like a lot.”

“Yeah, that’s right. It feels like she’s always there.”

“And when you’re actually with her?”

“I know this sounds bad, but I kind of want us to do whatever we’re going to do – go out to eat, go to the movies, whatever – go back to my place, have sex, and then have her leave. That’s enough for me.”

“While you’re with her, do you feel connected to her? You know, I just realized we’re both talking about ‘her,’ not using her name.”

“Her name’s Paula. And no, I don’t feel connected to her.” Pause. “I’m not sure I feel connected to anyone.”

“No one?”

“I don’t think so. I mean, I get along with people, I know what to say, how to act. But I wouldn’t say I feel connected. I tell my parents I love them. I hug my sister and my nieces. But it’s more that I know I’m supposed to do those things.”

“Do you feel connected to me?”

“To you?” he asks, surprised.

I nod.

“No. We have a professional relationship. I pay you to listen to me and then I leave. I can’t imagine feeling connected to you.”

Kind of like what he wants from Paula, I think. What I say is, “Can you imagine feeling connected to anyone?”

“I guess my wife when I have one. And my kids, whenever that happens.”

“And not feeling connected, how does that make you feel?”

“I don’t know. Normal, I guess. Normal for me anyway. It’s how I’ve always felt.”

“Do you ever feel lonely?”

“Lonely? I don’t know. I like being alone. I’ve always felt alone.”

“You know, Andrew, as I listen to you, I feel sad for you. You seem so alone, so cut off, so removed, both from others, as well as from your own feelings.”

He shrugs.

“And you did come into therapy. I think you said you wanted to figure out why you weren’t able to stay in a relationship with a woman. Sounds like we need to figure out why you can’t be in a relationship with anyone.”

“I guess.”

“Andrew, do you remember what you felt when you were little and your parents left you with one of your nannies and went away on business for months at a time.”

“That’s just how it was.”

“But how did you feel? How did you feel as that little boy?”

“I don’t remember.”

“Can you imagine doing that with your child some day?”

“Oh no! No, I couldn’t imagine ever doing that.”

“You seem to have more feelings about imagining leaving a child you still don’t have, leaving that imaginary child alone, than you’ve had about anything else we’ve talked about today.”

“I guess that’s true. But what does that mean?”

“That you’re that imaginary child; that buried deep inside you are lots of feelings about being left, sad feelings and scared feelings and angry feelings.”

“You think so?”

“Yes, I do.”

“So why don’t I feel them?”

“I imagine you locked those feelings away a long time ago and that opening that door feels overwhelmingly scary.”

“And how’s that related to my not staying in relationships?”

“I think that when you start to get close to someone or if someone starts to get close to you, the possibility of needing or relying on that person brings you way too close to the scared, vulnerable, needy feelings you had as a child and you immediately close off and run away.”

“I guess that makes sense, but what do I do about it?”

“We start by carefully looking at your feelings as you go about relating to people in your life, including me, and seeing if we can find when you start to get scared and start pulling away.”

“Sounds like a long process.”

“I’m not planning on going anywhere.”

Left|by Linda Sherby, Ph.D, ABPP

Fri, 11 Oct 2019 22:57:29 GMT

Left, strikes a theme familiar to us all. A therapist goes on vacation for a week and returns to an angry, defensive patient.

LeAnn has been sitting across from me for at least five minutes, staring down at her hands, occasionally raising her cobalt blue eyes to scowl at me. I have made several attempts to ask her what’s going on, but have been met with silence or another scowl.

“Are you angry with me because I was gone for a week?” I ask.

“I almost didn’t come today,” she responds.

“I guess you’re angry with me.”

Silence.

I continue, “I understand that separations are hard for you, LeAnn, that you have lots of feelings about being left. You’re frightened that I won’t come back, just like your mother didn’t come back.”

LeAnn’s eyes fill with tears. Fiercely, she brushes them away. “I’m such a baby! I’m 28 years old, not five. Besides she didn’t mean to leave, she died! Why can’t I get that through my head!? And you’re not my mother. It shouldn’t be a trauma for me to have you leave for a week.”

“You notice, LeAnn, that first you were angry at me and now you’re angry with yourself. I wonder why you have to be angry with someone.”

“What’s the alternative? It has to be someone’s fault. You left me and that’s your fault and it bothers me and that’s my fault. If it didn’t bother me, you could go on as many vacations as you’d like and I wouldn’t care one way or the other.”

“Except that’s asking yourself to be like a robot, to have no feelings about anything, to make your past disappear and not affect you in the present.”

“Yeah! That would be a great idea. Not having the past affect me. Wait a minute, you mean I’m doing all this therapy and I’m still going to fall apart every time anyone I care about goes away for a few days? That would be pretty pointless.”

“Well, let’s look at that. What did you feel when I left for a week?”

“Mad. Like how dare you leave me when you know I need you, when you know how hard it is for me.”

“Okay. Did you feel anything besides mad?”

“Why don’t you just tell me what you’re after?”

“I guess you’re still mad.”

She sighs deeply, rolling her eyes.

Despite LeAnn’s provocativeness, I don’t feel angry with her. Her scared, powerless child-self is so glaringly apparent. “I think anger is easy for you. It’s the feelings underneath that are more difficult – sadness, fear, vulnerability.”

“Those all sound charming.”

“As I said, anger is your easy go to. But think about yourself as that little child. Your parents go on vacation, leave you with an aunt you don’t particularly like. Your father comes home alone. He tries to explain to you that your Mom had an accident, that she fell from the balcony of their hotel room, that the railing gave way. That would be a lot for an adult to take in let alone a five year-old child. And then your father himself becomes unavailable, never really coming back from his grief. You’re all alone. How could you not feel overwhelmed by fear and sadness?”

“And this will help me how?”

“As long as you defend against your feelings of sadness and fear with your anger, you can never really complete the mourning process. The five year-old child in you needs to feel all your feelings so that you can move beyond them, so that you can truly know that although you may feel sad and scared as an adult, you won’t feel it with the same desperation as that five year-old. You won’t feel as though you can’t survive. You won’t feel that your very life is threatened when I or your boyfriend or whomever leaves. You can never predict what will happen, you may not have someone to blame, but you’ll know that you can indeed survive whatever happens.”

“That sounds like a pretty story, but how do I know it will work like that? What if I let myself feel all those feelings and all that happens is that I’m stuck there, stuck as that five year-old forever? That scares the shit out of me. As it is, I’m a mess when you leave for a week. I don’t want to be a sniveling baby forever.”

“I understand that it’s scary, LeAnn, but not feeling all the feelings involved in mourning is much more likely to keep you stuck than daring to let yourself dive into the muck and come out a stronger person in the end.”

“I hear you. I just don’t know if I believe you.”

“Fair enough. We’ll keep working and see what develops.”

A Member of the Family|by Linda Sherby, Ph.D, ABPP

Mon, 16 Sep 2019 23:05:58 GMT

a patient's early guilt feelings spill over into her present, including the treatment.

Opening my waiting room door I’m surprised to see the usual bubbly Marlene sitting downcast, twisting a tissue in her hands. She rises slowly, manages a weak smile and walks into my office. “I feel awful,” she says. treatment.

“I can tell. What’s wrong?”

“It’s Scooter.”

It takes me a second, but I realize she’s talking about the family’s dog, a relatively young schnauzer if I remember correctly.

“My son will never forgive me. He keeps telling me he hates me, that Scooter was a member of our family, that it’s all my fault. And he’s right! I don’t know how I could be so stupid,” she says, bursting into tears.

I find myself holding my breath, wondering what happened to Scooter, hoping he’s not dead.

Marlene continues, “I opened the garage door. Scooter ran out. He was hit by a car. He’s not dead, but the vet doesn’t know if he’ll make it. His leg’s broken. Depends on how much internal bleeding there is.”

Tears well in my eyes, as images flash in my head. Poor rescued Siggy who I’d nursed back to health on a graduate student’s stipend, running out the front door, killed by a car; Brenna, our black Lab, poisoned, hovering between life and death but fortunately making it; and Hadley, so connected in my mind to my late husband, needing to be put down when auto-immune disease ravaged her seven year old body.

“I’m so sorry, Marlene. I know how hard this must be for you. And for your son. I really hope Scooter’s all right.”

“Me too,” she says smiling wanly. “Didn’t take any time for my ex – almost ex – to start screaming at me. Even threatened to bring it up in mediation. Said he wasn’t sure he could trust me with Davey. How could he know I might not let Davey out the door? Talk about pouring salt on the wound.” Pause. “Davey’s so mad at me. He doesn’t remember a life without Scooter. And now without his Dad…,” she says crying. “I can’t believe I was so stupid.”

“You keep saying that. I don’t think it has anything to do with being stupid.”

Marlene looks up at me, frowning. “What are you implying?”

Taken aback I say, “That you’re not stupid.”

“So are you saying I did it on purpose?”

Puzzled, I look at Marlene and say, “Absolutely not! I was saying it was an accident.”

“I thought you people didn’t believe in accidents.”

“’You people?’”

“You know, shrinks.”

“Tell me what’s going on Marlene. I understand that you’re sad and distressed about Scooter. I understand you feel guilty. But it sounds like you’re attributing thoughts to me that I’m in no way thinking. What is it that you’re thinking, fearing, worrying about?”

She sighs. “When I was a kid we had a parakeet. Actually it was my younger sister’s. I wanted a dog. My mother said no way. So we got a bird. I never liked it much. The bird got out of the cage and ended up flying out the window. My sister cried for days. My mother said it was my fault, that I let the bird out.”

“And you’re worrying I’ll think you let Scooter out the garage door?”

“I didn’t!”

“It never occurred to me that you did.”

“It didn’t?”

“No, it didn’t.” Somewhat hesitantly I add, “But I don’t know about that bird. How did the bird get out of the cage?”

Marlene lowers her eyes. “I let it out,” she says quietly. “But I didn’t mean for it to fly away. I just wanted it to do something besides sit in that dumb cage all day!”

“Sounds like a perfectly understandable thing a child might do.”

“It does?”

I nod. “Also sounds like you’ve been carrying that guilt around with you for a long time.”

“But I didn’t want to get rid of Scooter! I know he can be demanding sometimes and that he does take up time, but he’s a member of the family. I didn’t want him gone.”

“I believe you Marlene. We all want beings we love gone sometimes, including human beings. It doesn’t mean we stop loving them or that we really want them gone forever.”

Marlene is sobbing. “Thank you. I really needed to hear that.” Pause. “Cause truthfully I got scared when my ex said he wasn’t sure he could trust me with Davey. I started wondering if I was purposefully negligent.” Pause. “If I was evil. That I’d harm Scooter or even Davey just like I hurt that bird.”

“You’ve been carrying around a lot of guilt for a very long time. Seems like it’s something we need to look at.”

Murder on Her Mind|by Linda Sherby, Ph.D, ABPP

Thu, 22 Aug 2019 17:21:05 GMT

A patient's competitiveness is directly on display in the treatment room.

Gina smiles at me, sashaying into my office from the waiting room in her short, tight, floral dress.

“Like my new dress?” she asks, settling into the chair, trying unsuccessfully to both cross her legs and cover them. “My friends tell me 45 is too old to wear a dress like this. But I don’t care. I’ve got it, I’m flaunting it. They’re just jealous. What do you think?”

I silently agree with her friends and wonder if she wants me to be another jealous woman. I say, “You get to wear whatever you want to wear.”

“It makes me feel alive. Of course, I’ve been feeling pretty alive these days anyway. Nothing like an affair to spice up one’s life. New man, new compliments, new sex. I love it when I get on top of him and all the lights are on and he looks at me while stroking and pinching my nipples. We can go for hours.”

Gina and I have talked a lot about her affair. I remain silent.

She pauses and then continues, “You know how I like to read all these mysteries – some old, some new – Agatha Christie, John Grisham, Patricia Cornwell, Scott Turow…?”

I nod, unclear where Gina is headed.

“Well, ever since I’ve read that Presumed Innocent book about the wife trying to get back at her husband by framing him for his girlfriend’s murder by using his semen, I’ve been fantasizing about how to kill you know whose wife and set my husband up to take the fall.”

My anxiety spikes. “Actually I don’t know who,” I blurt out, “since you continue to refuse to tell me who he is.”

She laughs. “It’s just an expression. We’ve been over this a million times. She’s in your field. I’m afraid you’d know her, or even him. End of topic.”

“It can’t be ‘end of topic’ if you’re considering killing her!”

“You’re being so silly today,” she says dismissing me with a wave of her hand. “I didn’t say I was going to kill her – I couldn’t do that – I’m just fantasizing about it.”

I think about what she just said. It’s true. She was talking about fantasy, not action. I’ve listened to many patients over the years talk about their murderous and/or suicidal fantasies without assuming they were going to act on them. What’s different here, I ask myself.

Gina is speaking, “..it wouldn’t even be hard. My husband and I even have a better sex life these days. I guess I’m so turned on all the time, I’ve been more sexy with him too. See, he’s enjoying my affair too. But I can’t figure out how I’d get him to use a condom. So far my fantasy hasn’t helped me with that one.”

And do you find your murderous fantasies a turn-on?”

She taps her lips with her left index finger, considering my question. “I guess. But the turn on is having the power to figure something like this out – not dummy Gina after all. It’s exciting.” Pause. “Don’t you think it’s exciting?”

Suddenly I’m convinced that everything that’s happened in this room today is about Gina and my relationship.

“Gina, I wonder if we can step back for a minute. It feels to me that you’re trying to one up me..”

“What are you talking about?”

“Well, I think you’ve tried to make me jealous, tried to titillate me with your sexual stories, dangled withheld information in front of me, and terrified me with talk of murder.”

“You have one warped mind if you think I’m trying to turn you on!”

Interesting comment, I think to myself. “I didn’t say that you were trying to turn me on. I think you’re trying – and I’m not saying it’s conscious – that you’re trying to make me feel less than you, trying to win over me, just as you tried to win over your mother to be closer to your father.”

“I’ve told you, I did win! My father called me ‘the beauty.’ It’s me he wanted to twirl around in my new clothes. It’s me he took to breakfast on Sunday morning, just me, not my mother, not by brothers.”

I think, but reject saying, ‘but who went into the bedroom at night?’ a remark that feels both premature and hostile. “Let’s go back to us for the moment,” I say instead. “You started the session talking about your friends being jealous of you. Seemed as though you wanted me to be jealous too, like you’re flaunting your beauty, your sexuality.”

Gina looks at me coyly. She drops her head for a second and then looks at me defiantly, “I don’t want to be mean, but you’re not a worthy opponent. You’re too old.”

“Wow!” I say. “You’re correct. I’m considerably older than you. But the way you just said that, sounded like you were intent on delivering a death blow. I guess I’m another murder victim.”

Boredom|by Linda Sherby, Ph.D, ABPP

Fri, 19 Jul 2019 20:20:30 GMT

In this blog, Boredom, a therapist seeks to understand her patient's consistent lateness and her underlying boredom.

I look at the clock. Camilla is now 15 minutes late for her session. I’m not surprised. She’s been consistently late for every session since we started working together several weeks ago. She always apologizes, always has some reason – the car wouldn’t start, she got a last minute phone call, the traffic was bad.

Finally I see the red light that signals a patient is in my waiting room.

“I’m sorry,” she says, breathless. “I told myself I’d be on time today. But my Mom called and was telling me I needed to call my Grandmother. I know I should. I love my Grandmother, but I don’t like talking to her on the phone. It’s boring. She asks the same questions – how’s my job, have I met any nice boys, am I going out with my friends. Boring!”

“What makes it boring?” I ask and then immediately regret my question. I want to talk to her about her lateness. Or at least ask her what she means by boring.

“I told you,” she replies, crossing and uncrossing her legs, combing her fingers through her long brown hair. “She always asks the same questions. My job is fine, I haven’t met anyone and, yes, I go out with my friends.”

We sit in silence for a few seconds until she says, “What? You think I should call my Grandmother?”

I shrug my shoulder. “I think that’s up to you.”

She sighs. “I wish my mother felt like that.”

Silence.

“What?” she asks again. “Aren’t you going to ask me anything?”

“What do you feel in the silence?” I ask.

“What?”

“What do you feel in the silence?”

“Like we’re wasting time, not getting anywhere.”

“That’s what you’re thinking, what are you feeling?”

“I don’t know.” Pause. “Bored I guess.”

“Sounds like it’s easy for you to feel bored.”

“Yeah, I guess,” she says fidgeting in the chair. “I don’t like sitting still. I don’t like quiet. I need to have stuff going on. That’s why I like my job at Saks, even though my parents say they didn’t pay for me to go to college for me to work at Saks. But there are people around and all those great clothes. Even if we have no customers I can walk around picking out clothes, holding them against me, deciding if I see something I really, really want. Although that’s frustrating because I can’t afford most of that stuff anyway, even with the employee discount. Not until my parents give me an allowance again. They say they’re paying for my apartment and until I get a real job that’s all I get.” Pause. “But I’ve told you all this already. What else should we talk about?” she asks, glancing at the clock.

“Do you have any thoughts about why you looked at the clock just then?”

“I don’t know. I guess because I’m bored and because time is just crawling by.”

Ah ha, I think. “Camilla, do you think it’s possible that you’re consistently late here because 45 minutes feels like a long time to sit and talk to me?”

She looks startled. Then smiles. “Yeah! 45 minutes is a long time! I never sit for 45 minutes. It’s why I always nix going to the movies. Who can sit for two hours watching a dumb movie?”

“So you come late so you don’t have to sit so long?”

“Yeah. But it’s not like I decide to come late. It just happens.”

“I understand. But it may ‘just happen’ because you unconsciously don’t want be here for the full session.”

“I suppose.”

“Is there any other reason you might want not to come here?”

“I don’t know. What are you getting at?”

“Well, I was wondering if coming here is kind of like calling your Grandmother. You feel you should do it. You know your parents want you to do it. But maybe it’s not really something you want to do.”

“Maybe,” she says shrugging.

“You’re 25 years old, Camilla. You don’t have to be here if you don’t want to.”

“I know,” she says looking down. “But I have to do some of the things my parents ask.”

“I think it would be important for you and for us to know what it is that you want to do.”

“I don’t know what I want to do! That’s why I’m here.”

“Does that mean you’re not only being an obedient child by coming here, but that you do want help figuring yourself out?”

“I guess.”

“That doesn’t sound too certain.”

“Can we make the sessions 30 minutes?”

“No. My schedule is based on 45 minute sessions. And, besides, if you decide you want to come, I think it would be good for us to work on what makes it so difficult for you to be still, on what you feel underneath what you call boredom. And perhaps we could look at your lateness – or being on time – as a message about how you’re feeling about me and the therapy. That’s if you decide to continue. And that’s something you will have to decide.”

Father's Day|by Linda Sherby, Ph.D, ABPP

Tue, 18 Jun 2019 21:50:25 GMT

In this week's blog, "Father's Day" a patient's ambivalence about his parents takes center stage, increasing his anxiety about separation and loss.

“I have to decide today,” says 44 year old Brian, a patient who started seeing me last month because of overwhelming anxiety. Passing his hand through his brown, wavy hair he continues. “I’ve delayed and delayed, but if I’m driving to Pensacola tomorrow in time for Father’s Day, I have to make a decision today. No more procrastinating.” Pause. “It’s no secret that I don’t want to go. Even my mother who’s calling me every day to bug me about coming knows I dread the idea. And my wife is staying out of the whole thing. Which is kind of her. All I’d need is for her to be pulling me in the other direction and saying I need to stay for our boys.”

“I notice you’ve mentioned your mother, your wife and your boys, but not your father.”

Brian chuckles. “You’ve got that right. I realize it’s supposed to be his day, but if it were only for him I know I wouldn’t go. I mean, he was awful my whole life, but ever since he banished my brother because he’s gay and then Trump was elected, it’s impossible to have five minutes of a civil conversation. My father has always been a tyrant. He has an opinion about everything and for some reason he thinks he’s an expert on everything too. Which is ridiculous, since he barely finished high school and clearly isn’t very bright.”

I think of my father, definitely smart, politically like-minded, but most definitely a tyrant. “So why would you go?” I ask.

“My mother.” Pause. “And she’s right, they’re not getting any younger. But she’s pulled out every guilt inducing maneuver she can think of. ‘What if Dad dies and you never see him again?’ ‘Why does his relationship with Paul have to affect you?’ ‘Can you imagine how embarrassing it would be for him if not one of his children is present?’ ‘You can bring Janet and the boys; we’d love to have them; the whole family together’ As if I would subject my boys to whatever explosion is bound to happen.”

“And how do you feel about your mother pressuring you?”

“I don’t know. It’s what mothers do.”

My mind wanders to the many difficult years I had with my father, coupled with my mother’s constant inability to ever see my point of view. Regardless of the circumstances I was always the one who had to make things right.

“But that doesn’t tell us how you feel about your mother pressuring you,” I say.

Brian sighs. “It’s the same old, same old. My mother’s whole life revolves around my father. She has nothing else in her life. Except for us of course. But she’s followed my father’s lead as far as my brother. I wonder how she feels about being totally disconnected from Paul.” Pause. “It’s sad.”

“Sad for her? For Paul?”

“I was thinking sad for her. But it must be sad for Paul too.” Pause. “You know, I’m getting more anxious as we talk about this.” Pause. “And feeling like I should go.”

Silence.

“I, I need you to say something. My anxiety is going through the roof,” Brian says, clenching his hands and fidgeting in the chair.

“So the silence made you more anxious, just like thinking about the disconnect between Paul and your mother.”

“Yeah, I guess so, but I’m not sure how they’re related.”

“Nothing comes to mind?” I ask.

Brian shakes his head, looking puzzled.

Although I would prefer to wait to see what might emerge from Brian, his escalating anxiety pressures me to speak. “I wonder if one of the things that makes you anxious is the fear of being disconnected, not connected to your mother or to me.”

“I’m not sure I understand.”

“Well, you were talking about how your mother has no relationship with Paul. I think that scared you. You wouldn’t want to have no relationship with your mother, so I suspect when that thought went through your mind – consciously or unconsciously – you felt you’d better go for Father’s Day.”

“Wow! You think that’s what my anxiety is all about, being disconnected from my mother?”

“Your anxiety could be the result of many things, but the fear of separation could certainly be one of them.”

“And with you too?”

“Well, you were already feeling scared of being separated from your mother and when I wasn’t speaking I think you experienced that feeling of separation with me as well.”

“I’ll have to think about that. But meantime, what should I do about Father’s Day?”

“I can’t decide that for you Brian. There’s not a right or wrong decision, just your decision.”

“That scares me too.”

“Because?”

“What if I make a mistake?”

“What if you do?”

“I think I’m going to go. It feels like the safest choice.”

“You need to do whatever you need to do. There was a lot that came up in this session today, too much for us to deal with it all. So I’m sure whatever you decide will be fine and we’ll have other times to work on your anxiety and your relationship with both your parents and with me.”

I'm Finished|by Linda Sherby, Ph.D, ABPP

Fri, 10 May 2019 21:36:12 GMT

In this blog, "I'm Finished" a therapist deals with her patient's anger and feelings of exclusion.

“I don’t know why I have to keep talking about this,” Paulette says angrily. “I’m going to be 50 years old. I’m finished. I want out of my marriage! There’s nothing more to talk about.”

Keeping my voice calm, I say, “I certainly wasn’t suggesting you stay in your marriage, but I know every time you’ve left Derek before you’ve gone back, so I thought it would be helpful for us to look at what feels different this time.”

Paulette runs her hand through her hair and sighs. “The kids are gone, either in college or out on their own. They’re launched. I don’t have to worry about them any more.”

Treading carefully I say, “I wasn’t aware that you went back the last several times because of the kids.”

Paulette glares at me. She says nothing.

“Right this moment do you feel you want to leave me too?” I ask.

“That’s exactly what I was thinking. Maybe I should. Maybe I should leave you too. Maybe this has gone on way too long. And now you’re telling me I should stay married even though I’m so unhappy.”

I know that is not what I said, but arguing with Paulette is not helpful, especially when she’s incensed. “So you’d leave me and you’d leave Derek. What specifically would you do?”

“Are you daring me? You think I couldn’t do it. You think I couldn’t walk out of here right now, go home and pack up and leave?”

“I think you’re angry, Paulette. I think when you’re angry it’s a poor time for you – or anyone – to decide anything.”

“Are you trying to aggravate me? Because you’re doing a pretty damn good job of doing so.”

“No, Paulette, I’m not trying to aggravate you. As we’ve talked about, once you’re angry anything and everything can make you angrier.”

“You’re talking to me in that goddamn condescending voice, like I’m a child.”

“I’m sorry. You’re right. I am. But in some ways you feel like a child right now, Paulette. You know when you get angry the feeling just gets bigger and bigger until it wipes everything else away. So much so that you can forgot what you’re even angry about.”

“Did you just apologize to me?” Paulette asks, surprised.

“Yes. I have apologized before. Especially when I’ve let these interactions between us escalate to the point of us both just being angry.”

Paulette takes a deep breath. “That’s true. I remember,” she says, more calm now. She pauses. “Why can’t Derek do that?”

My thought - because he’s not your therapist - goes unsaid. Instead I say, “I imagine because he gets caught up in his own feelings.”

Silence.

“Can you say what you’re thinking?” I ask.

“I was thinking about what set off this whole argument over the weekend and that what I’m afraid of is exactly that, his getting caught up in his own feelings.”

I wait.

She sighs. “He made plans to go see our youngest daughter at college. Didn’t invite me, didn’t ask me, didn’t tell me,” she says, her voice rising. “Why would he do that?” Paulette demands. “He’d know what my reaction would be.”

“So you see him as provoking you?”

“Well yeah!” she says sarcastically. “But you know that’s not the worst part. He wants to be alone with her. He doesn’t want me around messing it up. I know, she’s a big girl now – sort of – and she’s not going to let him do anything inappropriate. But what if he tries? What if his feelings get the better of him? He’s always wanted her. He always preferred her over me.”

“Paulette,” I say gently. “Your father started molesting you when you were 10. You’ve asked your daughters multiple times, cautioned them multiple times to not let anyone touch them inappropriately, to tell you if anyone ever made them feel even vaguely uncomfortable. Neither of them has ever said a word to you about their father.”

“But what if she likes it?”

Oh, oh, I think. Lots of issues there and we’re near the end of the hour. The thorniest question of whether she’s talking about herself will have to wait for our next session. For now I’ll take the easier path. “Well,” I say, “she may enjoy her father’s attention, the special relationship she feels they have.”

“They’re always excluding me. I feel I’m in competition with my own daughter! That’s sick.”

“Lots of issues came up here, Paulette. Why don’t we table them for the moment and talk about them at our next session.”

The Dream|by Linda Sherby, Ph.D, ABPP

Mon, 15 Apr 2019 22:19:55 GMT

In this blog, The Dream, a patient struggles with his terror in the aftermath of a dream, while his therapist must deal with her patient's resulting paranoia and her own uneasiness.

“I had a dream last night,” Justin begins, squirming nervously in his chair. “I can’t remember any of it, but I feel haunted by it. I know that doesn’t make much sense, but it’s like I woke up scared, like something terrible is going to happen, like something or someone is going to get me. I kind of want to keep looking over my shoulder. Even here, I wonder if there’s someone else in the room, although I know that’s ridiculous.”

Justin, a 45 year old accountant, has been my patient for several years and, as far as I can remember, has never before spoken about a dream.

“Well,” I respond, “the dream obviously affected you, so maybe you can talk about your feelings and what those feelings bring to mind.”

“You’re charging your phone,” he says.

“Yes,” I say, surprised. It’s not unusual for me to charge my cell phone while patients are in the office.

“How do I know you’re not recording me?”

Justin can sometimes be a bit paranoid, but his question is beyond anything I would expect. “I guess you are feeling frightened, Justin. Your world suddenly feels very unsafe so even innocuous things can feel threatening."

"You didn’t answer my question.”

I’m taken aback, perhaps even a little frightened myself. Hmm, I imagine Justin is unconsciously inducing his feelings in me. “No, I’m not recording you. You’ve seen me charge my phone before, so I’m assuming that your concern is being triggered by your fear.”

Justin stares at me. My fear builds.

“Would you like me to unplug my phone?” I ask.

“I’d like you to turn it off,” he replies woodenly.

“Okay,” I say as I lean to my left, pick up my phone and turn it off.

The silence that ensues is deafening.

Finally, Justin drops his head in his hands, shakes his head and mumbles, “I’m sorry, I don’t know what’s wrong with me.

I breathe a sigh of relief. “So let’s see if we can figure out what’s going on, perhaps what triggered the dream, what might have led you to feel so frightened.”

“It’s such a terrible time of year. Tax time you know. Some days I’m working 5AM to 10PM at night. And everyone wants a piece of me. My ex-wife’s mad because I haven’t taken the kids. My older son says he needs money for college. My clients are driving me crazy. Everyone wants their taxes last week. I keep telling them it’s no big deal if we have to file an extension. But, no, that’s not good enough.”

“When you say everyone wants a piece of you, what comes to mind?”

“That’s it!” he says excitedly. “That’s what was happening in the dream. Everyone was pulling at my skin, like they were trying to rip me apart. I know there was more after that but …” He stops. “I think there was like a monster there. Maybe like a monster waiting to eat the pieces of me that they threw to it.”

I grimace internally. “That does sound terrifying.”

Silence.

After a few moments I ask, “What’s going on in your head?”

“I don’t know. I sort of feel I used to have that nightmare as a kid. A lot.”

“Any thoughts about it?”

Silence.

“I’m sorry,” he says after a few moments. “I suddenly felt frozen. Like I couldn’t move. And… I know this is ridiculous, but you seem menacing again.”

“What is it that you’re afraid I’ll do?”

“I know this is crazy, but what jumped into my head was, eat me.”

“Like in the dream.”

He nods.

“Any thoughts?” I ask, although I have a pretty good idea of the answer.

He nods again. “Yeah, my mother. I used to say she loved me to death. But I guess I meant that literally. She wanted all of me. She didn’t want me to have anyone else in my life. She didn’t do that to my sisters, just me. They hated me, thought as the boy I got all of my mother. But I didn’t want all of her! And I sure didn’t want her to have all of me! Yuck! I feel beyond creeped out. I mean, I know we’ve talked about all this before, but having that dream made it so much more real.”

“The dream actually brought you back to the feelings you had as a child, the terror of being eaten, of being swallowed up.”

“Stop! I can’t deal with any more today.”

“Of course. Whatever feels comfortable for you.”

Justin looks at me with tears in his eyes. “I wish my mother could have been concerned about my comfort. And I’m sorry I thought you were recording me.”

“Nothing to apologize for. Totally understandable given what you were feeling.”

Guilt|by Linda Sherby, Ph.D, ABPP

Fri, 15 Mar 2019 22:02:28 GMT

In "Guilt" a therapist meets with a young woman who desperately strives to please her parents, blaming herself for falling short and giving them problems.

“I feel so awful, I can’t believe that I had to disappoint my parents. I can’t believe I couldn’t handle college, that I had to come home. My parents have always been there for me, always wanted the best for and all I do is screw up.”

This is my first session with Tiffany, a slender, attractive young woman with blue eyes and long blonde hair. Her mother, sounding concerned, had called to make the appointment, saying that Tiffany was having difficulty at Duke and needed to come home.

“I hate myself!” Tiffany continues.

“Wow! That’s pretty strong. Can you say why you hate yourself?”

“All I’ve done is give my parents problems my whole life, even before I was born. My mother had to be in bed for two months before she had me! She’s a physician – so’s my father – she can’t just take two months off. But she had to because of me.”

“That hardly sounds like your fault, Tiffany. I assume it was some medical condition your mother had.”

“She never had that problem with my brother. My brother never gives them problems. He’s graduating from Yale and going on to medical school. Of course!”

Clearly hearing her sense of competition and failure in relationship to her brother, I decide, for the moment, to focus more on her current situation. “Can you tell me what was going on for you at college?”

“All those science courses! I can’t handle them. I’m just not smart enough. I started crying at every little thing. And I think I pretty much stopped eating. And then I couldn’t even get myself out of bed to go to class. Especially Chemistry class. I don’t understand it. It makes me feel stupider than I already feel.”

“Are there classes that you enjoy, that you do well in?”

“Oh yes,” she says, brightening. “I love anthropology and I’m…hmm…I’m a pretty good writer.”

“So you take science courses because…?”

“What do you mean? I have to take science courses to get into medical school.”

“And do you want to go to medical school?”

“I’ve always known I’d go to medical school.”

“That’s not the same thing as wanting to go.”

“Yes, I want to go to medical school. I put my parents through a lot when I was a kid. I got rheumatic fever and ended up in the hospital for quite a while. I could tell how scared they were.”

“You must have been pretty scared too.”

“I was, particularly when I was alone. But the doctors and nurses were great. And I kind of enjoyed watching all the machines and monitors. That’s the kind of doctor I want to be, a pediatrician, to help kids like me.”

“And do your parents want you to be a doctor?”

“Definitely. It’s like a given.”

“So what if it wasn’t a given? What if you could decide to do anything you wanted to do?”

“I’d go on archeological digs and write about them or even write made-up stuff about the digs, like mysteries. But that’s not at all practical. No way to make a living.”

“Have you ever wondered, Tiffany, why you feel so guilty in relation to your parents?”

“I told you why, I’ve always given them problems. Besides rheumatic fever I was a sickly kid. And I broke my arm doing gymnastics. They always had to worry about me.”

“It seems that a lot of the things you feel guilty about you had absolutely no control over, like your mother needing bed rest or your having rheumatic fever or breaking your arm.”

“I was fooling around on the bar, that’s how I broke my arm.”

“You sound determined to have things be your fault. Do you think, Tiffany, if you felt things weren’t your fault, you’d end up feeling powerless and scared?”

“I don’t know. I’m not sure I know what you mean.”

Too soon for that interpretation I tell myself. I decide to pursue a different path. “Do you ever feel angry at all the pressure you’re under?”

“Angry? I don’t think so. I feel mad at myself for not being able to keep up and, like I said, worrying my parents.”

“So, now that you’re home, do you think you’re going to be able to relax and take it easy for the rest of the semester?”

“Oh no. My parents are going to get me a chemistry tutor so I can go back to school more prepared.”

At this point I find myself feeling angry at Tiffany’s parents and wonder if I’m feeling Tiffany’s unacknowledged anger. That could explain the tremendous guilt she feels – guilt for the anger she doesn’t even know she has. But those interpretations are also premature.

“Our time is almost up for today. But I hope I’ll be able to get to know you more and I hope you’ll tell me more about your wishes and your dreams, even if they aren’t always practical.”

“I wish you could make me smarter.”

“I don’t know if I can do that, but perhaps I can help you to be more accepting of yourself.”

Being Checked Out|by Linda Sherby, Ph.D, ABPP

Fri, 15 Feb 2019 19:07:40 GMT

"Being Checked Out" illustrates a therapist's attempt to engage an untrusting, young African-American man in the treatment process.

This is a first time I am seeing Maurice, a tall, thin, 22 year old African-American man. He looks uneasily around the room, settles himself in the chair across from me, still holding his phone and keys in his hands.

“How can I help you?” I ask.

“Dr. Hudson said I should come. He’s my English professor at the University. Says I have more potential than I show.”

“And do you agree with him?”

“About my potential, yeah, I do.” Pause. “But if you can help me, I don’t know.”

“Because…?”

“I don’t mean to be disrespectful, but you’re white. And you’re a lady.”

“You’re right. I am both white and a lady. And that makes you feel I couldn’t help you, couldn’t understand you?”

He nods.

“Well, we’d only know that as we got to know each other and, hopefully, learned to trust and respect each other.”

Silence.

Maurice sighs, shakes his head. “I don’t know. I don’t know if I can just do that, just start talking and hope that I can trust you.”

“Do you trust Dr. Hudson, since he’s the person who referred you to me?”

“I trust him as a teacher. I’m not telling him all kinds of shit about myself.”

“That’s true.”

Silence.

“You’re not trying to talk me into trusting you,” he says.

“I think that’s pretty hard to do. But I was about to ask what you thought might help you trust me enough to tell me about yourself.”

“I know shrinks don’t usually do this, but what if I ask the questions, ask you about yourself?”

“Well, I guess that would depend what the questions were. If you asked me to tell you about every person I ever dated and what our sex life was like, I’d probably want to know how that was relevant to your concerns about trusting me.”

He laughs. “No, I wasn’t going to ask you that.” Pause. “Although now that you mention it, I did think of something kind of like that. Did you ever date a black man?”

I hesitate. “The answer happens to be yes, but I don’t think if the answer was no, that would mean you couldn’t trust me.”

“No. But, it’s a piece of information.” Pause. “Did you ever have a black friend?”

“Yes.”

“Did you ever live in the ghetto?”

“No.”

“Have you ever been inside a prison?”

“Yes.”

He looks surprised. “How come?”

“I worked as a group therapist in a men’s prison when I was in graduate school. I did my doctoral dissertation in that prison. I also worked in a forensic center and at a women’s prison.”

Maurice nods his head. He places his phone and keys on the small table next to him.

I take those gestures as a sign I can take on my more traditional therapeutic role. “So I assume you or someone close to you has been in prison.”

“Yeah. Like all my brothers. I did a little time in juvie, but no hard time.”

“And you feel how about having been the only one of your brothers to avoid prison?”

“Bad. Lucky. Glad. Guilty. Like shit. Fortunate.”

“Lots of mixed feelings.”

“Yeah.”

“So can you tell me more about you?”

Silence.

“I can, but I wouldn’t want you to think that means I totally trust you.”

“Maurice, trust takes a long time to build. There’s no question, no hundred questions that you could ask me that would assure you that you can trust me. And besides, trust is a complicated word. What does trust mean to you?”

“First thing I thought, ‘That you’re not going to stab me in the back.’ And I guess I mean that both literally and figuratively.”

“I get it that young black men have to first be concerned for their lives. And after that, I guess you’re saying that you’re afraid I’ll somehow lure you in and then turn on you, betray you.”

Maurice nods. “I want to write. I think I have something to say. But I’m ignorant. I don’t know enough. I need to get my degree. So many of my people – both my family and black people in general – have sacrificed so much so that I can have this opportunity. I don’t want to let them down. I can’t let them down. But I can’t get out of my own way,” Maurice says with clenched teeth.

“Any idea why that is?”

Silence.

“I wish you were black. And I wish you were a man.”

“Well, I’m not,” I say shaking my head. “And it’s not like I have any black, male colleagues I can refer you to. So I guess you’ll have to decide if I’m good enough.”

“I like you, Doc. I guess that’s as good a place as any to start.”

The Unexpected Affairs|by Linda Sherby, Ph.D, ABPP

Sat, 19 Jan 2019 00:52:55 GMT

Exploring a therapist's attempt to understand her patient's sudden pronouncement that she's going to have an affair.

Judith is a tall, attractive 44 year old woman who carries herself as if she knows she will be noticed, clearly distinguished from those around her. Although she’s presently a stay at home Mom, today she is dressed as the lawyer she is, a perfectly fitting gray suit and black high heels.

“I’ve decided to have an affair,” she says matter-of-factly.

I’m startled. In the six or so months I’ve seen Judith, she talked about being dissatisfied in her marriage, but hadn’t mentioned the presence of another man.

“With whom?” I ask.

“I don’t know yet.”

Silence.

“I know,” she continues, “that’s a rather unusual way to go about it, but since my husband hardly gives me the time of day – I can’t even remember the last time we had sex or even had a real conversation - I decided I might as well get my needs met elsewhere. I’m not going to leave him. The kids need their father and I need some male attention so, an affair’s the answer.”

During the course of my career I have seen many men and women who have been unfaithful to their partners with one or many other people. I’ve always been comfortable talking with them about both their feelings and the meaning of these multiple relationships. But Judith’s cavalier manner, her impulsive decision, and her pronouncement to me without any apparent willingness to discuss her decision, is both off-putting and confusing.

“When did you make this decision? And how do you feel about it?”

“It feels like a good decision. Solves lots of problems. I guess I decided a couple of days ago. Hence my outfit today. I figure any time I’m out and about I need to be looking my best.”

“Did anything happen in the last couple of days? Anything happen since we last met?”

“No,” she replies flatly. “Nothing happened. Same old, same old, I guess that’s what happened.”

“Do you plan to talk to your husband about your decision?”

“What!? Are you crazy? He’d divorce me in a minute.”

I knew she wouldn’t tell her husband. Why did I ask that question? Was I trying to make her feel guilty? Surprisingly, what Judith is contemplating does feel ‘wrong’ to me, it feels ‘wrong’ for a person in a committed relationship to decide in a calculated and apparently logical way to become involved with an unknown other person. I feel very differently if the person has an affair and wants to talk about it, understand it, and deal with the meaning it has for them. Hmm, I think. Her pronouncement felt as though she was throwing down a gauntlet. Perhaps that means her decision is about me, about our relationship. What was it we talked about in last week? Of course! She told me she read my book, the book in which I discuss both the intensely loving relationship I had with my late husband, as well as my strong emotional involvement with many of my patients.

“Judith, how did you feel about my book? I know we talked a little about it last week, but you seemed to skirt really looking at your feelings.”

“Now where are you going? I told you I thought you wrote very well and that the book was engaging.”

“But how did you feel about it? How did you feel about my relationship with my husband? About my relationship with my patients.”

She shrugs. “I guess I felt you were lucky. Here you had this shitty relationship with your father, but you found this adoring man to marry. I didn’t have that shitty a relationship with my father – not that he paid much attention to me, too focused on my mother – and I married a man who still doesn’t pay any attention to me.”

“So, perhaps you felt angry with me, that, in your words, I got lucky, while you got stuck.”

“Yeah, that’s about right.”

“So I came out ahead just as your mother came out ahead and that makes you doubly angry.”

“I hadn’t thought of that, but I guess that’s true.”

“So your ‘decision’ to have an affair is really based on your anger at both me and your mother for getting more than you, for leaving you feeling cheated.”

“You really don’t want me to have an affair, do you?”

“I think you’re saying I’m trying to keep you away from happiness, from your father.”

“That’s a bit too deep for me. I think you think having an affair is wrong.”

“I don’t necessarily think that having an affair is wrong. I think affairs have many meanings. For you those meanings are clearly related to feelings about both your parents, that you bring into the present and into this room.”

“So you think I shouldn’t have an affair?”

“I think we should talk about it a lot more before you act.”

“I can’t promise that.”

“I understand. You don’t have to promise anything. You get to do what you do and we get to deal with it.”

“Okay. As long as that’s clear, I’ll see you next week.”

Diminished|by Linda Sherby, Ph.D, ABPP

Sat, 05 Jan 2019 03:17:36 GMT

A patient lashes out as a result of feeling 'less than' allowing his therapist to demonstrate how the past impacts the present.

“I hope you had a better New Year than me,” Jeff says with a bitter edge as he settles into the chair across from me.

“I thought you were really looking forward to spending New Year’s with Eileen.”

“Yeah, me too. She broke up with me.”

“Oh, I’m sorry. You thought this relationship had real potential.”

“Them’s the breaks. I don’t seem to be able to find anyone since my divorce. Sometimes I wonder if I should have stayed with my ex, but I know we were both totally miserable.”

Forty-two year old Jeff is a good looking man with blonde curly hair, a dimple in his chin and intense blue eyes. He has, however, had little success in establishing a new relationship.

“Did Eileen say why she broke up with you?”

“Something about my being too sarcastic or too needy or some stuff like that.”

Silence.

“I guess you want to know what I think about what she said to me.”

“Jeff, your tone is pretty biting today. Are you angry with me?”

“I guess.”

Silence.

“I’ve been reading your blogs. And I was wondering why you never write about me. What makes the patients you write about more interesting than me?”

“Before I address that question directly, I’d like to look at the feelings that were brought up for you.”

“Makes me feel like I’m not as good as your other patients, not as important, not as interesting.”

“Sounds pretty much how you felt in relation to your two older brothers.”

“That’s for sure,” he says, smirking. “I was the pretty one, but not a girl. And my brothers had the smarts and the artistic talent which was way more important than looks in my family.”

“So you feel less than.”

“Yup! Guess you could say that.”

“And the fact that you’ve built a thriving accounting firm doesn’t undue the messages of ‘less than’ that you took in as a child.”

“Right again!” Pause. “I’m just a numbers man, not an intellectual, not an artist.”

“And the worse you feel about yourself, the angrier you are at the other – me, Eileen, whoever – for, in your eyes, not being valued.”

“So you’re saying Eileen was right about me. That’s great, real support, and from my therapist no less!”

“I don’t know if Eileen was right about you or not. What I do know is that when you feel diminished, less than, you’re so hurt by those feelings that you lash out and that doesn’t serve you well.”

“So why haven’t you written about me?”

Although Jeff’s demandingness makes me want to withhold from him, I feel it is more important to respond to his question and then deal with his reaction to what I have to say. “I don’t know, Jeff, how many of my blogs you read, but every so often I explain that the ‘patients’ in my blogs are fictionalized. I’m real – as real as I can imagine myself to be in a made up situation with a fictionalized patient. Otherwise I’d be concerned about patient confidentiality.”

“You’re kidding me?! Now I feel like a real ass. Competing with imaginary people! You must have been laughing your head off at me.”

“Not at all. This has been a very important session. We could see right in front of us how hurt you feel when you feel devalued and how quick you are to attack the person you experience as diminishing you. It clearly comes from how you felt as a child, but we need to work on helping you not to automatically assume that you are being devalued and, even if you are, not to bring to the current situation all the rage you felt as a child.”

“You know, I don’t even remember being enraged as a child.”

“Well, you might not have been allowed to show it.”

“That’s for sure. No one did anger in my family. We talked about issues like ‘civilized’ people. Anger was off the table.”

“So you’re probably sitting on years and years of anger.”

“You mean like when my mother would make me draw and draw and draw, despite the fact that I had no talent and that she would sit there criticizing everything I produced?”

“Yes, like that. I’m sure that made you plenty angry.”

“Holy shit! You know what I just realized. If the patients in your blogs are fictionalized, that means you’re one of those creative people. Does that make me feel less than? Yes, it does. But for whatever reason, right now that actually makes me feel more sad than angry. I guess I feel sad for the kid whose talents weren’t recognized and only found lacking for what he wasn’t.”

“That’s great, Jeff. I’m really glad you’re able to feel compassion for yourself as that child. That awareness will serve you well.”

Wanting to Flee - Part II |by Linda Sherby, Ph.D, ABPP

Mon, 17 Dec 2018 19:02:54 GMT

In this blog a patient continues to struggle with his terror about his therapist dying, as the therapist seeks to understand the origin of that terror.

“I can’t stop thinking about it,” Trevor begins. “Two therapists in this office died. Who’s to say you won’t be next? I’m having nightmares about your dying almost every night. What did they die of?”

Trevor’s speech is rapid, staccato, his anxiety palpable.

“I’m sorry you’re so distressed, Trevor, but I can’t see how knowing the details of other therapists’ deaths would help to calm you. What we need to do is deal with your fear of losing me.”

“More like terror.”

“Well let’s talk about that terror.”

“In my dreams I see you here in this office and as I’m talking to you, you start fading away, vanishing right in front of my eyes. And then you’re just gone and I’m here in an empty office. Sometimes I start screaming. Sometimes I wake myself up screaming.”

Listening to Trevor’s dream is difficult – his distress, the description of my death, plus the whole idea of fading away which actually taps into my own childhood nightmares. But I’m the therapist here and my patient needs me to act as one.

“Any idea, Trevor, why you’re dreaming this particular way of losing me, my fading away?”

“What difference does it make? Any way you’re gone.”

I’m surprised by what I hear as an angry tone to Trevor’s response. I remain silent.

“I really feel I should cut down on my sessions. I need to become less dependent on you. I need to prepare myself for your… for your leaving.”

“And how do you feel when you think about that?”

He pauses. “Not so good.”

“If you cut down on your sessions, would that be like your gradually fading away from me?”

“Oh! I never thought of that!” Pause. “But maybe that’s not a bad idea.”

“As in you’d leave me before I left you?”

“Yeah. Yeah. Something like that.”

“Would that feel like you’re getting back at me?”

“I don’t know. Feels more self-protective.”

“Trevor, it strikes me that a lot of how you’ve been in the world is self-protective, removing yourself from people, remaining distanced.”

“I suppose.”

“And we’ve always thought about that self-protection as stemming from your feeling the need to protect yourself from your father, and even more so when you realized you were gay.”

He nods.

I’m silent.

“What are you getting at?” he asks.

“Well, I was wondering two things, first how your mother fits into all this and second whether there isn’t some anger, some retaliation in your withdrawal.”

“Wow! I need to think about that.” Pause. “You know, Myra, my oldest sister, used to say that as my mother had more kids – 4 after me - she faded away more and more.” Pause. “I think that’s true. Early on Myra and I probably had the best of my mother, but then she kind of vanished.” Pause. “Just like you in my dreams.” Pause. “You think that’s why I’m so terrified of losing you, it’s like losing my mother all over again?”

“I think it’s very possibly at least one of the reasons. And it’s certainly interesting that Myra talked about your mother vanishing and your nightmares are about my vanishing.”

“But that doesn’t change the terror.”

“Well, if we’re able to help you re-experience your childhood terrors and come to know – and feel – that you’re not the helpless, dependent child you once were, I suspect you’d have much less terror about losing me. And there’s still the question about your anger and retaliation.”

“But what if I don’t feel the anger? What makes you sure I’m angry?”

“I can never be sure, but when you talk about wanting to leave me before I leave you, it sounds like retaliation, it sounds like you want to punish me and that feels like retaliation.”

“Like you think I was angry at my mother?”

“Yes.”

“Myra was certainly angry at my mother. She had no doubt about it. Practically ruined her life. She was so busy rebelling she became a drug addict! But she came around.”

“So you’re saying that anger is dangerous.”

“You bet! Just try being angry around my father!”

“And what about your mother? How did she react to anger?”

“I can’t believe I’m saying this, but she faded away even more.”

“So being angry with your father is physically dangerous and being angry with your mother leads to abandonment. No wonder you don’t feel your anger.”

“This has been a heavy session. Feels like a lot going on.”

“I agree.”

He sighs. “So I guess I shouldn’t cut back on sessions.”

I smile. “Sounds like a wise choice.”

Wanting to Flee |by Linda Sherby, Ph.D, ABPP

Mon, 03 Dec 2018 20:42:43 GMT

This week's blog deals with a therapist's need to first understand her patient's desire to withdraw and then address his underlying fears.

Trevor sits quietly in the chair across from me. After a few moments he says, “It was an okay week. Nothing special happened.”

I wait. There is silence. I’m puzzled. I have seen 26 year old Trevor for many years. I might even say I helped him grow up. When he first came to me he described himself as shy. During those years long silences were commonplace. But as he moved away from his fear and self-loathing he’s been far more engaged with me and, to a lesser extent, with the world outside my office. He acknowledged his gayness and was able to come out to his family and some of his friends. He’s still never been in a love relationship, a problem that we’ve been working on. But today his silence confuses me.

“Is something going on, Trevor?” I ask. “You seem particularly quiet, uncomfortable.”

He shakes his head and looks away from me.

I wait. I think about our last session. Did something happen that distressed him? We’d been talking about Thanksgiving with his family, but that had seemed to go fairly well despite his father’s usual blustering. Was there some tension between us? Nothing that comes to me. Don’t be impatient, I tell myself, just sit with him.

After a while he says, “I’ve been thinking maybe I should cut back to once a week. I’m doing pretty well and, like today, I don’t have much to say.”

I’m stunned. In all the years, Trevor has never asked to come less frequently and, in fact, has often asked for additional sessions. Something must have happened between us.

“Trevor, you need to tell me what’s going on. Did I say something last session that distressed you?”

“Why does something have to be wrong? Why can’t I just want to cut back?”

“Because you know as well as I do that there’s always a reason – usually more than one – for everything we do.”

He sighs. “Why did that psychiatrist retire?”

“What psychiatrist?”

“The one next door.”

The light dawns. He asked me last time what had happened to my neighbor. When I told him he retired, he obviously became fearful that I might follow a similar path. “He retired because he wanted to travel, have more time to himself, pursue other interests. And, no, I have no plans to retire, ever. I love what I do and as long as my mind is still with me I plan to stay right where I am.”

“And why is the sign on your door different? What happened to the other therapists? The ones who’d worked here? Did they retire too?”

Now we’re in more difficult territory. I’ve been surprised by how few patients have asked me about the change of signage on the front door. “No, Trevor, they died.”

His already pale skin blanches further.

“Okay,” I say in a calm voice. “I understand that you’re frightened of losing me. First you were afraid I might retire and now you’re afraid that I’ll die. And of course I can’t make guarantees about my dying, but it’s certainly my hope to stick around for a long time.”

“I have to cut back to once a week. I have to become less dependent on you. Right now if something happened to you I don’t think I’d survive.”

“Trevor, the idea is that our work together will help you to be able to be more and more engaged with people other than me, but we can’t accomplish that by your cutting the frequency of your sessions. You’ve been doing very well lately, going out to lunch with people, meeting friends for dinner and a movie …”

“But that’s because of you!” he says. “I wouldn’t be able to do that without you.”

“Then we’ll have to understand why you feel you can’t do those things without me and help you to feel more comfortable being in the world.”

“Did they know they were going to die?”

Loathe to provide too many details, I say, “Yes, they both knew they were ill.”

“So they could tell their patients?”

“Yes, their patients knew they were ill.”

Trevor starts to cry. “I couldn’t stand it! I couldn’t stand it if you died! I couldn’t watch you die.”

“I understand, Trevor, but I’m not ill and I’m not planning to die any time soon. Obviously none of us know when we’re going to die and it’s always sad to lose someone we love, but what we need to do is focus on helping you to be fully in the world, to embrace life and enjoy it.”

“Can we talk about this again next week?”

“Of course. I’ll see you Monday.”

The Invitation |by Linda Sherby, Ph.D, ABPP

Mon, 26 Nov 2018 22:03:27 GMT

This week's blog illustrates a therapist's frustration with a patient who is both unaware of her own anger and unable to see how she provokes anger in others.

“You sound less than excited about the invitation.”“My neighbor invited me for Thanksgiving,” Marnie says without enthusiasm.

“Yeah.”

I remain silent.

“It’s her family.” Pause. “It’s not my family. I won’t know anyone. Except her husband and I don’t like him much.” Pause. “I don’t see why my sister couldn’t have invited me. Or my daughter.”

“I thought your sister was going on a cruise.”

“She is. But she didn’t have to. And I know, I told my daughter I didn’t want to travel all the way to Seattle, but she could have insisted.”

I find Marnie maddening. Nothing is ever good enough for her. I try, yet again, to provide some insight into her behavior.

“You notice, Marnie, that you’ve again set up a situation where you can’t be satisfied. Your neighbor invites you to her house, but you’re unhappy because it’s not your family. You expect your sister to not go on her cruise because she should be here to invite you for Thanksgiving…”

“What’s so wrong about that?” she asks, interrupting me.

Responses flit through my mind from ‘you’ve got to be kidding’ to ‘would you have canceled your cruise for the sister you rarely speak well of?’ Instead I take a breath and pause. “Marnie, I know that you grew up in a hostile, unloving home. I know that your parents were too involved in their own battles to care about their young daughter who had the misfortune to be born just when they were considering divorce. I know you didn’t get enough love, enough nurturing, enough care. But by finding fault with everyone, by demanding that everyone always think of you first, you’re insuring that you will never feel as though anyone cares about you.”

Marnie’s head droops. Tears fall silently from her eyes. I can anticipate what’s coming next and, unfortunately, Marnie doesn’t disappoint me. “So you’ve turned against me too,” she says, whining.

I want to scream. I suspect my anger is not only mine, but also a projection of the anger Marnie keeps buried inside herself. “Marnie, can you tell me what you’d like from me right now?”

“I’d like you to understand how much pain I’m in and support me.”

“And your pain is about never feeling loved?”

She nods.

“And you feel angry about never being loved?”

“I guess.” Pause. “You know anger wasn’t allowed in my house. Not as a child. I don’t like to feel angry.”

“But it would make sense for you to feel angry about never being loved, right?”

“I guess,” Marcie responds reluctantly.

“So you weren’t allowed to feel anger as a child and you’re not comfortable feeling angry now.”

She nods.

“Would you consider the possibility that you bring all that stored up anger into the present and behave in ways that both expresses your anger and probably leads people to be angry with you?”

“I don’t understand. Why would anyone be angry with me?”

I consider whether I should answer that question in the here and now about Marnie and my relationship, and decide a bit more distance might be preferable. “Well, let’s consider the invitation from your neighbor. If in accepting the invitation…”

She interrupts me. “I didn’t accept, I told her I’d let her know.”

In my mind, I think, ‘well that certainly illustrates my point.’ I continue, “I wonder if your not immediately accepting the invitation is an expression of your anger. It’s like saying the invitation isn’t good enough. It’s possible your neighbor might have felt hurt or insulted about your not accepting and might be less likely to invite you in the future which would lead you to again feeling rejected.”

“But I’m not sure I do want to go to someone else’s family.”

“I wonder if you realize, Marnie, that you do the same thing to others as was done to you – you’re not good enough so I won’t love you.”

“So do I have to accept whatever anyone offers me?”

“Good question.” I pause. “I guess I’d say it would be important for you to consider why you’re rejecting an offer. Like, would you really prefer to be alone for Thanksgiving? Do you want to be alone so that your sister feels bad for you? So that your daughter feels bad for you?”

“What’s wrong with wanting them to feel bad for me?”

“”Because you’re cutting off your nose to spite your face. And because you don’t realize that wanting them to feel bad for you is an expression of your anger.”

“I don’t understand that at all.”

“And you’re angry with me right now, correct?”

Pause. “I don’t think so. I’m just confused.”

‘Foiled again,’ I think. “Well, it’s time for us to stop, but we’ll continue next week."

Choose Me |by Linda Sherby, Ph.D, ABPP

Thu, 08 Nov 2018 16:24:07 GMT

In this week's blog, Choose Me, a therapist struggles to understand and cope with a patient who insists on being loved while behaving in very unlovable ways.

“I don’t understand!” Marcy shrieks at me, continuing the stalemate we have been have been in for weeks. “Why won’t you just tell me I’m your most favorite patient? You know that I am. You know that you care about me more than anyone else, that you love me, so why don’t you just say it!”

Thoughts race through my mind as my patience runs thin: ‘You’re upping the ante. Now you want to be the person I care most about in my life, the person I love above all others. You’re certainly not being very loveable right now.’ I remain silent.

“Why don’t you say something?” Marcy yells.

I sigh. “Truthfully, I don’t know what to say. We’ve been arguing about this for weeks. We know that your mother abandoned you to the care of her sister. We know that your aunt clearly favored her own daughter over you, that you felt like a second class citizen, like Cinderella, as you say. And all these things are horribly sad and painful for a child, but there’s no way I or anyone else can make up for that. If I told you you were my favorite patient, that wouldn’t take away your pain about your mother or your aunt.”

“Then what good are you?”

“I’m here to help you mourn the past, to be sad and angry, sad and angry, sad and angry about what you didn’t get as a child and then to be able to accept what was and to move on, able to take in the good from others in the present.”

“Is that a script you read? You say the same stupid shit all the time,” Marcy responds, crossing her arms in front of her chest, chin raised, staring at me defiantly.

I’m pissed. I remain silent while I try to collect myself.

“What?” March says.

“You know, Marcy…” I begin before she interrupts me.

“Oh,” she says sarcastically, “here comes the lecture.”

I ignore the interruption. “It’s interesting to me how much your behavior is counterproductive.”

“What’s that supposed to mean?”

“You say you want to be my favorite patient, but you behave in a way that would make you anything but my favorite patient.”

“Oh! So now I’m supposed to be Miss Goody Two-Shoes. I thought you always told me – for years and years in fact – that I was supposed to say everything I was thinking, not censor anything.”

“I’m not suggesting that you censor what you say. I’m suggesting that what you say has consequences.”

“So now you’re threatening me?”

‘Stay calm’ I tell myself, knowing Marcy wants to provoke me. “The more you angrily demand that someone care about you, the less likely that person – me in this instance – is going to respond the way you want. So the question becomes why do you behave in a way that is least likely to get you what you want?”

“Don’t change the topic,” Marcy demands.

“I’m not…” I stop myself. “That last comment, for example. You know I’m not changing the topic. You’re just being provocative and trying to not consider what I’m saying.”

“OK, smarty pants, why don’t you tell me why I behave this way. I know you have some nice little theory floating around in your head.”

“Let me ask something else first. What would happen if I did tell you you were my favorite patient?”

“I’d ask if that meant you loved me.”

“And what would you feel if I told you I loved you?”

“I’d need you to prove it. Like, would you see me for free?”

“So you’re saying you’d add more and more demands until you got to a place where you could again feel unloved and unchosen.”

“Why would I do that?”

“Good question. Why would you?”

“I don’t know.”

“I suspect you unconsciously want to be rejected so that you can stay connected to your rejecting mother and aunt who walk around in your head. If you take in the good, the caring in the present, then – here’s my script again - you have to mourn what you didn’t get in the past. You have to give up the hope of getting the love you needed and deserved as a child from the people in your life who were supposed to care for you but never came through.”

“That sounds way too hard.”

“I wonder if it’s any harder than repeatedly demanding love from people in the present in such a way that you insure you’ll never get it.”

Untold II |by Linda Sherby, Ph.D, ABPP

Tue, 16 Oct 2018 02:25:26 GMT

This piece is a continuation of my last blog, "Untold," in which a patient was finally able to tell his therapist about his sexual abuse by his priest as a child. In this blog, the patient struggles with his feelings of disgust, shame and guilt as a result of the abuse he has carried with him into adulthood.

“Thank you for seeing me for an extra session this week,” Peter begins.

“No problem.”

“I haven’t been able to think of anything else but what you said, that by not talking about my priest abusing me I’ve done exactly the opposite of what I intended, I’ve let him continue to control my life.” Pause. “That makes me sick. But I can’t stop thinking about it.”

“And feeling …?”

“Sick. Angry! Scared. I keep remembering what he did to me. I try to figure out how many times it happened. I wonder why I never told my parents, anyone.” Pause. “I guess I know the answer to the last one, I didn’t think anyone would believe me.”

“Do you feel sad for you as the abused child?”

“I hate when you put it like that! That’s not all I am!”

“That’s true. It would have been better for me to say, do you feel sad for the child in you who was abused?”

Peter’s eyes well with tears. “You’re amazing. You listen and understand and take responsibility for even a little mistake.”

“Unlike the priest who took responsibility for nothing.”

“Unlike the priest. Unlike my parents who could never understand.”

Silence.

“Would it be helpful if you told me what actually happened between you and the priest or do you feel you’re not ready?”

Silence.

“He’d touch me. Usually until I climaxed. And then he’d make me touch him. Sometimes – I don’t know how often – he’d tell me to kneel – Catholics are good at that – and then he’d… he’d, you know, he’d make me use my mouth. I hated that. It was disgusting.”

“Thank you for telling me Peter. I know how hard it was for you. How do you feel now having told me?”

“Relieved. I knew I’d have to tell you. It feels like a relief to have it over.”

Silence.

“Can I ask you what you’re thinking?” I ask.

“I was actually wondering what you’re thinking. I was afraid you’d think I was disgusting.”

“You’re not in any way disgusting, Peter.”

“I was afraid my wife would think that too. I wonder if she thinks about it when we make love. I wonder if a part of her recoils from me.”

I wonder to myself if Peter thinks about the abuse when they make love, but decide it’s too soon to ask that question. “Does she seem to recoil from you?”

He shakes his head. “No, not at all.” Pause. “But, but it’s hard for me to have … to have oral sex. Either to give it or receive it. I know it’s because of the abuse. Sometimes I force myself because I know she likes it, but it seems kind of disgusting to me.” Pause. “Actually, when she does it to me it feels good at the time, but then, then afterwards I don’t feel good at all.”

“You feel guilty?”

“Definitely.”

“And you felt guilty with the priest as well?”

“Yes. Guilty and ashamed. I was afraid someone would find out and think I was disgusting. Afterwards I’d come out from the church… If it was sunny I’d wonder how that was possible. It seemed so dark where I’d just been. I couldn’t understand how the sun could be shining. I didn’t want it to be sunny. I wanted to hide.”

“Peter, very often the hardest thing childhood sexual victims struggle with is the pleasure that they themselves felt. Like how could I have been abused if part of me enjoyed it?”

“That’s exactly right! How can it be abuse if I, if I climaxed?”

“Because your genitals were being stimulated and your body responded just as it’s supposed to. You were also a frightened, lonely child and some esteemed authority figure was paying attention to you, making you feel special and bringing you pleasure.”

“No, that’s not completely right. I didn’t feel special at all. I felt I was being singled out because I was disgusting and he knew I was disgusting. Don’t forget he was my confessor.”

“And what had you done that made you feel disgusting?”

“I touched myself.”

“You masturbated just like every child. I’m sure the priest made you feel guilty and ashamed of doing what was entirely normal, but the horrible irony is that he was the one who was doing what was horrible, illegal, destructive. That’s enraging. I feel enraged for you.”

“I feel as though I’ve been in a trance this session. Like I want to shake myself and come back to reality.”

“I think what you’re saying, Peter, is that you’ve been back being your child self. I’m sure that will be helpful to you - and to us - because it’s that part of you that was damaged and needs to heal.”

Untold |by Linda Sherby, Ph.D, ABPP

Wed, 05 Sep 2018 22:19:53 GMT

Untold, which describes the experience of both patient and therapist when after almost three years of treatment, the patient reveals what he has kept secret.

Peter is unusually quiet at the start his session. He looks down at his hands, then gazes out the window. I resist the temptation to ask him what is going on and remain silent with him. The silence grows more comfortable, the connection between us palpable.

“I know I’m going to tell you today. That doesn’t seem like such a problem. I guess the question is why I’ve never told you before. It’s been almost three years since I started seeing you. I know you’ll ask why I didn’t tell you sooner. I’m asking that myself.” Pause. “The answer isn’t obvious to me. If I hear myself say it never seemed like such a big deal, that seems ridiculous, even to me. If I say it was too hard to talk about, too embarrassing, too uncomfortable, I just don’t think that’s it.”

My discomfort increases as Peter continues speaking, trying to imagine what he might not have revealed. He’s talked about his rigid, explosive father; his removed, distanced mother; his bullying older brothers. I like Peter. Shy, reserved, anxious Peter has done well in his life. He’s a sociology professor at a local university, is married to a warm, accomplished woman, and thinking about having children. He worries about his anxiety, his tendency towards depression and his discomfort with the competition in the academic world.

“I was molested by my Catholic priest,” he blurts out. “By my confessor. It’s like a joke. I wonder who he was confessing to.”

I’m shocked. Not by the revelation, but just as he’d anticipated, by his not having told me long before.

“I’m so sorry, Peter,” I say, “So sorry that you had to endure that experience.”

“And wonder why I didn’t tell you before.”

“Yes, that’s true.”

“Obviously the case in Pennsylvania brought it all back up. Not that I’d forgotten about it. Just brought it back to the forefront.”

“Leaving you feeling how?”

“Sad. Depressed. Disgusted. Angry. You name it. The feelings all victims describe.”

“And how do you feel telling me now?”

“I don’t know. Kind of numb I guess. It’s not like I thought about it every time I was in session. Occasionally it would go through my mind and I’d say, no, this isn’t a good time.”

“And when you thought it wasn’t a good time, why did you think you thought that?”

He shrugs. “Other things seemed more pressing? I really don’t know.”

Suddenly a thought comes to me. “Have you ever told anyone?”

“I told my wife. Before we got married. I thought she should know…”

“Can you finish that sentence?”

“See, this is exactly the problem. Once I tell, it all becomes about my having been abused by my priest.”

“What all becomes about your having been abused by your priest?” I ask, confused.

“Everything. My shyness. My depression. My anxiety. It’s not! It’s not only him. He didn’t cause everything,” he says angrily.

“Of course not,” I reply. “Being sexually abused – however significant - was one of the events that affected your life, along with many other things.”

Peter stares at me. “Do you really mean that?”

“Yes, of course.” I pause. “I just had a thought. That priest had so much power over you as a child, perhaps it’s that you don’t want to give him the power to have made you the adult you are, you don’t want him to control your adult self.”

Tears run down Peter’s cheeks. “That’s right. That’s exactly right. I could never put it into words, but that’s what it is. The bastard manipulated me as a child. I didn’t want him to matter anymore,” he says burying his face in his hands, sobbing.

“I don’t think you’re going to like what I say next, but the problem is, that by not speaking about him, you have unconsciously given him the power to continue to silence you, to continue to hide as if you’ve done something wrong - which you haven’t.”

“No! That can’t be! Oh my God, you’re right. I’ve let the bastard continue to control me!”

“Well, you’re now unsilenced. You’ve spoken. You told me. We have a lot of work to do around this Peter – and I don’t mean that he’s the only factor influencing your life – but he has been a significant force and it’s time for you to speak.”

“I’m so sorry, so sorry I never told you.”

“You have nothing to apologize for. As I always say, you can only do what you can do and you’ve now spoken.”

The Underachiever |by Linda Sherby, Ph.D, ABPP

Wed, 15 Aug 2018 18:12:28 GMT

"The Underachiever" depicts a first session in which a therapist wonders if a patient's need to bury his feelings has affected his ability to realize his potential.

Tall and thin with a wiry red beard, Daron Wilson sits across from me looking lost and forlorn. “I’ve never done this before. Never thought I would.”

“How can I be of help to you?” I ask.

“I don’t know. I know you can’t make my wife come back to me.” He sighs, shaking his head. “I love her so much. Her and the kids. But she says she wants more, more for the kids, more for her, more for our family. I don’t know how to give that to her.”

“More in what way?”

“Easy answer would be financially, but I know that’s not what she means. Wants me home more? Yeah, that’s true. But that’s not it either. We were high school sweethearts, madly in love almost from the moment we met. I was valedictorian of my class. She wanted to be a psychologist. Like you. Me, I didn’t know what I wanted. We got pregnant, got married right after high school. She was determined to go to college and she did for a while. I became a long distance trucker. Good way to make money to support a family. And then we had two kids and she dropped out of college and I kept driving. Truthfully, I kind of like it. Feeling of freedom on the road. I drove for other people until I had enough money to get my own truck. Big financial commitment, but now I’m my own boss. It’s okay.” He shrugs. “But Chelsea wants more. And I get it. Our kids are nine and seven. Do we really want them to see that driving a truck is all there is to life?”

“You sound so sad and lost.”

“Yeah, that’s about right. I don’t know what to do. It’s not like I can snap my fingers and suddenly have a college degree and be working as some hot shit IT guy.”

“You said you were valedictorian of your class. Was that important to you? Were you proud of yourself?”

He shrugs. “Yeah, I guess.”

“Were your parents proud of you?”

He scoffs. “My parents? My parents could have cared less. My father was too drunk to come to my graduation. My mother came, looking uncomfortable every minute. They raised five kids. I was the last. They didn’t have much left over for me.”

“That’s very sad.”

“I guess. After a while you just stop caring.”

“So what motivated you to put forth the effort to become valedictorian of your class?”

“I don’t know.”

“Had you met Chelsea by then?”

“Yeah. We met when we were Juniors.” Pause. “I might have wanted to do it for her.”

“What have your siblings done with their lives?”

“Liz – the only girl - is a wife and mother. My brothers? One’s an alcoholic; one has serious mental problems, can’t hold down a job. Joe – he’s the oldest - has done okay. He worked for GM when you could still make a decent living that way. I guess they all have their problems.”

“So if you had gone to college when you graduated from high school, that would have been a radical departure from the rest of your family?”

“That’s for sure.”

“And did you have feelings about being that different from your family? Even being valedictorian?”

“I don’t know.”

“How did you feel when you studied? How did you feel when you got good grades?”

“It’s too long ago to remember.”

“Daron, I think over the years you worked pretty hard – unknowingly of course – at trying not to know your feelings, your feelings of sadness and anger and disappointment and hurt. You turned yourself off so that now it’s very hard for you to know what you feel either now or in the past. I guess when you met Chelsea you were able to open yourself up to loving her which may have also opened you up to strive and succeed and do well. I’m not saying you don’t do well as a trucker - you obviously do - but it sounds as though a part of you died in the process.”

Daron’s eyes fill with tears. “That’s what Chelsea says. She says I feel dead.” Pause. “I wonder if that’s one of the reasons I like to drive. Always something new. Sort of escaping from myself.”

“That’s a great insight Daron. I guess the question is whether you’re ready to stop escaping and to look at all the painful feelings you have buried inside you.”

“First thing I thought? How long will it take? Can I do it before Chelsea leaves me?”

“I don’t know the answer to that, Daron. You’ve sat on your feelings for a long time. It won’t be a quick or painless fix.”

“But it’s a shot. I don’t have anything else.”

The Move |by Linda Sherby, Ph.D, ABPP

Fri, 29 Jun 2018 01:00:00 GMT

This blog, The Move, focuses on how a patient's prospective move re-stimulates old issues which result in her returning to therapy to continue the process of mourning and working through.

“Thank you for seeing me again on such short notice,” Joslyn begins hurriedly. Then she pauses and looks at me. “It’s good to see you again after so long. You haven’t changed at all. It must be 10 years.”

“It’s good to see you too, Joselyn. I’m pleased to be able to catch up on your life.”

"Yeah, well lots has happened since I've seen you - I have two sons, I'm a pretty successful elder care attorney - but the funny thing is I'm kind of coming back for the same reason I did before, except in reverse." Then I was miserable about having to leave Wisconsin to move to Boca Raton and now I’m miserable about having to leave Boca to move to Boston. Both times for my husband’s jobs! But I understand. I do. Then he was lucky to get a job teaching history at Florida Atlantic University, but he’s been languishing here and Harvard has offered him a tenure track position. It’s a great opportunity for him.” Pause. “But then there’s me. What about my practice? I’m doing so well here. And somehow I think there’s more of a demand for elder law here than there will be in Boston. And the cold! Brrr. I left the cold when I left Madison. I don’t want to go back to it!”

“So you’re feeling …?”

“Angry. And scared.” Pause. “And sad too. I have a life here. My kids have a life here. There’s a lot to lose.”

“You’re angry at…?”

“My husband. I don’t know why we always have to do what he wants to do. I mean, I shouldn’t say it that way. It’s not like we didn’t talk about it. As I said, I do understand. It’s such a great opportunity for him.”

Listening to Joslyn brings me back to the time I moved from Ann Arbor to Boca Raton 25 years ago, to all the pains of leaving – my friends, my practice and the house I so cherished. I try to shake my feelings and return to Joslyn who continues.

“I try to remind myself that the move to Boca turned out well. So why can’t I assume the same will be true of moving to Boston?”

“Are your parents still alive Joselyn?”

She sighs. “My father died three years ago. He had pancreatic cancer.”

“I’m sorry. And he was the good parent.”

“Yeah. My mother and I have continued to struggle. She needs me more now, so she’s been a little warmer. We were even talking about her moving down here. Obviously that isn’t going to happen.”

“And you feel how about that not happening?”

“Good question.” Pause. “Part of me is relieved, but part is … I don’t know. I guess I’m sad about it.”

“And what exactly are you sad about?”

“I don’t know. I guess it’s like maybe the move would give us another chance. Like maybe it could be different this time. Maybe since she needs me more she’ll be warmer.”

“I notice, Joslyn, that you’re talking a lot about warm and cold. Wisconsin and Boston are cold. Florida is warm. Maybe your mother will be warmer when she’s in Florida. If I remember correctly a lot of your conflict about leaving Wisconsin was leaving your parents, your father because of his ‘warmth’ and your mother because you were afraid if you moved away you’d never, ever get the chance to somehow fix her and finally get the mother you wanted.”

“That’s right! Hmm. So you’re saying maybe that’s still true, maybe I don’t want to give up what will be my last chance to get the mother I want.”

“Yes. It’s like moving from the ‘warmth’ will mean you’ll have to give up forever the hope of getting the mother you never had. It’s again having to give up hope.”

Joslyn eyes fill with tears. “I thought I had already done that.”

“You certainly moved away from that hope when we worked together, but when confronted with lots of new losses, those feelings can resurface. And I’m not saying that all the feelings you’re having are about your mother. Obviously you’re facing real, present day losses – your practice, your friends, lots of things. But I suspect that the relationship with your mother is heightening all these other feelings.”

“I think I’d like to come back and see you for a while. Is that all right?”

“Of course. I imagine you want to say good-bye to me as well.”

“Oh!” Joslyn exclaims. “I hadn’t thought of that. You were my good mother. And yes, I’ll have to say good-bye to you too. That makes me very sad.”

Forbidden |by Linda Sherby, Ph.D, ABPP

Fri, 08 Jun 2018 03:14:59 GMT

In this week's blog, Forbidden, a therapist treads carefully in examining a patient's taboo sexual dream.

“I didn’t want to come today,” Marlene begins. “I don’t want to talk about what I know I have to talk about since it’s all I keep thinking about. I feel so ashamed.”

I’ve been seeing Marlene in therapy for a little over a year. She was concerned about being a good mother to her then six month old son, Dereck. She felt her own mother had never wanted children and that she remained cold and aloof until she died of cancer when Marlene was 12. Not surprisingly, Dereck’s vulnerability rekindled many of her own feelings of longing and loss, but nothing springs to my mind as something Marlene might do that would create this level of shame.

“I had this dream,” she begins hesitantly. “Dereck was cuddling in my lap.” Pause. “He was as cute as always,” she says, a brief smile flickering across her lips. She lowers her head. “He was naked. I was stroking his hair. He looked up at me and smiled. He reached up and grabbed my breast like he used to when he was nursing. Then he started stroking my breast. I could feel myself getting aroused.” Pause. “But… but this was the worst part. I stared stroking him back. First just his arms and shoulders. But then… but then I started stroking his penis and his penis started growing really big, almost like he was a grown man. What’s wrong with me?! That’s so disgusting!”

“I appreciate your being able to tell me the dream, Marlene. I realize how difficult it was for you. But you do need to remember it was a dream. You didn’t actually do anything to your son.”

“But it’s so perverted. How could I even think such a thing?”

“I would like us to try and understand the dream. Can you talk about it even though it’s difficult?”

“I guess.”

“You say you keep thinking about the dream, what do you think about?”

“It plays over and over in my mind. I’ve asked myself if I’ve ever done anything inappropriate to my son. Like when I’m changing his diaper. I don’t think I have. I mean I have to touch his penis to wash him, but that seems pretty normal. I thought it was cute, this little miniature penis. Is that all right?” she asks, panic rising in her voice. “Is it okay to think it’s cute?”

“Of course it is,” I say reassuringly. “Let me ask you, the tremendous feeling of shame you’re having, is the feeling familiar to you?”

“I don’t know.” Pause. “I was ashamed about how I thought my mother looked the last months of her life. The nurses would bathe her or change her in front of me, in front of any of us. She looked disgusting. I’d kind of look sideways at my Dad and he’d always have this gentle, loving look on his face and I’d wonder how he could not be disgusted too. They weren’t sleeping together at that point. She was in a hospital bed. But still…” Pause. “But that doesn’t seem to have anything to do with my dream.”

I wait.

“You’re not thinking my father abused me, are you?” she asks, wide eyed.

“No. I wasn’t thinking that. What made you ask?”

“I don’t know. Like my having this disgusting dream about my son and now I’m talking about my Dad. I don’t know. It doesn’t make sense.”

“Sounds like you felt bad for your Dad.”

“I did.”

“Were you and your Dad close during the time your mother was dying?”

“Close? I wouldn’t say that. The only person he was ever close to was my mother. He really didn’t care for anyone else. I mean he must have cared a little about us… and about my stepmother, but my mother was really the only person he loved.”

“Did you ever try to comfort your Dad when he was sad?”

“I think I remember stroking his arm sometime, like maybe even at the cemetery when we buried my mother. I don’t think he even noticed.” Pause. “I was talking to my Dad the other night. They’re going to come visit. It was our usual non-conversation, conversation.”

“When was your dream in relation to your conversation with your Dad?”

“I think it was the same night. Maybe the night after. No, it was the same night.” Pause. “Do you think there’s a connection?”

I proceed cautiously. “Well, your son is certainly a lot warmer and more responsive to you than your father. You stroke Dereck and he gets an erection. You stroke your father and he doesn’t even notice.”

“But I didn’t want my father to get an erection!”

“You wanted your father to care about you, you wanted a relationship like the one you and Dereck have.”

“But it’s not sexual! My dream was so sexual.”

“Longing for closeness can take many forms – wanting to be cared about, wanting to be loved, wanting to be sexual. Especially in the unconscious those get all mixed up.”

“I don’t know. I still feel like a pervert.”

“I know this has been hard for you. It would be helpful if we could continue talking about your longings and it would be especially helpful if you could be less judgmental about yourself.”

And Then There Were None |by Linda Sherby, Ph.D, ABPP

Mon, 21 May 2018 20:08:19 GMT

In this week's blog, And Then There Were None, a therapist tries to contain a patient's overwhelming feelings of pain and loss after the violent deaths of both her sons.

Mary Collins, a 49 year old woman who looks at least 10 tens older, sits across from me, tears streaming down her face, unable to speak. Although I have never seen or spoken to this woman before – her husband made the appointment - I feel the intensity of her pain and find myself similarly at a loss for words. Finally I decide on the most basic of human responses.

“I’m so, so sorry for your loss. I can only imagine the depth of your suffering.”

Mrs. Collins shakes her head again and again, her straight brown hair falling forward over her face. “I can’t …,” she says, continuing to shake her head.

I wait.

“I can’t stand it. I can’t!” she says more loudly. “I can’t stand the pain. I have nothing left, nothing to live for.” Pause. “I know you’re going to say it will get better. My husband says that all the time. But this? How can this get better?”

“Can you tell me about your son, Mrs. Collins?”

“Mary,” she says, still shaking her head.

“Mary, can you tell me about your son?”

“Billy. He was a good boy. A little wild as a kid, but what boy isn’t? He always wanted to be a policeman. I don’t know why.” A blank, distracted look comes across her face. She repeats, “I don’t know why. I don’t know why. I don’t know why.”

“You don’t know why he shot himself?” I ask.

Wailing she beats her fists into her thighs. “Why? Why? Why?”

Without thinking I get up from my chair, kneel in front of her and take hold of her hands. “Hurting yourself won’t bring your son back,” I say softly.

She stops hitting herself and sobs.

After a few moments I return to my chair.

She hides her head in her hands and continues sobbing.

“He didn’t want a divorce. Til death do us part. That’s what he wanted. That’s what he saw in our family. But she, she didn’t want to be married to a policeman, although she knew that’s what he was when she married him.” Pause. “And maybe it was more the boys for Billy, two little boys. Tore Billy to pieces.”

She pauses. I think about what she said and wonder what her words will trigger for her. I watch the awareness go across her face.

“No! Not both of them! God couldn’t be so cruel. How could he take both my boys? Blown to bits by one of those IEDs. Who cares about that godforsaken place? Why do we keep sending these children to Afghanistan? It’s all so senseless, senseless.”

“I imagine Billy was pretty broken up by his brother’s death.”

“Sure was. And angry. Like me, angry. Ron was his baby brother. Billy kept saying he should have gone first. And now they’re both gone. And I have nothing.”

“Can you say who you’re angry at Mary?”

“Everyone.”

“Can you be more specific?”

“God. The government. The universe. Sue. I’m definitely mad at Sue. That’s Billy’s wife.”

I suspect she’s also angry with Billy for killing himself, but know it’s way too early to broach that topic. “Are you going to maintain contact with Sue? I imagine you’ll need to in order to see your grandchildren.”

She shrugs. “Who knows what she’ll do.”

“You saw each other at the funeral?”

She nods. “But I didn’t know what was going on that day. I don’t think she brought the boys, although I think I saw them later at the house.” Knitting her brow, she pauses. “I don’t know. What difference does it make anyway? Nothing matters anymore.”

“Do your grandsons matter?”

“I guess.” Pause. “Yes, they matter. They carry part of Billy.” Pause. “They’re the only grandchildren I’ll ever have.”

I can see Mary’s despair and rage begin to build, her hands in fists.

“Remember,” I say quickly, “Hurting yourself won’t bring your sons back.”

“But it’s easier. The physical is easier, easier than thinking, easier than remembering.”

“I do understand, Mary. But I don’t want you to hurt yourself. And I’m sure your husband doesn’t want you to hurt yourself either. I know the pain often feels intolerable, but you can survive it. As awful as it is, you can survive it.”

Mary sobs.

“And we can talk about your pain, Mary, your pain and your anger. I know that won’t bring your sons back either, but talking does help. And maybe us talking together will make it easier to bear the pain.”

Tradition |by Linda Sherby, Ph.D, ABPP

Mon, 30 Apr 2018 22:15:42 GMT

This week's blog is entitled "Tradition." It illustrates the conflict a man brings into therapy between his parent's culture - most particularly his mother's - and his own desires, only to discover that his loved one is more like his mother than he realized.

Art sits dejectedly in my office, his elbows on his thighs, his head, shaking side to side, cradled by his hands. “I told you it would never work. She’s unrelenting. Tradition is everything to her. But it’s ridiculous! I’ve been in this country most of my life. How can she expect me to accept an arranged marriage? Go back to India and marry the girl her sister finds for me? It’s crazy.”

“I’m so sorry, Art. I can only imagine how difficult this must be for you.”

Lifting his head, he says, “And that’s another thing. She said she absolutely forbid me to have anyone call me anything but my given name, Arjun. She repeated it, yelling, ‘Arjun, Arjun, Arjun. That’s your name and I don’t expect to hear you called anything else.’ Of course I’m not about to do that. My friends haven’t called me Arjun since the first or second grade. And they made fun of me even then. She has no idea what it’s like, how difficult it is for a kid to fit into this culture. And particularly today. Even my brown skin can bring those looks – are you one of those?; are you illegal?; are you stealing our jobs?” He covers his face with one hand. “But there’s no point discussing all that.” Pause. “What am I going to do?” he asks beseechingly?

“I was just going to ask you the same thing.”

“I don’t know. I love Jessica. I want to marry her. We like the same things – hiking, kayaking, watching old movies. We think the same way, have the same values, love kids. My mother just doesn’t get it. We don’t have to be from the same culture, although we basically are. I’m probably more American than Indian.”

“Is that true? I mean you have grown up here most of your life, educated here, working here, but is it true that your Indian culture means so little to you?”

“Right now I just wish I could disown the whole culture.”

“But that’s your anger speaking, right?”

“I don’t know,” he says dismissively.

“I remember how joyfully you’ve described the Hindu weddings you’ve attended, how you know all about your gods, how you say you sometimes pray to one god or another.”

“But that’s just habit. It’s all a bunch of superstition. I don’t believe any of that stuff.”

I realize I’m pushing too hard to have Art take ownership of the Indian part of himself and wonder if that’s because he’s projecting those feelings onto me rather than feeling them himself. I need to step back.

“What are your thoughts?”

“I know I’m not going let my mother bully me. And I also know she won’t retreat. She said Jessica – no, actually she said ‘that girl’ – would never be welcome in her house, that she would never see our children. That hurts. And I know she’ll stick to it. There’s not going to be any Hollywood ending like in The Big Sick.”

Silence.

“I wish my father would say something.”

Is he also wishing I’d say something? I wonder.

“I know my father agrees with me. Or at least he’d accept my decision. But he always bows to her.” Pause. “And that’s another thing she said, ‘Your father and I had an arranged marriage. It turned out well for us.’ I had to bite my tongue there. It turned out well for her. She got to move to the US, be a doctor’s wife and stay enclosed in the Indian community. I don’t think that’s what my father would have wanted, but he’d never say.”

“So you’re angry at your mother for being too dominant and at your father for being too passive.”

“Exactly!”

Silence.

“I was thinking about Jessica and my relationship. Wondering who’s the more dominant one.” Pause. “I guess I’d say she is.” Pause. “I wonder how I feel about that.”

“Good question.”

“Not so good actually.”

“So are you implying that you were raised by a dominant woman and that perhaps now you’re attracted to a similarly dominant women?”

“Oh no! I came in here thinking I had one problem – how to deal with my mother – and now I have two problems – how to deal with my mother and Jessica.”

“Perhaps it’s not so much how you deal with either of them, but how you deal with yourself, the person you want to be, the person you are now given the family and the culture you were raised in. Is there a place between complying and rebelling? Are you unwittingly driven to repeat patterns from your past that you may not consciously want to repeat?”

“Stop! Too much. It’s giving me a headache.”

“There is a lot , but I was just trying to say that we humans are very complex beings and that it’s helpful for us to try and understand ourselves as best as possible.”

There’s Something Wrong With Me |by Linda Sherby, Ph.D, ABPP

Fri, 13 Apr 2018 19:24:29 GMT

In this week's blog a woman's identification with her mother results in her inability to love her young daughter, thereby increasing her own self-hatred. She seeks therapy hoping to have more "normal" feelings restored.

Staring down, Cristina pulls at the fingers of her hands. She has been unable to say anything since entering my office.

As Cristina’s silence continues and her tears fall silently from her eyes, her pain becomes palpable. “I can see how much pain you’re in, Cristina. Can you tell me what’s wrong?”

She shakes her head. But then she practically whispers, “Me. I’m wrong. I’m all wrong.”

Although I have no idea what Cristina’s referring to, I feel the heaviness of her burden.

“I’m sorry you’re in so much pain, Cristina. Can you tell me what’s causing your pain?”

“There’s something wrong with me,” she replies, barely audible.

“Can you say what makes you feel there’s something wrong with you?”

Tears pour down her cheeks. She makes no attempt to wipe them away.

“I can’t love her,” she says looking up at me beseechingly. “What normal mother can’t love her child?” She pulls harder at her fingers. “They said it was post-partum depression. And maybe it was. But no one has post-partum depression for two years. And, besides, I didn’t feel that way with my son. Peter was my precious baby. I couldn’t stop holding him and cooing at him. I loved him instantly. And I still do. But with her, it’s different. It was different from the start. And it hasn’t gotten any better.”

“So your daughter is two and your son is …?”

“Five.”

“And her name is …?” I ask, aware that she spoke her son’s name, but not her daughter’s.

“Caroline. I want to love her. I do. But it’s not there.” Pause. “Can you help me? Can you cure me? Can you make me normal again?”

“I can certainly help, but it isn’t like you have a disease, Cristina. I understand that you want to love Caroline, but perhaps first we have to understand why your feelings about Caroline are different from your feelings about Peter. And if you could try to understand what you feel rather than beating yourself up for your feelings, that would be really helpful.”

Cristina shakes her head empathically. “It’s not normal. I’m not normal.”

“Is anyone telling you you’re not normal?”

“Oh, yeah. My mother. She’s told me I’m not normal my whole life.”

“Because?”

“Because I’m not like her. My mother is one of these brash, strong, outdoorsy types who won’t take anything from anybody. And me, well today’s not a great example of how I usually look, but I’m usually pretty well put together. People tell me I’m pretty. I care about clothes and my nails, kind of a girlie girl. My mother couldn’t stand that about me.” Pause. “The truth is she wanted another boy, boy number four, but she got me instead. Unfortunately for both of us.”

“Do you think there’s a connection between how your mother felt about you and you feel about Cristina?” I ask.

Cristina looks at me blankly. “In what way?”

“Well, your mother didn’t like you because you were a girl and it sounds like you’re saying it’s much easier for you to love Peter, your boy, than Caroline, your girl.”

“You’d think I’d love Caroline all the more because I know how awful it feels not to be loved.”

“Well, rationally that may be true, but we humans don’t always act on the basis of rationality. There’s our unconscious to consider. There’s, for example, identifying with the parent who hurt us and then despite our best intentions behaving like them. I’m not saying that’s what’s going on for you, but it does sound as though your feelings about your daughter are similar to your mother’s feelings about you.”

“But I don’t know if Caroline is going to turn out to be a girlie girl.” Pause. “But she is tiny. And she seems so vulnerable.” Crying, Cristina adds, “My mother hated vulnerable. I think that’s what she hated more than anything. She hated when I cried. She hated that I cried. Said I wasn’t normal to cry so much. I guess I’m proving her right.”

“No, you’re not proving her right. You’re proving that you’re human. There’s nothing wrong with crying. And there’s nothing wrong with feeling vulnerable. We all feel vulnerable. And children feel most vulnerable of all.”

“You know, that is one of the things that bothers me about Caroline. She seems so fragile. And for some reason rather than being drawn to that fragility and wanting to protect her, I want her to get it together and be strong.” Pause. “You’re right! I sound like my mother. That’s awful. I never wanted to be like my mother. Now I have something else to hate myself for.”

“You’ve brought in a lot of material today, Cristina, and we’ll have plenty of time to work on it, but the more you could wonder why you do or feel what you do, rather than judging yourself, the easier it would be.”

Panic |by Linda Sherby, Ph.D, ABPP

Mon, 26 Mar 2018 21:47:18 GMT

In this week's blog, "Panic," the present rekindles the past when a man's wife asks him for a divorce. Overwhelmed by panic just as he was as a child when his mother emotionally abandoned him after the death of his father, he looks to his therapist for a magical solution.

“I couldn’t wait to get here,” Ray says, almost breathless. “Pamela asked me for a divorce. She said we’ve been working on our relationship for years and it just doesn’t get any better. She wants out. She wants a chance to find greater happiness with someone else.”

“I’m sorry, Ray,” I say empathically.

“I…I’m a mess. I don’t think I’ve slept two hours since she told me. I never thought she’d leave me. I don’t know what to do. I can’t think straight. I’m like beyond panicked.”

“What’s fueling your panic?”

“What? What do you mean?”

“I can certainly understand you’re feeling sad and scared and maybe even angry, but what’s underneath your panic?”

“I’ll be alone. She’ll leave and take the kids and I’ll be alone. Oh my God, I can hardly say that. I can’t breathe.”

“I’m here. You’re not alone now. Take a few deep breaths and then let’s try to look at what feels so terrifying to you about being alone.”

Ray looks at me incredulously. He buries his head in his hands and tries to slow his breathing. He bursts into tears.

I sit silently while Ray cries, hoping he has broken through some of the anxiety to feel his sadness underneath.

“Why? Why? Why did she do this?”

Ray’s shock about his wife’s decision is rather surprising to me since they have indeed been working on their relationship for years. Ray told me she had repeatedly said she was unhappy in the relationship, feeling him unable to give to her emotionally or sexually.

“What did prompt her decision?” I ask.

“I don’t know. Maybe because we didn’t have sex?” he says questioningly.

“You’ve told me that has been one of Pamela’s consistent complaints. That you withhold from her.”

“Do you break up a 15 year relationship because of sex?”

Ray’s consistent disbelief feels incredibly naïve to me. I even wonder if it’s disingenuous. Then I have another thought.

“You feel very much like a scared, hurt child to me,” I say gently.

Crying again, Ray mumbles, “That’s exactly how I feel.”

“So perhaps that’s why you’re panicked. When a child is left he feels panicked because he can’t survive without his mother - or some caretaker.”

“So you think Pamela’s leaving me feels like my mother leaving me?”

I nod.

“But my mother never left me.”

“That’s not exactly true Ray. You’ve told me how she reacted after your father died.”

“Yeah, that’s true. Before I was seven – when my father died – we had a very close relationship. In fact, she was all over me. Sometimes I just wanted to get away from her. It was too much. But after he died, I don’t know, it was like she died too. She got so depressed and didn’t want me anywhere around. In fact she shipped me off to her sister’s for a while. It was awful. My cousins hated me. I’m sure they didn’t want another kid in the family. I had to change schools and that was awful. The whole thing was awful.” Pause. “And when I went back home, my mother still rejected me.” Pause. “And then she started dating. That was worse. All those men. And then my step-father. The whole thing was a nightmare.” Pause. “You know what just went through my mind? I wanted my Mommy back.”

Crying, Ray adds, “And that’s how I feel right now. I want my Mommy. Except it’s Pamela.”

I remain silent, thinking this is not the time to explore the meaning behind Ray’s similar feelings about his mother and Pamela.

“I guess that helps explain my panic,” he continues. “But it doesn’t take it away,” he adds, looking at me beseechingly. “Can’t you take it away?”

“So perhaps now I’m the Mommy who you want to take away all your fears and sadness.”

“Can you?”

“That’s clearly your wish, but I’m afraid I have no magic wand.”

“No?”

“No, but we can look at your desire for that magic wand, for the all-powerful, all-perfect mother who can take away all your fears, all your sadness so that you feel nothing but perpetual bliss.”

“Sounds wonderful.”

“But I wonder if it would feel wonderful or, as you said before about your early mother, whether it would feel too much and you’d want to get away.”

“I don’t know. Right now it sounds wonderful.”

“When faced with abandonment you yearn for closeness, but when there’s closeness it can feel like too much and you yearn to get away.”

“I don’t know. I can’t deal with all that now.”

“I understand. We’ll have plenty of time.”

I'm Afraid |by Linda Sherby, Ph.D, ABPP

Tue, 06 Mar 2018 22:07:45 GMT

In this week's blog, I'm Afraid, the past and present converge, inhibiting a young woman's desire to protest against gun violence in America.

Jennifer sits in the chair across from me and cries. Tall and thin, with straight blonde hair, at 18 years old she is younger than most of the patients I see. I suspect her distress is about the school shooting at Marjory Stoneman Douglas High School on Valentine’s Day.

“Did you lose friends in the shooting, Jennifer?”

She shakes her head.

“Are you scared it will happen in your school?”

She shakes her head.

“You know, Jennifer, I saw your Mom a number of years ago and she called and asked that I see you. Does the fact that I saw your Mom feel all right to you?

She nods, then startles. “But what I say here is just between us, right?”

“Your Mom said you just turned 18, so yes, what we say here is confidential, unless I’m afraid you’re going to hurt yourself.”

“I won’t. I’m too much of a coward to do anything like that,” she adds sobbing.

“I lot of people are really scared right now, Jennifer. That doesn’t make you a coward.”

“No, they’re not. They’re marching. They’re going to Tallahassee. To Washington. They’re confronting the NRA, the President.”

“Yes, that’s true.”

“I can’t,” she says sobbing. “I can’t do it. I’m a coward. A coward!” she says with clenched teeth, her fists covering her tightly closed eyes. “Why can’t I do it? They can.”

I immediately flash on my younger self. I so admired my grandmother, willing to fight for what she believed, while I fearfully hung back. I don’t know that I saw myself as a coward, but I did feel disappointed in myself and wished I could be different. It was a wish that was at least partially fulfilled when I was able to confront my demons from the past. But none of this will help Jennifer right now.

“That’s actually a very good question, Jennifer, especially if you could ask it without beating yourself up. What do you think makes it so frightening for you to think about protesting like some of the other students?”

Jennifer stops crying. She looks up at me like a deer caught in the headlights. She pauses then shakes her head and says, “I can’t. I can’t say.”

“Can you tell me why you can’t?”

“I’m scared. And… and I don’t want to make it a big deal.”

“Anything that scares you so much is a big deal.”

Silence.

“Can you tell me a little about your life, Jennifer? You’re an only child, right? Do you live with both your parents?”

“Yeah, it’s just me. My parents divorced. It must be a long time since you saw my Mom. They’ve been divorced since I’m nine. They had joint custody. But now that I’m 18 I’ll live with my Mom until I go to college.”

“So you prefer living with your Mom?”

“Oh yeah.”

“What’s your relationship like with each of your parents?”

“I’m real close with my Mom. My Dad, not so much.”

“Can you say why?”

“He always criticizes me. Nothing I do is ever good enough.” She hangs her head.

“Anything else?” I ask.

“He has PTSD. He was in Vietnam.”

I had forgotten that, but I remember now that Jennifer’s Mom said he could be explosive and erratic.

“Are you afraid of your Dad?” I ask gently.

“I didn’t say that!” she says, sounding panicked. “Besides, what does my Dad have to do with my being afraid to stand up for what I believe?”

“And what do you believe, Jennifer?”

“That guns kill. That we should have way more restrictions on who can get guns and what kind of guns are available.”

“What does your father believe?”

“He believes people have the right to have guns, but he doesn’t think a 19 year old should have an assault rifle.”

“What does he think about the protests?”

“He hates them. Reminds him of the Vietnam protests.”

“How would he feel if you participated?”

“He wouldn’t allow it.”

“And what would he do if you participated anyway?”

Jennifer looks down and keeps shaking her head. “He’d scream and scream and scream. But not like normal people scream, like way, way out of control. He might also slap me or lock me in my room. He’s really scary,” she says, her words coming out in a rush.

“And you’ve been living with this all your life, Jennifer?”

“Yeah, although it got worse after the divorce. Before my mother could protect me a little. Afterwards he just got meaner. I never wanted my Mom to know. I didn’t want to upset her.”

“Well, Jennifer, I think we know why you can’t protest as many of your friends do. But I don’t think it’s only because your father disapproves of the protests. He’s scared you your whole life, so to stand up to any authority is terrifying, just like standing up to him as a little girl was terrifying.”

“Really? You think that’s true?”

“Yes, I definitely think that’s true.”

Disgruntled |by Linda Sherby, Ph.D, ABPP

Wed, 21 Feb 2018 19:33:00 GMT

This blog was rather fun to write. More fun, I'm sure, than it would have been to treat this patient.

"Disgruntled" presents a frustrated therapist trying valiantly to treat a demanding, embittered patient.

“I had this unbelievably horrible day yesterday,” 76 year old Joan Green begins. With dyed red hair and raised eyebrows penciled to match, she challenges everyone around her and looks perpetually amazed by their response. She is my patient only because a psychologist colleague of mine begged that I see her. She had moved to Boca Raton, Florida a year ago after her daughter who lives in Phoenix could no longer tolerate her and feared her mother would destroy her marriage. Her son, my colleague, was not faring much better and told his mother that he would no longer have anything to do with her unless she went into therapy.

She continues. “I spent my whole afternoon in the pain doctor’s office and didn’t even get everything done. The pain is terrible. Everything hurts me – my back, my hips, my neck, even my feet. I can’t take it anymore.”

“Did anything go well yesterday?” I ask, perpetually trying to find something positive in Mrs. Green’s constant tales of woe. I doubt I’m the best therapist for this patient. Constant complaining is not my forte, especially when someone is so resistant to looking at her part in the interaction.

“I liked the doctor.”

My eyebrows shoot up in surprise. “Well that’s important. And positive.”

“Well, he was nice, but I don’t see why he couldn’t give me an injection yesterday and not make me come back.”

“Did he tell you why?”

“He needed me to get an MRI first. And he couldn’t do it in his office – I guess he doesn’t have the equipment. That wasn’t good either. And he said I had to call for an appointment. I don’t know why they couldn’t call for me. I don’t carry my phone with me. It’s way too heavy. I didn’t want to have to go all the way home and then go out for an MRI another day. I’m in pain! Obviously or I wouldn’t be in his office. I told them – I was in the waiting room by then, arguing with the office staff - I’d be willing to sit wherever and wait until they could take me.”

“Mrs. Green, does it seem to you that you have lots of expectations of other people, expectations that might be impossible to fulfill?”

“What! What expectations?”

“Well, what are your thoughts about that?”

“Why should I have any thoughts about that? You’re the one who brought it up. You should be the one telling me.”

Annoyed at this constantly demanding patient, I try to step back. “I wonder if you feel so un-given to, so lacking in nurturing that you have a profound need to be taken care of, whether that’s me answering your question rather than your thinking about it yourself or wanting a doctor to have every possible piece of machinery available in his office, or needing others to make phone calls for you.”

“That’s just stupid psychobabble. Probably because you can’t answer your own dumb question.”

Feeling angry, I’m silent, trying to figure out what I want to say next.”

“What? Cat got your tongue?

“I wonder what you get out of being so difficult and demanding. I know that it can’t possibly get you what you want. Your daughter didn’t want you in the same city as her. Your son won’t deal with you unless you’re in therapy. But therapy is about looking at yourself. And if you’re not willing to look at yourself instead of blaming everyone else for their insufficiencies, we’re not going to get very far.”

“And that would be my fault?! How about your looking at you?”

“I’m happy to look at how I may be contributing to the difficulty we’re having, but that means you’ll need to look at how you might be contributing to the difficulty too.”

“Okay. So tell me. Both sides.”

“I’m going to answer that question, Mrs. Green, but I want to point out that you’ve again issued a demand and as a result of that demand I don’t really want to answer the question. I am going to answer the question, but I suspect that most people who aren’t therapists wouldn’t. They’d see you as an entitled, demanding, angry, embittered woman. And, from my perspective, that’s all true. But I do think there’s a reason you’re that way and I’m willing to work on us trying to figure out what that reason is which might help you to make some changes.”

“And what’s your part?”

“I think it may be particularly difficult for me to have people make demands on me without my wanting to resist their demands and that might make our work together more difficult.”

“So should I find someone else?”

“That’s certainly your choice. I’d be happy to give you some referrals if that’s what you decide.”

“You’re probably all alike. I’ll stick with you for a while and see what happens.”

“Okay. Fair enough.”

The New Year II| by Linda Sherby, Ph.D, ABPP

Mon, 22 Jan 2018 23:30:18 GMT

"The New Year - Part II" is another of my attempts at a follow-up session. Here the therapist struggles to remain non-judgmental as her patient tries to become someone she's not in order to avoid the pain of a breakup.

As I open the door, I am surprised to see a smiling Heather waiting for me. Quite a change from just three days ago, I think.

Once comfortably seated in the chair across from me, she says, “Not the person you expected to see today, right? Rob and I got back together.”

“How did that happen?” I ask, while silently thinking, oh no.

“He called. Said he made a mistake and wanted us to be together. Turned out that Brad was actually living with another man and Rob decided he couldn’t deal with the free-wheeling gay lifestyle.”

I struggle with whether to remain silent or share my concern. While deliberating, Heather says, “You don’t approve.”

“It’s not a question of approval, Heather. I just wonder why you were so quick to take him back. He told you he wasn’t in love with you and you certainly know that you can’t choose who you’re attracted to.”

“We had great sex after the breakup. I remembered what you and I talked about and tried to be more aggressive. It was terrific. We didn’t tie each other up, but I tried to do more to him, like … umm …. doing oral sex and … I’m not sure I can say this …”

Silence.

“Like putting my finger up his ass. I thought I’d be grossed out, but it was okay.”

“So you’re saying that you tried to be what you consider more masculine.”

“I guess.”

“It’s like what you said last time, you thought if you could be more of a man you’d be good enough.”

“Why are you trying to take this away from me?” Heather asks plaintively. “I was so miserable; I felt so shitty. And you can see how much better I feel.”

“I know that breakups are horribly painful, but it seems to me that you’ve put yourself in the position to be hurt all over again. If Rob is gay, he’s going to find another man he’s attracted to and …”

“No, he told me he wouldn’t.”

“Okay,” I say, asking myself why I am pushing Heather so hard. Why am I trying to protect her, rather than looking at the underlying dynamics that have led Heather to return to this relationship? Am I re-enacting something in her family dynamics? Something in my own?

Backing off I say, “What do you feel would be helpful for you today?”

“Oh!” she says, obviously surprised. “I don’t know.” Pause. “You just stopped. You didn’t keep badgering me. My mother never did that. She didn’t talk to me much, but when she did she was always trying to convince me to do what she thought I should, even if it made no sense.”

“So what do you want to do?”

“I want to stay with Rob, see what happens, and try to be more assertive.”

I think of all the rejoinders to her comment, but decide that confronting her directly will only feel like her old arguments with her mother. “And what would you like me to do?” I ask.

“Hmm. I’d like you to help me be more assertive.”

“So perhaps you’re being assertive right now, by telling me what you want me to do.”

“I guess, but it’s easy with women. Like I pretty much did what I wanted regardless of what my mother said. But with my father, there was no way. I toed his line.”

“So we’re talking about the power your father had and how being male was prized in your family.”

“Oh yeah.”

“And last week you talked about not feeling good enough to keep a man because you weren’t male enough.”

“Yeah, weird as that is.” Pause. “So I guess I’m saying that I’m going to try to be more male.” Pause. “I guess that’s okay.” Pause. “What do you think?”

“It depends how much you’re twisting yourself into someone you’re not, vs. how it flows naturally.”

“It doesn’t flow naturally.”

Silence.

“So are you saying there’s no hope?”

“Depends what you’re hoping for. If you feel you to need to be a man, there’s certainly no hope for that. If you’re talking about keeping Rob, I’m dubious – although I could be wrong – because I think it’s about him, not you. But there’s certainly hope that you can give up feeling your womanness is inadequate and feel that you’re more than enough for a man.”

“Right now I just want to make it work with Rob.”

“I hear you. And I’ll be with you in any way I can.”

The New Year| by Linda Sherby, Ph.D, ABPP

Tue, 09 Jan 2018 20:44:48 GMT

In this week's blog, The New Year, patient and the rapist seek to understand the patient's unconscious need to choose men who, seemingly unknown to her, are gay.

The New Year

Heather blows her nose and rubs her very red eyes.

“I feel as though all I’ve been doing since the New Year is crying,” she says. “I was sure Rob was it. I even thought he might propose on New Year’s Eve. Instead I just sat there waiting for him. Eventually I got panicked and started calling hospitals. He was always punctual. I don’t know why he couldn’t just call and tell me!”

“There you sound angry,” I say.

“I guess. But I can’t hold on to the anger. Mostly I just feel sad. And I think really stupid things like ‘it’s such a waste’ or ‘he was pretty good in bed.’ I know that’s ridiculous, he is who he is and that’s that.” Pause. “Except that I love him,” she exclaims, crying. “And I thought he loved me. When he finally got the nerve to call on New Year’s Day, he gave me that old line, he loves me but isn’t in love with me. Thought he could make it work until he met Brad and they just clicked. I had the sense they practically fell into bed two minutes after they met. And there I had one of those awful thoughts again. I was going to say, isn’t that what gay men do? I don’t want to be thinking that. That’s not who I am. I’m the most tolerant, liberal person around.”

“Perhaps that’s your anger speaking.”

“Maybe.” Pause. “This isn’t the first time,” she says softly.

“Isn’t the first time …?”

“I was involved with another man who realized he was gay. We weren’t quite as serious as Rob and I, but we’d been going together for a while.” Pause. “I’m not sure why I never told you. It was a pretty big deal to me, especially at the time. And now it’s happened again.”

“What are your thoughts about not telling me about the first man?”

“I’ve thought about it. I think I was ashamed. Ashamed that I wasn’t enough of a woman to hold onto a man. Or maybe ashamed of being a woman, that being a woman in and of itself isn’t enough.” Pause. “I think my mother thought that. I wasn’t enough and she wasn’t enough.”

“Enough for what?”

She shrugs. “Enough to be successful in the world, enough to be smart and educated and intellectual like my father. Enough to hold my father’s interest. He was never interested in her. He’d rather sit around with his fellow professors and have philosophical discussions. You know, I’ve told you, as a family we kind of weren’t. We all went our own way. My father paid attention to me when he wanted to impart some tidbit of knowledge, otherwise I was just kind of there. As for my Mom, we never talked, not even when we went on vacation. Just the two of us. My father never came.”

Heather continues. “You know. I wonder if there’s a connection between my not feeling like enough and choosing – unconsciously choosing – gay men. Almost like – this is ridiculous too – they’re less of a man and I’m less of a woman, so maybe I’d be able to hold onto them.”

“What was it like for you sexually, Heather? Did you feel like less of a woman in bed? Did you feel they were lesser men?”

“They weren’t lesser men. Rob was a very attentive lover, always wanting to please me. In fact, he embarrassed me. He wanted me to tell him what it felt like, what I felt when he’d do one thing or another. I didn’t like all that focus on my body. It embarrassed me, made me self-conscious. He’d always satisfy me, always. That made me uncomfortable too because he didn’t always … umm … ejaculate.”

“And the other man?”

“Now I’m really embarrassed.” Pause. “That was different. That was a lot rougher. Sometimes he’d tie my hands and like take me really hard and fast. It was a turn-on. For both of us. When he told me he was gay I asked him about our sex, about how exciting it seemed for both of us. He said it made him realize how much he wanted done to him what he did to me. That made me feel less than. I couldn’t do what he wanted, not only because I didn’t have a penis, but because I just couldn’t. I couldn’t be that aggressive.”

Heather pauses and then continues. “So what am I saying, that I’m not enough of a woman because I’m not a man? Wow! That’s wild. That’s messed up.”

“You’ve described your father as the source of power in the family, the person both you and your mother hoped to ‘interest,’ so it’s not surprising that only maleness feels like enough. How that relates to your choosing gay men isn’t clear – at least to me – and something we’ll have to continue talking about.”

“Definitely. I’m not interested in repeating this for a third time.”

Misery| by Linda Sherby, Ph.D, ABPP

Thu, 16 Nov 2017 13:00:00 GMT

In this blog, a patient stays stuck in misery, hoping to find someone - perhaps

her therapist - to take care of her, rather than owning her adult capabilities.

Beth smiles wanly at me as I open the waiting room door. I anticipate a long, dreary session.

“I’m still miserable,” she says, sitting down, immediately confirming my worst fears. I do understand that Beth has good reason to be miserable. Her husband divorced her after 20 years of marriage, leaving her with two teenagers, three dogs and a six bedroom house. It’s a lot to deal with. And we’ve been dealing with her misery for almost two years.

“Of course I had another problem this week. The kitchen sink started leaking. I freaked out. I went running around to my neighbors to ask if they knew a plumber. Luckily one of them did.”

Knowing I am about to make a futile statement, I say, “So that’s something that worked out well.”

“Not really. It took me days to reach the plumber and then more days before he could come. And in the meantime the kids and I had to eat out which certainly doesn’t help my budget.” She sighs. “It’s all so complicated. I don’t know why life has to be so difficult.”

I wonder how many times I have said things such as, ‘life can be difficult and you’ve certainly had a difficult time, but life can bring lots of joy as well.’ I remain silent.

“Well …?” she says.

My stomach tightens. I feel as though she is commanding me to respond.

“What is it that you want from me right now?” I ask. I hear my choice of words, the tone of my voice and realize that Beth is making me feel as she feels – burdened, put upon, ineffectual, despairing. Ineffectual. That’s an interesting word to flit through my mind. Perhaps that’s what Beth feels. Now alone, she feels unable to competently contend with life.

“I need you to reassure me, to tell me that it will all work out okay.”

“Would you believe me?”

Beth opens her mouth to speak and then stops. After a pause she says, “Well if you said it, it might reassure me.”

This time I don’t hear Beth’s words as a command to speak, but rather a wish that I take care of her. “I understand that you want reassurance, but you often hear that reassurance as empty words.”

“But I don’t know what to do. I have all these responsibilities. The kids. They’re certainly becoming more than a handful. How am I supposed to handle two teenagers by myself?” She takes a breath. “And what if I get sick? That’s all I’d need. How could I take care of all the things I need to take care of if I got sick? Who would take care of me?”

“I definitely hear how overwhelmed you feel, Beth. Like there are all these things that happen on a day to day basis and then there are all the things that might happen. How are you going to cope?”

“Exactly.”

“But I wonder, Beth, if it would be more helpful to you if you were able to see your own strength, if you were able to realize that you’re far more capable than you think you are.”

“But I’m not!”

“Do you really feel as though you’re not a competent, capable adult or are you afraid to let yourself know you’re a competent, capable adult?”

“They always said I wasn’t.”

“Who’s they?”

“My parents, my sisters, my husband. Even my children. They say I’m a wreck, that I can’t do anything right, that I’m always running around in circles. And I am. I’ve been doing that my whole life.”

“So what would it feel like to be competent?”

“How do I know? I’ve never felt it.”

“Would you like to?”

“Of course!”

“Beth, can you think about that a bit more? I wonder two things: If feeling competent feels so foreign to you that it would be like you’re becoming another person and that in itself would feel pretty scary. And two, you’re not sure you want to be all grown up before you find someone who’ll take care of you.”

“My husband said he’d take care of me. But he never did. He just nagged at me for what I didn’t do right. Even my parents. I was the fifth girl. They’d had enough by that time. I was kind of an add-on.”

“I understand, Beth, that it’s very difficult to give up on wanting the love and caretaking you never had, but there’s no way to get that kind of caretaking as an adult. It doesn’t mean you can’t be loved and cherished, but you can’t go back to being the child and, in the end, it does feel much better to have confidence in your ability to take care of your adult self.”

Anger: Expressed and Repressed (Part II)| by Linda Sherby, Ph.D, ABPP

Fri, 27 Oct 2017 18:59:38 GMT

In this session the patient, Jacquelyn, runs from the anger she felt in the previously, but is able to return to those feelings with her therapist's self-awareness, insight and support.

“You know, I’ve been thinking,” Jacquelyn begins. “I’ve been thinking I should take a break from therapy for a while.”

Internally, I scream, ‘What!? I thought you said you were going to think about your anger?’ To Jacquelyn I say, “And why is that?”

“I don’t know. I’ve been doing this for over a year, seems like it’s time for a vacation.”

“Does your desire for a vacation seem connected to last week’s session when you realized you were angry at your mother for not protecting you as a child?” I ask.

“I didn’t say that.”

“Not exactly, but you did want the woman in the TV show who reminded you of your mother to be killed by the serial killer.”

“I didn’t say that either.”

Disappointed that Jacquelyn has moved so far away from her more open, insightful stance of last week, I ask, “What’s your sense of what’s going on between us right now?”

“Nothing special.”

Feeling increasingly exasperated, I ask, “Can you say what you think is going on between us even if it’s not anything special.”

“You’re mad at me. You’re mad at me because I want to stop therapy.”

“I am annoyed with you, Jacquelyn, because I felt so hopeful last week, hopeful that we’d made a breakthrough, that you experienced your anger at your mother and that although you were scared of the repercussions, you went away wanting to think about it.”

“It was too scary.”

“I do understand that, Jacquelyn,” I say, thinking that perhaps she’s put one toe back in the water.

“But why were you angry at me if you understood?”

Hmm, I think to myself, I wonder if Jacquelyn wanted me to feel angry so that I could feel what she feels – angry but thwarted in its expression. I decide to keep that thought to myself. “I can understand and still be angry. Anger is a feeling. We can’t control what we feel, although we can control what we say or what we do.”

“So you don’t feel scared when you feel angry?”

“No, I don’t feel scared when I feel angry. Except some times.”

“Like when?”

Although repeatedly answering a patient’s questions is unusual for me, I feel that in Jacquelyn’s case it is a helpful form of modeling, perhaps making her own anger less frightening. “Well, I guess like in that TV show you talked about last week, I’d probably be scared if I got angry at the serial killer because I’d be afraid if my anger showed he might immediately kill me.”

“That’s it!” Jacquelyn says staring at me, her eyes wide open. A second later she’s sobbing, pulling at her hair.

“It’s ok, Jacquelyn,” I say quietly. “There’s no serial killer here and your father is long dead.”

She continues crying, but seems calmer. Through her tears she haltingly says, “I never even knew I was afraid he’d kill me. Like he could read my mind. Like he’d know I hated him. I was always so scared, so scared, so scared,” she says cradling her body in her arms and rocking in the chair.

“I’m so sorry, Jacquelyn. I’m so sorry that you had to go through all that. You were only a powerless, dependent little girl. You were so scared.”

I can see Jacquelyn bristle. She stops crying and lifts her head. I went too far.

“I’m sorry, Jacquelyn,” I say, “I know it’s very hard for you to be aware of how powerless you were as a child. It makes you feel all the more frightened. It’s more than you can bear.

“Maybe it is time to take a break from therapy.”

I look at Jacquelyn tenderly. “No, it isn’t,” I say. “I know I went too far. You were back there being that little girl and I so terrified you that you had to come back to your adult self, had to go back into a defensive mode. Will you forgive me?”

She is again crying. “I don’t think in my entire life anyone asked me to forgive them. I used to dream about that. I used to dream that one day both my mother and father would take me aside and apologize for all the bad things they’d done to me. But of course that was ridiculous. Except it’s kind of like you made my dream come true, even though you didn’t do anything nearly as bad as they did.” Pause. “Yes, I’ll forgive you,” she says crossing both her hands on her lap and staring directly at me.

Anger: Repressed and Expressed | Linda B. Sherby, Ph.D, ABPP

Thu, 19 Oct 2017 21:27:20 GMT

This weeks blog focuses on a patient's particular response to a TV show which further reveals the patient's conflict around aggression, enabling her therapist to bring the conflict more clearly and directly into the consulting room.

Thirty year old Jacquelyn looks unusually pensive as she settles herself into the chair across from me.

“A weird thing happened this week. Kind of disturbing ,” she begins. “You know how I tell you that I always watch those gruesome shows like Criminal Minds or CSI, but that I have to cover my eyes during the particularly gory scenes?” she says grimacing.

I nod.

“Well, one of those gory scenes came on, and instead of covering my eyes I felt sort of compelled to watch it. And I – this is kind of embarrassing. I, umm, I actually felt kind of excited and found myself rooting for the serial killer. I wanted to watch him kill that, that, umm, that woman.”

“What did you first think of, Jacquelyn, before you said ‘woman?’”

Jacquelyn lowers her head. “First I thought to say ‘bitch,’ then ‘sniveling baby,’ or ‘coward’ or ‘idiot.’ But they sounded too negative, so I settled on woman.” Pause. “You know, you’re always telling me that I have lots of anger, but that I keep it buried inside me.” Pause. “I didn’t feel angry, not even when I was wanting him to kill her.” Pause. “That doesn’t make sense when I say it out loud.”

Jacquelyn’s last comment is encouraging. Although I’m sure she’s at least of average intelligence, she tends to be quite concrete, has difficulty with self-reflection, and is often unable to take in what seems to me the most obvious of connections.

“Was it that you wanted this particular man to kill the woman or did you want this particular woman dead?” I ask.

“Do you think I’m terrible for thinking about this?”

“Not at all. You weren’t killing anyone, you were watching a TV show.”

“I guess,” she replies dubiously.

Silence.

“You want me to answer your question.”

“Yes.”

“I wanted this woman dead.”

“And can you say more about that? Why did you want her dead? Who did she remind you of?”

“I don’t know.”

“Well, how about thinking about it now.”

Silence. Jacquelyn squirms in her chair.

“Can’t she just be a woman?”

“If you think about a woman, what woman comes to mind?”

“She wasn’t like my mother.”

“Does that mean your mother was the first woman you thought of?”

She nods, looking down.

“And what’s the similarity between your mother and this woman in the TV show?”

Still not looking at me she says, “They were both housewives.” Pause. “They had children.” Pause. “Umm. Umm. They couldn’t stand up to their husbands.”

Thinking to myself, ‘now we’re getting somewhere,’ I ask, “How did the woman in the TV show not stand up to her husband?”

She looks up. I suspected that it would be easier for her to talk about the TV character than her mother.

“There’s this scene at the breakfast table where her husband is screaming his head off at both her and the kids. You know he’d be cursing in real life but of course they can’t show that on TV. He goes off on the little girl when she spills a glass of milk, calling her an idiot and worthless. The little girl starts to cry and the woman tells her husband to calm down and that does it, now he’s really off the wall, screaming at the woman and even looking as if he might hit her. She cowers and turns back to washing the dishes while the father starts screaming at the girl to stop crying and when she doesn’t he slaps her across the face. The woman doesn’t do anything.”

“Does that sound familiar, Jacquelyn?”

Tears roll down her face. “I didn’t want to kill my mother. Oh my God, I hope not. I hope I didn’t wish her gone, because then I would have been left with him.” Pause. “We were both such cowards,” she says now sobbing.

“What do you mean?” I ask.

“Both of us. Neither of us could stand up to him.”

“Jacquelyn, you were a little girl. How were you going to stand up to him?”

She shakes her head and continues sobbing. “Cowards. We were cowards. We should have done something.”

“You’re angry at both yourself and your mother for not being able to fight back.”

“We were cowards.”

“You can’t accept your own vulnerability, Jacquelyn.”

“No! I can’t!”

“So you wanted to kill the woman in the TV show because of her ‘weakness,’ because of her vulnerability.

“I didn’t want to kill her, I wanted her dead.”

I think Jacquelyn has had enough for today and decide to back off.

“You’ve done a lot of good work today,” I say. “I wonder how you’re feeling.”

“Scared.”

“Scared of?”

“I’m not sure. Being slapped across the face like the girl in the TV show. That’s silly. I feel bad, like I did something wrong and I’m going to be punished.”

“I understand, Jacquelyn. You’ve gotten closer to your anger than you’ve ever been and I think that’s frightening you.”

“You think so?”

“Yes, I do.”

“Okay. I’ll try to think about that.”

Chaos | by Linda Sherby, Ph.D, ABPP

Mon, 18 Sep 2017 19:45:34 GMT

This week's blog, Chaos, looks at a therapist working to calm a traumatized patient who is turning his aggression on himself.

“Welcome back,” I say to Ed, smiling. He attempts a smile in return, walks into my office, sits down in the chair across from me, and sighs. A smart, sensitive, psychologically minded twenty year old college student, Ed has had difficulties for much of his life – anxiety, compulsivity, facial tics, self-flagellation - but seemed markedly improved before returning to his home in New York City for the summer.

Shaking his head from side to side, he says, “It was too soon. I shouldn’t have gone home. And I shouldn’t have participated in that anti-Trump demonstration. Too much, way too much.” I watch Ed’s eye begin to twitch. He raises his right hand, then catches himself, makes a fist and puts his hand down. “As you can see, it’s back,” he says contemptuously.

“I’m sorry, Ed. I really am. Did you really feel so angry with you that you wanted to hit yourself?”

“Yes. I wanted to beat the shit out of myself,” he says clenching his jaw. “I’m sorry. I know you’ve worked so hard to help me stop that.”

“You don’t have to apologize, Ed. I’m just sorry you’re in so much pain.”

“I’m weak. I’m a sniveling baby. I can’t do anything to help myself.”

“That certainly sounds like the voice of your father.”

“Yeah, so what else is new? I thought I could take him on. I thought I was ready. How stupid of me. And joining that demonstration was terrible.” Ed’s eyes widen. I can feel the fear seeping from him. He fidgets, crossing his legs from side to side. “There were so many people, angry people. And they should be angry. We have an insane bully in the White House. North Korea, Venezuela, racists, Nazis! It’s insane. It scares me. But all the anger scares me too. It reverberates in my head. I can’t turn it off. I feel like I’m crazy too.” Ed digs his nails into both fists. He looks down at those fists as though they’re an alien part of him. He starts to beat his thighs.

I want to go and hold his hands to subdue him, to reassure him, to prevent him from hurting himself. Instead, I softly say, “Ed, Ed please look at me. I’m here. We’ll get through this. You’re with me now. You’re not in that demonstration, you’re not with your parents.”

Ed looks at me, first as though he doesn’t see me and then with dawning recognition. Tears roll down his face. He buries his head in his hands. “I don’t want to be crazy. I don’t want to be crazy,” he mumbles through his hands.

“You’re not crazy, Ed. You’ve been traumatized, actually re-traumatized, and it will take us a while to work it through. Can you talk about some of the things that happened with your parents or does that feel like too much for today?”

He lifts his head and smiles at me. “Well, that never happened. No one was ever sensitive to my feelings. It’s amazing what a difference just a little understanding and caring makes. How many times have I said I wish you were my mother?”

“Except there’s usually a second part to that statement.”

“Yeah, I’m afraid that not even you could stand up to my father and I wouldn’t want to find that out. And then you say you couldn’t promise me that you’d be able to stand up to my father but you certainly hope you’d try.”

“I also say that your father’s rage is not the only rage you’re afraid of, that you’re afraid of your own rage as well.”

He nods.

“I wonder if that’s what happened in the anti-Trump demonstration. You were…”

Ed interrupts me. “I did think that my father is a lot like Trump. A bombastic bully who’s thin skinned and easily narcissistically wounded.”

“So you mean you’d be afraid of going up against Trump, just like

you’re afraid of going up against your father?”

“Yes.”

“That makes a lot of sense.”

“But you were you going to say something when I interrupted you.”

“Oh, yes. About your anger. I was wondering if in the demonstration you saw all these people who seemed comfortable with their anger and that that scared you, made you afraid that your anger might get out of hand, especially since, as you just said, Trump reminds you of your father.”

“You know, I’ve never quite gotten that bit about my anger, but somehow it makes sense in the context of that demonstration. There were all these people yelling their heads off, shouting terrible things about Trump. I wanted to join in, to become a part of the crowd. But instead I drew in and had all this noise going on in my head.” Pause. “Thank you. I feel much better.”

“My pleasure. See you Thursday.”

“Thanks again.”

The Consultation | by Linda Sherby, Ph.D, ABPP

Tue, 22 Aug 2017 02:37:27 GMT

In this weeks blog, "The Consultation," a patient presents herself as an angry, contemptuous woman, hiding the sad, damaged child underneath.

Rebecca Whitman rises from the waiting room chair extending her hand to greet me. She is dressed in a pale lavender suit and matching high heeled shoes which are surprisingly flattering with her flowing dyed red hair. I wonder at her age. Mid-forties? Hard to know how much plastic surgery she’s had.

“This is a consultation, right?” she begins immediately . “I’ve had lots of them. You get to decide if you want to work with me and – never to be forgotten - I get to decide if I want to work with you. So what do you want to know?”

Feeling as though she has just thrown out her opening salvo, I say, “That’s quite a beginning.”

She sighs. “I believe in getting to the point. Why waste time. It is my money after all.”

“Do you want to be here, Ms. Whitman?” I ask, noticing that I have automatically called her by her last name.

“Why do you ask?”

“Well, we’ve never met before and yet it feels to me that you’re already angry with me. That doesn’t make much sense unless you’re angry at being here.”

“I’m always angry. I’m angry at being here. I’m angry that I have to pay you to listen to me. I’m angry that I’ve seen I don’t know how many therapists. I’m angry they’ve either thrown me out or been completely incompetent or both. I’m angry that even though I’m one of the best real estate agents in the area, I eventually get shown the door. No biggie, I’m good enough I always find another agency. I’m angry that I’ve had three failed marriages and heaven knows how many other relationships that failed. Any questions?”

I feel torn. A part of me wants to join all the others who have gone before me and stop this consultation immediately. But another part, perhaps the grandiose part, wants to give it a shot. I do know if I’m going to try, I want to do something other than taking her anger on directly.

“What would you be feeling if you weren’t feeling all that anger?” I ask.

She laughs. “I’ve heard that one many times before. You think a simple question is going to have me dissolve into tears. You’re going to have to do better than that.”

So much for not taking her anger on directly. “Do you like being angry? Do you like losing jobs and relationships and therapists? And why are you here? What do you want to accomplish?”

“Better,” she says.

I feel myself getting angry at her constant evaluation of me. I keep silent.

The silence persists.

“I guess you want me to answer your questions.” Pause. “Ok, Ok, I’ll answer the questions. Sometimes I like being angry and sometimes I don’t. And, no, of course I don’t like losing job or relationships.” Pause. “I’m not sure why I’m here. I guess I’m hoping someone doesn’t throw me out.”

Her last statement sounds so sad that I find myself fighting back tears.

“Someone I can have respect for, that is,” she adds with her typical bravado.

My sadness shuts down immediately. Rebecca Whitman has told me a lot about her defensive need for anger.

“If I ask you who was the most significant person in your life who threw you out, who would you say?”

She shrugs, “My mother.”

“Ok, Rebecca, so I do think you’re afraid if you let down your anger you’d be left with lots and lots of tears, tears of loss, abandonment, worthlessness and, of course, rage.”

“Think you’re smart, huh?”

“Rebecca this isn’t a contest. I’m not here to beat you in a competition. I’m on your side. And I know you can’t simply put away your defensive angry. It’s been a part of you for a long time. But hopefully if you come to trust me, you can let it down little by little and together we can deal with the pain underneath.”

“Ok smarty-pants, guess why my mother threw me out.”

“There’s no way I could guess that, but I’d appreciate your telling me.”

“Because I told her my step-father – step-father number three, by the way – was doing it to me.”

“Oh, Rebecca, I’m so sorry.”

“Yeah? Yeah? What the fuck good is your pity going to do for me? I was eleven years old. Eleven years old for God’s sake!”

“That’s more than reason enough to be angry. But you must also feel sorry for you as that eleven year old child.”

“I don’t believe in a pity party!”

“Compassion for a child is not a pity party.”

“So are you going to work with me?”

“Yes, Rebecca, I’m going to work with you. I’m not going to throw you out.”

“Ok,” Rebecca says as she sprints towards the door.

The Truth, the Whole Truth, and Nothing but the Truth | by Linda Sherby, Ph.D, ABPP

Fri, 11 Aug 2017 20:58:31 GMT

A therapist is confronted with a new patient who she suspects is fabricating her story. The therapist wants to know if she is indeed lying and, if so, why.

Maxine sits comfortably in my chair, runs her hand through her curly brown hair and begins. “I came to therapy because I keep having fantasies about killing my daughter.”

Oh oh, I think, remaining silent and neutral. Maxine seems a bit taken aback by my silence. What she doesn’t know is that I am immediately on guard, unsure if I am about to hear a story that is truly every therapist’s nightmare, or one that is completely fabricated. A colleague told me she saw a new patient who told her a similar story and then admitted it was only a test for the therapist.

“I don’t know why I’m having these fantasies,” Maxine continues. “I love my daughter. We’ve always been close.”

Not wanting to accuse a truly troubled person of lying, I decide to go along and see what develops. Of course, a woman who goes from therapist to therapist fabricating a story, must be pretty troubled as well. “What’s your guess?” I ask. “Why do you think you have been having these fantasies? How long have you been having them?”

Maxine sits comfortably in my chair, runs her hand through her curly brown hair and begins. “I came to therapy because I keep having fantasies about killing my daughter.”

“I don’t know why I’m having these fantasies,” Maxine continues. “I love my daughter. We’ve always been close.”

“It was right after Barbara’s – that’s my daughter – right after her thirteenth birthday, about six months ago. I don’t know why I’m having the fantasies. If I knew I wouldn’t have come here. What do you think?”

I think this is a sham, but I’m still reluctant to confront Maxine.

“It’s pretty hard for me to have any idea since I know next to nothing about you.”

Maxine sighs, seeming exasperated.

I’m rather annoyed myself, but try to return to my more neutral tone. “Can you tell me about you? What’s your present life like? Married? Other children? Working? And what was it like for you growing up?”

“I’m a stay at home Mom. My husband is an entrepreneur. He travels a lot. I was thinking I should probably go back to work. With Barbara growing up there’s not that much for me to do.”

“What are your feelings about Barbara growing up.”

“Mixed. I’d like my little girl back and I’m looking forward to seeing where my life takes me.”

“Where do you want it to take you?”

“I’m not sure yet. I think that’s one of the reasons I feel so dissatisfied with myself.”

I find myself liking Maxine more, yet feel entirely confused about what’s going on in the session or what’s real and what isn’t. I decide to take the plunge.

“Maxine, what of what you’ve told me today is true and what isn’t?”

“You figured it out! You’re the first one. Oh good, now you can be my therapist.”

“I had a rather big clue. One of my colleagues told me she’d seen a patient who told her a pretty similar story and that it was supposed to be a test for the therapist.”

“Oh! What a disappointment. Now I can’t tell if you’re really smart or not.”

“Maxine, you must by now know from therapists’ reactions that it’s quite insulting and infuriating to be tested by a series of lies. But I’d like to know the underlying reason you found it necessary to go through this charade.”

“I didn’t think I could trust someone who wasn’t smart enough to figure me out.”

“Well, I’d guess that you definitely feel you can’t trust people and I’d also guess that you see yourself as very troubled and in need of someone who can not only understand you but handle you as well.”

“You are smart. You can be my therapist.”

“But this is a two way contract. There’s the question of whether I feel I’m up to being your therapist.”

“Please, please, I’ll be good.”

“You sound like a scared little girl when you say that.”

Maxine starts to cry.

“Maxine, I know this is unusual for a first session, but this has been an unusual first session anyway. I want you to tell me what the secret is.”

“No, no, I can’t. Not yet.”

“I’m sorry. That’s my condition for us starting therapy. And if you tell me another lie you’ll only be hurting yourself. There’s something you’re terribly afraid of or guilty about, something you need to start dealing with even though you want to keep it hidden.”

“I killed my sister.”

“Is that another lie?”

“No, no, it isn’t. I wish it were. I didn’t do it deliberately.” Maxine’s next words are flat, expressionless. She stares straight ahead. “A group of us were playing soft ball. I was at bat. I swung. I lost control of the bat. It hit my sister in the head. She died. My parents sent me away.”

“I’m so sorry, Maxine. What a horrible accident. How traumatic. And then to be sent away on top of it. I’m really, really sorry.”

“So you’ll be my therapist?”

“Yes,” I say, although I realize that it will take me some time to totally trust what Maxine tells me. Hmm, I think, Maxine has led me to feel the distrust she feels in the world.

I think this is a sham, but I’m still reluctant to confront Maxine.

“It’s pretty hard for me to have any idea since I know next to nothing about you.”

Maxine sighs, seeming exasperated.

“I’m a stay at home Mom. My husband is an entrepreneur. He travels a lot. I was thinking I should probably go back to work. With Barbara growing up there’s not that much for me to do.”

“What are your feelings about Barbara growing up.”

“Mixed. I’d like my little girl back and I’m looking forward to seeing where my life takes me.”

“Where do you want it to take you?”

“I’m not sure yet. I think that’s one of the reasons I feel so dissatisfied with myself.”

I find myself liking Maxine more, yet feel entirely confused about what’s going on in the session or what’s real and what isn’t. I decide to take the plunge.

“Maxine, what of what you’ve told me today is true and what isn’t?”

“You figured it out! You’re the first one. Oh good, now you can be my therapist.”

“I had a rather big clue. One of my colleagues told me she’d seen a patient who told her a pretty similar story and that it was supposed to be a test for the therapist.”

“Oh! What a disappointment. Now I can’t tell if you’re really smart or not.”

“I didn’t think I could trust someone who wasn’t smart enough to figure me out.”

“You are smart. You can be my therapist.”

“But this is a two way contract. There’s the question of whether I feel I’m up to being your therapist.”

“Please, please, I’ll be good.”

“You sound like a scared little girl when you say that.”

Maxine starts to cry.

“Maxine, I know this is unusual for a first session, but this has been an unusual first session anyway. I want you to tell me what the secret is.”

“No, no, I can’t. Not yet.”

“I killed my sister.”

“Is that another lie?”

“I’m so sorry, Maxine. What a horrible accident. How traumatic. And then to be sent away on top of it. I’m really, really sorry.”

“So you’ll be my therapist?”

“Yes,” I say, although I realize that it will take me some time to totally trust what Maxine tells me. Hmm, I think, Maxine has led me to feel the distrust she feels in the world.

Shame | by Linda Sherby, Ph.D., ABPP

Tue, 18 Jul 2017 19:19:21 GMT

This week's blog deals with the difficult issue of love in the consulting room and how it can be dealt with appropriately with the patient's best interest in mind, or inappropriately creating long lasting damage.

“I love you,” Melanie says, looking downward.

Twenty-five year old Melanie has been my patient for two years, a lovely young woman struggling with anxiety and depression. One of six children raised on a farm by parents who saw their offspring as laborers, rather than cherished beings, Melanie has come to rely on me as one of the few people who is consistently in her corner. Professing her love for me doesn’t take me by surprise.

“Thank you, Melanie,” I say, “that’s a lovely gift.”

“No,” she replies. “It’s much more complicated.”

I wait, unsure what she means.

“I said that to my last therapist,” she says hesitantly. “You know, I’ve talked to you about Dr. Hopkins. I saw him for a couple of years before you.”

I nod.

“But I never told you what happened, why I left.” She pauses. “We had an affair.”

I’m shocked. Not that I’ve never heard of therapists inappropriately crossing sexual boundaries, but I’m surprised Melanie never told me something of such significance.

“I’m so sorry, Melanie. How come you never told me before?”

“I was too ashamed.”

The victim blaming herself. Not unusual I think to myself. “Do you realize that Dr. Hopkins abused you?”

“No. It wasn’t like that,” she protests. “I told you, I loved him. And he loved me back. That was the most wonderful surprise of my life. Someone I so looked up to and admired actually loved me!”

“Melanie, how did your therapy with Dr. Hopkins end?”

“Well, for a while we saw each on the outside and I continued to have my regular therapy sessions. Dr. Hopkins was very clear that we couldn’t do anything sexual in the office, that we had to remain professional during our sessions.”

I am beyond furious at this so-called therapist, but hope that I am successful at concealing my feelings.

“But then Dr. Hopkins told me he didn’t think I needed therapy anymore. So I quit and just saw him on the outside.”

Still seething, I wonder if Dr. Hopkins thought his prowess as a lover had “cured” Melanie or whether he just found it too difficult to keeps his hands off her during their sessions.

“But then one day,” she continues, “he said that we couldn’t see each other anymore. He told me his wife was sick and that he felt too guilty being with me. I was devastated. I mean, I knew he was married. I knew it wasn’t like we’d be together forever and ever. But I loved him so much. And I thought he loved me. So how could he just walk away?”

“When you say you thought he loved you, are you now questioning that?”

Melanie starts to cry. “I was a fool. I know I was a fool. Did I really think a smart, educated man more than twice my age would be in love with me? He wanted my body. But I just wanted so much for him to love me, that I deluded myself into thinking he did. That’s what I’m ashamed of, being such a fool.”

“There’s an awful lot to deal with here, Melanie, and I’m sure we’ll return to this many times, but I want to come back to us before the session ends. So what did it mean to you to tell me you loved me? And what response did you hope for – or fear?”

“I’m not sure. I know I don’t want to sleep with you, but I do want you to love me. I guess I want to crawl into your lap and have you stroke my hair and tell me you love me, just as you’d tell your own daughter. Is that wrong?”

“No, Melanie, what you wish for can never be wrong. But acting on that wish is different. You wanted Dr. Hopkins to love you, which really meant you wanted him to care about you, to cherish you and to act in your best interest, not his. He did abuse you, Melanie. He took advantage of your need, of your vulnerability and crossed what should have been an unbreakable boundary. As for us, the wish to crawl into my lap and be my daughter is a more than understandable wish for someone who was so neglected as a child. But if I were to act on that wish I would not be acting in your best interest, because I would be giving you the false hope that you can go back to being a child and get from me what you couldn’t get from either of your parents.”

“That makes me sad.”

“I’m sure it does. Mourning what you never got and never can get, is always sad.”

After a Year | by Linda Sherby, Ph.D., ABPP

Wed, 28 Jun 2017 07:14:22 GMT

It’s been a year since my wife died,” Andrew Solomon begins. “She died of breast cancer. It was a long process. Hard. She fought for as long as she could, but she had an aggressive cancer. She couldn’t beat it. Now, now I have the rest of my life. I’m 65. I guess people consider that young these days,” he adds with a slight smile. “I’m still working, thank goodness. It’s a great distraction. I’m an accountant. I have my own business so can pretty much make my own hours, except during tax season. But I cut down on my clients during my wife’s illness, so I do have more time on my hands.”

Mr. Solomon is a good looking man with wavy white hair, intense brown eyes and a slight dimple in his chin. I wonder what has brought him into therapy at this point, but wait to see where his thoughts take us.

He continues. “My friends tell me it’s time for me to start dating. That I’m young, secure financially, decent looking and that I’ll have women, younger women, flocking all over me. Maybe. But I don’t know. I don’t know that I feel ready.”

“How do you feel about your wife’s death?” I ask.

“Sad. Like there’s this big hole in my life. Don’t get me wrong, Bella – that’s her name, that was her name, hard for me to talk about her in the past tense – Bella and I didn’t have a perfect marriage. We had our fights. And I wasn’t always the ideal husband, especially when our kids were young. I had a couple of affairs. Never felt right about that. We got lots closer after our kids left. And actually we got even closer when she got sick. I guess I realized how much I was going to lose…” He trails off fighting back tears.

“Sounds like you’re still understandably very sad.”

“But shouldn’t I be better after a year?”

“What do you mean by better?”

“Better, less sad, not so teary, ready to move on. Finished with grieving.”

“Grieving the loss of a loved one is not something we ever finish.”

Mr. Solomon looks startled. “No that can’t be. I can’t stay at this level of pain forever.”

“It’s not that grief doesn’t diminish that, as you said, the level of pain remains as intense, but we certainly don’t stop loving or missing the person we’ve lost.”

“But does that mean I shouldn’t start dating? Maybe I should start dating, maybe that would help with the pain.”

“That’s certainly not a decision anyone but you can make. Some people start dating soon after their partner has died, others wait years, and still others never date at all. There’s not one right answer for everyone.”

“I had a friend who got involved with the woman who eventually became his second wife, a month after his wife died. I thought that was awful. I lost respect for him.”

I flash on what Mr. Solomon said about having affairs earlier in his marriage and wonder if guilt plays into his question about whether or not to start dating. “How would you feel about yourself if you decided to start dating?”

“Bella told me it would be all right with her. I thought that was an amazing gift she gave me, especially since she knew about the affairs, or at least one of them.”

“Sounds like you still feel guilty about your affairs.”

“Yes, yes I do. I know it’s silly. It’s so many years ago. But especially when Bella got sick, I kept thinking how horrible I had been to her. How could I have even looked at another woman when I had Bella this amazingly strong, brave, good, beautiful woman?”

“You know, Mr. Solomon…”

“Please, call me Andrew.”

“You know, Andrew, I wonder if your guilt about those affairs very much affects you in the present, both in terms of how you feel about Bella’s death and also about whether you feel comfortable dating.”

“Why should that be?”

“Well, our pasts always affect the present and we haven’t even talked about your past before Bella – your childhood, your young adulthood. I suspect that guilt may have played a role in your life then as well. And we haven’t talked about why you think you had those affairs. Were you angry with Bella? Were you angry with her attention to your children?”

“Wow! I guess there is a lot there. I thought I was going to come in today, solve the problem of whether or not I should start dating and that would be that.”

I smile. “Therapy is way more complicated than that. It opens lots of questions before you’re able to answer even one.”

Searching for Mother | by Linda Sherby, Ph.D., ABPP

Tue, 27 Jun 2017 18:51:45 GMT

An adopted patient again struggles with her feelings about her therapist not being her mother.

“I’ve decided to really start looking for my biological mother,” Liz says at the beginning of our session.

I have seen 27 year old Liz for a tumultuous five years, and although she has brought up trying to find her biological mother on previous occasions, today she does sound more determined.

“Did something happen that reawakened your desire to find your biological mother?” I ask.

She shrugs. “I’ve talked about it before. I just think it’s time. I know you don’t think it’s a good idea, but I want to know who she is.”

“It’s not that I think it’s a bad idea, I just want you to be prepared if the reunion with your biological mother doesn’t prove as idyllic as you hope.” I think of all the adopted people I have known – both patients and friends – who have found their biological mother only to be horribly disappointed yet again, people who have been outright rejected, others whose mother wanted to take over their lives, still others who wanted to be financially supported. Finding the perfect fantasized mother is rarely the outcome.

“What choice do I have?” she asks.

There’s a familiar edge to Liz’ voice, an underlying anger, an underlying demand. I look at her quizzically and remain silent.

“Don’t play dumb,” she says. I now definitely know that something is going on between us. “I have no mother. My so-called mother doesn’t give a shit about me. She was just thrilled when I finally moved out of the house so she could start redecorating and have my father all to herself. And then there’s you. You’re just never going to be more than my therapist. If I even move slightly towards wanting more from you, you run for the hills.”

This is a familiar refrain, one that has played out repeatedly over the time we have worked together. From the beginning, Liz wanted me to be her mother. She had fantasies of moving in with me, fantasies of traveling with me, fantasies of curling up next to me on a couch and watching a movie. Sometimes she presented these as poignant longings, at other times she lashed out at me in rage, furious at my refusal to satisfy her desire. I cared deeply about Liz, understood her longing and was able to hang in there with her during even the most difficult times. I think back on our last session and suddenly realize what has led Liz to experience me as pulling back and wanting to search for a more perfect mother.

“You were angry that I didn’t want you to take my picture,” I say.

“I don’t see what the big deal was. It was only a stupid picture! Everybody takes pictures these days, pictures of dogs, pictures of signs, pictures of themselves. So what was the big deal with taking your picture?”

“You tell me, Liz. What was the big deal about taking my picture? Obviously you have a lot of feelings about my asking you not to take my picture.”

“Yeah and you gave me some mumbo, jumbo about my needing to take you in and have a picture of you in my mind without needing to have an actual picture. So? I can do that. I have you in my mind. We worked on that for a long time and now I can do it.”

“That’s great, Liz. So the question remains, then why did you want an actual picture?”

Liz looks angry and then seems to deflate in front of my eyes. She sighs deeply and looks down at her hands. “I guess because people always have pictures of their family,” she says quietly.

“I know it’s very hard for you, Liz,” I say with compassion, “But the reality is that I will never be your mother. That doesn’t mean I don’t care about you, it doesn’t mean that I won’t be here for you, it doesn’t mean you’re not important to me, but it does mean that however much you may want it, I will never be your mother.”

“I hate when you say that,” Liz says, more sadly, than angrily.

“I know,” I reply.

“Can we still talk about my looking for my biological mother?”

“Of course. But as much as possible, you need to try and separate your wish to find your biological mother from your wish that I was your mother. And, as I’ve said, you also need to be prepared to be disappointed in your biological mother as well.”

“I hate when you say that, too.”

“I know.”

Twins | by Linda Sherby, Ph.D., ABPP

Tue, 27 Jun 2017 18:41:52 GMT

A situation in which a therapist begins working with a twin who is used to being devalued in her family.

Bethany squirms uncomfortably in the chair across from me. She’s a slender, attractive woman, her blonde hair pulled back into a pony tail accentuating her high cheek bones and large blue eyes. I’d guess her to be in her late twenties to early thirties.

“It’s hard to start,” she says. “I guess that’s because I feel guilty. My sister, Heather just got engaged. He’s a great guy. An attorney, sweet, caring. He’s crazy about her. But all I can think of is, why her, why her and not me. I forgot to say, we’re twins. Identical. I mean we look identical. But that’s where it ends. She’s smarter than me or at least she did better in school. She was way more popular. She always got the cool guys. I just stumble along through life.”

“Sounds hard to always be comparing yourself negatively to your sister.”

“I come by it honestly. My whole family does it, especially my mother.”

I flash on the memory of patient who years ago told me about giving birth to identical twins and feeling an immediate connection to the first twin that she didn’t experience with the second. Did Bethany’s mother have a similar experience with her twins that has shaped Bethany and Heather’s experience in the world? An unanswerable question, but an interesting one nonetheless.

“That must be painful.”

“I guess, but I suppose I’ve gotten used to it. I’ve always been shier than Heather, more introverted. I like to draw. I like art. That’s sort of what I do. I work in a design studio that sells lots of art. Although I work mainly in the back. I’m not the greatest sales person. I try, but it’s hard for me.”

“And do you show your own work?”

She shakes her head. “People tell me I’m good enough. But it feels so exposing. And the idea of marketing myself feels overwhelming.”

“Tell me about your family, Bethany.”

“Well, I have an older brother who’s been out of the house for a long time. And then there’s me and my sister and my parents. They’re all very social, outgoing people. They have lots of friends, go to parties, invite people over. I have friends too. I don’t want you to think I’m a total recluse. But we’re different. We sit around and talk, go to the movies, sometimes go to museums.”

“Sounds pretty rewarding. Why is what you do with your friends less valuable than what your parents or sister do?”

She shrugs. “I don’t know. I guess because my mother always seems so disapproving of me. I don’t have enough fun. I don’t wear make-up. I don’t get my hair done. She always wants me to be doing something different than what I’m doing.”

“Has that always been true?”

“Always. I remember when I was little. My friends and I would sit around the house drawing, or playing school, or making up stories and my mother would be telling me to go outside, to ride my bike, to go swimming. Whatever I was doing she wanted me to do something else.”

“Did that ever make you angry, Bethany?”

“Sometimes. But mostly it just made me feel bad about myself. Like what’s wrong with me? Why aren’t I more like Heather?”

“Did your mother ever praise you for your art? Did she ever listen to the stories you and your friends made up?”

“Never. Or at least not that I remember.”

“What just happened there, Bethany? First you said ‘never’ and then you quickly changed it to ‘not that I remember.’”

“Well, I was only a kid. I could have forgotten.”

“Or maybe it’s hard for you to think anything negative about your mother, like it wasn’t fair of her not to praise you for your strengths, just as she praised Heather for hers.”

“I was about to say, I didn’t have any strengths, but I know that’s not true. I really am a good artist. But my strengths weren’t important in my family.”

“You know, Bethany, when children aren’t valued, it’s very hard for them to think that it’s their parent’s problem for being unable to cherish them. They’re much more likely to feel it’s their fault and if only they could change, then their mother or father would love them.”

“I definitely feel that. I always wanted to be like Heather.”

“Well, I’ve only just met you, but it seems to me you have lots of wonderful qualities, qualities that would be loved and valued in many families. Maybe we can help you to learn to value yourself and give up on trying to win the approval of a mother who can’t seem to appreciate you for who you are. It’s really her loss, but I know you’re a long way from feeling that.”

“A long way.”

“I know. But we’ve just begun our work.”

Meeting the Family | by Linda Sherby, Ph.D., ABPP

Tue, 27 Jun 2017 18:36:38 GMT

A therapist must deal with both her own feelings and those of her patient when confronting a prejudiced father with the patient's interracial relationship

“Well, I started World War III,” Patrick says sighing deeply, as he settles into the chair across from me. “I knew Vi wouldn’t go down easily with my parents, but I didn’t think it would be that bad. My mother literally gasped and my father’s rage permeated the entire dinner. He didn’t say a word to her the whole time, but he had a lot to say to me afterwards. I guess I shouldn’t have just sprung her on them, but she surprised me by coming down for the weekend and I was supposed to go to my parents for dinner so, I guess I just decided to bring her along.”

“Wait, Patrick. You mean you hadn’t told your parents that Vi is African American? And then you just showed up with her for dinner?”

“Yeah. You know, she teaches law at Columbia University in New York, I’m down here in Florida, I knew my parents, particularly my father is very prejudiced, so I guess I kind of avoided the whole thing until I couldn’t anymore. Vi wasn’t very happy with me either. Obviously the dinner was awkward for her.”

Internally I find myself yelling at Patrick, ‘Awkward? That’s an understatement! She must have been consumed by anger she had to swallow. How could you have allowed this to happen? To everyone.”

Wondering if I’m feeling not only my anger, but Patrick’s as well, I ask, “Who are you feeling angry at Patrick?”

“Angry? Well, I’m angry at my parents, particularly my father. He really let me have it. He guessed no nice white woman would want me since I was such a loser; had to go looking in the gutter for some black chick.”

“And you felt and said what?”

“I hung up on him.”

“And felt?”

“Angry. Disgusted. Vi is this incredibly accomplished, smart, beautiful woman. I’m honored that she’d want me. And all he can see is her black skin. Except I don’t know if she still wants me. She’s pretty angry with me too. She didn’t know I hadn’t told my parents she was African American. She kept saying we’re not children, we’re in our 30s, what gives them the right to think they can decide our lives.”

“And can they? Can they decide your lives?”

Patrick hesitates before saying, “No, not exactly.”

“What do you mean, not exactly?”

“Well, I couldn’t figure out the long distant part of Vi and my relationship anyway. I mean, it would hard for me to start all over again as a financial planner in New York and to say that there are no law schools down here equivalent to Columbia would be putting it mildly.”

“You’re confusing me Patrick. Are you thinking of breaking up with Vi? Were you thinking of breaking up before the dinner with your parents? Is your parent’s reaction influencing your decision about breaking up?”

“I don’t know. I love Vi, but I can’t figure out the logistics. I couldn’t figure out the logistics before the dinner and I can’t figure it out now.”

“Have you talked to Vi about your concerns? I know you hadn’t talked with me about it.”

“No.”

“Did you set Vi up, Patrick?” Realizing my anger is seeping through, I try to temper my question. “I mean, did a part of you think taking Vi to dinner with your parents would precipitate World War III, as you said, and might lead to her breaking up with you?”

“I hadn’t thought of that at the time, but now that you mention it … I mean, she’s such a perfect woman for me, I can’t see how I could break up with her. Except she lives in New York and I don’t see how that’s workable.”

Now I feel more sad for Patrick than angry. “You know, Patrick, it’s difficult for you to take charge of your life, to decide what you want for you and make it happen. You don’t talk with Vi about your concern about living in two different cities and whether that can be worked out. I suspect you haven’t even looked at the possibility of becoming a financial planner in New York. You don’t confront your father about your feelings about what he said to you.”

“I guess I always take the coward’s way out. I run.”

Now that I am no longer angry with Patrick, I realize that I had been reacting to him much as his father did. “I wonder, Patrick, if you’ve heard your father call you a loser your whole life and if you’ve come to identify yourself as a loser, despite your obvious success and accomplishments. You feel you can’t do it, whatever it is, and so you don’t, you opt out.”

“I think that’s true. But it’s a hard pattern to break.”

“Yes, it’s a hard pattern to break, but we’ll work on it.”

An Emotional Storm | by Linda Sherby, Ph.D., ABPP

Tue, 27 Jun 2017 18:31:20 GMT

A patient turns her pain and anger on herself.

“Bill broke up with me Saturday night,” says 28 year old Chelsea in her Monday session, looking as though she may not have slept or bathed since then.

“I’m so sorry…” I begin.

“You didn’t call me back. I called and called and called.”

“I’m sorry, Chelsea, but when I called on Sunday I explained I was at a very long play, didn’t check my phone and got home way too late to call. Did you get my message?”

“It was too late,” Chelsea says, rolling up the left hand sleeve of her blouse.

Always a bit queasy, I resist the urge to look away, her left arm filled with red gashes from what I assume are self-inflicted cuts from a razor blade. “Oh, Chelsea,” I say, “It’s been years since you felt the need to cut yourself. I guess you were mad at both Bill and me.”

“You abandoned me. I couldn’t stand the pain.”

“What made the pain so unbearable?”

“What?” she asks, becoming angry. “That’s a stupid question. The two most important people in my life abandon me and you ask what made the pain so unbearable?”

“You’re definitely angry with me.”

“Duh!”

“But why did you need to turn the anger on yourself, why cut yourself, why not be angry at me, at Bill?”

“What was I supposed to do, go to your house and kill your dog?”

“Was that a fantasy you had on Saturday night?” I ask, hoping I sound calmer than I feel internally.

“What if it was?”

“You know, Chelsea, it’s always all right to have whatever fantasy you have, as long as it stays a fantasy.”

“Hah! Scared you, didn’t I?”

“It’s a scary fantasy, but the pleasure you took in scaring me indicates just how angry you are at me. I guess what you’re saying is that you felt afraid you couldn’t contain your rage, so had to turn in on yourself.”

“I wanted to kill you! I wanted to kill Bill. I did start swinging at him, but he just pushed me away and told me that’s why he had to get away from me and literally ran out the door.”

“I am sorry, Chelsea. I know you loved Bill and really wanted this relationship to work out.”

“Why don’t they? Why don’t any of my relationships work out?” Chelsea says, starting to cry.

Although we have dealt with the responses to those questions many times over the years – because you’re demanding and needy, because one moment you love the person and the next you hate him, because you can’t tolerate even brief separations without feeling enraged or terrified or both - I also know this is not the time to revisit them.

“When I didn’t call you back on Saturday, what did you think? Why did you think I didn’t call? And what did you think when I called on Sunday?”

“I felt you were just like Bill. That you didn’t care about me, that you were sick of me just like him, that you wanted to be rid of me.”

“I understand that’s what you felt, Chelsea, but I was asking something a little different. I was asking what you thought. If you thought there might have been a reason I didn’t call you back that might have had nothing to do with you, like maybe I lost my phone or forgot it.”

“But you didn’t. You chose not to call me back.”

“So it would have felt better for you if I’d called after midnight?”

“It would have felt better, but it still would have been too late.”

Only Chelsea’s feelings exist for her at this moment. “You’re caught up in so many painful feelings, Chelsea - hurt, loss, rage, abandonment – that from this place it’s impossible for you to step outside your feelings and try to reflect on them. So maybe it would be better if we focused on helping you not to turn all those feelings on yourself and hurt yourself. Can we do that?”

“I kinda liked doing it, it was like going back to an old friend.”

“I’m sorry to hear that. So are you saying that you think you’re going to start cutting again?”

Chelsea smirks. “That made you angry, didn’t it?”

“You know, I wasn’t aware of feeling angry, but you’ve always been incredibly sensitive and now that you mention it, perhaps that’s true.”

“And that’s one thing I’ve always appreciated about you, your honesty and your willingness to own your own shit.”

“Thank you. So maybe from there we can work on repairing our relationship and move forward.”

“Maybe,” Chelsea says with considerable hesitation.

“I understand. Right now repair feels difficult.”

“Yes, it does.”

Seeking Protection and Connection | by Linda Sherby, Ph.D., ABPP

Tue, 27 Jun 2017 18:28:56 GMT

A therapist hopes she can help a very defended woman dare to connect and relate

I smile at my new patient, Eileen, as I greet her in the waiting room, extending my hand in introduction. She doesn’t return my smile, but does warily shake my hand. Settling herself stiffly in the chair across from me, she looks slowly around the room.

Oh oh, I think, seems like a pretty disturbed woman, at best distanced and removed, perhaps paranoid, maybe a trauma survivor.

“I like your office,” she says. “All the windows. Feels free, like floating in space.”

“Thank you,” I say, not sure how to take her comment. An attempt to relate to me? A fear of being confined? A desire for freedom? Hopefully not a wish to jump.

A few moments pass in silence.

“What brings you here?” I ask in traditional therapist mode.

“I have no friends.”

“Can you say more?” I ask, while thinking that her demeanor would certainly make having friends difficult.

“I’m 36 years old. I live alone. I work at home. I’m an IT person, a computer geek.” She shrugs. “There’s no one in my life.”

“Sounds sad.”

“I guess.”

“How do you feel about not having friends?”

“It doesn’t seem normal. People are supposed to have friends.”

“Eileen, what made you decide to come into therapy right now?”

“I found you online. You had a kind face. I liked your website.”

“Like maybe you hoped I’d be your friend?”

“Maybe.”

“Eileen, can you tell me a little about your background, your childhood, your family.”

“It was messed up. My parents divorced when I was two. They’re both alcoholics, drug addicts, both with so many different partners I lost count. And a ridiculous number of so-called siblings. I’d go from one household to the other. Sometimes there would be six, eight of us in a small apartment. I hated it. Felt like I couldn’t breathe. I just wanted everyone to leave me alone. And basically they did.”

“So you learned to put up a wall that said ‘stay away.’”

“Yeah, that’s a good way to put it,” she says nodding. I have the sense she’s pleased by my understanding, although there’s no obvious change in her demeanor.

“Have any idea what’s behind that wall?”

“What do you mean?”

“Well, when you construct a wall, there’s usually something behind it, something you’re wanting to protect, perhaps something that feels vulnerable or scared.”

“I don’t do vulnerable or scared.”

“So it feels pretty scary to be vulnerable or scared,” I say smiling compassionately. I find myself liking Eileen, feeling sad for the deprived, needy child who must exist behind what feels like an impenetrable barrier.

“I didn’t say that,” she says, stiffening.

“Sorry,” I say, backing off. This is going to be slow, slow going. I need to be careful not to push to glimpse behind that wall too quickly. Her defenses are there for many reasons. They need to be respected, not ripped away.

“You said earlier that there’s no one in your life. Do you see your parents?”

“Not if I can help it. Maybe once or twice a year. Christmas time, Easter. Maybe not.” She shrugs. Doesn’t much matter to me.”

“Was there anyone in your life who did matter to you when you were a child?”

“Like who?”

“A grandparent, a teacher.”

“A math teacher in middle school. She thought I was more than a dumb oaf. She encouraged me. Maybe she was like my friend, except she was my teacher so she couldn’t be my friend. But she’s the one who helped me make something of myself. I don’t know where I’d be if it weren’t for her. Probably just like my parents. Except without the drugs. I’ve never touched drugs in my life. Swore I never would and I haven’t.”

“That’s pretty amazing determination, Eileen, given where you came from and what you’ve been through.”

“Mrs. H – that’s the teacher – she’d say things like that.”

“And when she or I say things like that, you feel a sense of warmth, of being understood and appreciated.”

She looks down. “Yeah, I guess that’s right.” She pauses. “So are you going to help me learn how to make friends?”

“Yes, Eileen, I am. But we have a lot of work to do before finding friends becomes our focus. First we have to help you find you. We have to find the person behind your wall and that’s going to take time. You’ve been hiding from that person for a long time and a sledge hammer isn’t going to work here. And I suspect it’s going to be painful and scary for you. I’ll be here with you and hopefully that will make it easier, but I’m sure there are times it will be tough going.”

“I’ve been through tough before.”

“Yes, I’m sure you have.”

Demands | by Linda Sherby, Ph.D., ABPP

Tue, 27 Jun 2017 18:26:20 GMT

A patient, seeing the world in black and white, makes impossible "Demands," hoping to find the "perfect" person who will always put her first and repair the neglect and damage of her past.

Beverly rushes into my office and throws herself into the chair across from me. “You know,” she begins, “this is just too hard for me. All this running around. I have too many things on my schedule. I mean I know I don’t work – I have no idea how people who work ever manage to get here – but between golf and tennis and bridge and painting – it’s just too much. I need to come on a Saturday. That would work better for me.”

Although I am more than a little annoyed at both Beverly’s demand and at being relegated to the bottom of her list, I decide on an initial non-confrontational approach. “I’m sorry, but I don’t work on Saturdays.”

“You don’t work on Saturdays? How do the people who work get to see you? I suppose they just don’t, right?”

“You’ve been coming for almost a year, Beverly, and you never seemed to have difficulty getting here before. Why do suppose it’s suddenly become an issue for you?”

“I started taking painting lessons. I hadn’t been doing that before.”

“And since you knew you had such a busy schedule, why do you think you decided to add something that might make it harder for you to get here?”

“I didn’t think about it in terms of getting here. I just wanted to take painting lessons.”

“It feels to me, Beverly, that you’re wanting to dismiss the importance of our work together, that you’re saying it doesn’t matter.”

“That’s not fair. You’re the one who won’t see me on Saturday!”

“I think we need to take a step back here. Was there something that happened in our last session that made you feel uncared about? Were you angry with me?”

“You always do that. You always make it about you. It has nothing to do with you.”

“Okay. Then tell me what it does have to do with other than with your schedule.”

“My sister.”

“I remember we talked about your sister last week, about how I saw her as being competitive with you, but that you thought that wasn’t true, that she loved you and always wanted the best for you. And I said both could be true, that she could love you and want the best for you and still be competitive with you.”

“You took her away from me. No one in my family gave a damn about me except her. I was an extraneous being. But Joyce cared about me, looked out for me. And you just took her away.”

“So you are angry with me.”

“I guess. And at her. I’m furious at her. How could she take herself away from me when I relied on her so much? But I decided to show her. She’s the painter you see. I decided I’d become a better painter than her.”

“So I guess you’re saying you feel competitive with her.”

“No. I’m just getting back at her.”

“Beverly, I want to point out that nothing out there in the real world happened or changed between you and your sister. This is all happening in your mind. You came to see your sister differently. And although you’re entitled to have your feelings, it would be helpful to you if you could hold onto the love and stability your sister provided for you in your chaotic childhood.”

“You’re taking it all back!”

“No. We’ve talked a lot about your living in a black/white world, with no shades of gray. Right now you want your sister to be the perfect sister – whatever that might mean to you – and you want me to be the perfect therapist who would see you whenever you want to be seen. But there is no such thing as a perfect person. You can get a lot of good from one person, but you can’t get everything and that doesn’t make either that person or you bad. And you can feel competitive towards your sister or towards me and that doesn’t make you bad either.”

“It doesn’t make sense to me. If she’s competitive with me how could she always be on my side? Sometimes she’d be on her side.”

“Well I suppose that’s true. But if she wanted, just let’s say, to be a better painter than you, that doesn’t mean she wouldn’t want you to be a better golfer or to find a loving husband or to take great joy from your children. Because there was so much cruelty and rejection in your childhood, it’s difficult for you to believe that someone can be in your corner and still take care of themselves. That’s like me saying I’m here for you, but I don’t work on Saturdays.”

“That makes me mad all over again.”

“I believe you. We’ll keep working on it.”

Failure to Thrive |by Linda Sherby, Ph.D., ABPP

Tue, 27 Jun 2017 18:15:46 GMT

A patient and therapist struggle to help the former realize her potential despite fears of envy and retaliation.

“I’ve decided to write a book,” Karen announces at the beginning of her of session. Dressed in casual jeans, no make-up with her hair pulled back in a ponytail, Karen looks younger than her 48 years.

Although her declaration leads me to think, ‘Oh no, not another idea that goes nowhere,’ I take a more supportive approach. “In art history?” I ask, Karen’s area of specialty.

“I don’t know. I haven’t decided yet. I have to do something. I can’t go on just being Dr. Thomas Hartfield’s wife. It’s too boring. I don’t want to have to get all dressed up and hang out at the club playing bridge, gossiping with the women.”

“Weren’t you recently talking about wanting to open an art gallery?”

“Yes. I still think that’s a good idea, but I don’t know, there’d have to be so many people involved, people I’d have to manage. It seems overwhelming. Writing is something I can do on my own, at my own time, in my own space.

“Of course, I haven’t written anything since I was in college. I was pretty good back then. I think I considered majoring in English. But then again I thought about majoring in lots of things. I’m not even sure how I ended up with a major in art history. I guess because I hung around college for so long and had so many credits, they told me it was time for me to graduate and art history was it.”

“So it seems, Karen, we’re back to talking about how difficult it is for you to make a decision and to carry a plan through to fruition.”

She sighs. “You don’t think I’d write that book do you?”

“Well, I don’t have a crystal ball, but when you say that you don’t know what you want to write about, it seems you could get stuck right there. I’d be concerned you could think endlessly about what you did or didn’t want to write and never be able to move beyond that point.”

“How did you know what you wanted to write?” Karen asks me.

I don’t introduce my book into my therapy sessions, but many patients Google me and find it online. Now I wonder if there’s some relationship between my book and Karen’s sudden interest in writing. “Before I answer that question, Karen, can I ask you how you feel about my having written a book?”

“Envious. You were able to follow through and do it. But maybe also inspired, like if you can write a book maybe I can too.” She hesitates.

“What just happened there?”

“Nothing. I guess I got anxious. There are so many choices. I don’t know how anyone ever decides on one path over another. I don’t know how you pick. I don’t know how you pick one and give up the others. So how did you decide what to write about?”

I wonder about Karen’s anxiety. Does she worry I’d feel angry or vindictive if she wrote a book? Does making one choice over others bring up fear of loss? Keeping these questions in mind, I answer Karen. “I felt compelled to write about my relationship with my late husband. I think there’s often an emotional press in writing; you have something you have to say. It’s like being in therapy. It’s sharing a vital part of yourself that you want to be known.”

“Do you think I don’t want to be known?”

“That’s a very interesting question. What do you think?”

“Well declaring myself, taking path A rather than path B would be a way of being more known.”

I’m silent, intrigued by Karen’s train of thought.

“But why wouldn’t I want to be known?”

“I was just asking myself the same thing.”

Silence.

“Weird. The words, ‘You’re a moving target’ just went through my head.” Pause. “Who did I think would shoot me?”

I wonder if it’s me, but I remain silent.

“My oldest sister for sure. She was horribly jealous of me. I was the pretty one, although I made myself as unattractive as possible until she left for college. She’d cut up my clothes, steal all my panties. One time she even cut off part of my hair in the middle of the night.”

“That’s called abuse, Karen,” I say, surprised by this revelation I had not previously heard.

“You think?”

“Definitely. What did your parents do?”

“I don’t know. I don’t remember telling them. Maybe I did. Maybe they said we had to work it out. That part of my childhood is a bit fuzzy.” Pause. “Do you think this is relevant?”

“I definitely think this is relevant, Karen. We have to stop now, but we definitely need to spend more time understanding how your sister affected your life.”

The March | by Linda Sherby, Ph.D., ABPP

Tue, 27 Jun 2017 18:09:14 GMT

A young patient who finds herself at odds with her parent's political views and then assumes, via the transference, that her therapist aligns herself more with the parents than the patient herself.

“I finally went to dinner at my parent’s,” 19 year old Bethany says dejectedly. “It was pretty bad. They just won’t let up. ‘I can’t believe you lied to us, going to the Women’s March on Washington without even telling us. If we hadn’t called and talked to your roommate we would never have known. What if something had happened to you? We didn’t even know you were gone.’ Blah, blah, blah. As if that was the issue. I bet if I went to the Trump Inaugural they would have been thrilled – even if I hadn’t told them. It’s such bullshit. They did do a bit of, ‘How could you be our child and believe those people have a right to marry.’ Or, ‘Didn’t we teach you that every life is sacred, especially the unborn, those most vulnerable?’ I thought I’d puke. I couldn’t wait to get out of there.” Pause. “I suppose you’re thinking, ‘I told you you should have told them.’”

“I don’t remember telling you you should have told them,” I say, surprised.

“You asked me why I didn’t tell them, didn’t you?”

“Yes, but that was a question meant to help you look at why you do or don’t do whatever.”

“Well, the answer’s pretty obvious. If I tell them I get all this shit. Just like I did.”

“And what did you say when you got all this shit?”

“Nothing.”

“Nothing?”

“Yeah. What am I going to say? You can’t argue with them. I just sit there, trying to tune them out, hoping they’ll stop sooner than later.”

“And why do you feel you can’t argue with them?”

She raises her eyebrows and snorts. “I don’t mean to be nasty, but how long has it been since you were 19?”

I smile inwardly. Although it’s been quite a while since I was 19, I do clearly remember the arguments I had with my parents, most especially my father. Not about politics. There are values were pretty similar, but often about psychology and science. My father was angry, dogmatic and unrelenting. For years, I argued and argued with him about dreams, about the cause of mental illness, about the unconscious, until I finally gave up. Then I was like Bethany, sitting at the table saying nothing, hoping he’d stop sooner than later. On the other hand, I never, ever stopped battling my father’s vicious temper, trying to put a clear limit how he could treat me. I bring myself back to my patient. “I get that it can be difficult to argue with your parents when you’re 19, but I’d like to understand specifically why YOU can’t argue with your parents, even at 19.”

She sighs. “First, they have the money. If they get mad enough, there goes college, plus whatever else.”

“Would they do that? They sound pretty determined for you to get an education, pretty invested in it.”

“They are.” Pause. “Especially my Dad. But sometimes I think my Mom believes I’m being corrupted by college, too liberal you know. And, I don’t know. This may sound weird, but I’m not sure that my Mom really wants me to succeed, like maybe she’s jealous or something. Like she never went to college, so why should I.”

“So are you saying you’re afraid your mother might undermine you?”

“I never thought of it that way, but I guess so. If I gave her any ammunition. Like the Women’s March.”

She pauses.

“I need to ask you something. What did you think about the Women’s March?”

“I’ll answer that in a minute, Bethany, but first I want to ask you something. Why did you ask that question right at this moment?”

She shrugs. “I don’t know. I’ve been thinking about it and just felt I had to ask.”

“Well, I have a thought as to why you had to ask right then. You were talking about your mother feeling threatening, dangerous and I wonder if you suddenly felt I might be dangerous too and had to check that out.”

“Are you?” she says quietly.

“No, Bethany, I’m not dangerous.” I could tell Bethany I was at the Women’s March too, but decide that might too greatly diminish the tension around the issue of whether difference between two people, perhaps especially two women, is inherently dangerous. “I suspect that our politics might be pretty similar, but even if it wasn’t, I’d still be on your side, still wanting you to have your own voice and make your own way in the world.”

How Grown Up Am I? | by Linda Sherby, Ph.D., ABPP

Tue, 27 Jun 2017 18:04:07 GMT

A young patient, dealing with the aftereffects of an abortion, struggles with her ambivalence about growing up and transfers her feelings about her parents onto her therapist.

“My house feels like a morgue,” 20 year old Chelsea says looking down at her hands. “I guess that’s a poor choice of words, since it sort of is, but not exactly. I mean, I’m not happy I had to have an abortion, but I also don’t think it will be the greatest tragedy of my life. And truthfully, I don’t think it’s the abortion that my parents are so upset about. They don’t like the idea that their ‘little girl’ was having sex. It’s not like I’m 14. And Brad and I have been going together for two years. He was pretty upset too. I think he feels guilty that he didn’t use a condom 100% of the time.”

I have been seeing Chelsea for several years now, watching her struggle between wanting to remain the child who is forever taken care of by her parents and striving towards adulthood with her own dreams and desires. We have a close bond although, not surprisingly, her internal struggle is often replayed with me in the consulting room.

“What are you going to use for birth control in the future?” I ask.

“We’re not. We’re not going to have sex.”

I knit my brows, puzzled and skeptical. “You mean you’re not going to have sex until you give yourself some time after the abortion?”

“No. We’re not going to have sex. Or at least not intercourse. Maybe we’ll fool around a little, maybe not.”

“Why?” I ask.

“Why, what?”

“Why did you decide not to have sex? Do you feel more guilty about the abortion than you’re saying? Is it a way to punish yourself?”

“No! For heaven’s sake, I don’t know why you’re making such a big deal about it. You sound like my parents!”

“In what way?”

“In making such a big deal about sex.”

“Wait. I’m getting confused. I thought your parents were making a big deal about your having sex. I’m questioning your saying that you’re not going to have sex.”

“You mean you don’t believe me? You don’t think I can give up sex?” Chelsea says angrily.

“I’m trying to understand why you’d want to give up sex.”

“Because I don’t want to risk getting pregnant again. That seems pretty simple.”

“I hear you’re angry with me but I’m not clear why.”

“Everyone thinks I’m doing something wrong and you’re just like everyone else,” Chelsea says, her voice cracking. “If I say I’m not going to have sex, I’m not going to have sex! End of discussion.”

“And how does Brad feel about that?”

Chelsea crosses her arms in front of her chest and glares at me. “Why should I care how Brad feels?”

Aware I’m feeling more and more confused, I suspect my feelings mirror Chelsea’s own confusion. “Chelsea, tell me what’s going on. What’s going on inside of you? What has you so distressed?”

“Brad wanted me to have the baby. He said we should get married, that we were old enough, that we could both work and go to school and take care of the baby.” She pauses. Tears fall silently from her eyes. “I couldn’t. I couldn’t do it. I’m not ready. I don’t want to be responsible for another person. I don’t want to leave my parent’s house and go off on my own. It’s way too scary. Brad’s really mad at me. I’m not even sure we’ll stay together.”

“I’m sorry, Chelsea. It’s like your parents are mad at you for being too adult and Brad’s mad at you for not being adult enough and each side represents your own conflict about how grown up you feel or want to be.”

“Yeah, that’s right. That’s exactly right.”

“And does my asking you about birth control feel like I’m pushing you towards the adult side?”

“I guess. I hadn’t thought of it that way, but I suppose it does.” She pauses. “So what about my deciding not to have sex? Is that my going towards the child side?”

“What do you think?” I ask, aware that my not answering her question could also be construed as my pushing her to be more adult.

“Yeah, I suppose it is,” she sighs. “But is that so bad? Can’t I take a little break here?”

“You can, but none of us can stop time. We keep growing older whether we like it or not, but that doesn’t mean you can’t have conflicting feelings about growing up and it also doesn’t mean you have to push yourself to act or be more grown up than you feel.”

“Thanks. You gave me a lot to think about.”

Divorce? | by Linda Sherby, Ph.D., ABPP

Tue, 28 Mar 2017 00:07:59 GMT

“I’m considering getting a divorce,” 52 year old Evelyn says, starting the session.

Although her marriage has been rocky for some time, this pronouncement surprises me given that her husband recently had a heart attack and by-pass surgery. She seemed genuinely concerned about him and committed to helping him through the rehabilitation process. I remain silent.

“I was listening to this program on NPR, On Point, and there was this doctor on who wrote a book about solving medical mysteries. I don’t remember his name, but it was interesting.”

I heard a small part of that program too, but I wait to hear what led Evelyn from that program to her considering divorce.

“There was a man who had a heart attack who’d had a bad heart so his heart attack was no surprise, kind of like Jack. But then the doctor went on to say that like the very next day or something like that, his wife had a heart attack too. And she had been perfectly healthy. And the doctor said it was the stress, almost like being too close to her husband and having to have a heart attack just like him. Well, I don’t want that to be me. I know this might sound awful, but Jack’s not worth my health. He hasn’t been a good enough husband for me to lay down my life for him.”

Feeling unsure what to say, I continue to remain silent.

“Do you think I’m awful?” Evelyn asks.

“No, of course not, but I am a little confused. I heard a small part of that program too…”

“Do you remember the doctor’s name? I thought I could get his book.”

“No, I didn’t hear much of the program, but what I remember is that he was talking about a couple that was extremely loving and close and that it was that closeness that led to the wife’s distress and her perhaps unconscious need – those are my words, not his – to identify with her husband and go through the same experience he had.”

“Well I guess if that was true, I wouldn’t have to worry about that.”

“Evelyn, am I mistaken or do you feel particularly angry today?”

She shrugs. “I guess.”

“Can you say what’s going on?”

“I’ve been busting my butt taking care of Jack and do you think I even get so much as a thank you?!” All he does is bitch and complain – I’m in so much pain, I’m scared, what if this happens again, why does my right arm still hurt. Complain, complain, complain. I’m sick of it.”

Jack has definitely been a less than ideal husband - inattentive, otherwise preoccupied and, most likely, unfaithful. Still, Evelyn has stayed with him, continually hoping that she could make him different, just as she longed to do with her absent and eventually abandoning father. Still, right after a major scare and trauma seems an unusual time to be considering divorce. Then a thought comes to me.

“Evelyn, do you think this time you especially thought it would be different? Jack was scared and vulnerable. Maybe he’d need you in a different way? Maybe he’d let you in as he hadn’t before?”

Evelyn hangs her head. “Stupid of me, wasn’t it,” she says, her anger now turned on herself.

“No, definitely not stupid. It was you hoping again, hoping you – or something – could make Jack different, just as you hoped with your father.”

“But it is stupid! How many times do I have to go through the same thing to know it’s not going to work? It’s like continually hitting my head against the same brick wall.”

“It’s hard to give up hope. It’s hard to mourn what never was and never will be.”

“I can’t stand when you talk about mourning. Who wants to mourn, who wants to be sad all the time?”

“So you’d rather be angry.”

“Damn straight.”

“Well, it’s reasonable to be angry, but if you’re only angry you can’t ever finish the process of letting go.”

Evelyn’s eyes pierce me with fury.

“And,” I continue, “to end up being angry at everyone – yourself, me, your children, your friends - that doesn’t lead to a very fulfilling life.”

“So should I stay with Jack?”

“That’s a decision only you can make, Evelyn. But I do know regardless of what decision you make, you will have to mourn the impossible.”

The Risk | by Linda Sherby, Ph.D., ABPP

Fri, 20 Jan 2017 18:06:12 GMT

“It’s been a while,” says Delores. “I appreciate your seeing me so quickly.”

“My pleasure,” I respond, truthfully. I always liked Delores, a spunky, vibrant woman who was in her late 60s when I last saw her.

“This time it’s actually not an emergency. Not like last time. I was such a mess. Losing Marvin so unexpectedly was devastating. I just wasn’t prepared. And having him be the third husband I lost, well, that was all way too much.” She sighs. “But I guess that is part of why I’m here. I’m trying to figure out if I dare do it again. After Marvin I said never again, no more men. And now, now I just don’t know.”

I certainly remember Delores’ trauma at losing Marvin. I myself was a relatively recent widow, Delores’ pain clearly reverberating with my own. And the fact that she had lived through two other such losses felt truly overwhelming. I can certainly understand her reluctance to take the risk again.

“Is there a specific man?” I ask.

“Oh yes, Harry. A friend of mine kept asking me to go out with him. She said he was a widower, a friend of the man she dates, a good bridge player and an all-around nice guy. I said ‘no’ for quite a while. Then one day I felt lonely and they were going to a movie I wanted to see, so I said, why not, it’s just one date. That was three months ago. And now, well, it’s going to go one way or the other. I either have to stop seeing him or take the plunge.”

I certainly understand Delores’ conflict. Harry perhaps offers a more fulfilling, richer life, but certainly raises the specter of another devastating loss. I’ve lived my life believing that it’s “better to have loved and lost, than never to have loved at all,” but perhaps there’s a limit to the number of excruciating losses any person can sustain. Fortunately I don’t have to make Delores’ decision for her.

“So, what are your thoughts?” I ask.

“Well, I’ve thought of all the obvious things – he’s older than me, although only by a couple of years; he has prostate cancer but they’ve been watching it for years and it’s never gotten worse; he’s also had a lot of skin cancer, but that seems under control as well; no heart disease, but Marvin supposedly didn’t have heart disease either, until he keeled over dead. I go round and around in my head about all that. But what’s really odd, is that I keep thinking about my father, dreaming about him too.”

I remain silent, giving Delores time to reflect.

“My father’s been dead for almost 50 years. It was very traumatic for me when he died. I felt like an orphan, even though I was in my 20s. My mother had been dead since I was 10, so it had been just me and my Dad for a while.” Pause. “But I don’t know why I’m particularly thinking of my Dad now. He didn’t come up for me when Marvin died, or any of my other husbands either if I remember correctly. No, that’s not true. John, my first, died not that long after my Dad. I wasn’t 30 yet and I remember then thinking of my Dad a lot. There were so many losses. I could cry just thinking about it.”

“I’m sure that’s true.”

“So do I want another one? I mean, I know no one ever knows, that I could drop dead tomorrow, especially since I don’t exactly have longevity in my family, but I guess my experience is always that the men go first.”

“Except not for your mother. She died first.”

“That’s true,” Delores says pensively. “I wonder what that meant for me. This is a crazy thought, but I wonder if I expected my Dad to live forever. I mean I knew he couldn’t, but still …”

“Was that a wish, Delores? As in you wanted your Dad to live forever because you couldn’t face another loss.”

“I’ve certainly faced lots of them.” She chuckles. “I wonder if I keep looking for the one who’ll live forever. Just kidding.”

“Maybe you’re not kidding. Maybe you keep looking for the man who won’t abandon you, who will live to be there for you, unlike either of your parents.”

“That’s deep. My unconscious would have to be real smart to think that one up.”

“Perhaps it’s that the child part of you is still yearning for the safety and security that was so absent in your childhood.”

“Perhaps. But I don’t know if that helps me figure out what to do about Harry. I’ll have to think about it during the week and see what my unconscious comes up with.”

“Sounds good.”

You're Back | by Linda Sherby, Ph.D., ABPP

Tue, 10 Jan 2017 18:00:39 GMT

“I’m really glad you’re back,” Christine says, her eyes filling with tears. “I know you were only gone a week, but it’s been a hard week. I thought I was more prepared, more ready to deal with my parents this time, but I don’t know, I guess it was the holidays. It was awful. I felt sorry for my girls. They were so looking forward to Nana and Poppy coming for Christmas and it was such a disaster. My parents never stopped fighting, my mother never stopped telling me what I was doing wrong, most particularly as a mother and, of course, as someone who couldn’t keep my husband from straying and my father just got more and more depressed.”

“I’m sorry, Christine. It does sound awful and so disappointing.”

“Yes, that’s exactly right, terribly disappointing. I guess I thought since we’d been working so much on my parents these days, I’d be able to handle them differently or be less affected by them or something.”

“So it sounds as though you’re saying that you’re disappointed in me too, in our work together.”

“No. I don’t think so. I was disappointed that you weren’t here to bounce things off of, to maybe give me some ideas of how to handle things differently.”

Although Christine’s denial doesn’t convince me, I let it go for the moment. “For example,” I say. “Can you give me an idea of what you thought you could have handled differently?”

“There are so many things. How I could have gotten them to stop fighting. How I could have stopped my mother from being so critical of me. How I could have stopped her from being critical of my girls.”

“All right, let’s look at those three things which don’t all strike me as the same. Could you have gotten them to stop fighting? If I’m not mistaken you’ve been trying unsuccessfully your whole life to get them to stop fighting.”

Christine looks startled. “Oh, right. One of the things I need to give up on. I forgot. I can’t keep hoping for what will never be. I need to accept my powerlessness. I knew you should have been here. But why did I forget? I feel ashamed of myself. Why couldn’t I hold onto that?”

“Seems like you said a lot there, Christine. First, I think you are angry with me for not being here. Then I think you got uncomfortable with your anger and felt ashamed instead. And, I agree we should look at why it’s easier for you to hold onto your feelings of hopelessness and powerlessness when I’m here.”

“I do feel ashamed of myself. We’ve talked and talked about my needing to give up hope with my parents and I just can’t seem to do it.”

“Well, it’s very painful. It means you can never have the parents you want or wanted either now or in the past. It involves mourning for what never was and never can be.”

“I know. I guess that’s why it’s harder to do when you’re not here. If you’re not here and I don’t have my parents – and I sure don’t have my ex any more – I feel all alone. Except for the girls of course, but that’s different.”

“That’s a great insight, Christine.”

“Thanks. But what about the other two things I mentioned, why did you feel they were different?”

“The second one might not be all that different, getting your mother not to be critical of you, but I guess I wondered what it is that you felt when your mother’s so critical.”

“I do feel angry, but I try to pretend it doesn’t bother me and just ignore her.”

“Because?”

“Confronting her only makes it worse.”

“And when she attacks your girls?”

“I guess I do about the same thing.”

I am annoyed by Christine’s passivity. I feel she is leaving her daughters unprotected, just as I felt unprotected by my mother in relation to my explosive father. I tread lightly. “I wonder what message you give your girls when you don’t stick up for them.”

“But I thought I’m supposed to give up hope of ever changing her,” she says plaintively.

“This could just be me, Christine, but I think there’s a difference between accepting there’s no way you’re ever going to change your mother and still giving your girls the message that it’s not okay with you for her to attack them, or you for that matter.”

“That’s confusing.”

“It’s like saying, you know you’re not going to change her behavior but you’re still going to let her – and your girls – know her behavior isn’t acceptable.”

“It scares me.”

“What scares you?”

“I guess her anger.”

“I get that. And perhaps your anger as well.”

“I don’t like all this talk about my anger.”

“I believe you.”

If You Loved Me | by Linda Sherby Ph.D., ABPP

Sat, 29 Oct 2016 18:36:41 GMT

“I got a great idea after our last session,” 30 year old Melinda says enthusiastically.

I remain silent.

“You know how we’re always arguing about whether or not you care about me? Well, I figured out how you can prove it to me.”

Oh my, I think to myself. Whatever’s coming can’t be good.

“You can stop charging me for some period of time we agree on. That way I’d believe you cared about me and weren’t just in it for the money.”

I feel as though I’m going to be walking through a field full of land mines. Other than agreeing to Melinda’s request which I know I’m not going to do, whatever I say has the very likely potential of a large explosion. I’m also aware of feeling angry and put upon. Hmm, I think to myself, I bet at some level Melinda could have anticipated that would be my reaction.

“When you came up with this idea, Melinda, how did you think I’d respond?”

“I don’t know. How should I know how you’d respond?”

“Well, we’ve worked together for about three years, you might have some thoughts about what I would or would not say or would or would not do.”

“You’re not going to do it, are you? You’re just stalling, playing games,” she says, her anger building.

“Is that what you would have expected?” I ask.

Melinda crosses her arms over her chest and glares at me. “I’m not saying another work until you answer me directly.”

I sigh inwardly. Melinda and I have frequently found ourselves in these kinds of power struggles. I can refuse to say anything, at which point she will indeed not say another word until she storms out at the end of the session. Or I can submit to her demand that I answer her, which feels to me like an uncomfortable submission. Or perhaps, just perhaps, I can try and interpret what’s happening between us. Melinda’s mother died when she was nine, leaving her to be raised by her distant, authoritarian father, who she rebelled against while desperately wanting his love and approval. In her interaction with me, Melinda can take the role of her authoritarian father who tries to force me to be as she wants me to be. Or she can be the needy, demanding child who wants both to win her father’s love, while insuring that her mother will not abandon her.

“So I’m going to run a few assumptions by you and you can tell me what you think. First, I think you knew – if only unconsciously – that I would not agree to your request, that it would stretch the boundary of our relationship in a way that would not be acceptable to me. Second, the reason you find it so difficult to believe – and accept, I might add – my caring is that you felt abandoned by your mother and rejected and criticized by your father. It’s also easy for you to become your father in this room with me and just as you refused to bow to your father’s demands, at some level you know that I will not bow to your demands either.”

“It wasn’t a demand, it was a compromise, a negotiation.”

“I’m not sure about that Melinda. I think you came prepared to fight with me. And that’s probably the most interesting question. Why is it that you want to fight with me?”

“I don’t want to fight with you. I fight with you because you won’t give me what I want.”

“Which was exactly your relationship with your father.”

“I guess,” Melinda says reluctantly.

“But I think that as much as you say you want my caring, you often do things that prevents your getting exactly what you say you want, which leads me to wonder if you need to reject my caring.”

“That doesn’t make sense. Why would I do that? I think you’re just playing therapist tricks, trying to get away from your not caring about me.”

I choose to ignore Melinda’s last provocation. “Melinda, if you accepted my caring you would be saying that you were a person who deserved caring about. And if you allow that in, then you’re left with the realization that you are indeed loveable and that no matter what you did – or do – you couldn’t keep your mother from dying and you can’t keep your father from being a cold, critical person. And that leaves you feeling powerless and helpless and we know how awful those feelings are for you.”

“Is there any way you’d consider my suggestion?”

So much for interpretations, I think to myself. What I say is, “Now I know you know the answer to that question, so I guess you’re saying you’re mad at me.”

“Yeah. I think you should have to do something to prove your caring.”

“I guess we’ll continue talking about this next time.”

Hooked | by Linda B. Sherby, Ph.D, ABPP

Tue, 04 Oct 2016 18:25:00 GMT

“I never thought I’d be seeing a therapist. And certainly not for this! After all, it isn’t a problem. It’s what everyone does. Everyone my age, anyway. But here I am,” Samantha says, looking at me expectantly, brushing her straight blonde hair away from her face.

She’s been speaking at me rapidly for several minutes although I still have no idea to what she’s referring. I look back at her and wait.

She sighs deeply. “This is harder than I thought. I guess it kind of feels like talking to my Nana. Don’t get me wrong, I love my Nana but …”

I smile inwardly. “But you wouldn’t want your Nana to know about whatever this is. ‘

“Exactly,” she says brightly.

“Well, I’m not your Nana, but it would be helpful if I knew what’s troubling you or, if it’s easier, you can tell me a little about yourself.”

“I’m 20, a sophomore in college, actually born in Florida, from Daytona. I have two younger brothers. My parents are divorced. My Mom’s a nurse, my Dad owns a car dealership. I told them I wanted to go into therapy because school has me stressed. Which is kind of true.” Pause. “That’s about it. So I guess I better tell you.” She takes a deep breath. “I assume you know about hooking up, where you just go on your phone and make a date to meet for sex, no strings attached?”

“Certainly,” I say nodding.

“Well, I do it quite a bit. Started in high school, much more in college. Like I said, no big deal, just lots of fun. Sometimes great sex, sometimes just so-so, but it’s a fantastic way to get lots of experience without having to worry about it getting messy.”

I now feel like Samantha’s Nana. It’s hard for me to imagine the pleasure involved in totally anonymous sex. But I hope to keep my judgment to myself. “So what about hooking up is becoming a problem for you?”

“I can’t not do it.”

“What do you mean?”

“Well, used to be I’d only do it on the weekend, sometimes with four or more guys, but still only Saturday and Sunday. Then it was also Friday night. And then maybe a couple of other nights during the week. But now I can’t not do it! I can’t sleep if I haven’t hooked up with at least one guy, sometimes more. Sometimes I try. I pace the floor, I drink some wine, I take a Xanax. Nothing works. Sometimes I end up hooking up at 3, 4 in the morning. I’m driven. And I know, it’s like being an addict and no kind of addict is good. My Dad’s an alcoholic and my Mom used to be addicted to pills. She’s clean now. But I know. It’s not good. Right?”

“No, Samantha, it’s not good.” Corroborating Samantha’s assessment doesn’t feel judgmental, but rather supportive of the stronger, less impulsive part of her. “But tell me what hooking up does for you? What about it makes you feel relaxed when nothing else works?”

“Like you said, it relaxes me. I guess part of it is just the physical release. Although I know that can’t be all of it, because it doesn’t work if I … uh … if I do it myself.” Pause. “I guess it fills me up, makes me feel less alone. And I like being wanted. Like the guy can’t have enough of me. Or the guys. They just all want me. It’s a high. Just talking about it makes me want to run out and do it.”

“And if you don’t. If you sit with your feelings right now?”

“I guess I feel blah. Yeah, blah. I feel ordinary, like a nobody, kind of lonely, like no one wants me. Yuk! I don’t like it. I don’t want to feel like that.”

“Can I ask you, Samantha, are the feelings you just described familiar? Did you feel them when you were a child?”

“For sure! First there were the two younger kids, boys at that. Then there was the booze and the pills and the screaming and the divorce and more screaming. I thought they might fight about who had to take us, but I guess that was the one non-issue. My Mom got us, no questions asked. Except they kept screaming because my Mom wanted more money, my Dad said no way. I don’t have much of a relationship with my Dad. He has lots of women. We kind of get in his way.”

There are so many interpretations to be made here, all related to Samantha’s feeling unimportant and insignificant, whether in relation to her brothers, her father, her father’s women or her parent’s involvement with their own lives and addictions. But there’s no rush. If she can tolerate her feelings, I suspect Samantha will be in treatment for some time.

The Opponent | by Linda B. Sherby, Ph.D, ABPP

Tue, 04 Oct 2016 18:21:59 GMT

I open my waiting room door to meet James Harrison for the first time. He rises, hand outstretched to shake mine. I’d guess he’s in his mid-forties. A good-looking man, tall, thin, seemingly comfortable in his own skin. We make the brief walk to my office and I gesture him to the sage chair across from mine.

“So,” he says, “Why should I be here?”

I inadvertently jerk my head back while, at the same time, stifling the urge to laugh. He’s certainly wasted no time throwing down the gauntlet. Still, it’s so startling, that I find it almost funny. Perhaps that’s a defensive reaction on my part.

I think about commenting on his provocativeness, but decide that would only escalate what is already a fencing match between us. “Well, since I’ve never laid eyes on you before,” I respond, “I have no idea why you should be here. Perhaps it would be helpful if you told me.” Too hostile, I tell myself. It’s hard not to meet aggression with aggression.

“At least you didn’t go into that bullshit about everyone can benefit from therapy, it’s always good to understand yourself better, etc., etc.”

Do I need this? I think to myself. We haven’t even said hello and we’re already adversaries. Actually that’s not a bad interpretation. “Mr. Harrison, I wonder why we’re already adversaries. As far as I know you voluntarily came into my office. I’m not forcing you to be here. There must be some reason you’re seeking the help of a therapist.”

“Ah ha. So you’re the try the gentle approach type of therapist.”

I am definitely getting pissed. Which must be what he wants. “I suspect it’s important for you to keep relationships on an adversarial basis. Perhaps that’s why you’re seeking therapy. Perhaps you have difficulty getting along with people.”

“Perhaps,” he says grudgingly.

Silence.

“OK. So now what?” he challenges.

I really do not need this. I want to tell this man that I don’t think we should work together, that I’m not the best person for him. Maybe that too would be a good interpretation. Or would it just be acting-out on my part?

“Why don’t you tell me a little about yourself?”

“Why would I want to do that if we’re not going to work together?”

“Have you decided that we’re not going to work together?” I ask.

“Have you?” is the rejoinder.

“I don’t know,” I answer truthfully. “I do know that I’m not willing to spend every session fighting with you when I have no understanding of why you need to fight. And I’m also not prepared to convince you that you should be in therapy with me.”

“But you do think I should be in therapy?”

“Yes,” I reply definitively.

“Why?”

“Because you are clearly someone who needs to fight which means that you either have a lot of anger or need to keep people at a very far distance or both.”

“You see. You were able to tell me why I needed to be here.”

“And I suspect that you could have told me that yourself far more quickly.”

“But then I wouldn’t have known if you’re smart enough to handle me.”

“So I suppose I should assume that you’re going to be continually testing me?”

“Perhaps.”

“Mr. Harrison…”

“James.”

“James, I do know that how you are in the world, is how you are in here with me, but I want to again say that I think it is very unhelpful for us to be continually sparring and that one of my goals for you, is going to be to find the James Harrison behind your defensive posturing.”

“You don’t like me much, do you?”

“I would say that you insure that no one likes you much. But I would very much like to learn to like you. And I hope you’ll allow that to happen.”

“Touche!”

I groan internally and wonder why I didn’t refuse to take him on as a patient. “Can you tell me what you’re feeling, James?”

“Satisfied. I think you’re the right person for me.”

“Can you say how you felt when I said I thought you insured that no one liked you, but that I’d like to learn to like you?”

“I told you, satisfied.”

“Did you feel anything else? Hurt? Relieved? Angry?”

“No. Just satisfied. I accomplished what I wanted to accomplish.”

“So you feel satisfied with yourself. Do you have any feelings about me?”

A slow smile spreads across his face. “I’ll tell you what came to mind. That’s what I’m supposed to do, right?”

I nod.

“I feel you’re a worthy opponent.”

Perhaps, I think to myself, this treatment will be about whether a worthy opponent can become a stalwart ally. If so, it’s going to be a slow slog through.

Disaster | by Linda B. Sherby, Ph.D, ABPP

Tue, 04 Oct 2016 18:12:13 GMT

“I had a dream about all these disasters last night,” Jenny says. “It was frightening. There was one disaster after another. I mean I know there have been lots of disasters – floods, hurricanes, earthquakes, tornados – but it was strange for me to be dreaming of them. I don’t know if I was in the disaster or watching the disaster or helping at the disaster. It was weird.”

Jenny‘s a young medical student. I wonder if, at a surface level, she’s anxious about how she will handle her responsibilities as a physician. I remain silent, waiting to see where Jenny’s thoughts will take her.

“My mother called last night. She was complaining about my step-father for a change, about this step-father, just like she complained about all the others. I don’t know why she keeps marrying them, always sure this one will be her most perfect love. I think I’ve even lost count of what number she’s up to. Ugh. I don’t think I ever want to get married. Or not until I’m really, really sure. I guess I see her as a disaster. That’s sad to say about your own mother. I joke with my friends that she’s my negative role model. I want to be everything she’s not and not be anything she is. Sad.”

“Did you feel that way as a child?” I ask.

“Maybe not as a small child, but before I became a teen-ager for sure. Our house was a revolving door. At least she was smart enough not to have any more kids, except that there were always the so-called Dad’s kids who revolved through and then disappeared forever.”

“Was that hard? Forming an attachment to these father figures or siblings and then having them disappear?”

She shrugs. “I don’t know. Maybe. Or maybe I just learned to do my own thing, be involved with my schoolwork, with my friends. I liked being alone.”

Despite the matter-of-factness in Jenny’s tone, I find myself becoming sad. I wonder about her desire for aloneness as a defense against loss. And I think again about her dream, since disaster almost always involves loss.

“When did you last see your own Dad?”

“Who knows. He vanished a long time ago. Every so often he’ll make an appearance, but I certainly wouldn’t want to count on him.”

“I wonder if it’s possible for you not to feel sad about all these losses, Jenny?”

“I’m too busy.”

To avoid sadness, I think to myself. I ask, “What were the disaster survivors doing in your dream?”

“I was going to say they were doing what disaster survivors always do, dig through their houses looking for stuff, try to find things that are important to them. But I don’t think so. I don’t remember seeing people. It was like one of those apocalyptic novels. Maybe there were a few people, I don’t remember, but basically it was empty, barren.”

“Sounds really sad.”

Silence.

“I just had a weird thought. I wonder if it wasn’t me in all those disasters, but you. Like I was the observer, but you were the one who was there. I wonder what that would mean,” she muses. “I could get it if you’re the one who’s trying to help in the disaster. But would that mean I’m the disaster? I don’t feel like a disaster. So am I trying to reduce you, to make you like me, so I don’t feel like so much of a disaster?” Pause. “I guess that’s possible.”

“Are you saying, Jenny, that it feels like a disaster to need people, to need help, to not want to be all alone in the world?”

“It is a disaster to need people. No one is ever there. You can’t count on anyone. Not your mother, not your father …” Her voice trails off.

“Were you going to say, ‘not your therapist’?”

“Yes,” Jenny says looking down. “I mean I know you’ve been there for me, but you’re only my therapist. Eventually this relationship will end. And then what? Then I’ll be alone. Again. Just like always.”

“It’s hard for you to imagine that even when we do end – which we certainly don’t have to do until you’re ready – that you will take me with you, as part of you, just as a part of you will remain with me.”

“I don’t know if I believe that,” she says. A moment letter, Jenny is crying. “And I’m not sure I even want to believe it,” she says between sobs. “What would that mean, that I would stay with you when my parents could discard me so easily?”

“It would mean that you are loveable and that it was your parent’s great loss that they weren’t able to cherish you as you needed and deserved to be cherished.”

Always Worried | by Linda Sherby, PhD, ABPP

Wed, 31 Aug 2016 20:12:06 GMT

“I really appreciate your seeing me again,” Estelle Peterson says wringing her hands. I had previously seen Mrs. Peterson for a number of years. Although we made some progress in curbing her anxiety, she remained a constant worrier.

“My daughter’s pregnant,” she says.

“Congratulations. I remember you were afraid you’d never have a grandchild.”

“Yes, yes, that’s true,” she says dismissively. “But she lives in Florida.”

“And that means?”

“Zika!”

“Oh, you’re worried about her getting the Zika virus.” Concern about Zika is certainly understandable, but I suspect it will only fuel Mrs. Peterson already considerable anxiety.

“And having a deformed child! I can’t imagine anything worse. I told her she has to leave Florida. Right now. Right away. She doesn’t have to worry about me, but she has to take care of her baby! I told her to go stay with her sister in Connecticut.”

“And she said?”

“That it wouldn’t be a practical. That she and Jonathon have jobs. That they just couldn’t pick up leave.”

“I told she could just quit her job and Jonathon can stay here, that she’d be all right with her sister. Then she got mad at me and told me to stop it. I told her I couldn’t stop it, that I couldn’t bear to spend the next six months worrying about her baby. They hadn’t even told me right away, so I’ll probably worry anyway, worry if one of those mosquitos got her early on. But she won’t listen to me. I don’t know what I’m going to do. How am I going to get through her pregnancy?”

“How’s your daughter feeling about being pregnant?”

“What? Oh, she’s pretty good. She said that some of her morning sickness was pretty bad, but I told her not to worry about that, that was to be expected. I remember when I was pregnant with her and her sister. I thought I would die. But I didn’t. And she won’t die either. But I might die of a heart attack if I have to worry about the baby for six months.”

I remember now. It wasn’t only Estelle’s constant worrying that was so difficult, but also her need to make everything about herself. Everyone’s pain becomes her pain. She sees herself as being constantly worried about others, but really she’s concerned about dealing with her own anxiety and discomfort.

“So how can we help you to survive the next six months?”

“No, you have to help me convince Diana. Tell me what I can say to her to make her leave?”

“Even if I could do that, which I can’t, it seems to me we both need to respect your daughter as an adult, to respect her decisions and to try to be as supportive of her as you can.”

“How can I respect her decision when it’s endangering her child, when it will leave me, her mother, a nervous wreck until the baby is born?”

“Do you generally respect your daughter’s decisions? Did you respect her decision to marry her husband, to become a teacher, to move to Florida?”

“I definitely wanted her to move to Florida. I wanted to keep an eye on her. Becoming a teacher was okay, although I wondered if she couldn’t do better. I guess that was true of Jonathon too, but he worked out pretty good.”

Knowing that I am most likely talking to myself, I continue on, “Mrs. Peterson, respecting your daughter’s decisions means recognizing that she’s an adult apart from you who has a right to make a decision even if it is different from the one you’d make.”

“Even if it endangers her child? No, I can’t respect her decision.”

And I don’t respect Mrs. Peterson’s way of being in the world, making it difficult for me to espouse respect when I don’t feel it myself. Perhaps I can try to accept Mrs. Peterson for who she is, and thereby move us both towards a more tolerant view of others.

“Mrs. Peterson. I suspect that you’re not going to change your daughter’s mind about not leaving Florida. Perhaps I can help you to accept that fact and perhaps we can work on managing your anxiety.”

“You’re not being helpful.”

“Sorry. I can only do what I can do.”

“You used to say that to me all the time, that I had to accept my limitations, that I couldn’t control everything, that I could only do what I could do.”

“Yes, that’s true.”

“But maybe this time I can do more.”

“I guess we’ll continue this discussion next week.”

Defeated | by Linda Sherby, PhD, ABPP

Wed, 31 Aug 2016 19:47:00 GMT

“What brings you here?” I ask Peter, a handsome young man I am seeing for the first time.

“My father.”

I wait for further elaboration. He offers none.

“Can you say more?” I ask.

“Nothing more to say. I’m here because of my father.”

“So I gather you don’t want to be here.”

“You got that right.”

“And you don’t feel you need to be in therapy.”

“Right again.”

“And you’re angry that your father insisted you come.”

“You’re batting a thousand.”

Ignoring his sarcasm, I ask, “So why did you feel you had to do what your father wanted?”

He snickers. “You don’t know my father.”

“That’s true. Why don’t you tell me about him?”

He snickers again. “Sneaky. You’re going to get me to talk. Okay, might as well. My father’s paying for it. My father pays for everything. He’s rich. Developed his own company. Made a fortune. And never lets anyone forget it. He’s smart, a good businessman. My brother works with him. Me, I can’t imagine sitting in an office all day. Just like I can’t sit in class all day. I’m 24 and still bouncing from one college to another. I guess that’s why my father wants me in therapy. He wants you to motivate me.”

“Are you angry with your father?”

“Yeah, I guess you could say that. He’s always on my case. Always wants something more from me. Always bugging me to make something of my life.”

“And what do you want for your life, Peter?” He shrugs. “Don’t know. Don’t know why I have to want anything. I like hanging out with my friends, surfing, hang gliding, sitting around getting high. Why should I have to work? Daddy will leave me more than enough money.”

I find myself empathizing more with my patient’s father than with Peter himself, making me uncertain how to respond, concerned that I will sound critical, like his father. I decide further exploration is preferable to any comment about the patient’s current life. “Did you always feel this way, Peter? What about in grade school or even before?”

Peter sits silently, but exudes less defiance. “My Dad was my hero,” he finally says. “He played baseball with us, took us to games. And even when he stared making money, and wasn’t around as much, I knew that he was doing it for us. And then he started making more money. And there were stories about him, interviews with him, he was making a big name for himself. And there was me. My brother was a straight A student. I couldn’t measure up. I never liked to read. I was lousy in math. There was nothing I was good at. Except baseball. And I wasn’t good enough at that. My father climbed up and up and I went nowhere but down. So I gave up. Why bother.”

“Sounds pretty sad.”

“I guess,” he says, shrugging, his defensive tone returned.

“Where was your mother in all this?”

“That’s another story. Nothing was ever enough for my mother. She criticized all of us – especially my father. I never understood why he took it, why he didn’t get out. I thought he probably had women on the side – who could blame him – but I don’t know that for sure. I once asked him. He slapped me across the face.”

“Was that typical of him? To hit you?”

“So when you feel angry, you turn yourself off, you ‘stop caring.’”

“I guess.”

“I wonder if the problem with that Peter is that without being able to tap into your anger, your aggression, it’s very hard to find your competitive spirit, your desire to win, perhaps even your desire to beat your father.”

“I could never beat my father. I could never even come close.”

“The problem, Peter, is that you gave up trying. You were so sure you’d lose, that you’d never come close, that you were defeated before you began.”

“But I couldn’t come close.”

“Maybe. Maybe not. I wonder what you might be able to accomplish if you didn’t feel so defeated, so shut down. I hope you’ll give yourself and us the chance to find out.”

Truth Revealed | by Linda Sherby, PhD, ABPP

Mon, 08 Aug 2016 15:21:04 GMT

Mrs. Cortez settles herself uncomfortably in the chair across from me, fidgeting nervously with her fingers. “I never expected to be in a therapist’s office,” she says. “Especially not for this.”

I smile at her. “Take your time. I can see you’re anxious,” I say reassuringly.

She sighs deeply. “My husband and I came from Mexico a long time ago. We wanted to have children in a place where they’d have more opportunity. We’ve done well. I’m the office manager of a large cardiologists’ office, my husband drives for FedEx. My daughter graduated from college. My son’s in college now.” She looks down at her hands. “It’s about my son,” she says, barely audible. “He…he told me he was gay.”

She glances up at me.

“It was after the Orlando killings, in the… the nightclub. He said he couldn’t stay silent. He couldn’t keep hiding who he was. He cried like a baby. I was shocked. I held him, told him I loved him, that I loved him whoever he was. But it’s so confusing to me. It’s against my religion. It’s against my culture. I know Pope Francis said who are we to judge and I’m trying not to, but it feels so unnatural to me. And he’s afraid to tell my husband, which I understand. But now I have this secret from my husband and I don’t like that either.”

“I can see how much pain you’re in, Mrs. Cortez.”

“Please call me Daniella. I just told you the biggest secret of my life, Mrs. Cortez is much too formal.”

“Of course, Daniella,” I respond. I like this woman. Although we come from vastly different backgrounds with vastly different values, I appreciate both her pain and her conflict. From a place of love, she’s struggling to take in a new reality, to expand her view of what’s acceptable, to integrate her new information about her son – her gay son – with who she always understood him to be.

“I know it’s hard,” I say, “But your son isn’t a different person from who he was before he told you he was gay.”

“It feels like he is. I look at him and I wonder…” Pause. “I imagine… I wonder who he’s been with and how. It kind of makes me sick. My son? How could my son kiss another man? Could he put another man’s… No, I can’t say it. I can’t even think it.” Pause. “I haven’t been to church since he told me.”

“Because?”

“I have all these impure thoughts, all these images. If I go to confession, what will I say? I don’t want to tell the priest.”

“I thought you said Pope Francis said who are we to judge.”

“That’s Pope Francis. Not all priests are like that.”

“So you’re afraid the priest will condemn your son, just like you’re afraid your husband will.”

“Yes. If I’m having all these problems, my husband is so much more traditional. And he’s a man. I know what men say about gays. All those jokes. And that’s something else. I worry about my son. He’ll have such a harder life. And Mexicans aren’t having such an easy time in this country right now. Then you add being gay. I’m scared for him.”

“Daniella, this may seem like an odd question, but can you say what you are hoping to get from therapy?

“I needed to tell somebody. It’s been such a burden.” Pause. “And I guess I want you to help me accept my son.” She cries silently. “He’s a good boy. I love him. I keep wishing this was a dream. That it will go away. But I know it won’t. I know I won’t change him. I want to accept him. And I want to figure out how to tell my husband.”

“Do you feel ashamed that your son is gay, Daniella?” I ask.

She nods. “I know you’re supposed to be born that way. But I keep wondering if it was something I did, something my husband did. Did I keep him too close, was my husband too strict?”

“There are no answers to those questions. But I wonder if we can understand how shame came to play such an important role in your life.”

She looks down. “I’ve always felt ashamed. Ashamed of my background, my poverty, my alcoholic father. Ashamed of being different, of not being born in this country. I always wanted to fit in. And now there’s my son. Another difference – for him and for me.”

“So hopefully as we talk about these issues and you find more peace, you’ll also be able to be more accepting of your son.”

Appeasement | by Linda Sherby, PhD, ABPP

Wed, 29 Jun 2016 22:05:35 GMT

“I won’t be here next week,” Mona begins. “I’m going fishing with my parents.”

I feel disappointed for Mona. I’ve been seeing her for a little under a year, working on her need to separate from her parents. A 30 year old paralegal, Mona works in the law firm where her mother was once senior partner and lives in a house her extremely successful father bought for her. Although Mona was raised by a series of nannies during her early years - her parents busy building a business and developing a career – they now crave her time and attention.

“I know,” she continues. “We’ve talked about it and talked about it. No, I don’t really want to go. No, I don’t like to fish. Yes, it’s awful being stuck on a boat with my folks for a week. Yes, I wanted to save my vacation time so I could go to Europe.”

Pause.

“And I’m going fishing.”

“Do you have a sense of why you made that decision?”

“The consequences of not going are too great.”

“And those consequences are?”

“My house. My job. Little things like that.”

“Do you think your parents would take away your house or your job if you said you didn’t want to go fishing with them?”

“It’s important to them. If I can make them happy, why not?”

“What about what makes you happy?”

“Oh yes. There is that I suppose.”

“What would make you happy, Mona?”

“Being on a desert island somewhere, all by myself.”

“Is that true?” I ask.

“Yes and no I guess. In some ways it would feel like I felt as a kid – alone and adrift – surrounded by my books instead of water. There were times that felt welcoming, peaceful. Other times I felt so, so lonely. All I wanted was Mommy or Daddy to come home and be with me. But even when they were home they weren’t with me. And that was worse.”

“So now Mommy and Daddy have come home to be with you.”

“I suppose.”

Pause.

“You know, I’m not sure that’s true,” Mona says. “I mean, yes, they’re always there. I can’t get rid of them. But I’m the Mommy and the Daddy. I have to take care of them.”

“So you’re still not getting what you need. And you’re certainly not getting what you needed as a child.”

“That’s for sure.”

“But I wonder, Mona, if you keep trying, if you keep trying to get what needed from them. If you keep trying to get them to take care of you as you hadn’t felt taken care of as a child.”

“No doubt. Look what I chose as a profession, a paralegal. Not putting paralegals down or anything, but I know I’m smart, I know I could have been anything I wanted to be – a doctor, a lawyer, CEO of a corporation. But, no, I’m a paralegal and Mommy and Daddy get to take care of me forever.”

“That’s really sad, Mona. You’re saying that you kept yourself from realizing your full potential in your attempt to get what you never got from your parents in the past.”

“It’s worse than that. Because what I get from them now are the same things I was able to get from them as a kid – material things. I never wanted for anything materially. But what I wanted was their time and attention. And, yeah, I suppose I do get that now, but it’s really all about them. I don’t even know why I keep trying.”

“I think you do know why, Mona. You keep trying because inside you there’s a needy dependent little girl who yearns for Mommy and Daddy to be home taking care of you.”

“I suppose that’s true.”

“The problem is that you can never make up for that, Mona. The past is past and however much you as that little girl might long for and deserve to have loving, attentive parents, there’s no way to redo that.”

“That’s charming. So what do I do?”

“You - and we - have to work on helping you to mourn that which you never had. It’s hard. It means feeling sad and angry, sad and angry, sad and angry, until you can get to a place of acceptance.”

“Doesn’t sound pleasant.”

“No, it’s a long, difficult process.”

“Meanwhile it will have to wait. I’m going fishing.”

Mourning | by Linda Sherby, PhD, ABPP

Wed, 15 Jun 2016 22:01:14 GMT

“I still can’t believe it,” Marcy says, tears streaming down her face, her hands clenched into fists. “

I can’t believe my big brother is dead. In an instance. He’d just played racket ball that morning. To die just like that. No sign of any heart problems. I can’t believe it.”

“I’m so sorry, Marcy. I know how important your brother was to you, almost like a stand-in father.”

Marcy nods, sobbing, unable to speak.

“And his sudden death must bring up all the feelings you had as a child when your father died so suddenly.”

March nods again, reaches for a tissue and blows her nose. “That’s why I know Dave did everything he could not to repeat our father’s history, not to leave a wife and young kids. He never smoked, didn’t eat red meat, exercised. And he barely made it into his fifties. It’s so unfair,” she says. “Life is so God damn unfair!”

Silence. Marcy looks up at me and says, “You look so sad yourself.”

Marcy has read me correctly. I reverberate with her pain. Although I never had a brother and my father didn’t die young, I’ve had my share of losses. The intensity of Marcy’s pain brings back the feelings of agonizing loss, of emptiness, of disbelief at knowing you will never again see the one you loved. That life is unfair goes without saying. I no longer rail against that indisputable reality. Loss is a necessary part of love and life. And life without love isn’t worth living.

I respond honestly. “Yes, Marcy. I am. I feel the depth of your loss, your sadness and just as your brother’s death brings up past feelings about your father’s death, it also stimulates feelings about my past losses.”

“I’m sorry. I didn’t mean to make you sad,” she says, immediately illustrating the problem of a therapist being self-revealing.

“That’s perfectly okay, Marcy. You don’t have to take care of me. You have more than enough to do right now taking care of your own feelings. And, besides, although your pain now feels overwhelmingly agonizing, I know that you wouldn’t have given up having your brother in your life. And that’s true for me and my losses as well.”

“Oh no! I would never have given up having him in my life. Not for a moment. I literally don’t know what I would have done without him as a kid.” Pause. “But I’m still going to miss him,” she adds plaintively. “I feel like a kid when I say that,” she says between sobs.

“We all carry the child part of us along with our adult self, so I’m sure both the adult you and the child you will miss him. Very much.”

Silence.

“You know what you said about my not having to take care of you?”

“Right. You don’t.”

“I was thinking how different that was than when my father died. I was only six, but I felt that I had to take care of my mother. I was supposed to be the one to make her feel better. And I couldn’t do that. She felt bad for a long, long time. I can feel how I felt as that child. That long, long time felt like forever. And while I tried to take care of her, she wasn’t so good at taking care of me. Good thing my brother was 18, or who knows what would have happened to me. Probably shipped off to some aunt I hardly knew. My brother tried hard. But sometimes my clothes didn’t match or my hair was all messy. I don’t remember the other kids making fun of me. They mostly felt sorry for me, but that didn’t feel so good either.”

“It all sounds terribly painful, Marcy. So hard for you.”

“And now I’m back at it again. Trying to make Mom feel better. But it always seems reasonable. First she loses her husband, now her son. What could be worse than that? But I don’t want in that role again. It’s such a burden.”

“Are you concerned, Marcy, that you will need to take care of me, too?”

“No,” she says hesitantly.

“You don’t sound too sure.”

“Well, you don’t seem depressed and you’re certainly functional.” Pause. “But maybe making you feel sad worries me. Like I’m not supposed to do that.”

“I understand, Marcy. We should continue to look at that. And maybe looking at your feelings of needing to take care of me, will help you work through some of the past issues with your mother and free you from the burden of feeling responsible for her happiness.”

Family Connections | by Linda Sherby, PhD, ABPP

Tue, 31 May 2016 21:49:36 GMT

“I’m kind of in a state of shock,” Sheila begins. “My sister was arrested for shoplifting. A lipstick for heaven sakes! She could have bought a million lipsticks! I don’t get it. And she doesn’t seem to be able to explain it. At least not to me.”

“You’ve never talked much about your sister,” I say to Sheila. “What’s your relationship like?”

Sheila sighs. “Pat’s two years younger than me, 36. I guess we’ve never been close. Not as kids, not now when we live less than a half hour apart. She was always difficult, always getting into trouble, creating some drama in the house. She’s very pretty. My father liked that. I guess I was jealous of her. I was the good girl, the one who always did well in school, the one who obeyed the rules. I got points for that, but her looks made her popular with the “in” girls and always got her dates with the most desirable boys. And then she married Cliff, married into all that wealth. She calmed down after that. I thought she was happy. Who knew?”

“Do you still feel jealous of your sister?”

“I guess. It seemed she was always creating problems, but still got everyone to love her. But I don’t know about this time. My parents are definitely not happy. And I can only imagine how Cliff’s family will react.”

“Does that bring you some satisfaction?”

“I wouldn’t say that to anyone but you, but yes, it does. Except she’ll probably get out of this too. And I really shouldn’t complain. I have a great career, a wonderful husband and a lovely daughter. You can’t ask for much more than that.”

“Do you feel less than your sister?”

“That’s a good question. It’s like if I think about my adult self and my adult life, I have absolutely no reason to feel less than Pat – except for her money, but that’s really not the issue for me. It’s these feelings from the past that creep in and suddenly I’m the one who gets to stay home on Saturday night, who watches my father look adoringly at my sister and, yes, I feel less than. Silly, right?”

“Not silly at all, Sheila. Our unconscious is timeless and the experiences and feelings we had at five and ten and fifteen, are as much with us, as our present day experiences and feelings.”

“Makes sense.”

“You haven’t talked at all about your mother’s feelings about you or your sister.”

“I guess that’s because I never knew how my mother felt. About anything. She was always efficient and proper and did the things she needed to do, including taking care of us, and I suppose loving us, but there was a shallowness to her feelings. Or maybe it’s that feelings were too messy. She did what she needed to do, her feelings on the shelf.”

“So in relation to your mother, your sister and you were equal, neither of you getting very much.”

“Oh, I wouldn’t say that. I mean we may have been equal, but it’s not that we didn’t get very much.”

“Emotionally?”

“Are you saying you think we were emotionally deprived?”

“You were the good girl, your sister acted out. Maybe you were both trying to get more love and attention.”

Pause.

“I wonder if that’s why I sometimes get depressed out of the blue. It’s like everything is going along fine and suddenly there’s this black cloud.”

“That a great insight, Sheila. What you’re saying is that those childhood feelings we were talking about earlier catch up with you and suddenly you’re a kid again feeling needy and ungiven to and depressed.”

“That’s exactly right!” She pauses. “You know, that also makes me feel more sympathy towards my sister. I like that. It’s a new feeling.” Another pause. “Do you think she shoplifted because she felt needy and thought the lipstick would make her feel better?”

“You’re saying she was trying to nurture herself with a material object, because she didn’t feel given to emotionally. That’s certainly a possibility. And I imagine there’s some anger thrown in there as well. Probably for both of you.”

“Hmm. I’ve never seen myself as an angry person, but I guess we’ll have to talk about that next time.”

“Okay. We will.”

Vacation | by Linda Sherby, PhD, ABPP

Wed, 27 Apr 2016 18:14:55 GMT

Belinda glares at me silently, arms crossed in front of her chest. “Look at you,” she says finally, “Sitting there so innocently, like you’re not about to shirk your responsibility and abandon us all.”

Finding myself more amused than angry, I wonder if Belinda is less distressed about my upcoming vacation than her words seem to imply. I’ve seen Belinda for a number of years now and watched her grow from a woman who was unable to feel much of anything, to someone who is more in touch with her emotions and more able to connect to others. But anger is her usual defense when she feels particularly vulnerable. “So you’re feeling angry about my being away for two weeks,” I say.

“Duh! Yeah, you could say that, great clinician that you are.”

I’m less amused. She may be angrier than I thought.

“This may seem like a silly question, but why? Why are you so angry?”

“That’s not silly, it’s stupid. Answer it yourself!”

“Belinda, what’s going on here? You’ve never liked when I’ve gone on vacation, but you seem particularly angry today.”

“All that talk about your being here for me, about my needing to take you with me, about my needing to rely on you. Great! So what happened to all that?”

“None of that has changed.”

“Right!”

Silence.

“Say something,” she demands.

I consider remaining silent and decide that would only escalate the confrontation. “I think you’re trying to provoke me, Belinda, and I’m not sure why that is.”

Silence.

“Do you feel anything besides anger about my being away for two weeks? Do you feel scared? Sad?”

“You’d like that wouldn’t you? You’d like me to be crying like a baby. Make you feel important. Like I couldn’t live without you.”

“You can live without me, Belinda, but that doesn’t mean you can’t have feelings about my being gone.”

“Why are you the one who decides when you get to leave? Why don’t I have a say in the matter? Why don’t your other patients?”

An image of my patients voting on when I should go on vacation floats through my mind and I again find myself amused. But then I wonder why I am being amused by Belinda’s anger today. Is it my defense? Is Belinda’s anger frightening me and am I trying to minimize it by finding it amusing? Or perhaps she’s the one who’s frightened of her anger.

“Well?” she asks challengingly.

“Are you afraid of how angry you are, Belinda?” I ask.

“Are you?” is her retort.

“I don’t know,” I reply. “I didn’t think I was, but then I wondered if I was minimizing your anger and if that meant I was afraid of it. And then I wondered if you were afraid of your anger.”

Belinda’s face softens. She looks almost like she might cry. She shakes her head. “I can’t believe it. I was sure I’d never let you in today. I was sure I’d hold onto my anger. I was sure I wouldn’t tell you. I cut myself last night.”

My stomach turns over. “Why?” I asked, shocked. As far as I knew Belinda was never a cutter.

“I just felt so angry you were leaving me. I didn’t know what to do with all the feelings. I tried screaming and hitting the wall but it didn’t help. So I took a knife and cut myself. Not much, truthfully. It was just a little nick. I don’t much like blood. I thought if I could really hurt myself, I’d probably feel better, but I couldn’t do it. And then I got even madder that you had that much power over me.”

“I’m glad you didn’t really hurt yourself, but inflicting pain on you in any way is really scary, Belinda. I’m sorry you didn’t call me and try and talk about your feelings.”

“That makes me mad too. Why would I call you and be even more dependent on you when there’s no way I’m going to be able to call you for two weeks?”

“It’s true, Belinda. I’m not going to be available for two weeks. But that doesn’t mean I stop existing for you or that you stop existing for me. We’re in each other’s lives; we’re in each other’s head. Our connection doesn’t vanish. And, yes, you can be angry that I’m going. And you can also feel sad and scared. And we can talk about all those feelings. But neither of us can or should try to take the feelings away or make light of them. You’re feelings always matter, because you matter.”

“I was about to say I wish you didn’t matter to me, but I guess that’s really not true.”

“I’m glad. We still have one more session before I leave, so let’s continue talking about this. And no cutting.”

Ending | by Linda B. Sherby, PhD, ABPP

Thu, 31 Mar 2016 16:25:17 GMT

“So,” Philip begins, “There’s something I’ve been thinking about and after all these years I certainly know I’m supposed to talk about everything I’m thinking about. So, here goes,” he says, inhaling deeply. “We have two weeks, six sessions left and for our last session I’d like to take you out to dinner.”

Many thoughts and feelings flit through my mind. I’m surprised. Philip is a 55 year old obsessive man who despite years of therapy is still fairly rule-bound. Taking me out to dinner would definitely be bending those rules. So should I consider his request an indication of progress? Perhaps, perhaps not. Either way, I know I’m not going accept. To do so would be stepping way outside the bounds of our relationship. I have gone to lunch or dinner with patients who have been out of treatment for long time, but then I know that the treatment is definitely over and it’s more like catching up with an old friend. Last sessions and, in fact, the entire process of termination is fraught with many intense and conflicting feelings. A restaurant is definitely not the place to deal with them.

“What makes you ask? Why do you want to take me to dinner for our last session?”

He looks instantly deflated. “You’re not going to do it.”

I smile inwardly. My apparently neutral question wasn’t so neutral after all. “No, Philip, I’m not going to accept. I’ll explain why, but first I’d be interested in knowing why you want to.”

“Is it because I’m a man? I mean I know we dealt with some of my, uhmm, feelings about you along the way, but this has nothing to do with that. I just want to say thank you for all you’ve done for me.”

“And when you say ‘thank you for all you’ve done for me,’ you’ve given me more than enough, a gift. You’ve been able to put your feelings into words. And your warm feelings at that. That’s a major accomplishment for you.”

“You didn’t answer my question.”

“I’m sorry. No, it’s not because you’re a man. Did I hear a hint of anger in there?”

“No one likes to be rejected.”

“Whoa. Let’s go back a minute. You say that you want to take me out to dinner to thank me for what I’ve done for you. What do you imagine you might be feelings that last day? Or the last week? Or what are you feeling today about ending?”

“Hard to separate out what I’m feeling about ending and what I’m feeling about your turning me down.”

“Okay. Just say what you feel right now.”

“Hmm. I feel disappointed. And hurt. And a little angry. And confused. I don’t understand why.”

“So let’s say we were at a restaurant right now. Would you like to be dealing with all those feelings at the restaurant?”

“I wouldn’t be having these feelings if we were at a restaurant.”

“Ah ha! So perhaps you’ve just told us another reason why you might want to take me to dinner for our last session. Maybe it’s so you won’t feel all the feelings you might be having during that session.”

“Oh.”

“Last sessions can be pretty emotional. I know there’s some excitement about leaving, a feeling of accomplishment. Some people describe it as feeling like graduation. But even graduation has sadness mixed with it, ending a chapter in your life, ending your relationship with me. We’re known each other a long time. It’s always sad to say good-bye. Sad for me too. I’m happy for you and your progress, but your leaving is a loss for me as well as for you.”

Philip stares at me. “You’re so dear to me,” he says softly. “You will always have a special place in my heart. You’ll be with me always and I’ll miss you more than I can say.”

“That’s so beautiful, Philip. Thank you. That means so much to me. I think about how you couldn’t even identify what you were feeling when we first started working together, let alone express it. And to be able to express such deep, caring feelings warms me all over.”

He smiles. “I was just going to say, ‘So how about dinner?’ and then I realized I was just running from all the feelings in the room. I guess we’ll be meeting here for the remainder of our sessions. Five more to go. Makes me sad.”

You Didn’t Do Anything Wrong | by Linda B. Sherby, PhD ABPP

Fri, 18 Mar 2016 18:14:23 GMT

“The most awful thing happened to me last week,” Francis begins. “I was walking out of Macy’s and a security guard stopped me. He asked me to open my purse. I looked at him like he was crazy and asked why. I even wondered if he was a security guard or if he was just wearing the uniform and wanted to steal my wallet or something. He kept insisting. I asked him if he thought I stole something which mortified me and he just kept asking me to open my purse. I finally did and he looked through everything. I felt like a thief. And then he said, ‘Thank you, ma’am, I guess there was a mistake.’ I was shaking. I ran out of the mall. When I got into my car I burst into tears. It was awful. And now I can’t stop thinking about it. I replay it over and over in my head.”

Francis is a conventional woman nearing fifty who came into therapy when the last of her children left for college, wondering what was next for her in life. “It sounds awful. Can you say a bit more about what you felt?” I ask.

“Humiliated. I couldn’t believe this was happening to me. How could anyone think I’m a thief? And I felt scared. Like I said I wondered if the security guard was an imposter and if he’d rob me. I know how crazy that sounds, but it didn’t seem any crazier than me stealing something.”

Francis was the “good girl” who evolved into the “good wife and mother.” It is hard to imagine her doing anything rebellious, let alone illegal. “Did you feel angry as being unjustly accused?”

“I guess I did. You know I don’t do anger very well.”

“And since the incident, what is it that you feel when you replay it in your head?”

“The same thing, humiliated and scared. I don’t feel the anger all that much.”

“Does the incident remind you of anything in your past?”

“No! I never stole anything in my life, if that’s what you mean.”

“No. That wasn’t what I meant. What made you think I was suggesting that?”

“I don’t know,” she says, starting to cry. “I just feel so awful. I feel like a criminal. I feel dirty. I know it’s crazy. It was a mistake. I need to let it go.”

“So you understand that what you’re feeling is an overreaction, but we need to figure out what’s causing that overreaction. I’d say it was something from your past, something that made you feel guilty or ashamed or both. That doesn’t mean you did anything wrong. You could feel you did something wrong even if you didn’t.”

“When you just said I didn’t do anything wrong, I felt this tremendous relief, like a burden was taken from me. But I have no idea why. What do I feel so guilty about? What did I do that was so bad? I was always the good kid.”

Various of my childhood and adolescent transgressions flit through my mind: blaming a friend’s sister for my mischief, wearing make-up when I wasn’t allowed to, lying about having a boyfriend. I don’t carry guilt for any of these infractions, but I’m sure far more serious “sins” exist in the cauldron of both my and my patient’s unconscious. “It doesn’t have to be anything you did, Francis. It could be something you wished for or dreamt about. It could be a fleeting thought, like ‘I wish you were dead.’”

“I killed my younger sister’s turtle,” Francis blurts out. “It was an accident. The turtle got out of its little house and I accidentally crushed it with my rocking chair. My sister was really mad. She said I was a murderer. My mother was mad too. I kept saying it was an accident, but they didn’t believe me.”

“Another example of being blamed when you didn’t do anything wrong.”

Francis hesitates then quietly says, “I didn’t like that turtle. It smelled bad. And I don’t like things that crawl around like that. But it was an accident. I didn’t deliberately kill it.”

I wonder if the turtle is a stand-in for Francis’ childhood feelings about her sister – something that smells bad and crawls around – but I decide to leave that interpretation for another day. “But it sounds like you still felt guilty, both because you might have wished the turtle dead and because your sister and mother were so angry.”

“But I didn’t do anything wrong,” she has almost plaintively.

“No, you didn’t do anything wrong,” I say. I suspect this “good girl” has many forbidden thoughts and feelings, but that too is for another day.

What If You Died? — by Linda Sherby, Ph.D., ABPP

Fri, 26 Feb 2016 03:18:54 GMT

Tall and thin, with long, straight brown hair, Alicia fidgets in the chair. “I have a new obsession,” she says hesitantly. “I keep worrying about your dying. I feel funny talking about it, but who else can I talk to about something like that?”

I’ve been seeing Alicia for almost five years now. She began when she was 20, when she was so paralyzed by anxiety and by magical, obsessional thoughts that she had to drop out of college. She’s much better now. She’s gone back to school and should graduate in a little over a year.

She continues. “I know we’ve talked about my being afraid of my parents dying in some horrible accident when they left to go out when I was little. And you said that was because part of me wished they were dead because I was mad that they were leaving me. But I don’t feel mad at you. At least I don’t think I do. Do you think I’m mad at you?”

“I think only you know how you feel, Alicia.”

She pouts. “You could help me.”

There is a childlike quality to Alicia. She looks to me to protect her, to save her, to give her the magical answer. I feel the pull to oblige, but think it best that Alicia find her own strength, her own voice, her own answers. Her mother was overly protective and although both parents pushed Alicia to succeed, there was the contrary message that she stay close to the protection of home.

“I will help you, but I can’t tell you how you feel.”

“All right. All right. Be that way.” She crosses her arms over her chest and glares at me.

I remain silent, but present in the room with her.

“Well now I feel angry. A little. No, not really. I know you can’t tell me what I feel.

The problem is that I don’t know what I feel myself.” She pauses. “Scared. I feel scared. I feel scared if I think about your dying. And it’s not like I imagine your dying in some gruesome accident. I just think what if you got sick and died? I mean I know you’re not old. But you’re not young either. Would I even know if you were sick? And how would I know if you died? I wouldn’t want to read it online somewhere.”

“Do you have any thoughts about what triggered your fears of my dying?” When I look in the mirror I certainly know I’m not getting younger, but I suspect Alicia’s fears have more to do with what’s going on for her internally than with my actual age.

“I just thought of something. My father’s been talking to me about graduate school. I keep telling him I’m not ready, that I still haven’t finished undergrad, that I have to take one step at a time. I can’t think about graduate school. It scares me. It was after that I started worrying about your dying.”

“So talking about graduate school means growing up, leaving home and that brings up fears about loss, including the loss of me.”

“You didn’t have to put it that bluntly. Now I’m terrified.”

“I’m sorry. I didn’t mean to increase your anxiety, but we do need to know what the issue is before we can work on it.”

“I could never leave you! I’m not even sure I could leave my parents. Oh my God, what happens when they die?”

“Alicia, let’s put the question of death to the side for a moment. What feels so scary about leaving home?”

“I can’t. I don’t think I could make it.”

“It feels as though you’d die?”

“It kind of does. But when you put it that way, I don’t know, that doesn’t really make sense.”

“So the idea of leaving home feels terrifying, feels like you couldn’t survive. But when you think about it rationally it’s not so clear what you’re afraid of.”

“Yeah. That’s right. That actually makes me feel a little better.”

“You know, Alicia, although leaving home does involve loss, it also involves gains: growth, independence, freedom. It’s about adding to your life, not just taking from it.”

“Yeah. I can see that.”

“On the other hand, I don’t want us to ignore your underlying feelings, including your fear of my dying. I do hear that you feel terrified and we need to talk about those feelings again and again until you’re more sure of your adult competence and your ability to cope.”

Until Death Do Us Part — by Linda Sherby, Ph.D., ABPP

Wed, 17 Feb 2016 23:44:22 GMT

Bob Samuels looks as though he would once have been a handsome man. Now his disheveled white hair, creased brown pants and too small plaid shirt, along with his sad eyes and almost shuffling gait, gives him the appearance of a man who has grown old before his time.

“I read your book,” he begins. “I thought maybe you could help me. You know about loss. But I worry that you don’t know about regret. You don’t mention it much.”

I immediately flash on some of the regrets I have regarding my husband’s treatment of prostate cancer and heart disease: Should we have chosen surgery rather than radiation? Why did no doctor ever tell us about the possible false negatives from chemical stress tests? Yes, I have regrets, but they don’t plague me. I accept that no one is infallible; no one can anticipate or control everything. I say nothing and wait for Mr. Samuels to continue.

“My wife died of ovarian cancer five years ago. She was diagnosed five years before that. In the beginning she put up a valiant fight, although I always wanted her to pursue more alternative treatments in addition to the chemo. I don’t mean anything way out there. Stuff like nutrition. I thought she should become a vegan, try juicing, stuff like that. But she couldn’t deal with it. And then in the end, when the cancer came back again and then again, she called it quits. Said she had enough. She stopped all treatment and just died. I wanted us to go to Europe and try some of the experimental treatments that aren’t available in the States. But she said she couldn’t, said she was done.”

I think about my husband’s words when he too decided to stop treatment: “It’s enough already.” He had fought for years to stay alive. But he reached his limit. Although I was grief stricken, I understood his decision.

“Sounds like you’re angry at your wife for giving up,” I say to Bob.

He startles. “No, no,” he says. “I could never be angry at her. I’m angry at myself for not being able to convince her, for not being able to make a good enough argument. I’m inadequate. I couldn’t make her see.”

“You couldn’t make her see what?”

“That there was a chance. That there were still things we could do.”

I believe that Bob is angry at his wife for letting go. I also believe that he can’t let himself feel that anger, that he blames himself rather than her. And he can’t tolerate the helplessness we must all deal with in the face of death. But these interpretations are all too premature.

“It sounds as though you miss your wife tremendously,” I say instead.

He sobs. Reaching for the tissues he tries to control of himself. “I’m sorry,” he says, his voice breaking.

“There’s nothing to apologize for,” I reply.

“It’s five years. I shouldn’t be like this anymore. But I keep tormenting myself. What if I’d done X? What if I’d say Y? What if I was enough of a husband for her that she wanted to stay?”

“You think if she loved you enough she would have fought harder?” I ask, wondering if his wife’s decision to stop treatment felt like a narcissistic injury to him.

He cocks his head and puts a finger to his lips, pondering my question. “I think I always loved my wife more than she loved me. I mean, she did love me, but I adored her. She was the only woman who really ever mattered to me. So do I think if she loved me more she would have continued to fight? Maybe I do. I don’t like to hear myself say that. It sounds so selfish, so much about me.”

“You know Bob, in the end, none of us can defeat death, no matter how much we might love or how much we might want to stay.”

“I know.”

“I wonder if you do. I mean I’m sure you know intellectually that we all die, but I wonder if on a gut level you feel that if only we do enough, if only we try harder, somehow we’ll be able to continue on.”

“I don’t know.”

“Bob, my sense is that we jumped right into this very painful, difficult topic because you’ve obviously been struggling with these feelings for quite some time. But I wonder if we could go back a bit so I can get some sense of you, of your life, of who you are.”

He takes a deep breath. “Where would you like me to start?”

“Wherever you’d like.”

Money Matters Again by Linda B. Sherby, Ph.D., ABPP

Wed, 27 Jan 2016 22:17:13 GMT

I am aware of feeling annoyed as I go to the waiting room to greet Philip. It’s been five weeks since I’ve seen him. Each of the last four weeks he cancelled three or more days prior to our session – well within the time required by my 48 hour cancellation policy to avoid being charged – with various excuses, mostly related to business. Philip is a successful import/exporter. It’s not unusual for him to travel, but we’ve usually been able to reschedule during the week or arrange to talk by phone, even when he’s out of the country.

“It’s been a while,” he says greeting me with a broad smile that enhances his already handsome face. “I’ve been incredibly busy. Business has really picked up. Not that I’m complaining. I know lots of people are hurting, so I’m more than grateful. Other than that, not much is happening. Things are going okay with Serena, although she hasn’t been too pleased with all my traveling. I have been able to keep up with my kids, although I can find myself squeezed between time with Serena and time with the kids.”

“And us?” I ask.

“Us?”

“We haven’t seen much of each other the past several weeks either and now you seem to be saying that there’s not much to talk about.”

“Truthfully, I haven’t had much time to think about myself. I just keep on truckin’.”

“Does that strike you as strange? You’re someone who usually spends a lot of time reflecting about yourself, trying to understand why you do what you do and now you’re being kind of flip and indifferent.”

“Maybe I’m just tired of spending all this time ruminating on myself. Maybe it’s time to just start living.”

“Philip, what’s going on?”

“What do you mean?”

“First you disappear for over a month …”

“I didn’t disappear,” he interrupts. “I called every time to say why I couldn’t come. Gave you enough advance notice too.”

I find myself confused, annoyed and stymied. When Philip kept cancelling, I thought about our last several sessions trying to understand what might have triggered his desire to keep away and hadn’t come up with anything. Now he’s being disinterested, dismissive and even hostile and I have no idea why. Was he feeling too close and needing to get away? And what was that comment about giving me advance notice? Philip is a wealthy man. Money never seemed to be an issue between us.

“Was it important that you gave me advance warning?” I ask.

“Yeah. Wouldn’t want you to be charging me for a session when I’m not here, especially since you just raised your fee.”

I try to keep my surprise from registering on my face. I raised Philip’s fee by $25, an amount I thought would be insignificant to him.

“Philip, what did it mean to you that I raised my fee?”

“Nothing. You’re entitled. This is your job. You deserve to make a living. And $25, it’s no big deal.”

“Seems like it is a big deal, Philip.”

“Don’t be silly. I can give $25 to the valet when I leave my car at the airport.”

“Except I’m not the valet,” I say quietly.

“I didn’t mean to insult you,” he says quickly.

“Philip, let’s stop a moment. I feel like we’ve been sparring all hour and I think I do understand what’s going on. I understand that the actual $25 an hour increase is inconsequential to you. But I think what it did is remind you that we have a professional relationship, that in addition to our human relationship, in addition to the caring interaction that goes on between us, you do pay me for my time. It reminded you, as you said, that this is my job. And I think that made you feel uncared about.”

“I never thought of that. At least not consciously. But now that you put it into words, I think you’re right.” He pauses. “Know what I just thought about? I thought about the time when I was a kid and my father and I had baseball tickets. I’d been looking forward to it for weeks. And then sometime before the game a delivery guy arrived with an electric guitar I’d been wanting and a note that said, ‘Sorry, kid, can’t make it. Enjoy. Love, Dad.’ I never did play that guitar. I realize it’s not the same thing …”

“But it felt that money, material things were taking the place of time and caring and that’s how it felt with me too.”

“I guess. I’m sorry. I know that’s not fair.”

“Nothing to apologize for. I’m glad our relationship matters to you. It matters to me too. And I’m glad we were able to figure out what was going on.”

Where is the Evidence for “Evidence-Based” Therapy? by Jonathan Shedler

Thu, 06 Aug 2015 14:57:12 GMT

“Evidence-based therapy” has become quite the catchphrase.

The term “evidence-based” comes from medicine. It gained

attention in the 1990s and was, at the time, a call for critical

thinking. It reflected the recognition that “we’ve always done it

this way” is not a good enough reason to keep doing something.

Medical decisions should reflect clinical judgment, patients’

values and preferences, and relevant scientific research.

But “evidence-based” has come to mean something very different

in the psychotherapy world. The term has been appropriated

to promote a particular ideology and agenda. It has become

a code word for manualised treatment—most often, brief, highlystructured

cognitive behavioural therapy (CBT). “Manualised”

means the therapy is literally conducted by following an instruction

manual. The treatment may be pre-scripted in a way that

leaves little room for understanding patients as individuals. ...

Click below to read the the full version of the recently updated paper from Division 39 member Jonathan Shedler, PhD.

http://jonathanshedler.com/wp-content/uploads/2015/07/Shedler-2015-Where-is-the-evidence-for-evidence-based-therapy-R.pdf

Secrets by Linda B. Sherby, Ph.D., ABPP

Sun, 05 Apr 2015 13:53:26 GMT

Secrets--by Linda B. Sherby, Ph.D., ABPP

Tall, thin, with neatly coifed grey hair, Estelle Harrison, fidgets in the chair, looking decidedly uncomfortable. “I’ve never done this before. I’m almost 80 years old. I can’t believe I’m coming to a psychologist. But I have to talk to someone. My husband has lung cancer and he won’t let me tell anyone. Another secret. I’ve been the keeper of secrets my entire life.”

“Why is your husband’s cancer a secret?” I ask, thinking how unimaginable it would have been for me to keep my late husband’s cancer secret, how more impossible it all would have been without the support of friends and family.

“He feels ashamed of being sick, like it’s a weakness.”

“So you’ve told no one?”

“Our daughters know. They call. But they have their own lives. And truthfully,” she says sighing, “I’m not sure how much they’d care anyway. Dave wasn’t a very good father. In fact, he was a terrible father. He used to beat them. That was another secret I kept. He’d take down their pants and beat them with a belt.”

For a reason I cannot completely explain, I think, “Did he get off on it?” What I ask is, “How old were they?”

“I can’t remember how old they were when he started. Young. Too young.”

“Until …?” I ask.

“They both left the house pretty early, so I’d say until they were seventeen. Actually after Maureen left – she’s the oldest – Liz got it worse.”

Finding this difficult to listen to, I say nothing. My mother didn’t protect me from my father’s rages, but he wasn’t beating me and his rage wasn’t fueled by a perverse sexual desire as seems to be true for Dave Harrison.

As if reading my thoughts, Mrs. Harrison says, “You think I’m terrible don’t you?”

“I don’t think you’re terrible, but I’m not sure why you didn’t try to intervene, to protect your daughters.”

“I was afraid he’d get physical with me too.”

“And did he?”

“He slapped me across the face a couple of time.”

I am again silent.

“You younger generation, you all think I should have left him. But it wasn’t so easy back then. I was a housewife. I had no way to support myself. I wouldn’t have known what to do,” she says starting to cry.

Feeling more compassion, I say, “It sounds like your daughters are angry with you for staying, for not protecting them. That must make it harder for them to be available to you; that must make you feel all the more alone.”

She nods her head, still crying.

“This might seem like a foolish question, but why haven’t you told whomever you want about your husband’s illness, regardless of what he wants?”

She looks at me, startled. “I can’t do that. It’s his illness. If he doesn’t want me to tell, I just can’t.”

I feel myself getting angry at Mrs. Harrison’s passivity. Is that reasonable? Or is my anger at my mother seeping into this therapy session? Or, yet another possibility, am I feeling Mrs. Harrison’s own anger?

“Are you angry with your husband, Mrs. Harrison?” I ask.

“I can’t be angry at him. He’s sick.”

“You can still feel angry with him. You can feel angry for his mistreating you and your daughters. You can be angry that he won’t allow you to speak, to tell people who could be supportive of you.” Suddenly I wonder, “Does your husband know you came here today?”

“Oh no, I could never tell him that. He’d be furious at me for telling our secrets.”

I again feel annoyed. Now I wonder if I am feeling angry like her husband, angry that she is so passive, angry that she presents as a martyr just waiting to be beaten. Does she carry within her both the beaten child and the angry parent, with the angry parent projected outward so she doesn’t have to feel the rage herself? Way too complicated for a first session but I do ask, “What about your own childhood, Mrs. Harrison? Were you beaten?”

“Oh no. I was the good one. My brother and sister got my mother’s rage, but I always did what she wanted and I never talked about what went on at home.”

“Just as you did with your husband. But were you angry with your mother?”

“I couldn’t be. I was too afraid I’d give her some sassy answer one day and then I’d get it too.”

“Sounds like you might have lots of angry stored up inside.”

She shrugs. “I guess.”

Unsurprisingly, another passive response.”

http://blog.lindasherbyphd.com

The Mask by Linda B. Sherby, Ph.D., ABPP

Mon, 30 Mar 2015 18:08:45 GMT

The Mask by Linda B. Sherby, Ph.D., ABPP

Elaine, burying her head in her hands, begins sobbing as soon as she sits down. Struggling to speak she says, “Baxter has cancer. That’s why he hasn’t been eating. I may have to put him down. I can’t believe I’m carrying on like this! I didn’t even shed a tear when my grandparents died.”

Sadness floods me as I feel for both Elaine and myself, thinking immediately of Pippin, the regal black and white cat my late husband and I adopted shortly after we moved to Florida. Putting her down two years after my husband’s death was beyond painful. “I’m so sorry, Elaine, I know how attached you are to Baxter, how much he’s meant to you.”

“And this is supposed to be good? Feeling like a wreck, feeling like my heart will break?” she says sarcastically.

I know what Elaine is referring to. I remember when she first walked into my office four years ago. Although attractive with tasteful make-up, Elaine looked like a doll, her face mask-like. Her mother died when she was three, her father when she was seven. She lived with her step-mother until their conflicts became unbearable, then moved to her paternal grandparents, who saw her as an unavoidable inconvenience. Listening to Elaine’s story I felt overwhelmed by sadness, while Elaine seemed devoid of feeling.

Elaine came into therapy because she couldn’t maintain a relationship. She had no difficulty finding men but the relationships never lasted. The men said she was unconnected, unavailable, that there was no passion. Sex wasn’t the problem, it was something else, but she didn’t know what. I suspected I knew. It’s impossible to connect to a doll. Our job would be getting behind the mask. It wouldn’t be easy. She had spent years fending off the pain of all her losses. The mask would have to be peeled off slowly.

“I have no memory of my mother or my father,” she told me. “Just pictures I’ve seen and what my step-mother was willing to tell me, which wasn’t much since she preferred not to talk to me. Of course my grandparents didn’t like to talk to me much either. Besides, they were old, they didn’t want to be reminded of their son’s death. I can imagine that would be painful for them.”

“And you don’t think it would be painful for a three year old, for a six year old?”

“I can’t feel what I can’t remember.”

Finding Elaine’s memories would be crucial to her growth.

While we focused mostly on Elaine’s difficulties with relationships in both her personal and professional life, over the years I asked questions about the past: “Do you remember your first day of school? Who took you? Do you have an image of the house you lived in with your father? Do you remember moving from your step-mother’s to your grandparent’s? Did you have to change schools? Leave friends?”

One session when Elaine came in she looked different. There was a crack in the mask. “I had a dream,” she began. “There was a child standing in an empty field. She was holding someone’s hand, a man’s. They were looking down. When I woke up I felt incredibly sad. I didn’t think the child was me. But then I wondered if it was me with my father standing at my mother’s grave. Could I possibly remember that? I was only three.”

“Let’s stay with your feeling, Elaine,” I say softly. “What is it like to feel that sadness? What does it bring up for you?”

“I don’t know,” she says starting to cry. “I guess I’m sad for that little girl. Standing by her mother’s grave, not knowing that in three more years her father will be dead too. It’s really awful. I guess I never thought of it like that. I guess I never thought about it at all.”

“You didn’t want to think of it, Elaine. You didn’t want to deal with your pent up sadness. But today you’ve taken a big step forward.”

Two years separates the session of Elaine’s dream and her telling me she might need to put down Baxter.

Returning to the present session I say, “I know you’re feeling tremendous pain, Elaine, not only for your beloved Baxter, but for all the losses you’ve endured in your life.”

She sobs. “Please tell me this pain is worth it.”

“It’s worth it, Elaine. If you can’t allow yourself to feel your sadness, you can’t feel joy either and, most importantly, you can’t be truly alive.”

Betrayal by Linda B. Sherby, Ph.D., ABPP

Wed, 18 Mar 2015 15:04:56 GMT

Betrayal

Twenty-seven year old Carla sits crying in my office, her eyes red, shredded tissues in her lap. “I can’t believe it happened again,” she says. “I thought Martin was different – kind, sensitive. I couldn’t imagine him being unfaithful. I don’t understand why this keeps happening to me!”

And that, I think to myself, is exactly the question. Carla is tall, attractive, shapely, smart, articulate, funny and yet Martin is the third man who’s been unfaithful to her. For the moment, however, Carla needs to deal with the immediacy of her pain.

“I thought I’d surprise him,” she continues. “Bring us Thai food for lunch. I knew he’d be writing. Or I thought he’d be writing. I didn’t even register the strange car in his driveway. Until he didn’t answer the door. I rang and rang. My stomach started to get all queasy. He finally answered in a bathrobe, tried to make some feeble excuse, but I’m not stupid. I threw the food at him and ran. I wanted to key the girl’s car as I went, but I knew that would be dumb. So here I am, betrayed again. What’s wrong with me?” she asks, beseechingly.

Odd, I muse, I had a similar experience with a man I dated 40 years ago, showing up at his door only to find him with another woman. I was both devastated and enraged. But that was a long time ago, those feelings long gone, not distracting me from my role as therapist.

“I don’t think there’s anything wrong with you, Carla. But I do think it’s important to understand why this scenario does keep repeating. What are your thoughts?”

“I don’t know!” she responds, crying. “My parents have been together for over 40 years. I’d be shocked if my father ever cheated on my mother.”

“And your mother?” I ask.

“What!?” she says, furrowing her brow. “You’re asking if my mother ever cheated on my father?” she asks, incredulously.

I nod.

“That’s impossible. My mother was the least sexual person around.”

“Is that because she’s your mother or …?”

“My mother pulled away when my father tried to be affectionate. And sometimes I could hear them arguing. He was frustrated.”

“So why are you so sure he was never unfaithful?”

“Because he wasn’t that type.”

“Obviously, Carla, I’m not saying that your father was unfaithful. I have no idea. But I do think it’s interesting that you’re so convinced he wasn’t.”

Shaking her head, she says, “My father stressed the importance of good moral values, insisted we go to church, lectured us on being good people. He’s a wonderful man.”

I’m surprised by Carla’s naiveté. I think of the people I’ve known – both men and women - who were unfaithful to their partners. Many of them were good people.

“Two questions. Do you think only “bad” men are unfaithful? And are there similarities between the men you’ve dated and your father?”

“Actually, Martin reminded me of my father. He even looks a bit like him.” She smiles uncomfortably. “You think I have an Oedipal thing going with my father?”

“What do you think?”

Carla looks out the window. After a pause she says, “My father put up with a lot from my mother. She’s difficult, demanding, cold, particularly to him. He dotes on me. I love him a lot so, yes, maybe I’m kind of in love with my father.”

Well, I think to myself, that opens up lots of possibilities. Does Carla choose unavailable men so that she can remain faithful to her father? Is her father more of a womanizer than she thinks and is she choosing men who are like her father? And if they’re like her father does the relationship feel incestuous so that she unconsciously does something to subvert it? If her mother is cold, is she choosing men like her mother to try to win in the present that which she lost in the past? Does she try to be not her mother and end up being too smothering and intense? Lots of questions, none of which will be answered today.

“How do you feel, Carla, about being kind of in love with your father and how does it affect your relationships?”

“I don’t know. Right now, all I know is that I’m sad. I’ve lost again.”

“As in you’ve lost Martin and lost your father again?”

“I haven’t lost my father,” Carla declares emphatically.

“Except that he’s with your mother, not you,” I respond gently.

“Oh, I get it. I don’t know. This has gotten too Freudian.”

“It’s time for us to stop for today, but you opened up lots of things today and I’m sure we’ll get back to them.”

Enemies on the Couch: Interview with Vamik Volkan, M.D. by Donna Bentolila, L.C.S.W.

Fri, 06 Feb 2015 12:58:18 GMT

Enemies on the Couch. Why is War Endless?

Interview with Vamik Volkan, M.D.

By: Donna Bentolila

Dr. Volkan, psychoanalyst, four time nominee for the Noble Peace Prize, spoke with me in October of 2013 regarding the development of large group identity that results in brutal confrontations amongst groups due to ethnic, religious or political differences.

History shows us that human beings have fought and killed each other since time immemorial. The advance in civilization has not been sufficient to arrest this aggression. The urgent problems faced by our world today lead us to think that this problem will continue to exist, perhaps in an even broader scale, due to the technological advances allowed by science.

Vamik Volkan is particularly schooled in these matters. In his professional career he has dedicated his life as observer, mediator and participant, to the study of ethnic conflicts, civil wars, terrorist attacks, identification with political leaders, and possible ways to intervene with adversarial groups who have long been in conflict with one another.

Dr. Vamik Volkan was born in Cyprus, is Emeritus Professor of Psychiatry of the Virginia School of Medicine, Emeritus training Analyst of the Washington Psychoanalytic Institute, Past President of the International Society of Political Psychology, Member of the Psychoanalytic Society of Virginia, The Turkish North-American Society of Neuropsychiatry and the American College of Psychoanalysts. Dr. Volkan is also the Senior Erik Erikson Scholar at the Erikson Institute of Education and Research of the Austen Riggs Center, Stockbridge, Mass. He has been awarded honorary Doctorates from the University of Kuopio, Finland, and from the University of Ankara in Turkey.

For almost three decades, Dr. Volkan coordinated interdisciplinary teams in multiple problematic areas around the globe. He was able to engage important representatives of “enemy groups” in order to sustain non-official dialogues for long periods of time. His work in this field has allowed him to develop new theories regarding the behaviors of large groups in times of peace and in times of war.

Dr. Volkan was nominated for the Nobel Peace Prize four times, with the support of 27 countries. His wide and fruitful range of publications surpasses well over 40 volumes. His teaching has addressed clinical questions about mourning, psychotherapeutic technique, psychology of large groups – their ”traumas“ and “chosen glories”, the intergenerational transmission of trauma, the psychology of terrorist leaders and an autobiographical narration of his international work, including the founding of the Initiative for an International Dialogue.

“Enemies on the Couch: A Psychopolitical Journey Through War and Peace”, is his new book in which he illustrates how psychological factors affect international relations, and how an interdisciplinary group knowledgeable about those factors can advance and help to establish a peaceful coexistence.

My interest in his work is long standing. In 2005 I had the privilege of meeting him personally and beginning an exchange that has continued to the present. The generosity with which he shares his knowledge is admirable and his amazing international trajectory never takes away from the kindness and simplicity that characterize him.

Interview with Dr. Volkan

1) You are a Training and Supervising Analyst for the American Psychoanalytic Association who has worked in private practice. What led you to become interested in questions beyond the individual and to the dynamics of large groups?

In 1979 the then Egyptian president Anwar Sadat went to Israel. When he addressed the Israeli Knesset he spoke about the existence of a psychological wall between Arabs and Israelis and stated that psychological barriers constitute 70 per cent of all problems between these two people. This statement was a turning point in my professional life. The American Psychiatric Association’s Committee on International Affairs of which I was a member was given the task of examining Sadat’s statement. With the blessings of the Egyptian, Israeli and American governments, my colleagues and I brought influential Egyptians, Israelis, and then later Palestinians together for a series of unofficial negotiations that took place between 1979 and 1986. This is how my psychopolitical journey started.

2) Can you tell us how the Virginia Institute for the Study of International Affairs was founded? What are its aims and framework? How has it developed since its establishment in 1987?

When the Egyptian-Israeli unofficial dialogue series ended in 1987, I opened the Center for the Study of Mind and Human Interaction (CSMHI) at the University of Virginia’s School of Medicine. The CSMHI’s interdisciplinary team (made up of psychoanalysts, former diplomats, political scientists and historians) became involved in bringing together influential Americans and Soviets for a series of dialogues at the time when the Cold War was ending. Later we conducted years-long unofficial diplomatic dialogues between Russians and Estonians, Croats and Bosnian Muslims, Georgians and South Ossetians and Turks and Greeks. Apart from bringing opposing political representatives together for psychoanalytically informed psycho-political dialogues at different locations, we also evaluated the psycho-political environments in societies that had experienced massive traumas. For example, we studied Albania after the death of dictator Enver Hoxha and Kuwait after Saddam Hussein’s forces were removed from that country. I also participated in the former US President Jimmy Carter’s International Negotiation Network (INN) activities in the 1980s and 1990s. This helped me to meet many political leaders in various countries and investigate political leader-followers psychology.

I retired from the University of Virginia in 2002 and the Center for the Study of Mind and Human Interaction was closed three years later. During the last ten years I spent several months each year at the Erikson Institute of Education and Research of Austen Riggs Center in Massachusetts as the Senior Erik Erikson Scholar. In 2008 the Erikson Institute became the administrative home of the International Dialogue Initiative (IDI). Lord John Alderdice,Convenor of the Liberal Democrats in the House of Lords in London and a psychoanalyst, Robi Friedman, a group analyst from Israel and I are co-chairs of the IDI. With the help of two more psychoanalysts from the Austen Riggs Center, Edward Shapiro and Gerard Fromm, we have been bringing influential people from Iran, Israel, Lebanon, West bank, Turkey, Germany, Russia, United Kingdom and United States together twice a year and examining world affairs from different cultural and political views. Meanwhile, for over two years, I was involved in bringing together influential people in Turkey, both Turkish and Kurdish origin, in order to open a dialogue between them and come up with suggestions for the solution for the so-called “Kurdish problem” in Turkey.

I have been involved in international relations for over 30 years. These experiences directed me to begin to develop a large-group psychology in its own right.

3) In your new book “Enemies on the Couch, A Psychopolitical Journey through War and Peace”, you review some of the work that you have done during the last thirty years in war and conflict zones. How has your perspective and thinking evolved in regard to what you refer to as “large group identity”?

I use the term “large group” to refer to tens of thousands or millions of people, most of whom will never know or see each other, and who share a feeling of sameness, a large-group identity. A large-group identity is the end-result of myths and realities of common beginnings, historical continuities, geographical realities, and other shared linguistic, societal, religious, cultural and political factors. In our daily lives we articulate such identities in terms of commonality such as “we are Apaches; we are Lithuanian Jews, we are Kurdish; we are Slav; we are Sunni Muslims; we are communist.” Yet, a simple definition of this abstract concept is not sufficient to explain the power it has to influence political, economic, legal, military and historical initiatives or to induce seemingly irrational resistances to change such initiatives. When our large group is attacked, our large group narcissism is hurt, or we are humiliated as Arabs, as Jews, as Americans—we begin clinging to our large group identity. In certain situations, large group identity becomes much more important than our individual identity. Wars, war-like situations, terrorism, diplomatic efforts, shared losses and gains associated with shared mourning or elation are all carried out in the name of large-group identity. This is true even though this psychological source is usually hidden behind rational real-world considerations—political, economic, legal, and moral.

4) Can you describe what large group psychology is in its own right?

Considering large-group psychology in its own right means making “formulations” as to the unconscious and dynamic aspects of shared psychological experiences and motivations that exist within a large group and that initiate specific social, cultural, political, ideological processes that influence this large group’s internal and external affairs, just as we make formulations about the internal world of our individual patients in order to summarize our understanding of their internal worlds and interpersonal relationships. Let me give an example:

We are very familiar with a person’s externalizing his or her unacceptable self and object images or projecting unacceptable thoughts or affects on another person. This creates a personal bad prejudice. “I am not the one who stinks; my neighbor is the one who stinks!” If we want to understand at least one key aspect of societal prejudice, we will try to describe what happens when a large-group uses externalization and projection. When a large group finds itself asking questions such as “Who are we now?” or “How do we define our large-group identity now?”—usually following a revolution, a war, a humiliating economic trauma, or freedom after a long oppression by “others”—it purifies itself from unwanted elements. Such purifications stand for large-group externalizations and projections. After the Greek struggle for independence Greeks purified their language from all Turkish words. After Latvia gained its independence from the Soviet Union its people wanted to get rid of some 20 dead “Russian” bodies in their national cemetery. After Serbia became independent following the collapse of communism Serbs attempted to purify themselves of Muslim Bosnians and that led to tragedies such as the one in Srebrenica. There are non-dangerous as well as genocidal purifications. Understanding the meaning and psychological necessity of purifications can help to develop strategies to keep shared prejudices within “normal” limits and from becoming destructive.

5) What would you say is the most important factor as to why humans are often led to raise walls that end up separating communities in conflict with one another?

Even in the present globalized world where persons from different large groups live in locations with mixed populations, most of the time the “other” shared by thousands or millions of individuals is still on the opposite side of some kind of physical border: a legal political border of a nation, a geographical border created by nature between tribes or ethnic groups, or a border created by force when an enemy surrounds another large group. When there is no extensive conflict between neighboring large groups, a physical border remains simply a physical border; when there is a conflict, the physical border assumes great psychological meaning as the border separating large-group identities.

As a way of handling the opposing large groups’ anxiety, two basic principles begin to govern the interactions between enemies in acute conflict:

1. Two opposing large groups need to maintain their identities as distinct from each other (principle of non-sameness).

2. Two opposing large groups need to maintain an unambiguous “psychological” border between them.

If a political border exists between the enemies, it becomes highly psychological. The aim of creating a psychological border is due to our wish to keep what one large group externalized and projected onto the “other” from returning to the first large group.

6) What can you tell us about the manner in which the marks of trauma and historical conflicts are transmitted from generation to generation?

Massive societal catastrophes can occur for any number of reasons, including natural or man-made disasters, political oppression, economic collapse, or death of a leader, but tragedies, brutalities and deaths that result from the deliberate actions of other ethnic, national, religious or ideological large groups called “enemies,” must be differentiated from other types of massive shared trauma. This is because they involve severe large-group identity issues. When the “other” who possesses a different large-group identity than the victims humiliates and oppresses a large group, the victimized large-group’s identity is threatened.

When a large group traumatized at the hand of the “other” cannot reverse it’s feelings of helplessness and humiliation, cannot assert itself, cannot effectively go through the work of mourning and cannot complete other psychological journeys, it transfers these unfinished psychological tasks to future generations. All tasks that are handed down contain references to the same historical event, and as decades pass, the shared mental representation of this event links all the individuals in the large group and evolves as a most significant large-group marker (Chosen Trauma). The chosen trauma makes thousands and millions of people designated – "chosen" – to be linked together.

When individuals regress they “go back” and repeat their

childhood ways of dealing with conflicts contaminated with

unconscious fantasies and mental defenses. When a large-group regresses the large-group also goes back and inflames chosen traumas. For example, under Slobodan Milosevic Serbians inflamed the 600-year-old image of the Battle of Kosovo.

When enemy representatives get together for dialogues they become spokespersons for their large groups. When one side feels humiliated they reactivate the images of historical events. For example, while discussing current international affairs, Russians might begin to focus on the Tatar-Mongol invasion or Greeks may refer to the loss of Constantinople; both events occurred centuries ago. When such images of past historical events are reactivated within a large group, a time collapse occurs. Shared perceptions, feelings, and thoughts about a past historical image become intertwined with perceptions, feelings and thoughts about current events. This magnifies the present danger. Unless a way is found to deal with the time collapse routine diplomatic efforts will most likely fail. Today’s extreme Muslim religious fundamentalists have reactivated numerous chosen traumas and glories. We need to study and understand them in order to develop new and hopefully more effective strategies for a peaceful world.

7) If I understand your correctly, you view the ideas that Freud presents in “Mass Psychology and Analysis of the Ego” as lacking and insufficient in that they only address the intra-psychic. What can you say about your contribution to this question? How do your concepts of “large group identity,” “shared glory” and “shared trauma” complement Freud’s ideas in his work on Psychology of the Masses?

Freud was the great discoverer of the hidden aspects of an individual’s mind. He also described some aspects of crowds and large groups. Generally speaking he told us what a large group means for an individual. Large-group psychology in its own right as I defined above is something new.

8) In your book you underline how “the other,” being both enemy and friend, can quickly shift from one position to the other. You also remark how enemies are often alike, physically and psychologically. Can you please tell us more about this phenomenon and dynamic?

If someone shoots at you the danger is real. Enemies are both real and fantasized. Since one large-group externalizes and projects many unwanted things into the enemy the latter’s image includes elements that originally belonged to the first large group. In this sense the two opposing large groups become connected.

9) In your latest book “Enemies on the Couch” you underline the importance of the “Initiative of Interdisciplinary Dialogue” in order to offer models of thinking that can help us to better understand social conflicts. Please tell us more about this idea.

At the Center for the Study of Mind and Human Interaction (CSMHI) we developed the “Tree Model” to tame conflicts between opposing large groups. The application of this methodology takes years----like it takes years to analyze an individual. It has three basic phases:

1-Psychopolitical assessment of the situation (representing the roots of a tree).

2-Psychopolitical dialogues between influential members of opposing groups (representing the trunk of a tree)

3-Collaborative actions and institutions that grow out of the dialogue process (representing the branches of a tree).

In Enemies on the Couch as well as in my several other books I describe this methodology in depth and give illustrations of its application.

10) As a continuation of the last question, can you tell us how the knowledge that you have gained has helped you to create models to assist large communities after they have undergone massive traumas?

After a trauma at the hand of the “other” there are specific societal responses (due to specific circumstances and historical issues) mostly in the service of protecting and maintaining the large-group identity. There are also typical societal responses. For example, the large-group rallies behind the leader. If the leader cannot maintain “basic trust” severe splits and fragmentations occur within the large group; the large group focuses on minor differences between itself and enemy group; large group members experience increased large-group narcissism (it can be masochistic or malignant narcissism), magical thinking (or religious fundamentalism) and reality blurring; the physical border becomes the boundary of the large-group’s identity; the large group engages in behaviors symbolizing “purification;” the personality organization of the political leader becomes a significant factor in societal/political realities and so on.

After a massive trauma at the hands of enemies, or after a period of political oppression by a government the people in the victimized group experience a shared sense of shame, humiliation, and even dehumanization. They cannot be assertive, because expressing direct rage toward the oppressors would threaten their livelihoods and even their lives. Their helpless anger interferes with their mourning over losses that touch every aspect of their lives, ranging from their dignity to their property, relatives or friends. Shared unfinished psychological tasks are then passed on from generation to generation. So guilt experienced by people belonging to the victimizing group may also be involved in transgenerational transmissions.

How to deal with traumatized societies is a vast topic. The facilitating team needs to spend time in the field in order to assess destructive responses and find “entry points” to tame them. In many of my books, including in Enemies on the Couch, I give detailed examples.

11) How did you come to consider yourself professionally as a “political psychologist”? Does this self-designation interweave global and personal perspectives?

I am a psychoanalyst working off the couch in order to understand large group psychology and find ways to tame, when possible, some large-group conflicts. I never called myself a “political psychologist”. But, many persons refer to me using this term.

We should also remember that there is no single theoretical or practical point of view or application of political psychology. Since I am also a psychoanalyst, I tried to examine both, conscious and unconscious motivations of how people with different large-group identities behave in peaceful or in stressful times. Other types of political psychologies depend more on the “logical” evaluations of conflicts and on “logical” solutions.

12) History shows us that humans have been slaughtering each other from time immemorial and that man will continue killing and murdering each other, perhaps in even larger numbers given the technological advances man has achieved. How do you understand the place of aggression in human beings? You seem to think, not without a dose of pessimism, that men will continue to slaughter each other.

There are various psychoanalytic theories on “aggression.” From a practical point of view, the human aggression as expressed in large-groups is here to stay. Psychoanalysts need to evolve a large-group psychology in its own right further if we wish to be effective in having a role in societal and international arenas.

Dr. Volkan, thank you for sharing your thoughts and ideas on this all important subject for both us as psychoanalysts and for all of humanity.

Nota Bene: A Spanish language translation of this interview first appeared in volume 25 of the cultural online Journal Letra Urbana.

Donna E. Bentolila, L.C.S.W. is a Past President (2014) and a board member of the Southeast Florida Association for Psychoanalytic Psychology (SEFAPP). She is a Teaching Analyst at the Florida Psychoanalytic Institute and a member of the American and International Psychoanalytic Associations. She maintains a private in Boca Raton and in Miami.

An Eye for An Eye by Linda B. Sherby, Ph.D., ABPP

Tue, 03 Feb 2015 02:59:51 GMT

An Eye for an Eye

“I’ll never be able to have sex again,” sobs 22 year old Ashley, her face, buried in her hands with her long brown hair falling forwards, her voice barely audible. “I don’t know how I could have been so stupid. I know better. I’m not some dumb freshman, for God’s sake. I know you don’t get drunk at a frat party and go have unprotected sex with some guy you’ve never met before. My life is over!” she wails.

It has been a month since Ashley confirmed that she has herpes. We have been dealing with nothing else since her diagnosis. She is understandably distraught, unable to move beyond the feeling that she has forever ruined her life.

I think about some of the patients who have, over the years, told me about having herpes: The 60 year old woman who felt forever dirtied and punished by God. The session with a man who began by saying he needed to tell me his “secret,” and was then for so evasive, that I became afraid he was going to tell me he had committed murder. The young woman who said she contracted herpes after she had been drugged and raped, only to tell me months later that she had fabricated that story to hide her shame. All tragic stories that forever cast a shadow over the person’s life. And now there is Ashley.

“I can’t believe I’ll never be able to have sex again. I’m only 22. I’ll never get married. Never have children.”

“Ashley, I’m by no means minimizing the pain and difficulty of having herpes, but it doesn’t mean you can’t have sex or get married or have children,” I say, trying to temper Ashley’s overwhelming feelings of despair.

“And risk doing to someone else what that asshole did to me! Never!!”

I think about the anger that almost invariably accompanies contracting herpes: the 60 year old who talked of being punished by God, my fantasy that my male patient might have committed murder, the young woman who fabricated a story of rape. Rage makes its way into the experience one way or another.

“I certainly understand your angry at that guy.”

“Yeah, I’m angry at him. Lot of good that will do me.”

“Well, it’s important that you’re aware of your anger, rather than being scared of it.”

“What are you talking about?”

“You’re angry. You’d love to get back as this guy, but there’s really no way to do that. So you feel powerless and that makes you even more angry.”

“So, yeah, and what does all that mean?”

“You notice, Ashley, that you’re also getting angry with me, which is perfectly all right, but I think it’s an indication of how angry you feel and how easy it is to direct your anger at me or someone else.”

“Sorry.”

“You have nothing to apologize for. It’s just important that we look at what’s happening and try to understand it because I think it’s related to why you think you can never have sex again or get married or have children. I think you’re afraid – not consciously, of course – that your anger would spill over to a new partner, that perhaps you’d want to give him herpes, just as it was given to you.”

“No way” Ashley says, shaking her head emphatically, her hair flying from side to side. “I’d never, ever want to do that to someone else.”

“I know you’d consciously never WANT to harm someone else, but your unconscious desire for revenge is another matter. If you’re afraid of wanting to hurt, you might try to protect others from what you’re afraid is your dangerousness by depriving yourself of the pleasure of sex and marriage and children.”

“But how could I possibly have sex with someone and know I could harm him - especially if you’re saying I want to harm him?”

Although Ashley’s question might sound as though she’s still stuck, I hear some hope for she’s at least considering the possibility of having sex again. I reply, “It’s not that you’d want to harm a new partner, it’s that you might be afraid your anger could be expressed in that way. And the more we can deal with your anger here, the more you know about your anger, the less afraid you would be of expressing it unconsciously.”

Affects and Passions of Our Times: A Conversation with Dr. Lewis Kirshner by Dr. Donna Bentolila

Mon, 19 Jan 2015 23:57:57 GMT

Affects and Passions of Our Times.

A Conversation with Lewis A. Kirshner

By: Donna E. Bentolila

One morning in April of 2013, I spoke with Dr. Kirshner about affects and passions, a topic that investigators and psychoanalysts are re-thinking in light of recent research findings.

Lewis A. Kirshner is a psychiatrist as well as a Training and Supervising Analyst at the Boston Psychoanalytic Institute. He is a long time practicing clinician who is also interested in research. Dr. Kirshner is a former Director of an inpatient Unit of Mt. Auburn’s Hospital and has also worked in the outpatient unit at Harvard Community Health Plan and the Community Mental Health Center at Metropolitan–Beaverbrook. He is the author of Havinga Life, Self-Pathology after Lacan, edited by Routledge University Press in 2004. He is also the editor of Between Winnicott and Lacan, A Clinical Engagement, a book he published in 2011 (Routledge Press). Dr. Kirshner has published numerous articles in the field of psychoanalysis and is a member of both the American and International Psychoanalytic Associations. He has taught and lectured in the United States and in France.

In your book Having a Life, Self-Pathology after Lacan, you dedicate an entire chapter to the subject of affect. Can you tell us how you understand and conceive of affects?

I think that in that chapter I tried to offer a partial view of affect underlying its symbolic construction. I see this subject as a form of communication, based on the inter-subjective dimension of affect. This is a highly complex topic. What I am most interested in with regards to affect is its function as part of an inter-subjective relationship, as an experience that is framed in a social community structured by symbolic patterns. I believe that this is the central idea in my thinking and what I attempted to transmit in that book.

The current advances in the neurosciences offer various answers for many psychological processes which emphasize the predominant role that the brain plays. Do you think that the brain plays the most important role in the constitution of affects in human beings?

I find myself much more in this path now than when I wrote my book. I believe that I have somewhat surpassed my resistances to the advancements of neurosciences and now believe that there is much to learn from this field. The new developments no longer view the brain as a solitary or isolated organ but instead emphasize that the brains many parts and areas all work together and in conjunction. One needs to understand which parts are active in relationship to certain functions.

Today there is a new field within the neurosciences which underscores what they call the “social brain.” That is a central idea today in the cognitive and social neurosciences. These sciences understand the brain as an organ that basically develops as an instrument towards subjectivity, which for me is the same as “intersubjectivity.” I think that this model is transforming into something really important; there is therefore more interest today in the affective tools which infants have at their disposals, which at the onset are manifestations of a discharge of energy.

At the beginning of life these “tools” are very primitive with regards to the level of the functioning of the brain; they are, however, an important base for what we call affects. Whether one refers to these primitive phenomena as emotions or as early signs of either emotional or affective states, or even as a type of phenomena of discharge, we can notice that they are different. One wonders how many types of affects are at our disposal, some believe in the existence of up to nine: fear, pleasure, joy, fury, disgust, repulsion, etc. These types of signs are very primitive and can be recognized from very early on. Affect, however, requires that they be subjectified, so that one can recognize it oneself and be able to be enter and participate in a human system of exchange.

Then we need the recognition of a human other who is meaningful to us…

Yes of course. The recognition of the other is crucial and the other is also absolutely necessary for our developmental growth.

In this cultural understanding of affect that you propose, what relationship do you find between the body and affect, indeed between affect and language?

Well, like we were just saying all these phenomena refer to very early types of interactions, where certain affects receive a certain type of specific responses that produce an internalization of certain sequences. For example, there are certain affects that may or may not be accepted by the mother, or that she ignores or fails to respond to; this leads to very early distortions in human development. Therefore, from a strictly developmental perspective, where important research and experimentation is currently taking place, the question for us as psychoanalysts, which also coincides with the development that is taking place in the neurosciences, is that development does not occur simply from the “inside to the outside.”

It is also not the case of an unfolding of a genetic “potential”; rather, it is the case, and this we need to realize since it is of utmost importance, that development is the result of a process of interaction, where the role of the other is crucial. What most counts in all this, to be sure, is the role of the mother, as well as an entire set of small others who belong to her environment.

The human other, the others who are meaningful, are all crucial in the constitution of affect. But going back to the relationship affect- body, you were telling us that you located it in those very early signs that are expressed in a bodily experience (joy, fear, disgust, etc.) which must become part of a process of subjectification so that they can be recognized and receive a name that allows them to be represented in our consciousness.

Yes, Freud himself had already referred to these very primitive affects in “An Outline of Psychoanalysis.” This is Freud’s great and final last paper. Andre Green refers to this in some part of his work. Both authors suggest that hysterical attacks involve the discharges of affects related to the precocious sexual experiences of the child. Hysterical attacks are understood in this way, that is to say, as a memory that lives in the body and is acted-out and re-lived. In that paper, Freud states that affects are memories of early experiences, of phylogenetic experiences.

When Freud speaks of phylogenetic experiences he may mean that these types of affective responses, prior to birth, are like residues that we carry in ourselves of generations and ancestors who have come before us. This is a use which Freud makes of Lamarckian theory. Green also addresses this issue. He claims that the child’s very early experiences in relationship to his mother concern the body and that these experiences are the most powerful affective reactions. The baby experiences an affective excitation, whether in the form of fear, pleasure, or anger.

Lacan, for his part, refers to the experience of jubilation which the baby experiences in regards to his own image in the mirror, and for sure he takes into account anxiety. We can find in Lacan’s work references to this theory of affect, as in Freud, but in my view Green is the author who most develops this topic. He does so when he makes reference to these primitive affects as not yet mentalized, as not yet symbolized or represented, as if they are still in a certain animal level or state.

The other author who has worked on this topic and whom I quote in my book is Sylvan Tomkins. He is a pioneer with regards to these primitive affects and made this topic the center of his theory around human development. The group of analysts from Boston has been very interested in the topic of affect and they have taken it as an example of how we acquire relational knowledge and implicit knowledge. Personally, I don’t follow that direction so much.

Could you describe for us the affects that you distinguish in human beings? And how do you understand the process by which each subject receives the affective traits with which he or she responds and navigates the world?

I believe that this was the central point in my chapter on affect in my book. There are cultural scenarios that offer patterns regarding the appropriate affective responses in relationship to certain situations, and how these must be interpreted. I focused more on an anthropological perspective. I could think of a myriad of examples where there are obvious cultural differences regarding how one must feel or how one should express one’s affects. The simple fact of maintaining a conversation with someone from another culture, even if it is very similar to ours, leads one to feel a bit outside and to lose some codes, including the way of saying hello to someone.

The example I use in my book is that of an anthropologist who converses with a community that is very different from hers and uses the personal pronoun “I” instead of “us”; her doing so ends up hurting the feelings of the group. That is something that is really taboo in that community. The members of the group felt that she was self-centered but what happened was that she had simply used the wrong pronoun.

Not long ago I was talking with a colleague who supervises with me in a research study that we are doing on psychosis and we were reflecting about the elements that must be present so that a normal social interaction can occur. It is as if there was a script to follow and when it fails one becomes aware that there is something one is not doing correctly.

This reminds me of a term from the neurosciences: “prediction error.” These are two nouns in the neurosciences. Some are saying that consciousness is related to a “prediction error”. We start an action, and we are not necessarily conscious about it until something doesn’t work right, until something fails. And it is at this point that we become conscious. This is a theory where one suddenly becomes conscious of what one was trying to do and leads one to make a conscious effort to monitor the process of what one was doing.

I think we can say the same about affect. We become conscious of what we feel when something fails in the process of affective exchange. I think that this idea from the neurosciences is very interesting.

Some people experience intense anxiety or they are very impulsive. Could you explain to us how you understand the relationship between affect, the urgency of the drive, and the satisfaction of the drive?

This subject is probably the weakest part of what I have to say. At least in the way I understand what Lacan says about the drives, is that in the last instance the object of all these drives is the mother, they attempt to reach the mother, but fail. The subject simply receives something of her, a piece or a partial object. This seems to me to be Lacan’s original idea regarding the drives, namely, that they attempt to re-create a part of some original experience with the mother.

This would also be compatible with Green’s ideas, as a sort of motivational force, but for him Lacan leaves out the affect that associates with the drive and that is what Green underscores and highlights. I believe that in Seminar XVII Lacan mentions that someone is about to publish on the question of affect and that this person misunderstood him, that he doesn’t know anything. I think he was referring to Green. It would have helped if both ideas ( Lacan’s and Green’s ) about affect could have been clarified.

You know, Green was very sensitive to the ways in which these primitive affects were excitable and pleasurable, but also about the fact that they are excessive or overly painful. And I think that Lacan also takes this question into consideration with his concept of jouissance. This is something that only the psychoanalysts can contribute to, this particular question around the role of this sort of primary driving search of jouissance.

We know all too well that intense emotional experiences can be both pleasurable and painful and that they provoke fear and de-center or destabilize the human subject. And because all this relates to impulsivity, I don’t know, it would seem that they are at different levels. It appears to me to be a discharge phenomenon.

But wouldn’t you say that someone feels or is impulsive when they are experiencing a high level of anxiety?

Yes, it is true, since one of the ways to deal with intense anxiety is through impulsive acts so that it can be discharged; but I don’t know if it is the only source of impulsivity. It certainly is one of them. We also have the question of how we learn to deal with our desires. Children are generally very impulsive and careless, but that is normal at their age. Nonetheless, they have to develop a way to mediate their impulses. This is an area of great interest.

What is your idea in relationship to the contemporary approaches of emotions that underline the preeminence of neuroplasticity?

Well, this connects with what we discussed previously. We know about the plasticity of the development of the brain and that it doesn’t follow a purely innate path. It does follow an innate path in a way, but it is molded and requires exposure to a human other, to human voices, so that the brain can develop.

The most obvious example is that one needs to listen to language; one needs to hear the phonemes in order to receive language. The visual cortex, for example, needs to receive visual information to organize itself and develop and I think that the visual image of the other is crucial in order to be able to organize the human face, even if there might be a certain predetermined potentiality. But in order to really recognize the face of the other, this must relate to a visual exposure.

The same happens with smell and with a variety of networks of neuroplasticity that are at stake in order to enhance and move development forward. These are the advances of the neurosciences of the last 20 years, but the idea that the networks of neuroplasticity that underline the brain in some sense respond greatly to the experience or encounter with the human other is a fairly recent finding.

If we follow Lacan’s position of underscoring the preeminence of the symbolic, the preeminence of the Other in the birth of subjectivity, couldn’t we say that even if the human infant has a certain innate capacity, without the Other’s support, without the Other’s loving offer, or without the provision offered by the Other, in the manner that Winnicott understands it, the human infant would simply not be able to develop?

Yes, that is a just word “support”, the support of the other, and the idea of the mirror neurons. Someone presented this theme for us this past week in Boston and told us that, in reality, the brain itself is a mirror system, not just some neurons, and that the brain has developed throughout evolution so as to function within a social frame. And this has to do with the unconscious theme of listening to the voice of the Other; we are listening to these voices all the time and they really change us, even if we are not present. These messages about us truly arrive to mark us.

We were mentioning that throughout the second part of the 20th Century, Andre Green wrote psychoanalytic studies of important value regarding the question of affect. What else can you add about the contributions of Dr. Green?

Green is an author that I value deeply. I don’t believe him to be the most elegant in his style; sometimes he is a bit arrogant, for example in his book “The Living Discourse”, where he writes about affects and passions. Yet, I believe that this is one of his best works. Green has tried to synthesize and to present a teaching; he has tried to organize this theme and to see if a consistent model could be developed. I think that Lacan was not interested in this work; for him this brought about the risk of concretizing things more than what he aspired to. Maybe it is a question of personality styles, of someone who is more of a hysteric rather than someone who is more of an obsessive. I don’t know.

What we can say is that Green really offers us a very broad and profound reading of the question of affects, particularly in The Living Discourse, which is truly a revision of everything which has been thought around this particular topic, in Freud and beyond Freud. He also makes reference to Lacan in this book and really argues with him there, whereas in other books such as “Private Madness” he is no longer as interested in Lacan. I believe that his contribution to this topic and question is really important and that he is very rigorous in his research.

Are emotions and passions the same? Which would you say are the emotions and passions more characteristic of the times that we live in?

I was thinking in the question of religious passion, like in the case of the passion of Christ. Green speaks about this and also about saints.

Lacan does as well. He claims that analysts occupy the position of saints…

And then, what type of passion is that? Would Lacan say that it is a masochistic passion? I don’t know, is it that we as analysts accept all the suffering? I don’t know … And would ask myself what the object of a passion such as that might be. It does seem different to me to other passions that motivate people, including the great amorous passions; this seems to me really different from the passion of the saints, but maybe the similarity resides in the common amount of suffering that they each carry.

Green refers to passion as a residue of infantile experience, of the intensity of that experience, of an experience which the infant can barely tolerate because it reaches a limit which can de-subjectify, dissolve or annihilate the child. Green speaks about such cases as a question of energy, of discharge phenomena, so perhaps we could claim that passions are more on the side of the quantitative aspects of the drive and that emotions, as affects, might be the part that is more evolved, more developed and socialized of the drives.

What about the passion of hating?

Yes, hatred as a negative passion. We can also find ourselves with the passion to collect, to acquire, to build, to paint, the mania. In France they call it “la petite manie.” Maybe this is at the heart of this question, that we all have our petite manie, our “private madness”. For Green, passion is more closely related to madness, and he understands madness as a passion that exceeds the limits of containment.

I think about the need that Don Quijote had to have a companion like Sancho Panza, who had to be with him all the time. I think he needed Sancho Panza to calm and soothe him, he had his passions and he needed Sancho to help him modulate them, in order to insure that they would not exceed a certain limit.

Yes, that is really interesting. Well, like Freud says regarding the progress of culture, it has more to do with our capacity of emptying out our passions in order to put them to work.

Anything more regarding the passions of the times we live? You have referred to the religious passion and we could say that such passions have indeed resurfaced in our times and have returned with great vigor and strength.

I an interview I recently gave for French television they asked me what was the life theme most important in Boston. I answered: “Work”. The people of Boston work all the time. Boston is a city of workaholics. As I remember in Civilization and its Discontents work is central in American society. Maybe religious passion is a reaction against rationalization, globalization and programmation. I don’t know, it’s an interesting question. The passion for control is also important, to control life, what exceeds us, like the fear of death, the fear of existence, the fear of a lack of meaning. We try to feel that life has a meaning and that we can somehow control it. Well, here we are.

Dr Kirshner, thank you for sharing your thoughts and ideas on this all important subject for us psychoanalysts.

Nota Bene: A Spanish language translation of this interview first appeared in volume 24 of the cultural online journal Letra Urbana.

Donna E. Bentolila L.C.S.W. is a past President (2014) and a board member of The Southeast Florida Association for Psychoanalytic Psychology (SEFFAP). She is a Teaching Analyst at the Florida Psychoanalytic Institute and a member of the American and International Psychoanalytic Associations. She maintains a private practice in Boca Raton and Miami.