Blogs

“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.”

“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.”

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.”   

“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.”

“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.”

“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.”

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.”

“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.”

“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.

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.”