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  • 04/13/2018 3:24 PM | Anonymous

    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 …?”


    “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 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.”

  • 03/26/2018 5:47 PM | Anonymous

    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, 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.”

  • 03/06/2018 5:07 PM | Anonymous

    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.”


    “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.”

  • 02/21/2018 2:33 PM | Anonymous
    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.”

  • 01/22/2018 6:30 PM | Anonymous

    "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 …”


    “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.”


    “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.”

  • 01/09/2018 3:44 PM | Anonymous

    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.”  

  • 11/16/2017 8:00 AM | Anonymous

    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?”


    “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.”

  • 10/27/2017 2:59 PM | Anonymous

    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.

  • 10/19/2017 5:27 PM | Anonymous

    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.


    “You want me to answer your question.”


    “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 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.”

  • 09/18/2017 3:45 PM | Anonymous

    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?”


    “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.”

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