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.”
