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In this weeks blog, "The Consultation," a patient presents herself as an angry, contemptuous woman, hiding the sad, damaged child underneath.

Rebecca Whitman rises from the waiting room chair extending her hand to greet me. She is dressed in a pale lavender suit and matching high heeled shoes which are surprisingly flattering with her flowing dyed red hair. I wonder at her age. Mid-forties? Hard to know how much plastic surgery she’s had.

“This is a consultation, right?” she begins immediately . “I’ve had lots of them. You get to decide if you want to work with me and – never to be forgotten - I get to decide if I want to work with you. So what do you want to know?”

Feeling as though she has just thrown out her opening salvo, I say, “That’s quite a beginning.”

She sighs. “I believe in getting to the point. Why waste time. It is my money after all.”

“Do you want to be here, Ms. Whitman?” I ask, noticing that I have automatically called her by her last name.

“Why do you ask?”

“Well, we’ve never met before and yet it feels to me that you’re already angry with me. That doesn’t make much sense unless you’re angry at being here.”

“I’m always angry. I’m angry at being here. I’m angry that I have to pay you to listen to me. I’m angry that I’ve seen I don’t know how many therapists. I’m angry they’ve either thrown me out or been completely incompetent or both. I’m angry that even though I’m one of the best real estate agents in the area, I eventually get shown the door. No biggie, I’m good enough I always find another agency. I’m angry that I’ve had three failed marriages and heaven knows how many other relationships that failed. Any questions?”

I feel torn. A part of me wants to join all the others who have gone before me and stop this consultation immediately.  But another part, perhaps the grandiose part, wants to give it a shot. I do know if I’m going to try, I want to do something other than taking her anger on directly. 

“What would you be feeling if you weren’t feeling all that anger?” I ask.

She laughs. “I’ve heard that one many times before. You think a simple question is going to have me dissolve into tears. You’re going to have to do better than that.”

So much for not taking her anger on directly. “Do you like being angry? Do you like losing jobs and relationships and therapists? And why are you here? What do you want to accomplish?”

“Better,” she says.

I feel myself getting angry at her constant evaluation of me. I keep silent.  

The silence persists.

“I guess you want me to answer your questions.” Pause. “Ok, Ok, I’ll answer the questions. Sometimes I like being angry and sometimes I don’t. And, no, of course I don’t like losing job or relationships.” Pause. “I’m not sure why I’m here. I guess I’m hoping someone doesn’t throw me out.”

Her last statement sounds so sad that I find myself fighting back tears. 

“Someone I can have respect for, that is,” she adds with her typical bravado. 

My sadness shuts down immediately. Rebecca Whitman has told me a lot about her defensive need for anger.

“If I ask you who was the most significant person in your life who threw you out, who would you say?”

She shrugs, “My mother.”

“Ok, Rebecca, so I do think you’re afraid if you let down your anger you’d be left with lots and lots of tears, tears of loss, abandonment, worthlessness and, of course, rage.”

“Think you’re smart, huh?”

“Rebecca this isn’t a contest. I’m not here to beat you in a competition. I’m on your side. And I know you can’t simply put away your defensive angry. It’s been a part of you for a long time. But hopefully if you come to trust me, you can let it down little by little and together we can deal with the pain underneath.”

“Ok smarty-pants, guess why my mother threw me out.”

“There’s no way I could guess that, but I’d appreciate your telling me.”

“Because I told her my step-father – step-father number three, by the way – was doing it to me.”

“Oh, Rebecca, I’m so sorry.”

“Yeah? Yeah? What the fuck good is your pity going to do for me? I was eleven years old. Eleven years old for God’s sake!”

“That’s more than reason enough to be angry. But you must also feel sorry for you as that eleven year old child.” 

“I don’t believe in a pity party!”

“Compassion for a child is not a pity party.”

“So are you going to work with me?”

“Yes, Rebecca, I’m going to work with you. I’m not going to throw you out.”

“Ok,” Rebecca says as she sprints towards the door.

A therapist is confronted with a new patient who she suspects is fabricating her story. The therapist wants to know if she is indeed lying and, if so, why.

Maxine sits comfortably in my chair, runs her hand through her curly brown hair and begins. “I came to therapy because I keep having fantasies about killing my daughter.”

Oh oh, I think, remaining silent and neutral. Maxine seems a bit taken aback by my silence. What she doesn’t know is that I am immediately on guard, unsure if I am about to hear a story that is truly every therapist’s nightmare, or one that is completely fabricated. A colleague told me she saw a new patient who told her a similar story and then admitted it was only a test for the therapist.

“I don’t know why I’m having these fantasies,” Maxine continues. “I love my daughter. We’ve always been close.”   

Not wanting to accuse a truly troubled person of lying, I decide to go along and see what develops. Of course, a woman who goes from therapist to therapist fabricating a story, must be pretty troubled as well. “What’s your guess?” I ask. “Why do you think you have been having these fantasies? How long have you been having them?”

Maxine sits comfortably in my chair, runs her hand through her curly brown hair and begins. “I came to therapy because I keep having fantasies about killing my daughter.”

Oh oh, I think, remaining silent and neutral. Maxine seems a bit taken aback by my silence. What she doesn’t know is that I am immediately on guard, unsure if I am about to hear a story that is truly every therapist’s nightmare, or one that is completely fabricated. A colleague told me she saw a new patient who told her a similar story and then admitted it was only a test for the therapist.

“I don’t know why I’m having these fantasies,” Maxine continues. “I love my daughter. We’ve always been close.”   

Not wanting to accuse a truly troubled person of lying, I decide to go along and see what develops. Of course, a woman who goes from therapist to therapist fabricating a story, must be pretty troubled as well. “What’s your guess?” I ask. “Why do you think you have been having these fantasies? How long have you been having them?”

“It was right after Barbara’s – that’s my daughter – right after her thirteenth birthday, about six months ago. I don’t know why I’m having the fantasies. If I knew I wouldn’t have come here. What do you think?”

I think this is a sham, but I’m still reluctant to confront Maxine.

“It’s pretty hard for me to have any idea since I know next to nothing about you.”

Maxine sighs, seeming exasperated.

I’m rather annoyed myself, but try to return to my more neutral tone. “Can you tell me about you?  What’s your present life like? Married? Other children? Working? And what was it like for you growing up?”

“I’m a stay at home Mom. My husband is an entrepreneur. He travels a lot. I was thinking I should probably go back to work. With Barbara growing up there’s not that much for me to do.”

“What are your feelings about Barbara growing up.”

“Mixed. I’d like my little girl back and I’m looking forward to seeing where my life takes me.”

“Where do you want it to take you?”

“I’m not sure yet. I think that’s one of the reasons I feel so dissatisfied with myself.”

I find myself liking Maxine more, yet feel entirely confused about what’s going on in the session or what’s real and what isn’t. I decide to take the plunge.

“Maxine, what of what you’ve told me today is true and what isn’t?”

“You figured it out! You’re the first one. Oh good, now you can be my therapist.”

“I had a rather big clue. One of my colleagues told me she’d seen a patient who told her a pretty similar story and that it was supposed to be a test for the therapist.”

“Oh! What a disappointment. Now I can’t tell if you’re really smart or not.”

“Maxine, you must by now know from therapists’ reactions that it’s quite insulting and infuriating to be tested by a series of lies. But I’d like to know the underlying reason you found it necessary to go through this charade.”

“I didn’t think I could trust someone who wasn’t smart enough to figure me out.”

“Well, I’d guess that you definitely feel you can’t trust people and I’d also guess that you see yourself as very troubled and in need of someone who can not only understand you but handle you as well.”

“You are smart. You can be my therapist.”

“But this is a two way contract. There’s the question of whether I feel I’m up to being your therapist.”

“Please, please, I’ll be good.”

“You sound like a scared little girl when you say that.”

Maxine starts to cry.

“Maxine, I know this is unusual for a first session, but this has been an unusual first session anyway. I want you to tell me what the secret is.”

“No, no, I can’t. Not yet.”

“I’m sorry. That’s my condition for us starting therapy. And if you tell me another lie you’ll only be hurting yourself. There’s something you’re terribly afraid of or guilty about, something you need to start dealing with even though you want to keep it hidden.”

“I killed my sister.”

“Is that another lie?”

“No, no, it isn’t. I wish it were. I didn’t do it deliberately.” Maxine’s next words are flat, expressionless. She stares straight ahead. “A group of us were playing soft ball. I was at bat. I swung. I lost control of the bat. It hit my sister in the head. She died. My parents sent me away.”

“I’m so sorry, Maxine. What a horrible accident. How traumatic. And then to be sent away on top of it. I’m really, really sorry.”

“So you’ll be my therapist?”

“Yes,” I say, although I realize that it will take me some time to totally trust what Maxine tells me.  Hmm, I think, Maxine has led me to feel the distrust she feels in the world.  

“It was right after Barbara’s – that’s my daughter – right after her thirteenth birthday, about six months ago. I don’t know why I’m having the fantasies. If I knew I wouldn’t have come here. What do you think?”

I think this is a sham, but I’m still reluctant to confront Maxine.

“It’s pretty hard for me to have any idea since I know next to nothing about you.”

Maxine sighs, seeming exasperated.

I’m rather annoyed myself, but try to return to my more neutral tone. “Can you tell me about you?  What’s your present life like? Married? Other children? Working? And what was it like for you growing up?”

“I’m a stay at home Mom. My husband is an entrepreneur. He travels a lot. I was thinking I should probably go back to work. With Barbara growing up there’s not that much for me to do.”

“What are your feelings about Barbara growing up.”

“Mixed. I’d like my little girl back and I’m looking forward to seeing where my life takes me.”

“Where do you want it to take you?”

“I’m not sure yet. I think that’s one of the reasons I feel so dissatisfied with myself.”

I find myself liking Maxine more, yet feel entirely confused about what’s going on in the session or what’s real and what isn’t. I decide to take the plunge.

“Maxine, what of what you’ve told me today is true and what isn’t?”

“You figured it out! You’re the first one. Oh good, now you can be my therapist.”

“I had a rather big clue. One of my colleagues told me she’d seen a patient who told her a pretty similar story and that it was supposed to be a test for the therapist.”

“Oh! What a disappointment. Now I can’t tell if you’re really smart or not.”

“Maxine, you must by now know from therapists’ reactions that it’s quite insulting and infuriating to be tested by a series of lies. But I’d like to know the underlying reason you found it necessary to go through this charade.”

“I didn’t think I could trust someone who wasn’t smart enough to figure me out.”

“Well, I’d guess that you definitely feel you can’t trust people and I’d also guess that you see yourself as very troubled and in need of someone who can not only understand you but handle you as well.”

“You are smart. You can be my therapist.”

“But this is a two way contract. There’s the question of whether I feel I’m up to being your therapist.”

“Please, please, I’ll be good.”

“You sound like a scared little girl when you say that.”

Maxine starts to cry.

“Maxine, I know this is unusual for a first session, but this has been an unusual first session anyway. I want you to tell me what the secret is.”

“No, no, I can’t. Not yet.”

“I’m sorry. That’s my condition for us starting therapy. And if you tell me another lie you’ll only be hurting yourself. There’s something you’re terribly afraid of or guilty about, something you need to start dealing with even though you want to keep it hidden.”

“I killed my sister.”

“Is that another lie?”

“No, no, it isn’t. I wish it were. I didn’t do it deliberately.” Maxine’s next words are flat, expressionless. She stares straight ahead. “A group of us were playing soft ball. I was at bat. I swung. I lost control of the bat. It hit my sister in the head. She died. My parents sent me away.”

“I’m so sorry, Maxine. What a horrible accident. How traumatic. And then to be sent away on top of it. I’m really, really sorry.”

“So you’ll be my therapist?”

“Yes,” I say, although I realize that it will take me some time to totally trust what Maxine tells me.  Hmm, I think, Maxine has led me to feel the distrust she feels in the world.  

This week's blog deals with the difficult issue of love in the consulting room and how it can be dealt with appropriately with the patient's best interest in mind, or inappropriately creating long lasting damage.

“I love you,” Melanie says, looking downward.

Twenty-five year old Melanie has been my patient for two years, a lovely young woman struggling with anxiety and depression.  One of six children raised on a farm by parents who saw their offspring as laborers, rather than cherished beings, Melanie has come to rely on me as one of the few people who is consistently in her corner. Professing her love for me doesn’t take me by surprise.

“Thank you, Melanie,” I say, “that’s a lovely gift.”

“No,” she replies. “It’s much more complicated.”

I wait, unsure what she means.

“I said that to my last therapist,” she says hesitantly. “You know, I’ve talked to you about Dr. Hopkins. I saw him for a couple of years before you.”

I nod.

“But I never told you what happened, why I left.” She pauses. “We had an affair.”

I’m shocked. Not that I’ve never heard of therapists inappropriately crossing sexual boundaries, but I’m surprised Melanie never told me something of such significance.

“I’m so sorry, Melanie. How come you never told me before?”

“I was too ashamed.”

The victim blaming herself. Not unusual I think to myself. “Do you realize that Dr. Hopkins abused you?”

“No. It wasn’t like that,” she protests. “I told you, I loved him. And he loved me back. That was the most wonderful surprise of my life. Someone I so looked up to and admired actually loved me!”

“Melanie, how did your therapy with Dr. Hopkins end?”

“Well, for a while we saw each on the outside and I continued to have my regular therapy sessions. Dr. Hopkins was very clear that we couldn’t do anything sexual in the office, that we had to remain professional during our sessions.”

I am beyond furious at this so-called therapist, but hope that I am successful at concealing my feelings.

“But then Dr. Hopkins told me he didn’t think I needed therapy anymore. So I quit and just saw him on the outside.”

Still seething, I wonder if Dr. Hopkins thought his prowess as a lover had “cured” Melanie or whether he just found it too difficult to keeps his hands off her during their sessions.

“But then one day,” she continues, “he said that we couldn’t see each other anymore. He told me his wife was sick and that he felt too guilty being with me. I was devastated. I mean, I knew he was married. I knew it wasn’t like we’d be together forever and ever. But I loved him so much. And I thought he loved me. So how could he just walk away?”

“When you say you thought he loved you, are you now questioning that?”

Melanie starts to cry. “I was a fool. I know I was a fool. Did I really think a smart, educated man more than twice my age would be in love with me? He wanted my body. But I just wanted so much for him to love me, that I deluded myself into thinking he did. That’s what I’m ashamed of, being such a fool.”

“There’s an awful lot to deal with here, Melanie, and I’m sure we’ll return to this many times, but I want to come back to us before the session ends. So what did it mean to you to tell me you loved me? And what response did you hope for – or fear?”

“I’m not sure. I know I don’t want to sleep with you, but I do want you to love me. I guess I want to crawl into your lap and have you stroke my hair and tell me you love me, just as you’d tell your own daughter. Is that wrong?”

“No, Melanie, what you wish for can never be wrong. But acting on that wish is different. You wanted Dr. Hopkins to love you, which really meant you wanted him to care about you, to cherish you and to act in your best interest, not his. He did abuse you, Melanie. He took advantage of your need, of your vulnerability and crossed what should have been an unbreakable boundary. As for us, the wish to crawl into my lap and be my daughter is a more than understandable wish for someone who was so neglected as a child. But if I were to act on that wish I would not be acting in your best interest, because I would be giving you the false hope that you can go back to being a child and get from me what you couldn’t get from either of your parents.”

“That makes me sad.”

“I’m sure it does. Mourning what you never got and never can get, is always sad.”

It’s been a year since my wife died,” Andrew    Solomon begins. “She died of breast cancer. It    was a long process. Hard. She fought for as long    as she could, but she had an aggressive cancer.    She couldn’t beat it. Now, now I have the rest of    my life. I’m 65. I guess people consider that young  these days,” he adds with a slight smile. “I’m still working, thank goodness. It’s a great distraction. I’m an accountant. I have my own business so can pretty much make my own hours, except during tax season. But I cut down on my clients during my wife’s illness, so I do have more time on my hands.”

Mr. Solomon is a good looking man with wavy white hair, intense brown eyes and a slight dimple in his chin. I wonder what has brought him into therapy at this point, but wait to see where his thoughts take us.

He continues. “My friends tell me it’s time for me to start dating. That I’m young, secure financially, decent looking and that I’ll have women, younger women, flocking all over me. Maybe. But I don’t know. I don’t know that I feel ready.”

“How do you feel about your wife’s death?” I ask.

“Sad. Like there’s this big hole in my life. Don’t get me wrong, Bella – that’s her name, that was her name, hard for me to talk about her in the past tense – Bella and I didn’t have a perfect marriage. We had our fights. And I wasn’t always the ideal husband, especially when our kids were young. I had a couple of affairs. Never felt right about that. We got lots closer after our kids left. And actually we got even closer when she got sick. I guess I realized how much I was going to lose…” He trails off fighting back tears.  

“Sounds like you’re still understandably very sad.”

“But shouldn’t I be better after a year?”

“What do you mean by better?”

“Better, less sad, not so teary, ready to move on. Finished with grieving.”

“Grieving the loss of a loved one is not something we ever finish.”

Mr. Solomon looks startled. “No that can’t be. I can’t stay at this level of pain forever.”

“It’s not that grief doesn’t diminish that, as you said, the level of pain remains as intense, but we certainly don’t stop loving or missing the person we’ve lost.”

“But does that mean I shouldn’t start dating? Maybe I should start dating, maybe that would help with the pain.”

“That’s certainly not a decision anyone but you can make. Some people start dating soon after their partner has died, others wait years, and still others never date at all. There’s not one right answer for everyone.”

“I had a friend who got involved with the woman who eventually became his second wife, a month after his wife died. I thought that was awful. I lost respect for him.”

I flash on what Mr. Solomon said about having affairs earlier in his marriage and wonder if guilt plays into his question about whether or not to start dating. “How would you feel about yourself if you decided to start dating?”

“Bella told me it would be all right with her. I thought that was an amazing gift she gave me, especially since she knew about the affairs, or at least one of them.”

“Sounds like you still feel guilty about your affairs.”

“Yes, yes I do. I know it’s silly. It’s so many years ago. But especially when Bella got sick, I kept thinking how horrible I had been to her. How could I have even looked at another woman when I had Bella this amazingly strong, brave, good, beautiful woman?”

“You know, Mr. Solomon…”

“Please, call me Andrew.”

“You know, Andrew, I wonder if your guilt about those affairs very much affects you in the present, both in terms of how you feel about Bella’s death and also about whether you feel comfortable dating.”

“Why should that be?”

“Well, our pasts always affect the present and we haven’t even talked about your past before Bella – your childhood, your young adulthood. I suspect that guilt may have played a role in your life then as well. And we haven’t talked about why you think you had those affairs. Were you angry with Bella? Were you angry with her attention to your children?”

“Wow! I guess there is a lot there. I thought I was going to come in today, solve the problem of whether or not I should start dating and that would be that.”

I smile. “Therapy is way more complicated than that. It opens lots of questions before you’re able to answer even one.”

 

 

 

An adopted patient again struggles with her feelings about her therapist not being her mother.

“I’ve decided to really start looking for my biological mother,” Liz says at the beginning of our session.

I have seen 27 year old Liz for a tumultuous five years, and although she has brought up trying to find her biological mother on previous occasions, today she does sound more determined.

“Did something happen that reawakened your desire to find your biological mother?” I ask.

She shrugs. “I’ve talked about it before. I just think it’s time. I know you don’t think it’s a good idea, but I want to know who she is.”

“It’s not that I think it’s a bad idea, I just want you to be prepared if the reunion with your biological mother doesn’t prove as idyllic as you hope.” I think of all the adopted people I have known – both patients and friends – who have found their biological mother only to be horribly disappointed yet again, people who have been outright rejected, others whose mother wanted to take over their lives, still others who wanted to be financially supported. Finding the perfect fantasized mother is rarely the outcome.

“What choice do I have?” she asks.

There’s a familiar edge to Liz’ voice, an underlying anger, an underlying demand. I look at her quizzically and remain silent.

“Don’t play dumb,” she says. I now definitely know that something is going on between us. “I have no mother. My so-called mother doesn’t give a shit about me. She was just thrilled when I finally moved out of the house so she could start redecorating and have my father all to herself. And then there’s you. You’re just never going to be more than my therapist. If I even move slightly towards wanting more from you, you run for the hills.”

This is a familiar refrain, one that has played out repeatedly over the time we have worked together. From the beginning, Liz wanted me to be her mother. She had fantasies of moving in with me, fantasies of traveling with me, fantasies of curling up next to me on a couch and watching a movie. Sometimes she presented these as poignant longings, at other times she lashed out at me in rage, furious at my refusal to satisfy her desire. I cared deeply about Liz, understood her longing and was able to hang in there with her during even the most difficult times. I think back on our last session and suddenly realize what has led Liz to experience me as pulling back and wanting to search for a more perfect mother.

“You were angry that I didn’t want you to take my picture,” I say.

“I don’t see what the big deal was. It was only a stupid picture! Everybody takes pictures these days, pictures of dogs, pictures of signs, pictures of themselves. So what was the big deal with taking your picture?”

“You tell me, Liz. What was the big deal about taking my picture? Obviously you have a lot of feelings about my asking you not to take my picture.”

“Yeah and you gave me some mumbo, jumbo about my needing to take you in and have a picture of you in my mind without needing to have an actual picture. So? I can do that. I have you in my mind. We worked on that for a long time and now I can do it.”

“That’s great, Liz. So the question remains, then why did you want an actual picture?”

Liz looks angry and then seems to deflate in front of my eyes. She sighs deeply and looks down at her hands. “I guess because people always have pictures of their family,” she says quietly.

“I know it’s very hard for you, Liz,” I say with compassion, “But the reality is that I will never be your mother. That doesn’t mean I don’t care about you, it doesn’t mean that I won’t be here for you, it doesn’t mean you’re not important to me, but it does mean that however much you may want it, I will never be your mother.”

“I hate when you say that,” Liz says, more sadly, than angrily.

“I know,” I reply.

“Can we still talk about my looking for my biological mother?”

“Of course. But as much as possible, you need to try and separate your wish to find your biological mother from your wish that I was your mother. And, as I’ve said, you also need to be prepared to be disappointed in your biological mother as well.”

“I hate when you say that, too.”

“I know.”    

A situation in which a therapist begins working with a twin who is used to being devalued in her family.

Bethany squirms uncomfortably in the chair across from me. She’s a slender, attractive woman, her blonde hair pulled back into a pony tail accentuating her high cheek bones and large blue eyes. I’d guess her to be in her late twenties to early thirties.

“It’s hard to start,” she says. “I guess that’s because I feel guilty. My sister, Heather just got engaged. He’s a great guy. An attorney, sweet, caring. He’s crazy about her. But all I can think of is, why her, why her and not me. I forgot to say, we’re twins. Identical. I mean we look identical. But that’s where it ends. She’s smarter than me or at least she did better in school. She was way more popular. She always got the cool guys. I just stumble along through life.”

“Sounds hard to always be comparing yourself negatively to your sister.”

“I come by it honestly. My whole family does it, especially my mother.”

I flash on the memory of patient who years ago told me about giving birth to identical twins and feeling an immediate connection to the first twin that she didn’t experience with the second. Did Bethany’s mother have a similar experience with her twins that has shaped Bethany and Heather’s experience in the world? An unanswerable question, but an interesting one nonetheless.

“That must be painful.”

“I guess, but I suppose I’ve gotten used to it. I’ve always been shier than Heather, more introverted. I like to draw. I like art. That’s sort of what I do. I work in a design studio that sells lots of art. Although I work mainly in the back. I’m not the greatest sales person. I try, but it’s hard for me.”

“And do you show your own work?”

She shakes her head. “People tell me I’m good enough. But it feels so exposing. And the idea of marketing myself feels overwhelming.”

“Tell me about your family, Bethany.”

“Well, I have an older brother who’s been out of the house for a long time. And then there’s me and my sister and my parents. They’re all very social, outgoing people. They have lots of friends, go to parties, invite people over. I have friends too. I don’t want you to think I’m a total recluse. But we’re different. We sit around and talk, go to the movies, sometimes go to museums.”

“Sounds pretty rewarding. Why is what you do with your friends less valuable than what your parents or sister do?”

She shrugs. “I don’t know. I guess because my mother always seems so disapproving of me. I don’t have enough fun. I don’t wear make-up. I don’t get my hair done. She always wants me to be doing something different than what I’m doing.”

“Has that always been true?”

“Always. I remember when I was little. My friends and I would sit around the house drawing, or playing school, or making up stories and my mother would be telling me to go outside, to ride my bike, to go swimming. Whatever I was doing she wanted me to do something else.”

“Did that ever make you angry, Bethany?”

“Sometimes. But mostly it just made me feel bad about myself. Like what’s wrong with me? Why aren’t I more like Heather?”  

“Did your mother ever praise you for your art? Did she ever listen to the stories you and your friends made up?”

“Never. Or at least not that I remember.”

“What just happened there, Bethany? First you said ‘never’ and then you quickly changed it to ‘not that I remember.’”

“Well, I was only a kid. I could have forgotten.”

“Or maybe it’s hard for you to think anything negative about your mother, like it wasn’t fair of her not to praise you for your strengths, just as she praised Heather for hers.”

“I was about to say, I didn’t have any strengths, but I know that’s not true. I really am a good artist. But my strengths weren’t important in my family.”

“You know, Bethany, when children aren’t valued, it’s very hard for them to think that it’s their parent’s problem for being unable to cherish them. They’re much more likely to feel it’s their fault and if only they could change, then their mother or father would love them.”

“I definitely feel that. I always wanted to be like Heather.”

“Well, I’ve only just met you, but it seems to me you have lots of wonderful qualities, qualities that would be loved and valued in many families. Maybe we can help you to learn to value yourself and give up on trying to win the approval of a mother who can’t seem to appreciate you for who you are. It’s really her loss, but I know you’re a long way from feeling that.”    

“A long way.”

“I know. But we’ve just begun our work.”

A therapist must deal with both her own feelings and those of her patient when confronting a prejudiced father with the patient's interracial relationship

“Well, I started World War III,” Patrick says sighing deeply, as he settles into the chair across from me. “I knew Vi wouldn’t go down easily with my parents, but I didn’t think it would be that bad. My mother literally gasped and my father’s rage permeated the entire dinner. He didn’t say a word to her the whole time, but he had a lot to say to me afterwards. I guess I shouldn’t have just sprung her on them, but she surprised me by coming down for the weekend and I was supposed to go to my parents for dinner so, I guess I just decided to bring her along.”

“Wait, Patrick. You mean you hadn’t told your parents that Vi is African American? And then you just showed up with her for dinner?”

“Yeah. You know, she teaches law at Columbia University in New York, I’m down here in Florida, I knew my parents, particularly my father is very prejudiced, so I guess I kind of avoided the whole thing until I couldn’t anymore. Vi wasn’t very happy with me either. Obviously the dinner was awkward for her.”

Internally I find myself yelling at Patrick, ‘Awkward? That’s an understatement! She must have been consumed by anger she had to swallow. How could you have allowed this to happen? To everyone.”

Wondering if I’m feeling not only my anger, but Patrick’s as well, I ask, “Who are you feeling angry at Patrick?”

“Angry? Well, I’m angry at my parents, particularly my father. He really let me have it. He guessed no nice white woman would want me since I was such a loser; had to go looking in the gutter for some black chick.”

“And you felt and said what?”

“I hung up on him.”

“And felt?”

“Angry. Disgusted. Vi is this incredibly accomplished, smart, beautiful woman. I’m honored that she’d want me. And all he can see is her black skin. Except I don’t know if she still wants me. She’s pretty angry with me too. She didn’t know I hadn’t told my parents she was African American. She kept saying we’re not children, we’re in our 30s, what gives them the right to think they can decide our lives.”

“And can they? Can they decide your lives?”

Patrick hesitates before saying, “No, not exactly.”

“What do you mean, not exactly?”

“Well, I couldn’t figure out the long distant part of Vi and my relationship anyway. I mean, it would hard for me to start all over again as a financial planner in New York and to say that there are no law schools down here equivalent to Columbia would be putting it mildly.”

“You’re confusing me Patrick. Are you thinking of breaking up with Vi? Were you thinking of breaking up before the dinner with your parents? Is your parent’s reaction influencing your decision about breaking up?”

“I don’t know. I love Vi, but I can’t figure out the logistics. I couldn’t figure out the logistics before the dinner and I can’t figure it out now.”

“Have you talked to Vi about your concerns? I know you hadn’t talked with me about it.”

“No.”

“Did you set Vi up, Patrick?” Realizing my anger is seeping through, I try to temper my question. “I mean, did a part of you think taking Vi to dinner with your parents would precipitate World War III, as you said, and might lead to her breaking up with you?”

“I hadn’t thought of that at the time, but now that you mention it … I mean, she’s such a perfect woman for me, I can’t see how I could break up with her. Except she lives in New York and I don’t see how that’s workable.”

Now I feel more sad for Patrick than angry. “You know, Patrick, it’s difficult for you to take charge of your life, to decide what you want for you and make it happen. You don’t talk with Vi about your concern about living in two different cities and whether that can be worked out. I suspect you haven’t even looked at the possibility of becoming a financial planner in New York. You don’t confront your father about your feelings about what he said to you.”

“I guess I always take the coward’s way out. I run.”

Now that I am no longer angry with Patrick, I realize that I had been reacting to him much as his father did. “I wonder, Patrick, if you’ve heard your father call you a loser your whole life and if you’ve come to identify yourself as a loser, despite your obvious success and accomplishments. You feel you can’t do it, whatever it is, and so you don’t, you opt out.”

“I think that’s true. But it’s a hard pattern to break.”

“Yes, it’s a hard pattern to break, but we’ll work on it.”  

A patient turns her pain and anger on herself.

“Bill broke up with me Saturday night,” says 28 year old Chelsea in her Monday session, looking as though she may not have slept or bathed since then.

“I’m so sorry…” I begin.

“You didn’t call me back. I called and called and called.”

“I’m sorry, Chelsea, but when I called on Sunday I explained I was at a very long play, didn’t check my phone and got home way too late to call. Did you get my message?”

“It was too late,” Chelsea says, rolling up the left hand sleeve of her blouse.

Always a bit queasy, I resist the urge to look away, her left arm filled with red gashes from what I assume are self-inflicted cuts from a razor blade. “Oh, Chelsea,” I say, “It’s been years since you felt the need to cut yourself. I guess you were mad at both Bill and me.”

“You abandoned me. I couldn’t stand the pain.”

“What made the pain so unbearable?”

“What?” she asks, becoming angry. “That’s a stupid question. The two most important people in my life abandon me and you ask what made the pain so unbearable?”

“You’re definitely angry with me.”

“Duh!”

“But why did you need to turn the anger on yourself, why cut yourself, why not be angry at me, at Bill?”

“What was I supposed to do, go to your house and kill your dog?”

“Was that a fantasy you had on Saturday night?” I ask, hoping I sound calmer than I feel internally.  

“What if it was?”

“You know, Chelsea, it’s always all right to have whatever fantasy you have, as long as it stays a fantasy.”

“Hah! Scared you, didn’t I?”

“It’s a scary fantasy, but the pleasure you took in scaring me indicates just how angry you are at me. I guess what you’re saying is that you felt afraid you couldn’t contain your rage, so had to turn in on yourself.”

“I wanted to kill you! I wanted to kill Bill. I did start swinging at him, but he just pushed me away and told me that’s why he had to get away from me and literally ran out the door.”

“I am sorry, Chelsea. I know you loved Bill and really wanted this relationship to work out.”

“Why don’t they? Why don’t any of my relationships work out?” Chelsea says, starting to cry.

Although we have dealt with the responses to those questions many times over the years – because you’re demanding and needy, because one moment you love the person and the next you hate him, because you can’t tolerate even brief separations without feeling enraged or terrified or both  - I also know this is not the time to revisit them.

“When I didn’t call you back on Saturday, what did you think? Why did you think I didn’t call? And what did you think when I called on Sunday?”

“I felt you were just like Bill. That you didn’t care about me, that you were sick of me just like him, that you wanted to be rid of me.”

“I understand that’s what you felt, Chelsea, but I was asking something a little different. I was asking what you thought. If you thought there might have been a reason I didn’t call you back that might have had nothing to do with you, like maybe I lost my phone or forgot it.”

“But you didn’t. You chose not to call me back.”

“So it would have felt better for you if I’d called after midnight?”

“It would have felt better, but it still would have been too late.”

Only Chelsea’s feelings exist for her at this moment. “You’re caught up in so many painful feelings, Chelsea - hurt, loss, rage, abandonment – that from this place it’s impossible for you to step outside your feelings and try to reflect on them. So maybe it would be better if we focused on helping you not to turn all those feelings on yourself and hurt yourself. Can we do that?”

“I kinda liked doing it, it was like going back to an old friend.”

“I’m sorry to hear that. So are you saying that you think you’re going to start cutting again?”

Chelsea smirks. “That made you angry, didn’t it?”

“You know, I wasn’t aware of feeling angry, but you’ve always been incredibly sensitive and now that you mention it, perhaps that’s true.”

“And that’s one thing I’ve always appreciated about you, your honesty and your willingness to own your own shit.”

“Thank you. So maybe from there we can work on repairing our relationship and move forward.”

“Maybe,” Chelsea says with considerable hesitation.

“I understand. Right now repair feels difficult.”

“Yes, it does.”

A therapist hopes she can help a very defended woman dare to connect and relate

I smile at my new patient, Eileen, as I greet her in the waiting room, extending my hand in introduction. She doesn’t return my smile, but does warily shake my hand. Settling herself stiffly in the chair across from me, she looks slowly around the room.

Oh oh, I think, seems like a pretty disturbed woman, at best distanced and removed, perhaps paranoid, maybe a trauma survivor.  

“I like your office,” she says. “All the windows. Feels free, like floating in space.”

“Thank you,” I say, not sure how to take her comment. An attempt to relate to me? A fear of being confined? A desire for freedom? Hopefully not a wish to jump.

A few moments pass in silence.

“What brings you here?” I ask in traditional therapist mode.

“I have no friends.”

“Can you say more?” I ask, while thinking that her demeanor would certainly make having friends difficult.

“I’m 36 years old. I live alone. I work at home. I’m an IT person, a computer geek.” She shrugs. “There’s no one in my life.”

“Sounds sad.”

“I guess.”

“How do you feel about not having friends?”

“It doesn’t seem normal. People are supposed to have friends.”

“Eileen, what made you decide to come into therapy right now?”

“I found you online. You had a kind face. I liked your website.”

“Like maybe you hoped I’d be your friend?”

“Maybe.”

“Eileen, can you tell me a little about your background, your childhood, your family.”

“It was messed up. My parents divorced when I was two. They’re both alcoholics, drug addicts, both with so many different partners I lost count. And a ridiculous number of so-called siblings. I’d go from one household to the other. Sometimes there would be six, eight of us in a small apartment. I hated it. Felt like I couldn’t breathe. I just wanted everyone to leave me alone. And basically they did.”

“So you learned to put up a wall that said ‘stay away.’”

“Yeah, that’s a good way to put it,” she says nodding. I have the sense she’s pleased by my understanding, although there’s no obvious change in her demeanor.

“Have any idea what’s behind that wall?”  

“What do you mean?”

“Well, when you construct a wall, there’s usually something behind it, something you’re wanting to protect, perhaps something that feels vulnerable or scared.”

“I don’t do vulnerable or scared.”

“So it feels pretty scary to be vulnerable or scared,” I say smiling compassionately. I find myself liking Eileen, feeling sad for the deprived, needy child who must exist behind what feels like an impenetrable barrier.

“I didn’t say that,” she says, stiffening.

“Sorry,” I say, backing off. This is going to be slow, slow going. I need to be careful not to push to glimpse behind that wall too quickly. Her defenses are there for many reasons. They need to be respected, not ripped away.

“You said earlier that there’s no one in your life. Do you see your parents?”

“Not if I can help it. Maybe once or twice a year. Christmas time, Easter. Maybe not.” She shrugs. Doesn’t much matter to me.”

“Was there anyone in your life who did matter to you when you were a child?”

“Like who?”

“A grandparent, a teacher.”

“A math teacher in middle school. She thought I was more than a dumb oaf. She encouraged me. Maybe she was like my friend, except she was my teacher so she couldn’t be my friend. But she’s the one who helped me make something of myself. I don’t know where I’d be if it weren’t for her. Probably just like my parents. Except without the drugs. I’ve never touched drugs in my life. Swore I never would and I haven’t.”

“That’s pretty amazing determination, Eileen, given where you came from and what you’ve been through.”

“Mrs. H – that’s the teacher – she’d say things like that.”

“And when she or I say things like that, you feel a sense of warmth, of being understood and appreciated.”

She looks down. “Yeah, I guess that’s right.” She pauses. “So are you going to help me learn how to make friends?”

“Yes, Eileen, I am. But we have a lot of work to do before finding friends becomes our focus. First we have to help you find you. We have to find the person behind your wall and that’s going to take time. You’ve been hiding from that person for a long time and a sledge hammer isn’t going to work here. And I suspect it’s going to be painful and scary for you. I’ll be here with you and hopefully that will make it easier, but I’m sure there are times it will be tough going.”

“I’ve been through tough before.”

“Yes, I’m sure you have.”

A patient, seeing the world in black and white, makes impossible "Demands," hoping to find the "perfect" person who will always put her first and repair the neglect and damage of her past.

Beverly rushes into my office and throws herself into the chair across from me. “You know,” she begins, “this is just too hard for me. All this running around. I have too many things on my schedule. I mean I know I don’t work – I have no idea how people who work ever manage to get here – but between golf and tennis and bridge and painting – it’s just too much. I need to come on a Saturday. That would work better for me.”

Although I am more than a little annoyed at both Beverly’s demand and at being relegated to the bottom of her list, I decide on an initial non-confrontational approach. “I’m sorry, but I don’t work on Saturdays.”

“You don’t work on Saturdays? How do the people who work get to see you? I suppose they just don’t, right?”

“You’ve been coming for almost a year, Beverly, and you never seemed to have difficulty getting here before. Why do suppose it’s suddenly become an issue for you?”

“I started taking painting lessons. I hadn’t been doing that before.”

“And since you knew you had such a busy schedule, why do you think you decided to add something that might make it harder for you to get here?”

“I didn’t think about it in terms of getting here. I just wanted to take painting lessons.”

“It feels to me, Beverly, that you’re wanting to dismiss the importance of our work together, that you’re saying it doesn’t matter.”

“That’s not fair. You’re the one who won’t see me on Saturday!”

“I think we need to take a step back here. Was there something that happened in our last session that made you feel uncared about? Were you angry with me?”

“You always do that. You always make it about you. It has nothing to do with you.”

“Okay. Then tell me what it does have to do with other than with your schedule.”

“My sister.”

“I remember we talked about your sister last week, about how I saw her as being competitive with you, but that you thought that wasn’t true, that she loved you and always wanted the best for you. And I said both could be true, that she could love you and want the best for you and still be competitive with you.”

“You took her away from me. No one in my family gave a damn about me except her. I was an extraneous being. But Joyce cared about me, looked out for me. And you just took her away.”

“So you are angry with me.”

“I guess. And at her. I’m furious at her. How could she take herself away from me when I relied on her so much? But I decided to show her. She’s the painter you see. I decided I’d become a better painter than her.”  

“So I guess you’re saying you feel competitive with her.”

“No. I’m just getting back at her.”

“Beverly, I want to point out that nothing out there in the real world happened or changed between you and your sister. This is all happening in your mind. You came to see your sister differently. And although you’re entitled to have your feelings, it would be helpful to you if you could hold onto the love and stability your sister provided for you in your chaotic childhood.”

“You’re taking it all back!”

“No. We’ve talked a lot about your living in a black/white world, with no shades of gray. Right now you want your sister to be the perfect sister – whatever that might mean to you – and you want me to be the perfect therapist who would see you whenever you want to be seen. But there is no such thing as a perfect person. You can get a lot of good from one person, but you can’t get everything and that doesn’t make either that person or you bad. And you can feel competitive towards your sister or towards me and that doesn’t make you bad either.”

“It doesn’t make sense to me. If she’s competitive with me how could she always be on my side? Sometimes she’d be on her side.”

“Well I suppose that’s true. But if she wanted, just let’s say, to be a better painter than you, that doesn’t mean she wouldn’t want you to be a better golfer or to find a loving husband or to take great joy from your children. Because there was so much cruelty and rejection in your childhood, it’s difficult for you to believe that someone can be in your corner and still take care of themselves. That’s like me saying I’m here for you, but I don’t work on Saturdays.”

“That makes me mad all over again.”

“I believe you. We’ll keep working on it.”