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A patient and therapist struggle to help the former realize her potential despite fears of envy and retaliation.

“I’ve decided to write a book,” Karen announces at the beginning of her of session. Dressed in casual jeans, no make-up with her hair pulled back in a ponytail, Karen looks younger than her 48 years.

Although her declaration leads me to think, ‘Oh no, not another idea that goes nowhere,’ I take a more supportive approach. “In art history?” I ask, Karen’s area of specialty.

“I don’t know. I haven’t decided yet. I have to do something. I can’t go on just being Dr. Thomas Hartfield’s wife. It’s too boring. I don’t want to have to get all dressed up and hang out at the club playing bridge, gossiping with the women.”

“Weren’t you recently talking about wanting to open an art gallery?”

“Yes. I still think that’s a good idea, but I don’t know, there’d have to be so many people involved, people I’d have to manage. It seems overwhelming. Writing is something I can do on my own, at my own time, in my own space.

“Of course, I haven’t written anything since I was in college. I was pretty good back then. I think I considered majoring in English. But then again I thought about majoring in lots of things. I’m not even sure how I ended up with a major in art history. I guess because I hung around college for so long and had so many credits, they told me it was time for me to graduate and art history was it.”

“So it seems, Karen, we’re back to talking about how difficult it is for you to make a decision and to carry a plan through to fruition.”

She sighs. “You don’t think I’d write that book do you?”

“Well, I don’t have a crystal ball, but when you say that you don’t  know what you want to write about, it seems you could get stuck right there. I’d be concerned you could think endlessly about what you did or didn’t want to write and never be able to move beyond that point.”

“How did you know what you wanted to write?” Karen asks me.

I don’t introduce my book into my therapy sessions, but many patients Google me and find it online. Now I wonder if there’s some relationship between my book and Karen’s sudden interest in writing. “Before I answer that question, Karen, can I ask you how you feel about my having written a book?”

“Envious. You were able to follow through and do it. But maybe also inspired, like if you can write a book maybe I can too.” She hesitates.

“What just happened there?”

“Nothing. I guess I got anxious. There are so many choices. I don’t know how anyone ever decides on one path over another. I don’t know how you pick. I don’t know how you pick one and give up the others. So how did you decide what to write about?”

I wonder about Karen’s anxiety. Does she worry I’d feel angry or vindictive if she wrote a book? Does making one choice over others bring up fear of loss? Keeping these questions in mind, I answer Karen. “I felt compelled to write about my relationship with my late husband. I think there’s often an emotional press in writing; you have something you have to say. It’s like being in therapy. It’s sharing a vital part of yourself that you want to be known.”    

“Do you think I don’t want to be known?”

“That’s a very interesting question. What do you think?”

“Well declaring myself, taking path A rather than path B would be a way of being more known.”

I’m silent, intrigued by Karen’s train of thought.

“But why wouldn’t I want to be known?”

“I was just asking myself the same thing.”

Silence.

“Weird. The words, ‘You’re a moving target’ just went through my head.” Pause. “Who did I think would shoot me?”

I wonder if it’s me, but I remain silent.

“My oldest sister for sure. She was horribly jealous of me. I was the pretty one, although I made myself as unattractive as possible until she left for college. She’d cut up my clothes, steal all my panties. One time she even cut off part of my hair in the middle of the night.”

“That’s called abuse, Karen,” I say, surprised by this revelation I had not previously heard.

“You think?”

“Definitely. What did your parents do?”

“I don’t know. I don’t remember telling them. Maybe I did. Maybe they said we had to work it out. That part of my childhood is a bit fuzzy.” Pause. “Do you think this is relevant?”

“I definitely think this is relevant, Karen. We have to stop now, but we definitely need to spend more time understanding how your sister affected your life.”

A young patient who finds herself at odds with her parent's political views and then assumes, via the transference, that her therapist aligns herself more with the parents than the patient herself.

“I finally went to dinner at my parent’s,” 19 year old Bethany says dejectedly. “It was pretty bad. They just won’t let up. ‘I can’t believe you lied to us, going to the Women’s March on Washington without even telling us. If we hadn’t called and talked to your roommate we would never have known. What if something had happened to you? We didn’t even know you were gone.’ Blah, blah, blah. As if that was the issue. I bet if I went to the Trump Inaugural they would have been thrilled – even if I hadn’t told them. It’s such bullshit. They did do a bit of, ‘How could you be our child and believe those people have a right to marry.’ Or, ‘Didn’t we teach you that every life is sacred, especially the unborn, those most vulnerable?’ I thought I’d puke. I couldn’t wait to get out of there.” Pause. “I suppose you’re thinking, ‘I told you you should have told them.’”

A young patient, dealing with the aftereffects of an abortion, struggles with her ambivalence about growing up and transfers her feelings about her parents onto her therapist.

“My house feels like a morgue,” 20 year old Chelsea says looking down at her hands. “I guess that’s a poor choice of words, since it sort of is, but not exactly. I mean, I’m not happy I had to have an abortion, but I also don’t think it will be the greatest tragedy of my life. And truthfully, I don’t think it’s the abortion that my parents are so upset about. They don’t like the idea that their ‘little girl’ was having sex. It’s not like I’m 14. And Brad and I have been going together for two years. He was pretty upset too. I think he feels guilty that he didn’t use a condom 100% of the time.”

I have been seeing Chelsea for several years now, watching her struggle between wanting to remain the child who is forever taken care of by her parents and striving towards adulthood with her own dreams and desires. We have a close bond although, not surprisingly, her internal struggle is often replayed with me in the consulting room.

“What are you going to use for birth control in the future?” I ask.

“We’re not. We’re not going to have sex.”

I knit my brows, puzzled and skeptical. “You mean you’re not going to have sex until you give yourself some time after the abortion?”

“No. We’re not going to have sex. Or at least not intercourse. Maybe we’ll fool around a little, maybe not.”

“Why?” I ask.

“Why, what?”

“Why did you decide not to have sex? Do you feel more guilty about the abortion than you’re saying? Is it a way to punish yourself?”

“No! For heaven’s sake, I don’t know why you’re making such a big deal about it. You sound like my parents!”

“In what way?”

“In making such a big deal about sex.”

“Wait. I’m getting confused. I thought your parents were making a big deal about your having sex. I’m questioning your saying that you’re not going to have sex.”

“You mean you don’t believe me? You don’t think I can give up sex?” Chelsea says angrily.

“I’m trying to understand why you’d want to give up sex.”

“Because I don’t want to risk getting pregnant again. That seems pretty simple.”

“I hear you’re angry with me but I’m not clear why.”

“Everyone thinks I’m doing something wrong and you’re just like everyone else,” Chelsea says, her voice cracking. “If I say I’m not going to have sex, I’m not going to have sex! End of discussion.”

“And how does Brad feel about that?”

Chelsea crosses her arms in front of her chest and glares at me. “Why should I care how Brad feels?”

Aware I’m feeling more and more confused, I suspect my feelings mirror Chelsea’s own confusion. “Chelsea, tell me what’s going on. What’s going on inside of you? What has you so distressed?”

“Brad wanted me to have the baby. He said we should get married, that we were old enough, that we could both work and go to school and take care of the baby.” She pauses. Tears fall silently from her eyes. “I couldn’t. I couldn’t do it. I’m not ready. I don’t want to be responsible for another person. I don’t want to leave my parent’s house and go off on my own. It’s way too scary. Brad’s really mad at me. I’m not even sure we’ll stay together.”

“I’m sorry, Chelsea. It’s like your parents are mad at you for being too adult and Brad’s mad at you for not being adult enough and each side represents your own conflict about how grown up you feel or want to be.”

“Yeah, that’s right. That’s exactly right.”

“And does my asking you about birth control feel like I’m pushing you towards the adult side?”

“I guess. I hadn’t thought of it that way, but I suppose it does.” She pauses. “So what about my deciding not to have sex? Is that my going towards the child side?”

“What do you think?” I ask, aware that my not answering her question could also be construed as my pushing her to be more adult.

“Yeah, I suppose it is,” she sighs. “But is that so bad? Can’t I take a little break here?”

“You can, but none of us can stop time. We keep growing older whether we like it or not, but that doesn’t mean you can’t have conflicting feelings about growing up and it also doesn’t mean you have to push yourself to act or be more grown up than you feel.”

“Thanks. You gave me a lot to think about.”

“I’m considering getting a divorce,” 52 year old Evelyn says, starting the session.

Although her marriage has been rocky for some time, this pronouncement surprises me given that her husband recently had a heart attack and by-pass surgery. She seemed genuinely concerned about him and committed to helping him through the rehabilitation process. I remain silent.

“I was listening to this program on NPR, On Point, and there was this doctor on who wrote a book about solving medical mysteries. I don’t remember his name, but it was interesting.”

I heard a small part of that program too, but I wait to hear what led Evelyn from that program to her considering divorce.

“There was a man who had a heart attack who’d had a bad heart so his heart attack was no surprise, kind of like Jack. But then the doctor went on to say that like the very next day or something like that, his wife had a heart attack too. And she had been perfectly healthy. And the doctor said it was the stress, almost like being too close to her husband and having to have a heart attack just like him. Well, I don’t want that to be me. I know this might sound awful, but Jack’s not worth my health. He hasn’t been a good enough husband for me to lay down my life for him.”

Feeling unsure what to say, I continue to remain silent.

“Do you think I’m awful?” Evelyn asks.

“No, of course not, but I am a little confused. I heard a small part of that program too…”

“Do you remember the doctor’s name? I thought I could get his book.”

“No, I didn’t hear much of the program, but what I remember is that he was talking about a couple that was extremely loving and close and that it was that closeness that led to the wife’s distress and her perhaps unconscious need – those are my words, not his – to identify with her husband and go through the same experience he had.”

“Well I guess if that was true, I wouldn’t have to worry about that.”

“Evelyn, am I mistaken or do you feel particularly angry today?”

She shrugs. “I guess.”

“Can you say what’s going on?”

“I’ve been busting my butt taking care of Jack and do you think I even get so much as a thank you?!” All he does is bitch and complain – I’m in so much pain, I’m scared, what if this happens again, why does my right arm still hurt. Complain, complain, complain. I’m sick of it.”

Jack has definitely been a less than ideal husband - inattentive, otherwise preoccupied and, most likely, unfaithful. Still, Evelyn has stayed with him, continually hoping that she could make him different, just as she longed to do with her absent and eventually abandoning father. Still, right after a major scare and trauma seems an unusual time to be considering divorce. Then a thought comes to me.

“Evelyn, do you think this time you especially thought it would be different? Jack was scared and vulnerable. Maybe he’d need you in a different way? Maybe he’d let you in as he hadn’t before?”  

Evelyn hangs her head. “Stupid of me, wasn’t it,” she says, her anger now turned on herself.

“No, definitely not stupid. It was you hoping again, hoping you – or something – could make Jack different, just as you hoped with your father.”

“But it is stupid! How many times do I have to go through the same thing to know it’s not going to work? It’s like continually hitting my head against the same brick wall.”

“It’s hard to give up hope. It’s hard to mourn what never was and never will be.”

“I can’t stand when you talk about mourning. Who wants to mourn, who wants to be sad all the time?”

“So you’d rather be angry.”

“Damn straight.”

“Well, it’s reasonable to be angry, but if you’re only angry you can’t ever finish the process of letting go.”

Evelyn’s eyes pierce me with fury.

“And,” I continue, “to end up being angry at everyone – yourself, me, your children, your friends - that doesn’t lead to a very fulfilling life.”

“So should I stay with Jack?”

“That’s a decision only you can make, Evelyn. But I do know regardless of what decision you make, you will have to mourn the impossible.”

“It’s been a while,” says Delores. “I appreciate your seeing me so quickly.”

“My pleasure,” I respond, truthfully. I always liked Delores, a spunky, vibrant woman who was in her late 60s when I last saw her.

“This time it’s actually not an emergency. Not like last time. I was such a mess. Losing Marvin so unexpectedly was devastating. I just wasn’t prepared. And having him be the third husband I lost, well, that was all way too much.” She sighs. “But I guess that is part of why I’m here. I’m trying to figure out if I dare do it again. After Marvin I said never again, no more men. And now, now I just don’t know.”

I certainly remember Delores’ trauma at losing Marvin. I myself was a relatively recent widow, Delores’ pain clearly reverberating with my own. And the fact that she had lived through two other such losses felt truly overwhelming. I can certainly understand her reluctance to take the risk again.

“Is there a specific man?” I ask. 

“Oh yes, Harry. A friend of mine kept asking me to go out with him. She said he was a widower, a friend of the man she dates, a good bridge player and an all-around nice guy. I said ‘no’ for quite a while. Then one day I felt lonely and they were going to a movie I wanted to see, so I said, why not, it’s just one date. That was three months ago. And now, well, it’s going to go one way or the other. I either have to stop seeing him or take the plunge.”

I certainly understand Delores’ conflict. Harry perhaps offers a more fulfilling, richer life, but certainly raises the specter of another devastating loss. I’ve lived my life believing that it’s “better to have loved and lost, than never to have loved at all,” but perhaps there’s a limit to the number of excruciating losses any person can sustain. Fortunately I don’t have to make Delores’ decision for her.

“So, what are your thoughts?” I ask.

“Well, I’ve thought of all the obvious things – he’s older than me, although only by a couple of years; he has prostate cancer but they’ve been watching it for years and it’s never gotten worse; he’s also had a lot of skin cancer, but that seems under control as well; no heart disease, but Marvin supposedly didn’t have heart disease either, until he keeled over dead. I go round and around in my head about all that. But what’s really odd, is that I keep thinking about my father, dreaming about him too.”

I remain silent, giving Delores time to reflect.

“My father’s been dead for almost 50 years. It was very traumatic for me when he died. I felt like an orphan, even though I was in my 20s. My mother had been dead since I was 10, so it had been just me and my Dad for a while.” Pause. “But I don’t know why I’m particularly thinking of my Dad now. He didn’t come up for me when Marvin died, or any of my other husbands either if I remember correctly. No, that’s not true. John, my first, died not that long after my Dad. I wasn’t 30 yet and I remember then thinking of my Dad a lot. There were so many losses. I could cry just thinking about it.”

“I’m sure that’s true.”

“So do I want another one? I mean, I know no one ever knows, that I could drop dead tomorrow, especially since I don’t exactly have longevity in my family, but I guess my experience is always that the men go first.”

“Except not for your mother. She died first.”

“That’s true,” Delores says pensively. “I wonder what that meant for me. This is a crazy thought, but I wonder if I expected my Dad to live forever. I mean I knew he couldn’t, but still …”

“Was that a wish, Delores? As in you wanted your Dad to live forever because you couldn’t face another loss.”

“I’ve certainly faced lots of them.” She chuckles. “I wonder if I keep looking for the one who’ll live forever. Just kidding.”

“Maybe you’re not kidding. Maybe you keep looking for the man who won’t abandon you, who will live to be there for you, unlike either of your parents.”

“That’s deep. My unconscious would have to be real smart to think that one up.”

“Perhaps it’s that the child part of you is still yearning for the safety and security that was so absent in your childhood.”

“Perhaps. But I don’t know if that helps me figure out what to do about Harry. I’ll have to think about it during the week and see what my unconscious comes up with.”

“Sounds good.”  

“I’m really glad you’re back,” Christine says, her eyes filling with tears. “I know you were only gone a week, but it’s been a hard week. I thought I was more prepared, more ready to deal with my parents this time, but I don’t know, I guess it was the holidays. It was awful. I felt sorry for my girls. They were so looking forward to Nana and Poppy coming for Christmas and it was such a disaster. My parents never stopped fighting, my mother never stopped telling me what I was doing wrong, most particularly as a mother and, of course, as someone who couldn’t keep my husband from straying and my father just got more and more depressed.”

“I’m sorry, Christine. It does sound awful and so disappointing.”

“Yes, that’s exactly right, terribly disappointing. I guess I thought since we’d been working so much on my parents these days, I’d be able to handle them differently or be less affected by them or something.”

“So it sounds as though you’re saying that you’re disappointed in me too, in our work together.”

“No. I don’t think so. I was disappointed that you weren’t here to bounce things off of, to maybe give me some ideas of how to handle things differently.”

Although Christine’s denial doesn’t convince me, I let it go for the moment. “For example,” I say. “Can you give me an idea of what you thought you could have handled differently?”

“There are so many things. How I could have gotten them to stop fighting. How I could have stopped my mother from being so critical of me. How I could have stopped her from being critical of my girls.”

“All right, let’s look at those three things which don’t all strike me as the same. Could you have gotten them to stop fighting? If I’m not mistaken you’ve been trying unsuccessfully your whole life to get them to stop fighting.”

Christine looks startled. “Oh, right. One of the things I need to give up on. I forgot. I can’t keep hoping for what will never be. I need to accept my powerlessness. I knew you should have been here. But why did I forget? I feel ashamed of myself. Why couldn’t I hold onto that?”

“Seems like you said a lot there, Christine. First, I think you are angry with me for not being here. Then I think you got uncomfortable with your anger and felt ashamed instead. And, I agree we should look at why it’s easier for you to hold onto your feelings of hopelessness and powerlessness when I’m here.”

“I do feel ashamed of myself. We’ve talked and talked about my needing to give up hope with my parents and I just can’t seem to do it.”

“Well, it’s very painful. It means you can never have the parents you want or wanted either now or in the past. It involves mourning for what never was and never can be.”

“I know. I guess that’s why it’s harder to do when you’re not here. If you’re not here and I don’t have my parents – and I sure don’t have my ex any more – I feel all alone. Except for the girls of course, but that’s different.”

“That’s a great insight, Christine.”

“Thanks. But what about the other two things I mentioned, why did you feel they were different?”

“The second one might not be all that different, getting your mother not to be critical of you, but I guess I wondered what it is that you felt when your mother’s so critical.”

“I do feel angry, but I try to pretend it doesn’t bother me and just ignore her.”

“Because?”

“Confronting her only makes it worse.”

“And when she attacks your girls?”

“I guess I do about the same thing.”

I am annoyed by Christine’s passivity. I feel she is leaving her daughters unprotected, just as I felt unprotected by my mother in relation to my explosive father. I tread lightly. “I wonder what message you give your girls when you don’t stick up for them.”

“But I thought I’m supposed to give up hope of ever changing her,” she says plaintively.

“This could just be me, Christine, but I think there’s a difference between accepting there’s no way you’re ever going to change your mother and still giving your girls the message that it’s not okay with you for her to attack them, or you for that matter.”

“That’s confusing.”

“It’s like saying, you know you’re not going to change her behavior but you’re still going to let her – and your girls – know her behavior isn’t acceptable.”

“It scares me.”

“What scares you?”

“I guess her anger.”

“I get that. And perhaps your anger as well.”

“I don’t like all this talk about my anger.”

“I believe you.”

“I got a great idea after our last session,” 30 year old Melinda says enthusiastically.

I remain silent.

“You know how we’re always arguing about whether or not you care about me? Well, I figured out how you can prove it to me.”

Oh my, I think to myself. Whatever’s coming can’t be good.

“You can stop charging me for some period of time we agree on. That way I’d believe you cared about me and weren’t just in it for the money.”

I feel as though I’m going to be walking through a field full of land mines. Other than agreeing to Melinda’s request which I know I’m not going to do, whatever I say has the very likely potential of a large explosion. I’m also aware of feeling angry and put upon. Hmm, I think to myself, I bet at some level Melinda could have anticipated that would be my reaction. 

“When you came up with this idea, Melinda, how did you think I’d respond?”

“I don’t know. How should I know how you’d respond?”

“Well, we’ve worked together for about three years, you might have some thoughts about what I would or would not say or would or would not do.”

“You’re not going to do it, are you? You’re just stalling, playing games,” she says, her anger building. 

“Is that what you would have expected?” I ask.

Melinda crosses her arms over her chest and glares at me. “I’m not saying another work until you answer me directly.”

I sigh inwardly. Melinda and I have frequently found ourselves in these kinds of power struggles. I can refuse to say anything, at which point she will indeed not say another word until she storms out at the end of the session. Or I can submit to her demand that I answer her, which feels to me like an uncomfortable submission. Or perhaps, just perhaps, I can try and interpret what’s happening between us. Melinda’s mother died when she was nine, leaving her to be raised by her distant, authoritarian father, who she rebelled against while desperately wanting his love and approval. In her interaction with me, Melinda can take the role of her authoritarian father who tries to force me to be as she wants me to be. Or she can be the needy, demanding child who wants both to win her father’s love, while insuring that her mother will not abandon her.

“So I’m going to run a few assumptions by you and you can tell me what you think. First, I think you knew – if only unconsciously – that I would not agree to your request, that it would stretch the boundary of our relationship in a way that would not be acceptable to me. Second, the reason you find it so difficult to believe – and accept, I might add – my caring is that you felt abandoned by your mother and rejected and criticized by your father. It’s also easy for you to become your father in this room with me and just as you refused to bow to your father’s demands, at some level you know that I will not bow to your demands either.”

“It wasn’t a demand, it was a compromise, a negotiation.”

“I’m not sure about that Melinda. I think you came prepared to fight with me. And that’s probably the most interesting question. Why is it that you want to fight with me?”

“I don’t want to fight with you. I fight with you because you won’t give me what I want.”

“Which was exactly your relationship with your father.”

“I guess,” Melinda says reluctantly.

“But I think that as much as you say you want my caring, you often do things that prevents your getting exactly what you say you want, which leads me to wonder if you need to reject my caring.”

“That doesn’t make sense. Why would I do that? I think you’re just playing therapist tricks, trying to get away from your not caring about me.”

I choose to ignore Melinda’s last provocation. “Melinda, if you accepted my caring you would be saying that you were a person who deserved caring about. And if you allow that in, then you’re left with the realization that you are indeed loveable and that no matter what you did – or do – you couldn’t keep your mother from dying and you can’t keep your father from being a cold, critical person. And that leaves you feeling powerless and helpless and we know how awful those feelings are for you.”

“Is there any way you’d consider my suggestion?”

So much for interpretations, I think to myself. What I say is, “Now I know you know the answer to that question, so I guess you’re saying you’re mad at me.”

“Yeah. I think you should have to do something to prove your caring.”

“I guess we’ll continue talking about this next time.”  

I open my waiting room door to meet James Harrison for the first time. He rises, hand outstretched to shake mine. I’d guess he’s in his mid-forties. A good-looking man, tall, thin, seemingly comfortable in his own skin. We make the brief walk to my office and I gesture him to the sage chair across from mine.

“So,” he says, “Why should I be here?”

I inadvertently jerk my head back while, at the same time, stifling the urge to laugh. He’s certainly wasted no time throwing down the gauntlet. Still, it’s so startling, that I find it almost funny. Perhaps that’s a defensive reaction on my part.

I think about commenting on his provocativeness, but decide that would only escalate what is already a fencing match between us.  “Well, since I’ve never laid eyes on you before,” I respond, “I have no idea why you should be here. Perhaps it would be helpful if you told me.” Too hostile, I tell myself. It’s hard not to meet aggression with aggression.

“At least you didn’t go into that bullshit about everyone can benefit from therapy, it’s always good to understand yourself better, etc., etc.”

Do I need this? I think to myself. We haven’t even said hello and we’re already adversaries. Actually that’s not a bad interpretation. “Mr. Harrison, I wonder why we’re already adversaries. As far as I know you voluntarily came into my office. I’m not forcing you to be here. There must be some reason you’re seeking the help of a therapist.”

“Ah ha. So you’re the try the gentle approach type of therapist.”

I am definitely getting pissed. Which must be what he wants. “I suspect it’s important for you to keep relationships on an adversarial basis. Perhaps that’s why you’re seeking therapy. Perhaps you have difficulty getting along with people.”

“Perhaps,” he says grudgingly.

Silence.

“OK. So now what?” he challenges.

I really do not need this. I want to tell this man that I don’t think we should work together, that I’m not the best person for him. Maybe that too would be a good interpretation. Or would it just be acting-out on my part?

“Why don’t you tell me a little about yourself?”

“Why would I want to do that if we’re not going to work together?”

“Have you decided that we’re not going to work together?” I ask.

“Have you?” is the rejoinder. 

“I don’t know,” I answer truthfully. “I do know that I’m not willing to spend every session fighting with you when I have no understanding of why you need to fight. And I’m also not prepared to convince you that you should be in therapy with me.”

“But you do think I should be in therapy?”

“Yes,” I reply definitively.

“Why?”

“Because you are clearly someone who needs to fight which means that you either have a lot of anger or need to keep people at a very far distance or both.”

“You see. You were able to tell me why I needed to be here.”

“And I suspect that you could have told me that yourself far more quickly.”

“But then I wouldn’t have known if you’re smart enough to handle me.”

“So I suppose I should assume that you’re going to be continually testing me?”

“Perhaps.”

“Mr. Harrison…”

“James.”

“James, I do know that how you are in the world, is how you are in here with me, but I want to again say that I think it is very unhelpful for us to be continually sparring and that one of my goals for you, is going to be to find the James Harrison behind your defensive posturing.”

“You don’t like me much, do you?”

“I would say that you insure that no one likes you much. But I would very much like to learn to like you. And I hope you’ll allow that to happen.”

“Touche!”

I groan internally and wonder why I didn’t refuse to take him on as a patient. “Can you tell me what you’re feeling, James?”

“Satisfied. I think you’re the right person for me.”

“Can you say how you felt when I said I thought you insured that no one liked you, but that I’d like to learn to like you?”

“I told you, satisfied.”       

“Did you feel anything else? Hurt? Relieved? Angry?”

“No. Just satisfied. I accomplished what I wanted to accomplish.”

“So you feel satisfied with yourself. Do you have any feelings about me?”

A slow smile spreads across his face. “I’ll tell you what came to mind. That’s what I’m supposed to do, right?”

I nod.

“I feel you’re a worthy opponent.”

Perhaps, I think to myself, this treatment will be about whether a worthy opponent can become a stalwart ally. If so, it’s going to be a slow slog through.

“I had a dream about all these disasters last night,” Jenny says. “It was frightening. There was one disaster after another. I mean I know there have been lots of disasters – floods, hurricanes, earthquakes, tornados – but it was strange for me to be dreaming of them. I don’t know if I was in the disaster or watching the disaster or helping at the disaster. It was weird.”

Jenny‘s a young medical student. I wonder if, at a surface level, she’s anxious about how she will handle her responsibilities as a physician. I remain silent, waiting to see where Jenny’s thoughts will take her.

“My mother called last night. She was complaining about my step-father for a change, about this step-father, just like she complained about all the others. I don’t know why she keeps marrying them, always sure this one will be her most perfect love. I think I’ve even lost count of what number she’s up to. Ugh. I don’t think I ever want to get married. Or not until I’m really, really sure. I guess I see her as a disaster. That’s sad to say about your own mother. I joke with my friends that she’s my negative role model. I want to be everything she’s not and not be anything she is. Sad.”

“Did you feel that way as a child?” I ask.

“Maybe not as a small child, but before I became a teen-ager for sure. Our house was a revolving door. At least she was smart enough not to have any more kids, except that there were always the so-called Dad’s kids who revolved through and then disappeared forever.”

“Was that hard? Forming an attachment to these father figures or siblings and then having them disappear?”

She shrugs. “I don’t know. Maybe. Or maybe I just learned to do my own thing, be involved with my schoolwork, with my friends. I liked being alone.”

Despite the matter-of-factness in Jenny’s tone, I find myself becoming sad. I wonder about her desire for aloneness as a defense against loss. And I think again about her dream, since disaster almost always involves loss.

“When did you last see your own Dad?”

“Who knows. He vanished a long time ago. Every so often he’ll make an appearance, but I certainly wouldn’t want to count on him.”

“I wonder if it’s possible for you not to feel sad about all these losses, Jenny?”

“I’m too busy.”

To avoid sadness, I think to myself. I ask, “What were the disaster survivors doing in your dream?”

“I was going to say they were doing what disaster survivors always do, dig through their houses looking for stuff, try to find things that are important to them. But I don’t think so. I don’t remember seeing people. It was like one of those apocalyptic novels. Maybe there were a few people, I don’t remember, but basically it was empty, barren.”

“Sounds really sad.”

Silence.

“I just had a weird thought. I wonder if it wasn’t me in all those disasters, but you. Like I was the observer, but you were the one who was there. I wonder what that would mean,” she muses. “I could get it if you’re the one who’s trying to help in the disaster. But would that mean I’m the disaster? I don’t feel like a disaster. So am I trying to reduce you, to make you like me, so I don’t feel like so much of a disaster?” Pause. “I guess that’s possible.”

“Are you saying, Jenny, that it feels like a disaster to need people, to need help, to not want to be all alone in the world?”

“It is a disaster to need people. No one is ever there. You can’t count on anyone. Not your mother, not your father …” Her voice trails off.

“Were you going to say, ‘not your therapist’?”

“Yes,” Jenny says looking down. “I mean I know you’ve been there for me, but you’re only my therapist. Eventually this relationship will end. And then what? Then I’ll be alone. Again. Just like always.”

“It’s hard for you to imagine that even when we do end – which we certainly don’t have to do until you’re ready – that you will take me with you, as part of you, just as a part of you will remain with me.”

“I don’t know if I believe that,” she says. A moment letter, Jenny is crying. “And I’m not sure I even want to believe it,” she says between sobs. “What would that mean, that I would stay with you when my parents could discard me so easily?”

“It would mean that you are loveable and that it was your parent’s great loss that they weren’t able to cherish you as you needed and deserved to be cherished.”