Inside/Outside

Tuesday, August 23, 2016

Always Worried


“I really appreciate your seeing me again,” Estelle Peterson says wringing her hands. I had previously seen Mrs. Peterson for a number of years. Although we made some progress in curbing her anxiety, she remained a constant worrier.

“My daughter’s pregnant,” she says.

“Congratulations. I remember you were afraid you’d never have a grandchild.”

“Yes, yes, that’s true,” she says dismissively. “But she lives in Florida.”

“And that means?”

“Zika!”

“Oh, you’re worried about her getting the Zika virus.” Concern about  Zika is certainly understandable, but I suspect it will only fuel Mrs. Peterson already considerable anxiety.

“And having a deformed child! I can’t imagine anything worse. I told her she has to leave Florida. Right now. Right away. She doesn’t have to worry about me, but she has to take care of her baby! I told her to go stay with her sister in Connecticut.”

“And she said?”

“That it wouldn’t be a practical. That she and Jonathon have jobs. That they just couldn’t pick up leave.”

“I told she could just quit her job and Jonathon can stay here, that she’d be all right with her sister. Then she got mad at me and told me to stop it. I told her I couldn’t stop it, that I couldn’t bear to spend the next six months worrying about her baby. They hadn’t even told me right away, so I’ll probably worry anyway, worry if one of those mosquitos got her early on. But she won’t listen to me. I don’t know what I’m going to do. How am I going to get through her pregnancy?”

 “How’s your daughter feeling about being pregnant?”

“What? Oh, she’s pretty good. She said that some of her morning sickness was pretty bad, but I told her not to worry about that, that was to be expected. I remember when I was pregnant with her and her sister. I thought I would die. But I didn’t. And she won’t die either. But I might die of a heart attack if I have to worry about the baby for six months.”   

I remember now. It wasn’t only Estelle’s constant worrying that was so difficult, but also her need to make everything about herself. Everyone’s pain becomes her pain. She sees herself as being constantly worried about others, but really she’s concerned about dealing with her own anxiety and discomfort.

“So how can we help you to survive the next six months?”

“No, you have to help me convince Diana. Tell me what I can say to her to make her leave?”

“Even if I could do that, which I can’t, it seems to me we both need to respect your daughter as an adult, to respect her decisions and to try to be as supportive of her as you can.”

“How can I respect her decision when it’s endangering her child, when it will leave me, her mother, a nervous wreck until the baby is born?”

“Do you generally respect your daughter’s decisions? Did you respect her decision to marry her husband, to become a teacher, to move to Florida?”

“I definitely wanted her to move to Florida. I wanted to keep an eye on her. Becoming a teacher was okay, although I wondered if she couldn’t do better. I guess that was true of Jonathon too, but he worked out pretty good.”

Knowing that I am most likely talking to myself, I continue on, “Mrs. Peterson, respecting your daughter’s decisions means recognizing that she’s an adult apart from you who has a right to make a decision even if it is different from the one you’d make.”

“Even if it endangers her child? No, I can’t respect her decision.”

And I don’t respect Mrs. Peterson’s way of being in the world, making it difficult for me to espouse respect when I don’t feel it myself. Perhaps I can try to accept Mrs. Peterson for who she is, and thereby move us both towards a more tolerant view of others. 

“Mrs. Peterson. I suspect that you’re not going to change your daughter’s mind about not leaving Florida. Perhaps I can help you to accept that fact and perhaps we can work on managing your anxiety.”

“You’re not being helpful.”

“Sorry. I can only do what I can do.”

“You used to say that to me all the time, that I had to accept my limitations, that I couldn’t control everything, that I could only do what I could do.”

“Yes, that’s true.”

“But maybe this time I can do more.”

“I guess we’ll continue this discussion next week.” 

Tuesday, August 9, 2016

Defeated


“What brings you here?” I ask Peter, a handsome young man I am seeing for the first time.

“My father.”

I wait for further elaboration. He offers none.

“Can you say more?” I ask.

“Nothing more to say. I’m here because of my father.” 

“So I gather you don’t want to be here.”

“You got that right.”

“And you don’t feel you need to be in therapy.”

“Right again.”

“And you’re angry that your father insisted you come.”

“You’re batting a thousand.”

Ignoring his sarcasm, I ask, “So why did you feel you had to do what your father wanted?”

He snickers. “You don’t know my father.”

“That’s true. Why don’t you tell me about him?”

He snickers again. “Sneaky. You’re going to get me to talk. Okay, might as well. My father’s paying for it. My father pays for everything. He’s rich. Developed his own company. Made a fortune. And never lets anyone forget it. He’s smart, a good businessman. My brother works with him. Me, I can’t imagine sitting in an office all day. Just like I can’t sit in class all day. I’m 24 and still bouncing from one college to another. I guess that’s why my father wants me in therapy. He wants you to motivate me.”

“Are you angry with your father?”

“Yeah, I guess you could say that. He’s always on my case. Always wants something more from me. Always bugging me to make something of my life.”

“And what do you want for your life, Peter?”

He shrugs.   “Don’t know. Don’t know why I have to want anything. I like hanging out with my friends, surfing, hand gliding, sitting around getting high. Why should I have to work? Daddy will leave me more than enough money.”

I find myself empathizing more with my patient’s father than with Peter himself, making me uncertain how to respond, concerned that I will sound critical, like his father. I decide further exploration is preferable to any comment about the patient’s current life. “Did you always feel this way, Peter? What about in grade school or even before?”


Peter sits silently, but exudes less defiance. “My Dad was my hero,” he finally says. “He played baseball with us, took us to games. And even when he stared making money, and wasn’t around as much, I knew that he was doing it for us. And then he started making more money. And there were stories about him, interviews with him, he was making a big name for himself. And there was me. My brother was a straight A student. I couldn’t measure up. I never liked to read. I was lousy in math. There was nothing I was good at. Except baseball. And I wasn’t good enough at that. My father climbed up and up and I went nowhere but down. So I gave up. Why bother.”

“Sounds pretty sad.”

“I guess,” he says, shrugging, his defensive tone returned.

“Where was your mother in all this?”

“That’s another story. Nothing was ever enough for my mother. She criticized all of us – especially my father. I never understood why he took it, why he didn’t get out. I thought he probably had women on the side – who could blame him – but I don’t know that for sure. I once asked him. He slapped me across the face.”

“Was that typical of him? To hit you?”

“I wouldn’t say that. He hit me a few times. But that time was a surprise. I didn’t get why my question made him so angry. But I never asked again. And I guess I stopped caring.”

“So when you feel angry, you turn yourself off, you ‘stop caring.’”

“I guess.”

“I wonder if the problem with that Peter is that without being able to tap into your anger, your aggression, it’s very hard to find your competitive spirit, your desire to win, perhaps even your desire to beat your father.” 

 “I could never beat my father. I could never even come close.”

“The problem, Peter, is that you gave up trying. You were so sure you’d lose, that you’d never come close, that you were defeated before you began.” 

“But I couldn’t come close.”

“Maybe. Maybe not. I wonder what you might be able to accomplish if you didn’t feel so defeated, so shut down. I hope you’ll give yourself and us the chance to find out.”

Tuesday, July 26, 2016

Unfaithful

“I have a confession,” Randy says. “I’ve been sleeping around.”

A snide, why am I not surprised, goes through my head. I say nothing.

“I know,” he continues, “I was supposed to try not to, to think about my feelings before doing anything. But all I can think about is that there’s this gorgeous woman over there who I’ve never seen before and will probably never see again and why the hell not.”

I have been seeing 36 year old Randy in therapy for about six months. His wife got tired of his constant affairs and gave him an ultimatum – therapy or divorce. Whether she would have gone through with her threat I have no idea, but he chose therapy. Randy is neither the easiest patient for me to work with nor the easiest patient to like. His narcissism and his presentation of himself as God’s gift to women are very off-putting to me, as is his difficulty in self-reflection and his impulsivity.

“Randy, when you say ‘why the hell not’ do you think you’re feeling angry, like perhaps I or your wife shouldn’t be telling you what to do?”

He laughs. “Never thought of it.”

“Well, can you think about it now?”

He rolls his eyes.

“What were you feeling right then when you rolled your eyes?”
“Geesh! You don’t cut a man any slack, do you?”

I remain silent.

“Okay. Okay. I’ll think about it. What was the question again?”

I feel my anger rising and wonder if I am feeling my anger, his, or both of ours.

“I think you are angry, Randy. Can you perhaps tell me what you’re feeling angry at?”

“I think this is a waste of time. I’m clearly not getting better. I’m still messing around. You haven’t fixed me.”

“Wait a second. ‘I haven’t fixed you’ meaning what?” I ask, thinking about neutering a dog and wondering if that’s what he’s symbolically hoping and/or fearing I might do.

“Getting me to stop wanting to mess around.”

“And how do you think I’d do that?”

“I don’t know, you’re the doctor.”

“Randy, do you want to be different? Do you want to stop ‘messing around,’ as you say?

“My wife wants me to.”

“But that’s not what I asked. What do you want?”

“I have to do something if I want to stay married to her.”

“And do you want to stay married to her?”

“Yeah, I guess.”

“Why?”

“I love her.”

“What about her do you love?”

“She’s a good person. She’s a good mother, a good wife.”

“Can you be more specific? What makes her a good wife?”

“I don’t know. She takes care of the kids, the house, she likes entertaining, she always makes a good impression.”

I’m ready to scream. He’s giving me one inane answer after another and telling me absolutely nothing. Is he doing it deliberately? Is he trying to thwart me? Frustrate me? A thought goes through my head. “Randy, do you like frustrating women?”

“What do you mean?”

“Do you like frustrating women? Perhaps tantalizing them? Perhaps never quite giving them what they want?”

Randy straightens himself in the chair. He stares at me. “What made you ask that?”

“You seemed to be enjoying not really answering my questions. Perhaps you enjoy not giving me what I want. Perhaps you enjoy not giving your wife what she wants. And what about sexually, do you enjoy withholding pleasure from women?”

“Whoa. We’re getting way too personal here.”

“That’s what therapy does, Randy, it gets personal. If you really want to change – which I don’t know if you do – we have to first understand why you do what you do, really understand it, not just play at understanding.”

“I don’t know if I can do that.”

“You don’t know if you can do what?”

“You’re saying you want into my world, my mind.”

“Yes, that’s exactly what I’m saying.”

He shakes his head. “I don’t know.”

“Well, at least you’re being honest right now. I appreciate that. I feel like at least I’m getting a glimpse into who you are.”

Pause.

“I was my mother’s doll. She played with me. Not sexually as far as I know, but she might as well as have. She owned me.” Pause. “I hate her. You ready to deal with all that, doc?”

“I’m definitely ready, Randy. The question is are you?”

“I don’t know. I’ll have to think about it.”


“Fair enough.”


Wednesday, July 13, 2016

Truth Revealed

Mrs. Cortez settles herself uncomfortably in the chair across from me, fidgeting nervously with her fingers. “I never expected to be in a therapist’s office,” she says. “Especially not for this.”

I smile at her. “Take your time. I can see you’re anxious,” I say reassuringly.

She sighs deeply. “My husband and I came from Mexico a long time ago. We wanted to have children in a place where they’d have more opportunity. We’ve done well. I’m the office manager of a large cardiologists’ office, my husband drives for FedEx. My daughter graduated from college. My son’s in college now.” She looks down at her hands. “It’s about my son,” she says, barely audible. “He…he told me he was gay.”

She glances up at me.

“It was after the Orlando killings, in the… the nightclub. He said he couldn’t stay silent. He couldn’t keep hiding who he was. He cried like a baby. I was shocked. I held him, told him I loved him, that I loved him whoever he was. But it’s so confusing to me. It’s against my religion. It’s against my culture. I know Pope Francis said who are we to judge and I’m trying not to, but it feels so unnatural to me. And he’s afraid to tell my husband, which I understand. But now I have this secret from my husband and I don’t like that either.”

“I can see how much pain you’re in, Mrs. Cortez.”

“Please call me Daniella. I just told you the biggest secret of my life, Mrs. Cortez is much too formal.”

“Of course, Daniella,” I respond. I like this woman. Although we come from vastly different backgrounds with vastly different values, I appreciate both her pain and her conflict. From a place of love, she’s struggling to take in a new reality, to expand her view of what’s acceptable, to integrate her new information about her son – her gay son – with who she always understood him to be.

“I know it’s hard,” I say, “But your son isn’t a different person from who he was before he told you he was gay.”

“It feels like he is. I look at him and I wonder…” Pause. “I imagine… I wonder who he’s been with and how. It kind of makes me sick. My son? How could my son kiss another man? Could he put another man’s… No, I can’t say it. I can’t even think it.” Pause. “I haven’t been to church since he told me.”

“Because?”

“I have all these impure thoughts, all these images. If I go to confession, what will I say? I don’t want to tell the priest.”

“I thought you said Pope Francis said who are we to judge.”

“That’s Pope Francis. Not all priests are like that.”

“So you’re afraid the priest will condemn your son, just like you’re afraid your husband will.”

“Yes. If I’m having all these problems, my husband is so much more traditional. And he’s a man. I know what men say about gays. All those jokes. And that’s something else. I worry about my son. He’ll have such a harder life. And Mexicans aren’t having such an easy time in this country right now. Then you add being gay. I’m scared for him.”

“Daniella, this may seem like an odd question, but can you say what you are hoping to get from therapy?

“I needed to tell somebody. It’s been such a burden.” Pause. “And I guess I want you to help me accept my son.” She cries silently. “He’s a good boy. I love him. I keep wishing this was a dream. That it will go away. But I know it won’t. I know I won’t change him. I want to accept him. And I want to figure out how to tell my husband.”

“Do you feel ashamed that your son is gay, Daniella?” I ask.

She nods. “I know you’re supposed to be born that way. But I keep wondering if it was something I did, something my husband did. Did I keep him too close, was my husband too strict?”

“There are no answers to those questions. But I wonder if we can understand how shame came to play such an important role in your life.”

She looks down. “I’ve always felt ashamed. Ashamed of my background, my poverty, my alcoholic father. Ashamed of being different, of not being born in this country. I always wanted to fit in. And now there’s my son. Another difference – for him and for me.”

“So hopefully as we talk about these issues and you find more peace, you’ll also be able to be more accepting of your son.”     



Tuesday, June 28, 2016

Appeasement

“I won’t be here next week,” Mona begins. “I’m going fishing with my parents.”

I feel disappointed for Mona. I’ve been seeing her for a little under a year, working on her need to separate from her parents. A 30 year old paralegal, Mona works in the law firm where her mother was once senior partner and lives in a house her extremely successful father bought for her. Although Mona was raised by a series of nannies during her early years - her parents busy building a business and developing a career – they now crave her time and attention.   

“I know,” she continues. “We’ve talked about it and talked about it. No, I don’t really want to go. No, I don’t like to fish. Yes, it’s awful being stuck on a boat with my folks for a week. Yes, I wanted to save my vacation time so I could go to Europe.” Pause. “And I’m going fishing.” 

“Do you have a sense of why you made that decision?”

“The consequences of not going are too great.”

“And those consequences are?”

“My house. My job. Little things like that.”

“Do you think your parents would take away your house or your job if you said you didn’t want to go fishing with them?”

“It’s important to them. If I can make them happy, why not?”

“What about what makes you happy?”

“Oh yes. There is that I suppose.”

“What would make you happy, Mona?”

“Being on a desert island somewhere, all by myself.”

“Is that true?” I ask.

“Yes and no I guess. In some ways it would feel like I felt as a kid – alone and adrift – surrounded by my books instead of water. There were times that felt welcoming, peaceful. Other times I felt so, so lonely. All I wanted was Mommy or Daddy to come home and be with me. But even when they were home they weren’t with me. And that was worse.”

“So now Mommy and Daddy have come home to be with you.”

“I suppose.”

Pause.

“You know, I’m not sure that’s true,” Mona says. “I mean, yes, they’re always there. I can’t get rid of them. But I’m the Mommy and the Daddy. I have to take care of them.”

“So you’re still not getting what you need. And you’re certainly not getting what you needed as a child.”

“That’s for sure.”

“But I wonder, Mona, if you keep trying, if you keep trying to get what needed from them. If you keep trying to get them to take care of you as you hadn’t felt taken care of as a child.”

“No doubt. Look what I chose as a profession, a paralegal. Not putting paralegals down or anything, but I know I’m smart, I know I could have been anything I wanted to be – a doctor, a lawyer, CEO of a corporation. But, no, I’m a paralegal and Mommy and Daddy get to take care of me forever.”

“That’s really sad, Mona. You’re saying that you kept yourself from realizing your full potential in your attempt to get what you never got from your parents in the past.”

“It’s worse than that. Because what I get from them now are the same things I was able to get from them as a kid – material things. I never wanted for anything materially. But what I wanted was their time and attention. And, yeah, I suppose I do get that now, but it’s really all about them. I don’t even know why I keep trying.”

“I think you do know why, Mona. You keep trying because inside you there’s a needy dependent little girl who yearns for Mommy and Daddy to be home taking care of you.”

“I suppose that’s true.”

“The problem is that you can never make up for that, Mona. The past is past and however much you as that little girl might long for and deserve to have loving, attentive parents, there’s no way to redo that.”

“That’s charming. So what do I do?”

“You - and we - have to work on helping you to mourn that which you never had. It’s hard. It means feeling sad and angry, sad and angry, sad and angry, until you can get to a place of acceptance.”

“Doesn’t sound pleasant.”

“No, it’s a long, difficult process.”


“Meanwhile it will have to wait. I’m going fishing.”