Inside/Outside

Friday, November 12, 2021

Emptiness

 

“I can’t understand it,” Valerie says sobbing. “Why would he want to leave me? We said it was forever. He’s breaking his promise! It’s not fair!! This should have been the best time of our lives. Approaching retirement, soon able to travel wherever we wanted. And now I’m just going to be alone.”

“Valerie, is Dave really choosing to leave you?” I ask gently.

“Of course he is. The doctor said there were several other chemo options he could try.”


I am more than familiar with the pain of losing a life partner, so I know to tread carefully in this most difficult of life experiences. “Can you understand Dave’s decision to stop further treatment?”

“No. Definitely not.”

“Do you have a living will, Valerie?”

“Yes, of course. I wouldn’t want to be kept alive if I was in a vegetative state, or if my mind was totally gone. But that’s not where Dave’s at.”

“Where is Dave at? What’s his quality of life? How does he spend his days?”

“He’s in bed a lot. He’s always tired. He sleeps. I know it’s partly from the lung cancer and partly the pain medication. But we still have conversations. We still sleep in the same bed. Sometimes we watch TV together. He coughs all the time, sometimes says he can’t catch his breath. Tells me he has a lot of empathy for Covid patients but he also says…” Valerie breaks off, puts her head in her hands and sobs.

When she composes herself she continues, “He says at least they have vaccines for Covid now and new medications and that at least Covid patients have the chance to get better and live normal lives. He no longer has hope. But I have hope. He could try some of these other drugs, these other regimens.”

“It sounds as though Dave is very tired, Valerie.”

She sobs again. “You think I should let him go?”

“Sounds like he’s saying he’s had enough.”

She sobs. “I’m so scared. I’m going to miss him so much. I’m not saying our marriage
was perfect, no marriage is perfect I know that. But we’ve been together for over 30 years. I don’t know what it’s like to live alone. I’ve never lived alone. I lived with my parents then roommates and then Dave. I just see myself locked in that house rotting away.”

“Rotting away? That’s a very graphic image. What makes you think you’ll rot away?”

“I don’t know. I guess like old food in the refrigerator that is left and forgotten about and just rots away. Like no one would know whether I’m alive or dead.”

“I don’t in any way doubt that you’re describing your feelings, but it’s surprising to me that you picture yourself so desolately. Before your husband’s illness you seemed to have a very active social life, to be involved with lots of people, in lots of different ways.”

“All meaningless. And besides, it was my husband who was the social one. Left on my own I just rot.” Pause “There’s that word again, rot.”

“Do you feel as though you’re rotten, Valerie? Rotten as in bad?”

“No, I don’t think I’m bad.” Pause. “I just think I’m not much of anything. Kind of a blob. My husband brought life into our home. Left to my own devices I’m afraid I’ll be swallowed by the emptiness.”

“I know depression can put a pall over everything, but this sounds like something more, like you’re literally afraid of disappearing into the void.”

“That’s it exactly. No Dave, no me, just an empty blob.”

Feeling more and more of Valerie’s despair, I ask, “And you felt that way as a child as well and as a young adult, like in college?”

“Well, there were my parents to tell me what I was supposed to do and then, as I said, I had roommates and sort of followed along with the crowd.”


“It sounds, Valerie, as though you’ve spent your life following along with whomever you’ve been with. And now, with Dave’s decision to stop treatment, you’re confronted with the terrifying feeling of not knowing who you are apart from him, and perhaps of never knowing who you were.”

“I’m terrified. I think you’re absolutely right and that makes me need Dave even more. Do you think I can persuade him to continue treatment until you and I can work this out? Until you can fix me?”

“Right this minute you may feel that you need Dave more, but nothing has actually changed. We definitely do need to work on your feeling more your own sense of self, but whether Dave will stay around until we accomplish that I can’t say.”

“I’m not sure I can survive. I want to survive but I’m not sure I can.”

“You just said something very important. You said you want to survive. That’s you, Valerie, knowing what you want.”


Friday, October 15, 2021

Self = Bad

 “So I’ve been thinking about where we ended last time,” Paula says, starting right in from our previous session. “You said we’d need to figure out why I can’t forgive myself for not being more attentive to my mother when she was dying. I’ve thought about it and I don’t see why I SHOULD forgive myself. I know I was a teen-ager, but I was old enough to know better. I did know better. I was being cruel and nasty and just plain BAD.”

“So what made you bad?”

“I suppose I was just born that way – selfish, self-centered, only caring about myself. And that’s how I was being when my mother was dying, paying attention to me not her.”

Convinced of the futility of arguing with Paula’s view of herself, I pursue an alternative approach. “How does it feel for you to see yourself as selfish and self-centered?”

“It feels …” Pause. “It feels accurate and true and I guess kind of shitty….” Pause. “And familiar.”

“Familiar?”


“Yeah, like I’ve always seen myself like that.” Pause. “And I guess my parents, especially my mother, always told me I was selfish, like ‘why can’t Monica go with you to the movies?’ My mother was always trying to get me to take my sister along with me and my friends.” Pause. “I hated Monica. I hated her from the moment she was born. Everyone fussing over the baby. I didn’t see anything so special about her. She just lay there and stared. And then when she turned out to be autistic, well that just made everything worse. All the attention went to poor Monica, understanding Monica, making allowances for Monica. But you see, you see how selfish I am, wanting all the attention, wanting Monica and all her problems to just disappear.”


Here again I feel the pull to reassure Paula, to tell her she was just a child who of course had angry, rejecting feelings towards her younger, challenging sister. Yet I know that Paula will only dispute what I say. “Paula, if I were to try and reassure you, to tell you all children have negative feelings towards their siblings, you’d tell me that your feelings were worse, stronger, more heartless, right?”

“Yes. Because it’s true. And you’re only trying to make me feel better. But I don’t deserve to feel better.”

“Why don’t you deserve to feel better?”

“Because I’m bad, very bad.”

“It sounds as though being bad is almost like a core sense of who you are. Being Paula equals being bad.”

“Yes. I’m bad because I hated my sister and didn’t want to be there for my mother.”

“I wonder if you had fantasies about killing your sister.”

She nods. “See, I told you I was bad, worse than bad, evil.”

“It’s not unusual for children – or adults for that matter – to have fantasies of killing a sibling, or a parent, or boss or whomever. But I suspect my saying that isn’t going to make you feel any less bad.”

“I’m bad. I’ve always been bad. My grandma used to tell me that I was like that girl in an old movie, “The Bad Seed,” I think she called it.”

“Why did your grandma think you were bad?”

“She never liked me. She thought I was mean to both my mother and sister. And she doted on Monica. The sun rose and set on Monica.” Pause. “I think grandma might have been on the spectrum too, but of course no one talked about that.”

“Paula, do you have a sense of who you’d be if you weren’t ‘bad?’”

“But I am bad.”

“I understand that’s your view of yourself. But I’m asking if you can imagine you as someone who isn’t bad.”

“No, that’s impossible.”

“So that’s one of the big problems we have here. Being ‘bad’ is such a core sense of yourself that to imagine anything else is destabilizing. It’s like you said, being ‘bad’ feels familiar.”

“It’s familiar because it’s accurate.”

“Do you want me to dispute that with you right now?”

“What do you mean?”


“Well, it feels as though you’re almost asking me to say ‘no, that’s not so.’ But If I disagree with you, does that give you the hope that you might in fact not be bad or does it just help you shore up your argument when you counter me?”

“I’ve never thought of that.” Pause. “I wouldn’t want you to think I’m as bad as I think I am.” Pause. “So I guess maybe I am hoping that I could eventually see myself as you see me. It makes me sad when I say that.”

“I understand that. If you see yourself through my eyes, it means giving up seeing yourself through the eyes of your parents and your grandma, which means leaving them behind and bringing up feelings of loss and sadness.”


Friday, September 10, 2021

An Apology

An Apology


“I’ve been depressed since our session this past Monday,” Paula begins. “I’m not exactly sure why.” Pause. “I guess it’s because we were talking about my mother’s death – for a change – and that always makes me depressed. It’s been almost 20 years for God’s sake, I don’t see why I can’t let it go.”


“I know you get depressed when we talk about your mother’s death, Paula, but I thought about our last session too. I feel as though I was pushing you too hard and I want to apologize for that.”

“That’s what you get to do. If you didn’t push me, I’d be even more stuck than I am already.”

“I don’t know. You were talking about your guilt about your mother’s death and although it’s true that from my perspective you have nothing to feel guilty about, what matters is your perspective. I don’t think I gave you enough of a chance to talk about your feelings, including your guilt feelings.”

“My mother died of cancer. I get that I was a teen-ager, more preoccupied with my own life. But I could have gone to the hospital more. I could have spent more time with her. I could have just sat holding her hand.” Pause. “Besides, why would I get depressed if you were pushing me to not feel guilty? You’d think I’d appreciate it.”


“Well, what is one of the big problems you had with your mother even before she got sick?”

“She was always in my face, always on top of me, telling me what to do, telling me what I should think, what I should feel … Oh! I get it! You think you were being like my mother, intrusive like my mother”

“Yes.”

“Hmm. I guess that’s a good point.” Pause. “But I still don’t know why that would get me depressed.”

“Well, what did you feel when I was pushing you to not feel guilty”

“I don’t know if I felt it then or whether I’m feeling it now that we’re talking about it, but right now I guess I do feel, hey, isn’t this where I get to talk about my feelings? How come you’re not letting me feel what I feel?  I thought that’s what I get to do here!” Paula pauses. On my video screen I watch as she drops her head, her straight brown hair falling forward over her face. “I’m sorry,” she mumbles, “I didn’t mean to get annoyed.”


“Paula, what just happened? You seemed to go from a person expressing her feelings and her right to be heard, to what seemed to be a scared, apologetic little girl?”

“I felt guilty for being ang… annoyed at you.”

“So you can’t even say you’re angry at me.”

“I’m afraid to be angry at you.”

“Because?”

“I don’t know,” she says in a barely audible voice.

Silence.

“Your anger feels dangerous?” I ask.

She nods. “I was angry at my Mom and look what happened to her. It’s much better to keep it tucked safely away.”

“Except it’s never ‘safely away.’ It’s turned inward on yourself so that you end up feeling depressed.”

“So you’re saying I was depressed after last session because I was angry at you and turned it on myself, not because my mother died? That makes me sound even more selfish and self-centered!”

I feel the urge to argue against Paula’s interpretation of her depressed feelings and wonder if her way of being self-deprecating, tends to elicit a reassuring, albeit intrusive, response from me. Do I feel a similar pull with other patients? Does Paula unconsciously set up this dynamic?” I’ll have to think about all that, but right now I need to respond to Paula.

“I think you can be depressed for more than one reason, but it sounds as though you’re saying you should feel depressed about your mother’s death.”

“Yes, of course I should feel depressed about my mother’s death. She’s dead!”

“You can certainly feel sad about your mother’s death, but I don’t know that carrying depression around as a heavy weight that burdens all aspects of your life is at all helpful.”

Paula sighs. “I guess after almost 20 years I should be able to cut myself some slack.”

I nod, smiling.

“But why is that so difficult for me?”

“I guess because you still feel the need to punish yourself.”

“I think you’re right.” Pause. “But what can I do about that?”

“I guess we’ll need to talk more about why you can’t forgive yourself for what you see as your adolescent ‘sins.’”



Friday, August 13, 2021

Good-bye Again

 Although it is not my norm, today I begin Laurie’s session. “I need to tell you, Laurie, that starting next week I’m going back to working from home.”

“What?!” she shrieks. “You’ve got to be shitting me! We just came back to your office! You know how much I need to see you. You can’t do this to me. You can’t, you can’t,” she says sobbing, her face buried in her hands.


“I knew this would be very difficult for you, Laurie, but you know how Covid cases are tearing through Florida. I can’t risk your health, mine or anyone else’s.”

“I hate you! I hate you!! You’re like a big tease. ‘Here I am and now I’m gone!’ I can never rely on you. I can’t rely on you any more than I could rely on anyone else.”

Although I know it’s very unlikely to help Laurie to feel better, I feel compelled to say, “Remember when you felt just seeing me once would be reassuring to you, would convince you that I was indeed alive and not a figure of your imaginings.”

Laurie looks at me scornfully. “You’re joking, right? What does it matter what I was feeling then? This is now and I feel like crap and it’s your fault.” Pause. “What if we wore masks?”

“You know the answer to that, Laurie. I wouldn’t be able to hear you and it’s impossible to do therapy if I can’t hear you. We can do therapy without seeing each other, but it’s impossible to do therapy without hearing each other.”

“So there’s no compromise?”

“I don’t know if it’s a compromise, but you now know that we will see each other at some point, we will be back in the office as soon as it’s safe.”

“As soon as YOU say it’s safe!”

“Yes, that’s true. It is my call. And that is part of what I do, Laurie, keep us both as safe as possible.”


“You’re talking about my mother, right?”

“Yes. She didn’t keep you as the six-year-old child safe when she killed herself and she certainly wasn’t keeping herself safe.”

“But I don’t see how that helps me now!”

“Well, I may be mistaken, but it seems to be that you are feeling a little calmer right this minute.”

“I’m feeling depressed. I’m feeling I have to deal with yet another loss, the loss of you. Makes me very sad.”

“Do you feel depressed or sad?”

“You always ask me that. I can never tell the difference.”

“Depression is more a feeling of numbness, of nothingness. And it’s often a result of anger turned inward, like turning your anger at me in on yourself. Sadness is more acute, more intense and is often about mourning.”

“I’m feeling both. I don’t want to be angry at you. It scares me. What if I’m angry at you and then you get Covid? I’d feel horrible, guilty. I wouldn’t want that to be the last thing you remembered of me. But I also feel this huge loss. I know, you’ll say I’m still mourning my mother, and maybe I am. But it’s also about you. I need you so much and it is so good to see you in person and it just feels like this huge emptiness, again.”

“I do understand, Laurie. It’s a loss for me too. It’s been wonderful seeing you in person, actually having you as a real, live person in my office. But it’s not forever, unlike with your mother.”

“I wish you wouldn’t keep bringing her up.”

“Because…?”

“Well, what first jumped in my head, is that it feels like you’re trying to pass the buck, trying to get me to talk about her rather than you.”

“That’s a really good point, Laurie. Maybe you’re right. Maybe I also was trying to move away from the sadness between us.”


“Really! Wow, I’m surprised. I’m surprised that you’d feel that and, truthfully, surprised that you’d admit it.”

I smile. “Therapy is a place I get to be truthful too, it’s a place I get to reflect on myself just as you do.”

Tears fall down Laurie’s cheeks. “You see, that’s why I love you so much, that’s why I miss you, you’re such an amazing special person. There’s no one in the whole world like you.”

“Remember how much you hated me at the beginning of the session? I’m neither a horrible, evil person nor a saintly one. I’m both. And it’s important that you try and hold onto both parts of me.”

“But now I have to say good-bye again and that makes me really, really sad.”

“Yes, it is sad, but we’ll talk to each other next week and we’ll both be very much real and alive.”


Friday, July 16, 2021

Too Close

 

“I went out with Charles again last night,” Ashley begins. “You know the guy I met on Match who I’ve been out with a few times.”

“I remember,” I say, nodding at the computer screen. “You kind of liked him.”

“I guess, but he was a little too much last night.”

“Meaning?”


“I don’t know. Like he started telling me all about his childhood, which was pretty terrible. He was physically abused by his mother, like really bad. And he wanted to know all about me. I’m not sure I was ready for that.”

“What made you uncomfortable?”

“What if we don’t work out? Why should I tell him all about me? Does he really need to know that my mother died of cancer when I was four and that my father wanted nothing to do with me?”

“I’d say there would be no reason for him not to know.”

“I never understand why you feel I should be blabbing my whole life to anyone and everyone.”

“Well, if you’re not presenting who you are to people it’s kind of impossible to get close to them and it takes a lot of energy to be play acting through a large part of your life.”

“Aren’t you play acting? Isn’t being a therapist all play acting?”

“In what way?”

“You could be in terrible pain right now, physical or emotional, and you wouldn’t tell me about it, right?”

“That’s true. We do all have roles that we inhabit in our lives and…”

“See, I told you! So I’m no different than you or anyone else!”

“We all have roles that we inhabit. Being a therapist is one


role, just as being an attorney is another. And, no, in our professional roles we’re not telling everyone everything about us. You’re not going to be in front of a judge and say, “Your Honor I can’t try this case today because I had to put my dog down yesterday and I’m a total basket case. But yesterday, when you put your dog down – obviously I’m just using that as an example – would you have been able to call a friend and say I need to talk?”

“I don’t have a dog,” Ashley says matter-of-factly. “I don’t want a dog.” Pause. “Actually, dogs are kind of like that guy last night. They want too much. They’re always there, always begging. I guess you’ll say that’s my need to keep my distance.”

“Yes, I would. And there’s the question of why that distance feels so necessary for you.”

“It just popped in my head that we’re back in your office next week. I don’t like that idea either. This is much more convenient. I don’t have to drive to and from your office. I don’t have to waste time sitting in your waiting room. I just turn on my computer screen and here you are.”

“So I assume by bringing that up right now, you’re making the connection that returning to my office feels closer – literally and figuratively - than virtual therapy.”

“Right. And I’d prefer continuing just as we are.”

“So do you have any thoughts about what makes closeness so uncomfortable?”

“It’s messy. People are just so needy. They want so much. Just like a dog.”

“Are you needy, Ashley? Do you want so much?”

“Me? No way! I can take care of myself.”

“I think you learnt that early on. If there’s no one really there for you, you learn that you have to take care of yourself.”

“Right!”

“But there’s a problem with that, Ashley. When you were four years old you couldn’t take care of yourself. You were a helpless, dependent little girl who just lost the most important person in your life. That little girl is still inside you. She still wants and needs and longs for someone to care for her…”

“Ugh! That’s disgusting. I hope that’s not true. And if it is true I want her gone, poof! Like she never existed.”

“I wonder, Ashley, if that’s exactly the reason you didn’t like the man you saw last night and the reason you don’t want to return to in office visits and the reason you don’t want a dog, all of that brings you closer to that dependent, childhood part of yourself.”


“So what should I do about it?”

“Well, first we’ll resume in office visits and we’ll talk about how that feels for you. And when you’re with someone and feel the need to get away, maybe you can try to pay attention to what you’re really trying to get away from. I suspect it might be the needy part of yourself.”

“What if I just avoided people?”

“Well, what do you feel when you avoid people? What did you feel when we were locked down in the pandemic?”

“Lonely. Like something was missing.”

“I guess that’s your answer.”


Friday, June 11, 2021

On Vacation

“I’m sorry I’m late calling,” Mia begins. “Lots of little things came up just as I was supposed to call.” Pause. “Of course, I’m sure you don’t care, just gives you 10 more minutes to do whatever you do.”

Silence.

“Aren’t you going to say anything?”

“Sounds like you’re angry at me,” I respond.


“Why? Because I’m late calling? Why should I be angry with you? Are you feeling guilty about something?”

“So I assume you’re feeling angry because I’m not going to be here for two weeks.”

Silence.

“It’s so stupid!” Mia says angrily. “I can’t believe you’d be dumb enough to actually go somewhere and risk getting Covid. Even I’m not ready to start traveling and I’m probably 50 years younger than you! I don’t really know how old you are, but you’re certainly not young!”

I realize Mia is goading me but, at least on this occasion, I don’t feel pulled into her provocation. “It sounds as though you’re feeling scared about losing me,” I say softly.

“So is that supposed to be the great interpretation that makes everything all right? That makes me understand, makes me less angry, makes me more accepting?”


“Why do you think you’re so angry, Mia?”

“I told you! You’re being stupid! And I can’t afford to have a stupid therapist! And not only that, you’ve been my therapist for years and I assume you’ve been secretly stupid the whole time. Maybe I’d be a lot further along if you were smarter.”

“Don’t you think it’s interesting, Mia, that you’re choosing to focus on my being ‘stupid’?”

“Why? Because my mother always told me I was stupid? One thing has nothing to do with the other. She’d accuse me of being stupid because she wanted to put me down. She was a bitch! And when my Dad was out of town there was no stopping her. She hated me and couldn’t stand for me to ever accomplish anything.”

“And you feel how about that Mia?”

“Don’t change the topic!”

Beginning to feel annoyed I say, “I’m not changing the topic. I’m trying to get underneath your anger, whether that’s your anger at me or at your mother. We know that anger is your first line of defense but that underneath you have lots of other feelings – fear, sadness, longing.”

“So I suppose now you want me to cry?”

“Mia, stop a moment. It’s not going to help you if you feel only pissed at me when I’m gone. You know …”

“You’re not going yet, right? I still have a couple of weeks, right?”

“That sounded almost like panic. Yes, you’re right, I’m not going for a couple of weeks.”

“So I still have time to change your mind.”

“Mia, you’re not going to change my mind. I’m going on vacation. I’ll be gone for two weeks. You know I’m fully vaccinated and I’ll be fine. Which doesn’t mean you can’t feel angry about my leaving, although I wouldn’t want you to worry that your anger could magically kill me. You can also feel scared and abandoned and alone. Sometimes you may even feel you won’t survive without me. But you will. You’re not a little girl any more. And even though it may feel like it, I’m not your Dad abandoning you to the uncontrollable rage of your mother.”

“Are you sure?” Mia asks, plaintively. “Right, here I go, just what you wanted, whining like a baby.”

“Mia, tell me what you’re feeling right now.”

“It’s just that I’ve gotten used to your always being here. It’s been a while since you’ve been away. It scares me. What if I need you? What if something terrible happens? What if my Dad dies? What if I’m sure you died?”

“So my being away increases your fear of something bad happening.”

“Yes.” Pause. “I can tell myself rationally that’s not the case, but that’s not how it feels.” Pause. “I guess it must be like when my Dad went away. Bad things did happen. Sometimes awful things.” Pause. “But my Mom can’t hurt me like that anymore, right?”

“Right.”

“’Cause I’m not a little girl, right?”

“Right.”


“And we still have time to work on this before you leave?”

“That’s right. And if you remember, Mia, I did tell you that I’ll be covering myself this time when I’m on vacation so if you have an emergency you can reach me.”

“That’s right! I totally forgot!” Pause. “You don’t usually do that.”

“No, I don’t usually, but I’m doing it for exactly the reason you mentioned. I’ve been here and available to all my patients for over 18 months - an unusual stretch for me - so I thought it might be hard for people to go cold turkey. I figured covering myself in an emergency is a sort of in between step.”

“I guess you really do care,” Mia says with a catch in her throat. “Thank you.”

“My pleasure.”