Inside/Outside

Thursday, August 10, 2017

The Truth, the Whole Truth, and Nothing but the Truth

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.   

Tuesday, July 25, 2017

Infidelity

Jeffery throws himself in the chair across from me looking more disheveled and distraught than his usually calm, poised presentation of a mid-forties successful financial advisor.  
“I couldn’t wait to get here. I almost called and asked if you had a double session available today or any more sessions available today at all. Do you?”
Thinking about how reluctant Jeffery has been to increase his therapy sessions to more than once a week, I say, “I’m sure I can see you later this afternoon, but first why don’t you tell me what’s going on.”
“My wife told me she wants us to have an open marriage.”
Many thoughts go through my mind, including the sarcastic, ‘so now the shoe’s on the other foot.’ Instead I say, “Her request obviously disturbed you.”
“Hardly difficult to figure that out. Can you imagine?! My wife! The prissy little woman who left me begging for sex.”
“Jeffery, what’s so disturbing about her asking for an open marriage?”
“That’s a dumb question.”
“You could look at her request as freeing you to see as many women as you wanted without having to sneak around.”
“But she could also see as many men! In fact, she already has. She told me at first she wanted to get back at me for all the women I saw on the side – even though I never admitted to seeing any other women. So she went online and started going out on dates when she knew I’d be out. And then she’d have sex with them. It almost made me throw up to hear that. And then she told me she’s come to enjoy it and wants to be able to do it openly. Ugh!”
“Jeffery, I know you might think these are dumb questions, but why is a man who never followed his marriage vows, so disturbed about his wife wanting the same freedom?”
“It’s not the same. She said she did it because she wanted to get back at me, meaning she must have been angry at me.”
“And does that give you an idea about your own motivation?”
“I wasn’t angry at my wife.”
“’A prissy little woman who left me begging for sex’ doesn’t sound not angry, but maybe it’s more than just your wife you’re angry at.”
“That theory again. I’m angry at my mother for dying and leaving me and therefore I’m angry with all women. I don’t buy it.”
“Can you think seriously for a moment why you might not buy that theory?”

“It’s just a cliché.”
That’s not a moment’s worth of thought, I think. Then I realize I’ve had several sarcastic thoughts this hour. Am I angry with Jeffery for being unfaithful? But I’m not angry with other unfaithful patients. Am I feeling Jeffery’s conscious or unconscious anger at me? Certainly a possibility. Am I angry with Jeffery for not accepting anything I offer be it a question, an interpretation or a request? Another possibility.
“Have you ever noticed Jeffery that you rarely take in anything I offer?”
“For heaven’s sake, my wife just told me she wants an open marriage and you want to talk about us.”
I think, ‘well, there’s an example,’ but I swallow that sarcastic response and say, “Perhaps there’s a connection between the two, Jeffery.”
“What!?” he says, roiling his eyes towards the ceiling.
“I wonder, Jeffery, if the reason you feel angry with women is that you’re afraid of being dependent on them, of needing them.”
“That’s ridiculous.”
“Again, I’m going to ask you to think about what I just said and to try and take it in.”
“It doesn’t make sense to me,” he responds immediately.
“Okay. Let me ask you something else. Do you still want that second session today?”
“What!? You’re more scattered than I am. If it’s going to be like this, no, no I don’t want it.”
“I think you’re afraid of having to rely on women – particularly your wife and me - because either you’re afraid you’ll lose us or become so dependent on us that you’ll feel the extent of your own neediness. And if you reject my idea without considering it you’ll have proven my point.”
Jeffery laughs. “I guess I can’t win.”
“It depends what you want to win,” I say very seriously. “If you want to get to the place where you can have close, meaningful relationships with women, you can definitely win.”
“And what would I need to do to make that happen?”
“I guess you could start by accepting that session later this afternoon.”
“That was a trick.”
“No, it wasn’t a trick. When you were extremely distressed you wanted to see me as much as possible, but once you were here, you had to reject your desire to rely on me by refusing the second session, just as you’ve rejected coming more than once a week.”
“Okay, okay. I’ll come in later this afternoon.”

“I’m glad.”   

Wednesday, July 5, 2017

Shame

“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.”

Friday, June 23, 2017

After a Year

“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.”

Tuesday, June 6, 2017

Searching for 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.”        

Tuesday, May 23, 2017

Twins

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.”