Inside/Outside

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.”

Tuesday, May 9, 2017

Meeting the Family

“Well, I started World War III,” Patrick says sighing deeply, as he settles into the chair across from me. “I knew Vi wouldn’t go down easily with my parents, but I didn’t think it would be that bad. My mother literally gasped and my father’s rage permeated the entire dinner. He didn’t say a word to her the whole time, but he had a lot to say to me afterwards. I guess I shouldn’t have just sprung her on them, but she surprised me by coming down for the weekend and I was supposed to go to my parents for dinner so, I guess I just decided to bring her along.”
“Wait, Patrick. You mean you hadn’t told your parents that Vi is African American? And then you just showed up with her for dinner?”
“Yeah. You know, she teaches law at Columbia University in New York, I’m down here in Florida, I knew my parents, particularly my father is very prejudiced, so I guess I kind of avoided the whole thing until I couldn’t anymore. Vi wasn’t very happy with me either. Obviously the dinner was awkward for her.”
Internally I find myself yelling at Patrick, ‘Awkward? That’s an understatement! She must have been consumed by anger she had to swallow. How could you have allowed this to happen? To everyone.”
Wondering if I’m feeling not only my anger, but Patrick’s as well, I ask, “Who are you feeling angry at Patrick?”
“Angry? Well, I’m angry at my parents, particularly my father. He really let me have it. He guessed no nice white woman would want me since I was such a loser; had to go looking in the gutter for some black chick.”
“And you felt and said what?”
“I hung up on him.”
“And felt?”
“Angry. Disgusted. Vi is this incredibly accomplished, smart, beautiful woman. I’m honored that she’d want me. And all he can see is her black skin. Except I don’t know if she still wants me. She’s pretty angry with me too. She didn’t know I hadn’t told my parents she was African American. She kept saying we’re not children, we’re in our 30s, what gives them the right to think they can decide our lives.”
“And can they? Can they decide your lives?”
Patrick hesitates before saying, “No, not exactly.”
“What do you mean, not exactly?”
“Well, I couldn’t figure out the long distant part of Vi and my relationship anyway. I mean, it would hard for me to start all over again as a financial planner in New York and to say that there are no law schools down here equivalent to Columbia would be putting it mildly.”
“You’re confusing me Patrick. Are you thinking of breaking up with Vi? Were you thinking of breaking up before the dinner with your parents? Is your parent’s reaction influencing your decision about breaking up?”
“I don’t know. I love Vi, but I can’t figure out the logistics. I couldn’t figure out the logistics before the dinner and I can’t figure it out now.”
“Have you talked to Vi about your concerns? I know you hadn’t talked with me about it.”
“No.”
“Did you set Vi up, Patrick?” Realizing my anger is seeping through, I try to temper my question. “I mean, did a part of you think taking Vi to dinner with your parents would precipitate World War III, as you said, and might lead to her breaking up with you?”
“I hadn’t thought of that at the time, but now that you mention it … I mean, she’s such a perfect woman for me, I can’t see how I could break up with her. Except she lives in New York and I don’t see how that’s workable.”
Now I feel more sad for Patrick than angry. “You know, Patrick, it’s difficult for you to take charge of your life, to decide what you want for you and make it happen. You don’t talk with Vi about your concern about living in two different cities and whether that can be worked out. I suspect you haven’t even looked at the possibility of becoming a financial planner in New York. You don’t confront your father about your feelings about what he said to you.”
“I guess I always take the coward’s way out. I run.”
Now that I am no longer angry with Patrick, I realize that I had been reacting to him much as his father did. “I wonder, Patrick, if you’ve heard your father call you a loser your whole life and if you’ve come to identify yourself as a loser, despite your obvious success and accomplishments. You feel you can’t do it, whatever it is, and so you don’t, you opt out.”
“I think that’s true. But it’s a hard pattern to break.”
“Yes, it’s a hard pattern to break, but we’ll work on it.”  

Wednesday, April 26, 2017

An Emotional Storm

“Bill broke up with me Saturday night,” says 28 year old Chelsea in her Monday session, looking as though she may not have slept or bathed since then.
“I’m so sorry…” I begin.
“You didn’t call me back. I called and called and called.”
“I’m sorry, Chelsea, but when I called on Sunday I explained I was at a very long play, didn’t check my phone and got home way too late to call. Did you get my message?”
“It was too late,” Chelsea says, rolling up the left hand sleeve of her blouse.
Always a bit queasy, I resist the urge to look away, her left arm filled with red gashes from what I assume are self-inflicted cuts from a razor blade. “Oh, Chelsea,” I say, “It’s been years since you felt the need to cut yourself. I guess you were mad at both Bill and me.”
“You abandoned me. I couldn’t stand the pain.”
“What made the pain so unbearable?”
“What?” she asks, becoming angry. “That’s a stupid question. The two most important people in my life abandon me and you ask what made the pain so unbearable?”
“You’re definitely angry with me.”
“Duh!”
“But why did you need to turn the anger on yourself, why cut yourself, why not be angry at me, at Bill?”
“What was I supposed to do, go to your house and kill your dog?”
“Was that a fantasy you had on Saturday night?” I ask, hoping I sound calmer than I feel internally.  
“What if it was?”
“You know, Chelsea, it’s always all right to have whatever fantasy you have, as long as it stays a fantasy.”
“Hah! Scared you, didn’t I?”
“It’s a scary fantasy, but the pleasure you took in scaring me indicates just how angry you are at me. I guess what you’re saying is that you felt afraid you couldn’t contain your rage, so had to turn in on yourself.”
“I wanted to kill you! I wanted to kill Bill. I did start swinging at him, but he just pushed me away and told me that’s why he had to get away from me and literally ran out the door.”
“I am sorry, Chelsea. I know you loved Bill and really wanted this relationship to work out.”
“Why don’t they? Why don’t any of my relationships work out?” Chelsea says, starting to cry.
Although we have dealt with the responses to those questions many times over the years – because you’re demanding and needy, because one moment you love the person and the next you hate him, because you can’t tolerate even brief separations without feeling enraged or terrified or both  - I also know this is not the time to revisit them.
“When I didn’t call you back on Saturday, what did you think? Why did you think I didn’t call? And what did you think when I called on Sunday?”
“I felt you were just like Bill. That you didn’t care about me, that you were sick of me just like him, that you wanted to be rid of me.”
“I understand that’s what you felt, Chelsea, but I was asking something a little different. I was asking what you thought. If you thought there might have been a reason I didn’t call you back that might have had nothing to do with you, like maybe I lost my phone or forgot it.”
“But you didn’t. You chose not to call me back.”
“So it would have felt better for you if I’d called after midnight?”
“It would have felt better, but it still would have been too late.”
Only Chelsea’s feelings exist for her at this moment. “You’re caught up in so many painful feelings, Chelsea - hurt, loss, rage, abandonment – that from this place it’s impossible for you to step outside your feelings and try to reflect on them. So maybe it would be better if we focused on helping you not to turn all those feelings on yourself and hurt yourself. Can we do that?”
“I kinda liked doing it, it was like going back to an old friend.”
“I’m sorry to hear that. So are you saying that you think you’re going to start cutting again?”
Chelsea smirks. “That made you angry, didn’t it?”
“You know, I wasn’t aware of feeling angry, but you’ve always been incredibly sensitive and now that you mention it, perhaps that’s true.”
“And that’s one thing I’ve always appreciated about you, your honesty and your willingness to own your own shit.”
“Thank you. So maybe from there we can work on repairing our relationship and move forward.”
“Maybe,” Chelsea says with considerable hesitation.
“I understand. Right now repair feels difficult.”

“Yes, it does.”

Tuesday, April 11, 2017

Seeking Protection and Connection

I smile at my new patient, Eileen, as I greet her in the waiting room, extending my hand in introduction. She doesn’t return my smile, but does warily shake my hand. Settling herself stiffly in the chair across from me, she looks slowly around the room.
Oh oh, I think, seems like a pretty disturbed woman, at best distanced and removed, perhaps paranoid, maybe a trauma survivor.  
“I like your office,” she says. “All the windows. Feels free, like floating in space.”
“Thank you,” I say, not sure how to take her comment. An attempt to relate to me? A fear of being confined? A desire for freedom? Hopefully not a wish to jump.
A few moments pass in silence.
“What brings you here?” I ask in traditional therapist mode.
“I have no friends.”
“Can you say more?” I ask, while thinking that her demeanor would certainly make having friends difficult.
“I’m 36 years old. I live alone. I work at home. I’m an IT person, a computer geek.” She shrugs. “There’s no one in my life.”
“Sounds sad.”
“I guess.”
“How do you feel about not having friends?”
“It doesn’t seem normal. People are supposed to have friends.”
“Eileen, what made you decide to come into therapy right now?”
“I found you online. You had a kind face. I liked your website.”
“Like maybe you hoped I’d be your friend?”
“Maybe.”
“Eileen, can you tell me a little about your background, your childhood, your family.”
“It was messed up. My parents divorced when I was two. They’re both alcoholics, drug addicts, both with so many different partners I lost count. And a ridiculous number of so-called siblings. I’d go from one household to the other. Sometimes there would be six, eight of us in a small apartment. I hated it. Felt like I couldn’t breathe. I just wanted everyone to leave me alone. And basically they did.”
“So you learned to put up a wall that said ‘stay away.’”
“Yeah, that’s a good way to put it,” she says nodding. I have the sense she’s pleased by my understanding, although there’s no obvious change in her demeanor.
“Have any idea what’s behind that wall?”  
“What do you mean?”
“Well, when you construct a wall, there’s usually something behind it, something you’re wanting to protect, perhaps something that feels vulnerable or scared.”
“I don’t do vulnerable or scared.”
“So it feels pretty scary to be vulnerable or scared,” I say smiling compassionately. I find myself liking Eileen, feeling sad for the deprived, needy child who must exist behind what feels like an impenetrable barrier.
“I didn’t say that,” she says, stiffening.
“Sorry,” I say, backing off. This is going to be slow, slow going. I need to be careful not to push to glimpse behind that wall too quickly. Her defenses are there for many reasons. They need to be respected, not ripped away.
“You said earlier that there’s no one in your life. Do you see your parents?”
“Not if I can help it. Maybe once or twice a year. Christmas time, Easter. Maybe not.” She shrugs. Doesn’t much matter to me.”
“Was there anyone in your life who did matter to you when you were a child?”
“Like who?”
“A grandparent, a teacher.”
“A math teacher in middle school. She thought I was more than a dumb oaf. She encouraged me. Maybe she was like my friend, except she was my teacher so she couldn’t be my friend. But she’s the one who helped me make something of myself. I don’t know where I’d be if it weren’t for her. Probably just like my parents. Except without the drugs. I’ve never touched drugs in my life. Swore I never would and I haven’t.”
“That’s pretty amazing determination, Eileen, given where you came from and what you’ve been through.”
“Mrs. H – that’s the teacher – she’d say things like that.”
“And when she or I say things like that, you feel a sense of warmth, of being understood and appreciated.”
She looks down. “Yeah, I guess that’s right.” She pauses. “So are you going to help me learn how to make friends?”
“Yes, Eileen, I am. But we have a lot of work to do before finding friends becomes our focus. First we have to help you find you. We have to find the person behind your wall and that’s going to take time. You’ve been hiding from that person for a long time and a sledge hammer isn’t going to work here. And I suspect it’s going to be painful and scary for you. I’ll be here with you and hopefully that will make it easier, but I’m sure there are times it will be tough going.”
“I’ve been through tough before.”

“Yes, I’m sure you have.”

Tuesday, March 28, 2017

Demands

Beverly rushes into my office and throws herself into the chair across from me. “You know,” she begins, “this is just too hard for me. All this running around. I have too many things on my schedule. I mean I know I don’t work – I have no idea how people who work ever manage to get here – but between golf and tennis and bridge and painting – it’s just too much. I need to come on a Saturday. That would work better for me.”
Although I am more than a little annoyed at both Beverly’s demand and at being relegated to the bottom of her list, I decide on an initial non-confrontational approach. “I’m sorry, but I don’t work on Saturdays.”
“You don’t work on Saturdays? How do the people who work get to see you? I suppose they just don’t, right?”
“You’ve been coming for almost a year, Beverly, and you never seemed to have difficulty getting here before. Why do suppose it’s suddenly become an issue for you?”
“I started taking painting lessons. I hadn’t been doing that before.”
“And since you knew you had such a busy schedule, why do you think you decided to add something that might make it harder for you to get here?”
“I didn’t think about it in terms of getting here. I just wanted to take painting lessons.”
“It feels to me, Beverly, that you’re wanting to dismiss the importance of our work together, that you’re saying it doesn’t matter.”
“That’s not fair. You’re the one who won’t see me on Saturday!”
“I think we need to take a step back here. Was there something that happened in our last session that made you feel uncared about? Were you angry with me?”
“You always do that. You always make it about you. It has nothing to do with you.”
“Okay. Then tell me what it does have to do with other than with your schedule.”
“My sister.”
“I remember we talked about your sister last week, about how I saw her as being competitive with you, but that you thought that wasn’t true, that she loved you and always wanted the best for you. And I said both could be true, that she could love you and want the best for you and still be competitive with you.”
“You took her away from me. No one in my family gave a damn about me except her. I was an extraneous being. But Joyce cared about me, looked out for me. And you just took her away.”
“So you are angry with me.”
“I guess. And at her. I’m furious at her. How could she take herself away from me when I relied on her so much? But I decided to show her. She’s the painter you see. I decided I’d become a better painter than her.”  
“So I guess you’re saying you feel competitive with her.”
“No. I’m just getting back at her.”
“Beverly, I want to point out that nothing out there in the real world happened or changed between you and your sister. This is all happening in your mind. You came to see your sister differently. And although you’re entitled to have your feelings, it would be helpful to you if you could hold onto the love and stability your sister provided for you in your chaotic childhood.”
“You’re taking it all back!”
“No. We’ve talked a lot about your living in a black/white world, with no shades of gray. Right now you want your sister to be the perfect sister – whatever that might mean to you – and you want me to be the perfect therapist who would see you whenever you want to be seen. But there is no such thing as a perfect person. You can get a lot of good from one person, but you can’t get everything and that doesn’t make either that person or you bad. And you can feel competitive towards your sister or towards me and that doesn’t make you bad either.”
“It doesn’t make sense to me. If she’s competitive with me how could she always be on my side? Sometimes she’d be on her side.”
“Well I suppose that’s true. But if she wanted, just let’s say, to be a better painter than you, that doesn’t mean she wouldn’t want you to be a better golfer or to find a loving husband or to take great joy from your children. Because there was so much cruelty and rejection in your childhood, it’s difficult for you to believe that someone can be in your corner and still take care of themselves. That’s like me saying I’m here for you, but I don’t work on Saturdays.”
“That makes me mad all over again.”
“I believe you. We’ll keep working on it.”


Tuesday, March 14, 2017

Divorce?

“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.”