Inside/Outside

Friday, September 13, 2019

A Member of the Family

Opening my waiting room door I’m surprised to see the usual bubbly Marlene sitting downcast, twisting a tissue in her hands. She rises slowly, manages a weak smile and walks into my office. “I feel awful,” she says.
“I can tell. What’s wrong?”


“It’s Scooter.”
It takes me a second, but I realize she’s talking about the family’s dog, a relatively young schnauzer if I remember correctly. 
“My son will never forgive me. He keeps telling me he hates me, that Scooter was a member of our family, that it’s all my fault. And he’s right! I don’t know how I could be so stupid,” she says, bursting into tears.
I find myself holding my breath, wondering what happened to Scooter, hoping he’s not dead.    
Marlene continues, “I opened the garage door. Scooter ran out. He was hit by a car. He’s not dead, but the vet doesn’t know if he’ll make it. His leg’s broken. Depends on how much internal bleeding there is.”
Tears well in my eyes, as images flash in my head. Poor rescued Siggy who I’d nursed back to health on a graduate student’s stipend, running out the front door, killed by a car; Brenna, our black Lab, poisoned, hovering between life and death but fortunately making it; and Hadley, so connected in my mind to my late husband, needing to be put down when auto-immune disease ravaged her seven year old body.
“I’m so sorry, Marlene. I know how hard this must be for you. And for your son. I really hope Scooter’s all right.”
“Me too,” she says smiling wanly. “Didn’t take any time for my ex – almost ex – to start screaming at me. Even threatened to bring it up in mediation. Said he wasn’t sure he could trust me with Davey. How could he know I might not let Davey out the door? Talk about pouring salt on the wound.” Pause. “Davey’s so mad at me. He doesn’t remember a life without Scooter. And now without his Dad…,” she says crying. “I can’t believe I was so stupid.”
“You keep saying that. I don’t think it has anything to do with being stupid.”
Marlene looks up at me, frowning. “What are you implying?”
Taken aback I say, “That you’re not stupid.”  
“So are you saying I did it on purpose?”
Puzzled, I look at Marlene and say, “Absolutely not! I was saying it was an accident.”
“I thought you people didn’t believe in accidents.”
“’You people?’”
“You know, shrinks.”
“Tell me what’s going on Marlene. I understand that you’re sad and distressed about Scooter. I understand you feel guilty. But it sounds like you’re attributing thoughts to me that I’m in no way thinking. What is it that you’re thinking, fearing, worrying about?”
She sighs. “When I was a kid we had a parakeet. Actually it was my younger sister’s. I wanted a dog. My mother said no way. So we got a bird. I never liked it much. The bird got out of the cage and ended up flying out the window. My sister cried for days. My mother said it was my fault, that I let the bird out.”
“And you’re worrying I’ll think you let Scooter out the garage door?”
“I didn’t!”
“It never occurred to me that you did.”
“It didn’t?”
“No, it didn’t.” Somewhat hesitantly I add, “But I don’t know about that bird. How did the bird get out of the cage?”
Marlene lowers her eyes. “I let it out,” she says quietly. “But I didn’t mean for it to fly away. I just wanted it to do something besides sit in that dumb cage all day!”
“Sounds like a perfectly understandable thing a child might do.”
“It does?”
I nod. “Also sounds like you’ve been carrying that guilt around with you for a long time.”
“But I didn’t want to get rid of Scooter! I know he can be demanding sometimes and that he does take up time, but he’s a member of the family. I didn’t want him gone.”
“I believe you Marlene. We all want beings we love gone sometimes, including human beings. It doesn’t mean we stop loving them or that we really want them gone forever.”
Marlene is sobbing. “Thank you. I really needed to hear that.” Pause. “Cause truthfully I got scared when my ex said he wasn’t sure he could trust me with Davey. I started wondering if I was purposefully negligent.” Pause. “If I was evil. That I’d harm Scooter or even Davey just like I hurt that bird.”

“You’ve been carrying around a lot of guilt for a very long time. Seems like it’s something we need to look at.”

Friday, August 16, 2019

Murder on Her Mind

Gina smiles at me, sashaying into my office from the waiting room in her short, tight, floral dress.
“Like my new dress?” she asks, settling into the chair, trying unsuccessfully to both cross her legs and cover them. “My friends tell me 45 is too old to wear a dress like this. But I don’t care. I’ve got it, I’m flaunting it. They’re just jealous. What do you think?”
I silently agree with her friends and wonder if she wants me to be another jealous woman. I say, “You get to wear whatever you want to wear.”
“It makes me feel alive. Of course, I’ve been feeling pretty alive these days anyway. Nothing like an affair to spice up one’s life. New man, new compliments, new sex. I love it when I get on top of him and all the lights are on and he looks at me while stroking and pinching my nipples. We can go for hours.”
Gina and I have talked a lot about her affair. I remain silent.
She pauses and then continues, “You know how I like to read all these mysteries – some old, some new – Agatha Christie, John Grisham, Patricia Cornwell, Scott Turow…?”
I nod, unclear where Gina is headed.
“Well, ever since I’ve read that Presumed Innocent book about the wife trying to get back at her husband by framing him for his girlfriend’s murder by using his semen, I’ve been fantasizing about how to kill you know whose wife and set my husband up to take the fall.”
My anxiety spikes. “Actually I don’t know who,” I blurt out, “since you continue to refuse to tell me who he is.”
She laughs. “It’s just an expression. We’ve been over this a million times. She’s in your field. I’m afraid you’d know her, or even him. End of topic.”
“It can’t be ‘end of topic’ if you’re considering killing her!” 
“You’re being so silly today,” she says dismissing me with a wave of her hand. “I didn’t say I was going to kill her – I couldn’t do that – I’m just fantasizing about it.”
I think about what she just said. It’s true. She was talking about fantasy, not action. I’ve listened to many patients over the years talk about their murderous and/or suicidal fantasies without assuming they were going to act on them. What’s different here, I ask myself.
Gina is speaking, “..it wouldn’t even be hard. My husband and I even have a better sex life these days. I guess I’m so turned on all the time, I’ve been more sexy with him too. See, he’s enjoying my affair too. But I can’t figure out how I’d get him to use a condom. So far my fantasy hasn’t helped me with that one.”

And do you find your murderous fantasies a turn-on?”
She taps her lips with her left index finger, considering my question. “I guess. But the turn on is having the power to figure something like this out – not dummy Gina after all. It’s exciting.” Pause. “Don’t you think it’s exciting?”
Suddenly I’m convinced that everything that’s happened in this room today is about Gina and my relationship. 
“Gina, I wonder if we can step back for a minute. It feels to me that you’re trying to one up me..”
“What are you talking about?”
“Well, I think you’ve tried to make me jealous, tried to titillate me with your sexual stories, dangled withheld information in front of me, and terrified me with talk of murder.”
“You have one warped mind if you think I’m trying to turn you on!”
Interesting comment, I think to myself. “I didn’t say that you were trying to turn me on. I think you’re trying – and I’m not saying it’s conscious – that you’re trying to make me feel less than you, trying to win over me, just as you tried to win over your mother to be closer to your father.”
“I’ve told you, I did win! My father called me ‘the beauty.’ It’s me he wanted to twirl around in my new clothes. It’s me he took to breakfast on Sunday morning, just me, not my mother, not by brothers.”
I think, but reject saying, ‘but who went into the bedroom at night?’ a remark that feels both premature and hostile. “Let’s go back to us for the moment,” I say instead. “You started the session talking about your friends being jealous of you. Seemed as though you wanted me to be jealous too, like you’re flaunting your beauty, your sexuality.”
Gina looks at me coyly. She drops her head for a second and then looks at me defiantly, “I don’t want to be mean, but you’re not a worthy opponent. You’re too old.”

“Wow!” I say. “You’re correct. I’m considerably older than you. But the way you just said that, sounded like you were intent on delivering a death blow. I guess I’m another murder victim.” 

Friday, July 12, 2019

Boredom

I look at the clock. Camilla is now 15 minutes late for her session. I’m not surprised. She’s been consistently late for every session since we started working together several weeks ago. She always apologizes, always has some reason – the car wouldn’t start, she got a last minute phone call, the traffic was bad. 
Finally I see the red light that signals a patient is in my waiting room. 
“I’m sorry,” she says, breathless. “I told myself I’d be on time today. But my Mom called and was telling me I needed to call my Grandmother. I know I should. I love my Grandmother, but I don’t like talking to her on the phone. It’s boring. She asks the same questions – how’s my job, have I met any nice boys, am I going out with my friends. Boring!”

“What makes it boring?” I ask and then immediately regret my question. I want to talk to her about her lateness. Or at least ask her what she means by boring. 
“I told you,” she replies, crossing and uncrossing her legs, combing her fingers through her long brown hair. “She always asks the same questions. My job is fine, I haven’t met anyone and, yes, I go out with my friends.”
We sit in silence for a few seconds until she says, “What? You think I should call my Grandmother?”
I shrug my shoulder. “I think that’s up to you.”
She sighs. “I wish my mother felt like that.”
Silence.
“What?” she asks again. “Aren’t you going to ask me anything?”
“What do you feel in the silence?” I ask.
“What?”
“What do you feel in the silence?”
“Like we’re wasting time, not getting anywhere.”
“That’s what you’re thinking, what are you feeling?”
“I don’t know.” Pause. “Bored I guess.”
“Sounds like it’s easy for you to feel bored.”
“Yeah, I guess,” she says fidgeting in the chair. “I don’t like sitting still. I don’t like quiet. I need to have stuff going on. That’s why I like my job at Saks, even though my parents say they didn’t pay for me to go to college for me to work at Saks. But there are people around and all those great clothes. Even if we have no customers I can walk around picking out clothes, holding them against me, deciding if I see something I really, really want. Although that’s frustrating because I can’t afford most of that stuff anyway, even with the employee discount. Not until my parents give me an allowance again. They say they’re paying for my apartment and until I get a real job that’s all I get.” Pause. “But I’ve told you all this already. What else should we talk about?” she asks, glancing at the clock.
“Do you have any thoughts about why you looked at the clock just then?”
“I don’t know. I guess because I’m bored and because time is just crawling by.”
Ah ha, I think. “Camilla, do you think it’s possible that you’re consistently late here because 45 minutes feels like a long time to sit and talk to me?”
She looks startled. Then smiles. “Yeah! 45 minutes is a long time! I never sit for 45 minutes. It’s why I always nix going to the movies. Who can sit for two hours watching a dumb movie?”
“So you come late so you don’t have to sit so long?”
“Yeah. But it’s not like I decide to come late. It just happens.”
“I understand. But it may ‘just happen’ because you unconsciously don’t want be here for the full session.”
“I suppose.”
“Is there any other reason you might want not to come here?”
“I don’t know. What are you getting at?”
“Well, I was wondering if coming here is kind of like calling your Grandmother. You feel you should do it. You know your parents want you to do it. But maybe it’s not really something you want to do.”

“Maybe,” she says shrugging.
“You’re 25 years old, Camilla. You don’t have to be here if you don’t want to.”
“I know,” she says looking down. “But I have to do some of the things my parents ask.”
“I think it would be important for you and for us to know what it is that you want to do.”  
“I don’t know what I want to do! That’s why I’m here.”
“Does that mean you’re not only being an obedient child by coming here, but that you do want help figuring yourself out?”
“I guess.”
“That doesn’t sound too certain.”
“Can we make the sessions 30 minutes?”

“No. My schedule is based on 45 minute sessions. And, besides, if you decide you want to come, I think it would be good for us to work on what makes it so difficult for you to be still, on what you feel underneath what you call boredom. And perhaps we could look at your lateness – or being on time – as a message about how you’re feeling about me and the therapy. That’s if you decide to continue. And that’s something you will have to decide.”

Friday, June 14, 2019

Father’s Day

“I have to decide today,” says 44 year old Brian, a patient who started seeing me last month because of overwhelming anxiety. Passing his hand through his brown, wavy hair he continues. “I’ve delayed and delayed, but if I’m driving to Pensacola tomorrow in time for Father’s Day, I have to make a decision today. No more procrastinating.” Pause. “It’s no secret that I don’t want to go. Even my mother who’s calling me every day to bug me about coming knows I dread the idea. And my wife is staying out of the whole thing. Which is kind of her. All I’d need is for her to be pulling me in the other direction and saying I need to stay for our boys.”
“I notice you’ve mentioned your mother, your wife and your boys, but not your father.”
Brian chuckles. “You’ve got that right. I realize it’s supposed to be his day, but if it were only for him I know I wouldn’t go. I mean, he was awful my whole life, but ever since he banished my brother because he’s gay and then Trump was elected, it’s impossible to have five minutes of a civil conversation. My father has always been a tyrant. He has an opinion about everything and for some reason he thinks he’s an expert on everything too. Which is ridiculous, since he barely finished high school and clearly isn’t very bright.”
I think of my father, definitely smart, politically like-minded, but most definitely a tyrant. “So why would you go?” I ask.
“My mother.” Pause. “And she’s right, they’re not getting any younger. But she’s pulled out every guilt inducing maneuver she can think of. ‘What if Dad dies and you never see him again?’ ‘Why does his relationship with Paul have to affect you?’ ‘Can you imagine how embarrassing it would be for him if not one of his children is present?’ ‘You can bring Janet and the boys; we’d love to have them; the whole family together’ As if I would subject my boys to whatever explosion is bound to happen.”
“And how do you feel about your mother pressuring you?”
“I don’t know. It’s what mothers do.”
My mind wanders to the many difficult years I had with my father, coupled with my mother’s constant inability to ever see my point of view. Regardless of the circumstances I was always the one who had to make things right.
“But that doesn’t tell us how you feel about your mother pressuring you,” I say.

Brian sighs. “It’s the same old, same old. My mother’s whole life revolves around my father. She has nothing else in her life. Except for us of course. But she’s followed my father’s lead as far as my brother. I wonder how she feels about being totally disconnected from Paul.” Pause. “It’s sad.”
“Sad for her? For Paul?”
“I was thinking sad for her. But it must be sad for Paul too.” Pause. “You know, I’m getting more anxious as we talk about this.” Pause. “And feeling like I should go.”
Silence.
“I, I need you to say something. My anxiety is going through the roof,” Brian says, clenching his hands and fidgeting in the chair.
“So the silence made you more anxious, just like thinking about the disconnect between Paul and your mother.”
“Yeah, I guess so, but I’m not sure how they’re related.”
“Nothing comes to mind?” I ask.
Brian shakes his head, looking puzzled.
Although I would prefer to wait to see what might emerge from Brian, his escalating anxiety pressures me to speak. “I wonder if one of the things that makes you anxious is the fear of being disconnected, not connected to your mother or to me.”
“I’m not sure I understand.”
“Well, you were talking about how your mother has no relationship with Paul. I think that scared you. You wouldn’t want to have no relationship with your mother, so I suspect when that thought went through your mind – consciously or unconsciously – you felt you’d better go for Father’s Day.”
“Wow! You think that’s what my anxiety is all about, being disconnected from my mother?”
“Your anxiety could be the result of many things, but the fear of separation could certainly be one of them.”
“And with you too?”
“Well, you were already feeling scared of being separated from your mother and when I wasn’t speaking I think you experienced that feeling of separation with me as well.”
“I’ll have to think about that. But meantime, what should I do about Father’s Day?”
“I can’t decide that for you Brian. There’s not a right or wrong decision, just your decision.”
“That scares me too.”  
“Because?”
“What if I make a mistake?”
“What if you do?”
“I think I’m going to go. It feels like the safest choice.”

“You need to do whatever you need to do. There was a lot that came up in this session today, too much for us to deal with it all. So I’m sure whatever you decide will be fine and we’ll have other times to work on your anxiety and your relationship with both your parents and with me.”

Monday, April 15, 2019

The Dream

“I had a dream last night,” Justin begins, squirming nervously in his chair. “I can’t remember any of it, but I feel haunted by it. I know that doesn’t make much sense, but it’s like I woke up scared, like something terrible is going to happen, like something or someone is going to get me. I kind of want to keep looking over my shoulder. Even here, I wonder if there’s someone else in the room, although I know that’s ridiculous.”
Justin, a 45 year old accountant, has been my patient for several years and, as far as I can remember, has never before spoken about a dream.
“Well,” I respond, “the dream obviously affected you, so maybe you can talk about your feelings and what those feelings bring to mind.”
“You’re charging your phone,” he says.
“Yes,” I say, surprised. It’s not unusual for me to charge my cell phone while patients are in the office.
“How do I know you’re not recording me?”
Justin can sometimes be a bit paranoid, but his question is beyond anything I would expect. “I guess you are feeling frightened, Justin. Your world suddenly feels very unsafe so even innocuous things can feel threatening."

"You didn’t answer my question.”
I’m taken aback, perhaps even a little frightened myself. Hmm, I imagine Justin is unconsciously inducing his feelings in me. “No, I’m not recording you. You’ve seen me charge my phone before, so I’m assuming that your concern is being triggered by your fear.”
Justin stares at me. My fear builds.
“Would you like me to unplug my phone?” I ask.
“I’d like you to turn it off,” he replies woodenly.
“Okay,” I say as I lean to my left, pick up my phone and turn it off.
The silence that ensues is deafening.

Finally, Justin drops his head in his hands, shakes his head and mumbles, “I’m sorry, I don’t know what’s wrong with me.
I breathe a sigh of relief. “So let’s see if we can figure out what’s going on, perhaps what triggered the dream, what might have led you to feel so frightened.”
“It’s such a terrible time of year. Tax time you know. Some days I’m working 5AM to 10PM at night. And everyone wants a piece of me. My ex-wife’s mad because I haven’t taken the kids. My older son says he needs money for college. My clients are driving me crazy. Everyone wants their taxes last week. I keep telling them it’s no big deal if we have to file an extension. But, no, that’s not good enough.”
“When you say everyone wants a piece of you, what comes to mind?”
“That’s it!” he says excitedly. “That’s what was happening in the dream. Everyone was pulling at my skin, like they were trying to rip me apart. I know there was more after that but …” He stops. “I think there was like a monster there. Maybe like a monster waiting to eat the pieces of me that they threw to it.”
I grimace internally. “That does sound terrifying.”
Silence.
After a few moments I ask, “What’s going on in your head?”
“I don’t know. I sort of feel I used to have that nightmare as a kid. A lot.”
“Any thoughts about it?”
Silence.
“I’m sorry,” he says after a few moments. “I suddenly felt frozen. Like I couldn’t move. And… I know this is ridiculous, but you seem menacing again.”     
“What is it that you’re afraid I’ll do?”
“I know this is crazy, but what jumped into my head was, eat me.”
“Like in the dream.”
He nods.
“Any thoughts?” I ask, although I have a pretty good idea of the answer.
He nods again. “Yeah, my mother. I used to say she loved me to death. But I guess I meant that literally. She wanted all of me. She didn’t want me to have anyone else in my life. She didn’t do that to my sisters, just me. They hated me, thought as the boy I got all of my mother. But I didn’t want all of her! And I sure didn’t want her to have all of me! Yuck! I feel beyond creeped out. I mean, I know we’ve talked about all this before, but having that dream made it so much more real.”
“The dream actually brought you back to the feelings you had as a child, the terror of being eaten, of being swallowed up.”
“Stop! I can’t deal with any more today.”
“Of course. Whatever feels comfortable for you.”
Justin looks at me with tears in his eyes. “I wish my mother could have been concerned about my comfort. And I’m sorry I thought you were recording me.”
“Nothing to apologize for. Totally understandable given what you were feeling.”

Friday, March 15, 2019

Guilt

“I feel so awful, I can’t believe that I had to disappoint my parents. I can’t believe I couldn’t handle college, that I had to come home. My parents have always been there for me, always wanted the best for and all I do is screw up.”
This is my first session with Tiffany, a slender, attractive young woman with blue eyes and long blonde hair. Her mother, sounding concerned, had called to make the appointment, saying that Tiffany was having difficulty at Duke and needed to come home.
“I hate myself!” Tiffany continues.
“Wow! That’s pretty strong. Can you say why you hate yourself?”
“All I’ve done is give my parents problems my whole life, even before I was born. My mother had to be in bed for two months before she had me! She’s a physician – so’s my father – she can’t just take two months off. But she had to because of me.”
“That hardly sounds like your fault, Tiffany. I assume it was some medical condition your mother had.”
“She never had that problem with my brother. My brother never gives them problems. He’s graduating from Yale and going on to medical school. Of course!”
Clearly hearing her sense of competition and failure in relationship to her brother, I decide, for the moment, to focus more on her current situation. “Can you tell me what was going on for you at college?”     
“All those science courses! I can’t handle them. I’m just not smart enough. I started crying at every little thing. And I think I pretty much stopped eating. And then I couldn’t even get myself out of bed to go to class. Especially Chemistry class.  I don’t understand it. It makes me feel stupider than I already feel.”
“Are there classes that you enjoy, that you do well in?”
“Oh yes,” she says, brightening. “I love anthropology and I’m…hmm…I’m a pretty good writer.”
“So you take science courses because…?”
“What do you mean? I have to take science courses to get into medical school.”
“And do you want to go to medical school?”
“I’ve always known I’d go to medical school.”
“That’s not the same thing as wanting to go.”
“Yes, I want to go to medical school. I put my parents through a lot when I was a kid. I got rheumatic fever and ended up in the hospital for quite a while. I could tell how scared they were.”
“You must have been pretty scared too.”
“I was, particularly when I was alone. But the doctors and nurses were great. And I kind of enjoyed watching all the machines and monitors. That’s the kind of doctor I want to be, a pediatrician, to help kids like me.”
“And do your parents want you to be a doctor?”
“Definitely. It’s like a given.”
“So what if it wasn’t a given? What if you could decide to do anything you wanted to do?”
“I’d go on archeological digs and write about them or even write made-up stuff about the digs, like mysteries. But that’s not at all practical. No way to make a living.”  
“Have you ever wondered, Tiffany, why you feel so guilty in relation to your parents?”
“I told you why, I’ve always given them problems.  Besides rheumatic fever I was a sickly kid. And I broke my arm doing gymnastics. They always had to worry about me.”
“It seems that a lot of the things you feel guilty about you had absolutely no control over, like your mother needing bed rest or your having rheumatic fever or breaking your arm.”
“I was fooling around on the bar, that’s how I broke my arm.”
“You sound determined to have things be your fault. Do you think, Tiffany, if you felt things weren’t your fault, you’d end up feeling powerless and scared?”
“I don’t know. I’m not sure I know what you mean.”
Too soon for that interpretation I tell myself. I decide to pursue a different path. “Do you ever feel angry at all the pressure you’re under?”
“Angry? I don’t think so. I feel mad at myself for not being able to keep up and, like I said, worrying my parents.”
“So, now that you’re home, do you think you’re going to be able to relax and take it easy for the rest of the semester?”
“Oh no. My parents are going to get me a chemistry tutor so I can go back to school more prepared.”
At this point I find myself feeling angry at Tiffany’s parents and wonder if I’m feeling Tiffany’s unacknowledged  anger. That could explain the tremendous guilt she feels – guilt for the anger she doesn’t even know she has. But those interpretations are also premature.  
“Our time is almost up for today. But I hope I’ll be able to get to know you more and I hope you’ll tell me more about your wishes and your dreams, even if they aren’t always practical.”
“I wish you could make me smarter.”

“I don’t know if I can do that, but perhaps I can help you to be more accepting of yourself.”