Inside/Outside

Friday, January 4, 2019

Diminished

“I hope you had a better New Year than me,” Jeff says with a bitter edge as he settles into the chair across from me.
“I thought you were really looking forward to spending New Year’s with Eileen.”
“Yeah, me too. She broke up with me.”
“Oh, I’m sorry. You thought this relationship had real potential.”
“Them’s the breaks. I don’t seem to be able to find anyone since my divorce. Sometimes I wonder if I should have stayed with my ex, but I know we were both totally miserable.”
Forty-two year old Jeff is a good looking man with blonde curly hair, a dimple in his chin and intense blue eyes. He has, however, had little success in establishing a new relationship.
“Did Eileen say why she broke up with you?”
“Something about my being too sarcastic or too needy or some stuff like that.”
Silence.
“I guess you want to know what I think about what she said to me.”
“Jeff, your tone is pretty biting today. Are you angry with me?”
“I guess.”
Silence.
“I’ve been reading your blogs. And I was wondering why you never write about me. What makes the patients you write about more interesting than me?”
“Before I address that question directly, I’d like to look at the feelings that were brought up for you.”
“Makes me feel like I’m not as good as your other patients, not as important, not as interesting.”
“Sounds pretty much how you felt in relation to your two older brothers.”
“That’s for sure,” he says, smirking. “I was the pretty one, but not a girl. And my brothers had the smarts and the artistic talent which was way more important than looks in my family.”
“So you feel less than.”
“Yup! Guess you could say that.”
“And the fact that you’ve built a thriving accounting firm doesn’t undue the messages of ‘less than’ that you took in as a child.”
“Right again!” Pause. “I’m just a numbers man, not an intellectual, not an artist.”
“And the worse you feel about yourself, the angrier you are at the other – me, Eileen, whoever – for, in your eyes, not being valued.”
“So you’re saying Eileen was right about me. That’s great, real support, and from my therapist no less!”
“I don’t know if Eileen was right about you or not. What I do know is that when you feel diminished, less than, you’re so hurt by those feelings that you lash out and that doesn’t serve you well.”
“So why haven’t you written about me?”
Although Jeff’s demandingness makes me want to withhold from him, I feel it is more important to respond to his question and then deal with his reaction to what I have to say. “I don’t know, Jeff, how many of my blogs you read, but every so often I explain that the ‘patients’ in my blogs are fictionalized. I’m real – as real as I can imagine myself to be in a made up situation with a fictionalized patient. Otherwise I’d be concerned about patient confidentiality.”
“You’re kidding me?! Now I feel like a real ass. Competing with imaginary people! You must have been laughing your head off at me.”
“Not at all. This has been a very important session. We could see right in front of us how hurt you feel when you feel devalued and how quick you are to attack the person you experience as diminishing you. It clearly comes from how you felt as a child, but we need to work on helping you not to automatically assume that you are being devalued and, even if you are, not to bring to the current situation all the rage you felt as a child.”
“You know, I don’t even remember being enraged as a child.”
“Well, you might not have been allowed to show it.”
“That’s for sure. No one did anger in my family. We talked about issues like ‘civilized’ people. Anger was off the table.”
“So you’re probably sitting on years and years of anger.”
“You mean like when my mother would make me draw and draw and draw, despite the fact that I had no talent and that she would sit there criticizing everything I produced?”
“Yes, like that. I’m sure that made you plenty angry.”
“Holy shit! You know what I just realized. If the patients in your blogs are fictionalized, that means you’re one of those creative people. Does that make me feel less than? Yes, it does. But for whatever reason, right now that actually makes me feel more sad than angry. I guess I feel sad for the kid whose talents weren’t recognized and only found lacking for what he wasn’t.”

“That’s great, Jeff. I’m really glad you’re able to feel compassion for yourself as that child. That awareness will serve you well.”


Friday, December 14, 2018

Wanting to Flee – Part II

“I can’t stop thinking about it,” Trevor begins. “Two therapists in this office died. Who’s to say you won’t be next? I’m having nightmares about your dying almost every night. What did they die of?”
Trevor’s speech is rapid, staccato, his anxiety palpable.
“I’m sorry you’re so distressed, Trevor, but I can’t see how knowing the details of other therapists’ deaths would help to calm you. What we need to do is deal with your fear of losing me.”
“More like terror.”
“Well let’s talk about that terror.”
“In my dreams I see you here in this office and as I’m talking to you, you start fading away, vanishing right in front of my eyes. And then you’re just gone and I’m here in an empty office. Sometimes I start screaming. Sometimes I wake myself up screaming.”
Listening to Trevor’s dream is difficult – his distress, the description of my death, plus the whole idea of fading away which actually taps into my own childhood nightmares. But I’m the therapist here and my patient needs me to act as one.
“Any idea, Trevor, why you’re dreaming this particular way of losing me, my fading away?”
“What difference does it make? Any way you’re gone.”
I’m surprised by what I hear as an angry tone to Trevor’s response. I remain silent.
“I really feel I should cut down on my sessions. I need to become less dependent on you. I need to prepare myself for your… for your leaving.”
“And how do you feel when you think about that?”
He pauses. “Not so good.”
“If you cut down on your sessions, would that be like your gradually fading away from me?”
“Oh! I never thought of that!” Pause. “But maybe that’s not a bad idea.”
“As in you’d leave me before I left you?”
“Yeah. Yeah. Something like that.”
“Would that feel like you’re getting back at me?”
“I don’t know. Feels more self-protective.”
“Trevor, it strikes me that a lot of how you’ve been in the world is self-protective, removing yourself from people, remaining distanced.”
“I suppose.”
“And we’ve always thought about that self-protection as stemming from your feeling the need to protect yourself from your father, and even more so when you realized you were gay.”
He nods.
I’m silent.
“What are you getting at?” he asks.
“Well, I was wondering two things, first how your mother fits into all this and second whether there isn’t some anger, some retaliation in your withdrawal.”
“Wow! I need to think about that.” Pause. “You know, Myra, my oldest sister, used to say that as my mother had more kids – 4 after me - she faded away more and more.” Pause. “I think that’s true. Early on Myra and I probably had the best of my mother, but then she kind of vanished.” Pause. “Just like you in my dreams.” Pause. “You think that’s why I’m so terrified of losing you, it’s like losing my mother all over again?”     
“I think it’s very possibly at least one of the reasons. And it’s certainly interesting that Myra talked about your mother vanishing and your nightmares are about my vanishing.”
“But that doesn’t change the terror.”
“Well, if we’re able to help you re-experience your childhood terrors and come to know – and feel – that you’re not the helpless, dependent child you once were, I suspect you’d have much less terror about losing me. And there’s still the question about your anger and retaliation.”
“But what if I don’t feel the anger? What makes you sure I’m angry?”
“I can never be sure, but when you talk about wanting to leave me before I leave you, it sounds like retaliation, it sounds like you want to punish me and that feels like retaliation.”

“Like you think I was angry at my mother?”
“Yes.”
“Myra was certainly angry at my mother. She had no doubt about it. Practically ruined her life. She was so busy rebelling she became a drug addict! But she came around.”
“So you’re saying that anger is dangerous.”
“You bet! Just try being angry around my father!”
“And what about your mother? How did she react to anger?”
“I can’t believe I’m saying this, but she faded away even more.”
“So being angry with your father is physically dangerous and being angry with your mother leads to abandonment. No wonder you don’t feel your anger.”
“This has been a heavy session. Feels like a lot going on.”
“I agree.”
He sighs. “So I guess I shouldn’t cut back on sessions.”

I smile. “Sounds like a wise choice.”

Friday, November 30, 2018

Wanting to Flee

Trevor sits quietly in the chair across from me. After a few moments he says, “It was an okay week. Nothing special happened.”
I wait. There is silence. I’m puzzled. I have seen 26 year old Trevor for many years. I might even say I helped him grow up. When he first came to me he described himself as shy. During those years long silences were commonplace. But as he moved away from his fear and self-loathing he’s been far more engaged with me and, to a lesser extent, with the world outside my office. He acknowledged his gayness and was able to come out to his family and some of his friends. He’s still never been in a love relationship, a problem that we’ve been working on. But today his silence confuses me.
“Is something going on, Trevor?” I ask. “You seem particularly quiet, uncomfortable.”
He shakes his head and looks away from me.
I wait. I think about our last session. Did something happen that distressed him? We’d been talking about Thanksgiving with his family, but that had seemed to go fairly well despite his father’s usual blustering. Was there some tension between us? Nothing that comes to me. Don’t be impatient, I tell myself, just sit with him.
After a while he says, “I’ve been thinking maybe I should cut back to once a week. I’m doing pretty well and, like today, I don’t have much to say.”
I’m stunned. In all the years, Trevor has never asked to come less frequently and, in fact, has often asked for additional sessions. Something must have happened between us.
“Trevor, you need to tell me what’s going on. Did I say something last session that distressed you?”
“Why does something have to be wrong? Why can’t I just want to cut back?”
“Because you know as well as I do that there’s always a reason – usually more than one – for everything we do.”     
He sighs. “Why did that psychiatrist retire?”
“What psychiatrist?”
“The one next door.”
The light dawns. He asked me last time what had happened to my neighbor. When I told him he retired, he obviously became fearful that I might follow a similar path. “He retired because he wanted to travel, have more time to himself, pursue other interests. And, no, I have no plans to retire, ever. I love what I do and as long as my mind is still with me I plan to stay right where I am.”
“And why is the sign on your door different? What happened to the other therapists? The ones who’d worked here? Did they retire too?”
Now we’re in more difficult territory. I’ve been surprised by how few patients have asked me about the change of signage on the front door. “No, Trevor, they died.”
His already pale skin blanches further.
“Okay,” I say in a calm voice. “I understand that you’re frightened of losing me. First you were afraid I might retire and now you’re afraid that I’ll die. And of course I can’t make guarantees about my dying, but it’s certainly my hope to stick around for a long time.”
“I have to cut back to once a week. I have to become less dependent on you. Right now if something happened to you I don’t think I’d survive.”
“Trevor, the idea is that our work together will help you to be able to be more and more engaged with people other than me, but we can’t accomplish that by your cutting the frequency of your sessions. You’ve been doing very well lately, going out to lunch with people, meeting friends for dinner and a movie …”
“But that’s because of you!” he says. “I wouldn’t be able to do that without you.”
“Then we’ll have to understand why you feel you can’t do those things without me and help you to feel more comfortable being in the world.”
“Did they know they were going to die?”
Loathe to provide too many details, I say, “Yes, they both knew they were ill.”  
“So they could tell their patients?”
“Yes, their patients knew they were ill.”
Trevor starts to cry. “I couldn’t stand it! I couldn’t stand it if you died! I couldn’t watch you die.”
“I understand, Trevor, but I’m not ill and I’m not planning to die any time soon. Obviously none of us know when we’re going to die and it’s always sad to lose someone we love, but what we need to do is focus on helping you to be fully in the world, to embrace life and enjoy it.”
“Can we talk about this again next week?”

“Of course. I’ll see you Monday.”

Friday, November 16, 2018

The Invitation

“My neighbor invited me for Thanksgiving,” Marnie says without enthusiasm.
“You sound less than excited about the invitation.”
“Yeah.”
I remain silent.
“It’s her family.” Pause. “It’s not my family. I won’t know anyone. Except her husband and I don’t like him much.” Pause. “I don’t see why my sister couldn’t have invited me. Or my daughter.”

“I thought your sister was going on a cruise.”
“She is. But she didn’t have to. And I know, I told my daughter I didn’t want to travel all the way to Seattle, but she could have insisted.”
I find Marnie maddening. Nothing is ever good enough for her. I try, yet again, to provide some insight into her behavior.  
“You notice, Marnie, that you’ve again set up a situation where you can’t be satisfied. Your neighbor invites you to her house, but you’re unhappy because it’s not your family. You expect your sister to not go on her cruise because she should be here to invite you for Thanksgiving…”
“What’s so wrong about that?” she asks, interrupting me.
Responses flit through my mind from ‘you’ve got to be kidding’ to ‘would you have canceled your cruise for the sister you rarely speak well of?’ Instead I take a breath and pause. “Marnie, I know that you grew up in a hostile, unloving home. I know that your parents were too involved in their own battles to care about their young daughter who had the misfortune to be born just when they were considering divorce. I know you didn’t get enough love, enough nurturing, enough care. But by finding fault with everyone, by demanding that everyone always think of you first, you’re insuring that you will never feel as though anyone cares about you.”
Marnie’s head droops. Tears fall silently from her eyes. I can anticipate what’s coming next and, unfortunately, Marnie doesn’t disappoint me. “So you’ve turned against me too,” she says, whining.
I want to scream. I suspect my anger is not only mine, but also a projection of the anger Marnie keeps buried inside herself. “Marnie, can you tell me what you’d like from me right now?”
“I’d like you to understand how much pain I’m in and support me.”
“And your pain is about never feeling loved?”
She nods.
“And you feel angry about never being loved?”
“I guess.” Pause. “You know anger wasn’t allowed in my house. Not as a child. I don’t like to feel angry.”
“But it would make sense for you to feel angry about never being loved, right?”
“I guess,” Marcie responds reluctantly.
“So you weren’t allowed to feel anger as a child and you’re not comfortable feeling angry now.”
She nods.
“Would you consider the possibility that you bring all that stored up anger into the present and behave in ways that both expresses your anger and probably leads people to be angry with you?”
“I don’t understand. Why would anyone be angry with me?”
I consider whether I should answer that question in the here and now about Marnie and my relationship, and decide a bit more distance might be preferable. “Well, let’s consider the invitation from your neighbor. If in accepting the invitation…”
She interrupts me. “I didn’t accept, I told her I’d let her know.”
In my mind, I think, ‘well that certainly illustrates my point.’ I continue, “I wonder if your not immediately accepting the invitation is an expression of your anger. It’s like saying the invitation isn’t good enough.  It’s possible your neighbor might have felt hurt or insulted about your not accepting and might be less likely to invite you in the future which would lead you to again feeling rejected.”
“But I’m not sure I do want to go to someone else’s family.”
“I wonder if you realize, Marnie, that you do the same thing to others as was done to you – you’re not good enough so I won’t love you.”
“So do I have to accept whatever anyone offers me?”
“Good question.” I pause. “I guess I’d say it would be important for you to consider why you’re rejecting an offer. Like, would you really prefer to be alone for Thanksgiving? Do you want to be alone so that your sister feels bad for you? So that your daughter feels bad for you?”
“What’s wrong with wanting them to feel bad for me?”
“”Because you’re cutting off your nose to spite your face. And because you don’t realize that wanting them to feel bad for you is an expression of your anger.”
“I don’t understand that at all.”
“And you’re angry with me right now, correct?”
Pause. “I don’t think so. I’m just confused.”

‘Foiled again,’ I think. “Well, it’s time for us to stop, but we’ll continue next week.”

Thursday, November 1, 2018

Choose Me

“I don’t understand!” Marcy shrieks at me, continuing the stalemate we have been have been in for weeks. “Why won’t you just tell me I’m your most favorite patient? You know that I am. You know that you care about me more than anyone else, that you love me, so why don’t you just say it!”
Thoughts race through my mind as my patience runs thin: ‘You’re upping the ante. Now you want to be the person I care most about in my life, the person I love above all others. You’re certainly not being very loveable right now.’ I remain silent.
“Why don’t you say something?” Marcy yells.
I sigh. “Truthfully, I don’t know what to say. We’ve been arguing about this for weeks. We know that your mother abandoned you to the care of her sister. We know that your aunt clearly favored her own daughter over you, that you felt like a second class citizen, like Cinderella, as you say. And all these things are horribly sad and painful for a child, but there’s no way I or anyone else can make up for that. If I told you you were my favorite patient, that wouldn’t take away your pain about your mother or your aunt.”
“Then what good are you?”
“I’m here to help you mourn the past, to be sad and angry, sad and angry, sad and angry about what you didn’t get as a child and then to be able to accept what was and to move on, able to take in the good from others in the present.”
“Is that a script you read? You say the same stupid shit all the time,” Marcy responds, crossing her arms in front of her chest, chin raised, staring at me defiantly.
I’m pissed. I remain silent while I try to collect myself.
“What?” March says.
“You know, Marcy…” I begin before she interrupts me.
“Oh,” she says sarcastically, “here comes the lecture.”
I ignore the interruption. “It’s interesting to me how much your behavior is counterproductive.”
“What’s that supposed to mean?”
“You say you want to be my favorite patient, but you behave in a way that would make you anything but my favorite patient.”
“Oh! So now I’m supposed to be Miss Goody Two-Shoes. I thought you always told me – for years and years in fact – that I was supposed to say everything I was thinking, not censor anything.”
“I’m not suggesting that you censor what you say. I’m suggesting that what you say has consequences.”
“So now you’re threatening me?”
‘Stay calm’ I tell myself, knowing Marcy wants to provoke me. “The more you angrily demand that someone care about you, the less likely that person – me in this instance – is going to respond the way you want. So the question becomes why do you behave in a way that is least likely to get you what you want?”
“Don’t change the topic,” Marcy demands.
“I’m not…” I stop myself. “That last comment, for example. You know I’m not changing the topic. You’re just being provocative and trying to not consider what I’m saying.”
“OK, smarty pants, why don’t you tell me why I behave this way. I know you have some nice little theory floating around in your head.”
“Let me ask something else first. What would happen if I did tell you you were my favorite patient?”
“I’d ask if that meant you loved me.”
“And what would you feel if I told you I loved you?”
“I’d need you to prove it. Like, would you see me for free?”
“So you’re saying you’d add more and more demands until you got to a place where you could again feel unloved and unchosen.”
“Why would I do that?”
“Good question. Why would you?”
“I don’t know.”
“I suspect you unconsciously want to be rejected so that you can stay connected to your rejecting mother and aunt who walk around in your head. If you take in the good, the caring in the present, then – here’s my script again - you have to mourn what you didn’t get in the past. You have to give up the hope of getting the love you needed and deserved as a child from the people in your life who were supposed to care for you but never came through.”
“That sounds way too hard.”

“I wonder if it’s any harder than repeatedly demanding love from people in the present in such a way that you insure you’ll never get it.”    


Thursday, October 4, 2018

Untold II

“Thank you for seeing me for an extra session this week,” Peter begins.
“No problem.”

“I haven’t been able to think of anything else but what you said, that by not talking about my priest abusing me I’ve done exactly the opposite of what I intended, I’ve let him continue to control my life.” Pause. “That makes me sick. But I can’t stop thinking about it.”
“And feeling …?”
“Sick. Angry! Scared. I keep remembering what he did to me. I try to figure out how many times it happened. I wonder why I never told my parents, anyone.” Pause. “I guess I know the answer to the last one, I didn’t think anyone would believe me.”
“Do you feel sad for you as the abused child?”
“I hate when you put it like that! That’s not all I am!”
“That’s true. It would have been better for me to say, do you feel sad for the child in you who was abused?”
Peter’s eyes well with tears. “You’re amazing. You listen and understand and take responsibility for even a little mistake.”
“Unlike the priest who took responsibility for nothing.”
“Unlike the priest. Unlike my parents who could never understand.”
Silence.
“Would it be helpful if you told me what actually happened between you and the priest or do you feel you’re not ready?”
Silence.
“He’d touch me. Usually until I climaxed. And then he’d make me touch him. Sometimes – I don’t know how often – he’d tell me to kneel – Catholics are good at that – and then he’d… he’d, you know, he’d make me use my mouth. I hated that. It was disgusting.”
“Thank you for telling me Peter. I know how hard it was for you. How do you feel now having told me?”
“Relieved. I knew I’d have to tell you. It feels like a relief to have it over.”
Silence.
“Can I ask you what you’re thinking?” I ask.
“I was actually wondering what you’re thinking. I was afraid you’d think I was disgusting.”
“You’re not in any way disgusting, Peter.”
“I was afraid my wife would think that too. I wonder if she thinks about it when we make love. I wonder if a part of her recoils from me.”
I wonder to myself if Peter thinks about the abuse when they make love, but decide it’s too soon to ask that question. “Does she seem to recoil from you?”
He shakes his head. “No, not at all.” Pause. “But, but it’s hard for me to have … to have oral sex. Either to give it or receive it. I know it’s because of the abuse. Sometimes I force myself because I know she likes it, but it seems kind of disgusting to me.” Pause. “Actually, when she does it to me it feels good at the time, but then, then afterwards I don’t feel good at all.”
“You feel guilty?”
“Definitely.”
“And you felt guilty with the priest as well?”
“Yes. Guilty and ashamed. I was afraid someone would find out and think I was disgusting. Afterwards I’d come out from the church… If it was sunny I’d wonder how that was possible. It seemed so dark where I’d just been. I couldn’t understand how the sun could be shining. I didn’t want it to be sunny. I wanted to hide.”
“Peter, very often the hardest thing childhood sexual victims struggle with is the pleasure that they themselves felt. Like how could I have been abused if part of me enjoyed it?”
“That’s exactly right! How can it be abuse if I, if I climaxed?”
“Because your genitals were being stimulated and your body responded just as it’s supposed to. You were also a frightened, lonely child and some esteemed authority figure was paying attention to you, making you feel special and bringing you pleasure.”
“No, that’s not completely right. I didn’t feel special at all. I felt I was being singled out because I was disgusting and he knew I was disgusting. Don’t forget he was my confessor.”
“And what had you done that made you feel disgusting?”
“I touched myself.”
“You masturbated just like every child. I’m sure the priest made you feel guilty and ashamed of doing what was entirely normal, but the horrible irony is that he was the one who was doing what was horrible, illegal, destructive. That’s enraging. I feel enraged for you.”
“I feel as though I’ve been in a trance this session. Like I want to shake myself and come back to reality.”

“I think what you’re saying, Peter, is that you’ve been back being your child self. I’m sure that will be helpful to you - and to us - because it’s that part of you that was damaged and needs to heal.”