Inside/Outside

Thursday, September 14, 2017

Chaos

“Welcome back,” I say to Ed, smiling. He attempts a smile in return, walks into my office, sits down in the chair across from me, and sighs. A smart, sensitive, psychologically minded twenty year old college student, Ed has had difficulties for much of his life – anxiety, compulsivity, facial tics, self-flagellation - but seemed markedly improved before returning to his home in New York City for the summer.
Shaking his head from side to side, he says, “It was too soon. I shouldn’t have gone home. And I shouldn’t have participated in that anti-Trump demonstration. Too much, way too much.” I watch Ed’s eye begin to twitch. He raises his right hand, then catches himself, makes a fist and puts his hand down. “As you can see, it’s back,” he says contemptuously.
“I’m sorry, Ed. I really am. Did you really feel so angry with you that you wanted to hit yourself?”
“Yes. I wanted to beat the shit out of myself,” he says clenching his jaw. “I’m sorry. I know you’ve worked so hard to help me stop that.”
“You don’t have to apologize, Ed. I’m just sorry you’re in so much pain.”
“I’m weak. I’m a sniveling baby. I can’t do anything to help myself.”
“That certainly sounds like the voice of your father.”
“Yeah, so what else is new? I thought I could take him on. I thought I was ready. How stupid of me. And joining that demonstration was terrible.” Ed’s eyes widen. I can feel the fear seeping from him. He fidgets, crossing his legs from side to side. “There were so many people, angry people. And they should be angry. We have an insane bully in the White House. North Korea, Venezuela, racists, Nazis! It’s insane. It scares me. But all the anger scares me too. It reverberates in my head. I can’t turn it off. I feel like I’m crazy too.” Ed digs his nails into both fists. He looks down at those fists as though they’re an alien part of him. He starts to beat his thighs.
I want to go and hold his hands to subdue him, to reassure him, to prevent him from hurting himself. Instead, I softly say, “Ed, Ed please look at me. I’m here. We’ll get through this. You’re with me now. You’re not in that demonstration, you’re not with your parents.”
Ed looks at me, first as though he doesn’t see me and then with dawning recognition. Tears roll down his face. He buries his head in his hands. “I don’t want to be crazy. I don’t want to be crazy,” he mumbles through his hands.
“You’re not crazy, Ed. You’ve been traumatized, actually re-traumatized, and it will take us a while to work it through. Can you talk about some of the things that happened with your parents or does that feel like too much for today?”
He lifts his head and smiles at me. “Well, that never happened. No one was ever sensitive to my feelings. It’s amazing what a difference just a little understanding and caring makes. How many times have I said I wish you were my mother?”
“Except there’s usually a second part to that statement.”
“Yeah, I’m afraid that not even you could stand up to my father and I wouldn’t want to find that out. And then you say you couldn’t promise me that you’d be able to stand up to my father but you certainly hope you’d try.”
“I also say that your father’s rage is not the only rage you’re afraid of, that you’re afraid of your own rage as well.”
He nods.
“I wonder if that’s what happened in the anti-Trump demonstration. You were…”
Ed interrupts me. “I did think that my father is a lot like Trump. A bombastic bully who’s thin skinned and easily narcissistically wounded.”
“So you mean you’d be afraid of going up against Trump, just like you’re afraid of going up against your father?”
“Yes.”
“That makes a lot of sense.”
“But you were you going to say something when I interrupted you.”
“Oh, yes. About your anger. I was wondering if in the demonstration you saw all these people who seemed comfortable with their anger and that that scared you, made you afraid that your anger might get out of hand, especially since, as you just said, Trump reminds you of your father.”
“You know, I’ve never quite gotten that bit about my anger, but somehow it makes sense in the context of that demonstration. There were all these people yelling their heads off, shouting terrible things about Trump. I wanted to join in, to become a part of the crowd. But instead I drew in and had all this noise going on in my head.” Pause. “Thank you. I feel much better.”
“My pleasure. See you Thursday.”

“Thanks again.”

Monday, August 21, 2017

The Consultation

Rebecca Whitman rises from the waiting room chair extending her hand to greet me. She is dressed in a pale lavender suit and matching high heeled shoes which are surprisingly flattering with her flowing dyed red hair. I wonder at her age. Mid-forties? Hard to know how much plastic surgery she’s had.
“This is a consultation, right?” she begins immediately . “I’ve had lots of them. You get to decide if you want to work with me and – never to be forgotten - I get to decide if I want to work with you. So what do you want to know?”
Feeling as though she has just thrown out her opening salvo, I say, “That’s quite a beginning.”
She sighs. “I believe in getting to the point. Why waste time. It is my money after all.”
“Do you want to be here, Ms. Whitman?” I ask, noticing that I have automatically called her by her last name.
“Why do you ask?”
“Well, we’ve never met before and yet it feels to me that you’re already angry with me. That doesn’t make much sense unless you’re angry at being here.”
“I’m always angry. I’m angry at being here. I’m angry that I have to pay you to listen to me. I’m angry that I’ve seen I don’t know how many therapists. I’m angry they’ve either thrown me out or been completely incompetent or both. I’m angry that even though I’m one of the best real estate agents in the area, I eventually get shown the door. No biggie, I’m good enough I always find another agency. I’m angry that I’ve had three failed marriages and heaven knows how many other relationships that failed. Any questions?”
I feel torn. A part of me wants to join all the others who have gone before me and stop this consultation immediately.  But another part, perhaps the grandiose part, wants to give it a shot. I do know if I’m going to try, I want to do something other than taking her anger on directly.
“What would you be feeling if you weren’t feeling all that anger?” I ask.
She laughs. “I’ve heard that one many times before. You think a simple question is going to have me dissolve into tears. You’re going to have to do better than that.”
So much for not taking her anger on directly. “Do you like being angry? Do you like losing jobs and relationships and therapists? And why are you here? What do you want to accomplish?”
“Better,” she says.
I feel myself getting angry at her constant evaluation of me. I keep silent.  
The silence persists.
“I guess you want me to answer your questions.” Pause. “Ok, Ok, I’ll answer the questions. Sometimes I like being angry and sometimes I don’t. And, no, of course I don’t like losing job or relationships.” Pause. “I’m not sure why I’m here. I guess I’m hoping someone doesn’t throw me out.”
Her last statement sounds so sad that I find myself fighting back tears.
“Someone I can have respect for, that is,” she adds with her typical bravado.
My sadness shuts down immediately. Rebecca Whitman has told me a lot about her defensive need for anger.
“If I ask you who was the most significant person in your life who threw you out, who would you say?”
She shrugs, “My mother.”
“Ok, Rebecca, so I do think you’re afraid if you let down your anger you’d be left with lots and lots of tears, tears of loss, abandonment, worthlessness and, of course, rage.”
“Think you’re smart, huh?”
“Rebecca this isn’t a contest. I’m not here to beat you in a competition. I’m on your side. And I know you can’t simply put away your defensive angry. It’s been a part of you for a long time. But hopefully if you come to trust me, you can let it down little by little and together we can deal with the pain underneath.”
“Ok smarty-pants, guess why my mother threw me out.”
“There’s no way I could guess that, but I’d appreciate your telling me.”
“Because I told her my step-father – step-father number three, by the way – was doing it to me.”
“Oh, Rebecca, I’m so sorry.”
“Yeah? Yeah? What the fuck good is your pity going to do for me? I was eleven years old. Eleven years old for God’s sake!”
“That’s more than reason enough to be angry. But you must also feel sorry for you as that eleven year old child.”
“I don’t believe in a pity party!”
“Compassion for a child is not a pity party.”
“So are you going to work with me?”
“Yes, Rebecca, I’m going to work with you. I’m not going to throw you out.”

“Ok,” Rebecca says as she sprints towards the door.

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.”