Inside/Outside

Friday, February 15, 2019

Being Checked Out

This is a first time I am seeing Maurice, a tall, thin, 22 year old African-American man. He looks uneasily around the room, settles himself in the chair across from me, still holding his phone and keys in his hands.
“How can I help you?” I ask.
“Dr. Hudson said I should come. He’s my English professor at the University. Says I have more potential than I show.”
“And do you agree with him?”
“About my potential, yeah, I do.” Pause. “But if you can help me, I don’t know.”
“Because…?”
“I don’t mean to be disrespectful, but you’re white. And you’re a lady.”
“You’re right. I am both white and a lady. And that makes you feel I couldn’t help you, couldn’t understand you?”
He nods.
“Well, we’d only know that as we got to know each other and, hopefully, learned to trust and respect each other.”
Silence.
Maurice sighs, shakes his head. “I don’t know. I don’t know if I can just do that, just start talking and hope that I can trust you.”
“Do you trust Dr. Hudson, since he’s the person who referred you to me?”
“I trust him as a teacher. I’m not telling him all kinds of shit about myself.”
“That’s true.”
Silence.
“You’re not trying to talk me into trusting you,” he says.
“I think that’s pretty hard to do. But I was about to ask what you thought might help you trust me enough to tell me about yourself.”
“I know shrinks don’t usually do this, but what if I ask the questions, ask you about yourself?”
“Well, I guess that would depend what the questions were. If you asked me to tell you about every person I ever dated and what our sex life was like, I’d probably want to know how that was relevant to your concerns about trusting me.”  
He laughs. “No, I wasn’t going to ask you that.” Pause. “Although now that you mention it, I did think of something kind of like that. Did you ever date a black man?”
I hesitate. “The answer happens to be yes, but I don’t think if the answer was no, that would mean you couldn’t trust me.”
“No. But, it’s a piece of information.” Pause. “Did you ever have a black friend?”
“Yes.”
“Did you ever live in the ghetto?”
“No.”
“Have you ever been inside a prison?”
“Yes.”
He looks surprised. “How come?”
“I worked as a group therapist in a men’s prison when I was in graduate school. I did my doctoral dissertation in that prison. I also worked in a forensic center and at a women’s prison.”  
Maurice nods his head. He places his phone and keys on the small table next to him.
I take those gestures as a sign I can take on my more traditional therapeutic role. “So I assume you or someone close to you has been in prison.”
“Yeah. Like all my brothers. I did a little time in juvie, but no hard time.”
“And you feel how about having been the only one of your brothers to avoid prison?”
“Bad. Lucky. Glad. Guilty. Like shit. Fortunate.”
“Lots of mixed feelings.”
“Yeah.”
“So can you tell me more about you?”
Silence.
“I can, but I wouldn’t want you to think that means I totally trust you.”
“Maurice, trust takes a long time to build. There’s no question, no hundred questions that you could ask me that would assure you that you can trust me. And besides, trust is a complicated word. What does trust mean to you?”
“First thing I thought, ‘That you’re not going to stab me in the back.’ And I guess I mean that both literally and figuratively.”
“I get it that young black men have to first be concerned for their lives. And after that, I guess you’re saying that you’re afraid I’ll somehow lure you in and then turn on you, betray you.”
Maurice nods. “I want to write. I think I have something to say. But I’m ignorant. I don’t know enough. I need to get my degree. So many of my people – both my family and black people in general – have sacrificed so much so that I can have this opportunity. I don’t want to let them down. I can’t let them down. But I can’t get out of my own way,” Maurice says with clenched teeth.
“Any idea why that is?”
Silence.
“I wish you were black. And I wish you were a man.”
“Well, I’m not,” I say shaking my head. “And it’s not like I have any black, male colleagues I can refer you to. So I guess you’ll have to decide if I’m good enough.”

“I like you, Doc. I guess that’s as good a place as any to start.”   

Friday, January 18, 2019

The Unexpected Affair

Judith is a tall, attractive 44 year old woman who carries herself as if she knows she will be noticed, clearly distinguished from those around her. Although she’s presently a stay at home Mom, today she is dressed as the lawyer she is, a perfectly fitting gray suit and black high heels.
“I’ve decided to have an affair,” she says matter-of-factly.
I’m startled. In the six or so months I’ve seen Judith, she talked about being dissatisfied in her marriage, but hadn’t mentioned the presence of another man.
“With whom?” I ask.
“I don’t know yet.”
Silence.
“I know,” she continues, “that’s a rather unusual way to go about it, but since my husband hardly gives me the time of day – I can’t even remember the last time we had sex or even had a real conversation  - I decided I might as well get my needs met elsewhere. I’m not going to leave him. The kids need their father and I need some male attention so, an affair’s the answer.”
During the course of my career I have seen many men and women who have been unfaithful to their partners with one or many other people.  I’ve always been comfortable talking with them about both their feelings and the meaning of these multiple relationships. But Judith’s cavalier manner, her impulsive decision, and her pronouncement to me without any apparent willingness to discuss her decision, is both off-putting and confusing.
“When did you make this decision? And how do you feel about it?”
“It feels like a good decision. Solves lots of problems. I guess I decided a couple of days ago. Hence my outfit today. I figure any time I’m out and about I need to be looking my best.”
“Did anything happen in the last couple of days? Anything happen since we last met?”
“No,” she replies flatly. “Nothing happened. Same old, same old, I guess that’s what happened.”    
“Do you plan to talk to your husband about your decision?”
“What!? Are you crazy? He’d divorce me in a minute.”
I knew she wouldn’t tell her husband. Why did I ask that question? Was I trying to make her feel guilty? Surprisingly, what Judith is contemplating does feel ‘wrong’ to me, it feels ‘wrong’ for a person in a committed relationship to decide in a calculated and apparently logical way to become involved with an unknown other person. I feel very differently if the person has an affair and wants to talk about it, understand it, and deal with the meaning it has for them. Hmm, I think. Her pronouncement felt as though she was throwing down a gauntlet. Perhaps that means her decision is about me, about our relationship. What was it we talked about in last week? Of course! She told me she read my book, the book in which I discuss both the intensely loving relationship I had with my late husband, as well as my strong emotional involvement with many of my patients.
“Judith, how did you feel about my book? I know we talked a little about it last week, but you seemed to skirt really looking at your feelings.”
“Now where are you going? I told you I thought you wrote very well and that the book was engaging.”
“But how did you feel about it? How did you feel about my relationship with my husband? About my relationship with my patients.”
She shrugs. “I guess I felt you were lucky. Here you had this shitty relationship with your father, but you found this adoring man to marry. I didn’t have that shitty a relationship with my father – not that he paid much attention to me, too focused on my mother – and I married a man who still doesn’t pay any attention to me.”

“So, perhaps you felt angry with me, that, in your words, I got lucky, while you got stuck.”
“Yeah, that’s about right.”
“So I came out ahead just as your mother came out ahead and that makes you doubly angry.”
“I hadn’t thought of that, but I guess that’s true.”
“So your ‘decision’ to have an affair is really based on your anger at both me and your mother for getting more than you, for leaving you feeling cheated.”
“You really don’t want me to have an affair, do you?”
“I think you’re saying I’m trying to keep you away from happiness, from your father.”
“That’s a bit too deep for me. I think you think having an affair is wrong.”
“I don’t necessarily think that having an affair is wrong. I think affairs have many meanings.  For you those meanings are clearly related to feelings about both your parents, that you bring into the present and into this room.”
“So you think I shouldn’t have an affair?”
“I think we should talk about it a lot more before you act.”
“I can’t promise that.”
“I understand. You don’t have to promise anything. You get to do what you do and we get to deal with it.”

“Okay. As long as that’s clear, I’ll see you next week.”   

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.”