Inside/Outside

Tuesday, September 20, 2016

The Opponent


I open my waiting room door to meet James Harrison for the first time. He rises, hand outstretched to shake mine. I’d guess he’s in his mid-forties. A good-looking man, tall, thin, seemingly comfortable in his own skin. We make the brief walk to my office and I gesture him to the sage chair across from mine.

“So,” he says, “Why should I be here?”

I inadvertently jerk my head back while, at the same time, stifling the urge to laugh. He’s certainly wasted no time throwing down the gauntlet. Still, it’s so startling, that I find it almost funny. Perhaps that’s a defensive reaction on my part.

I think about commenting on his provocativeness, but decide that would only escalate what is already a fencing match between us.  “Well, since I’ve never laid eyes on you before,” I respond, “I have no idea why you should be here. Perhaps it would be helpful if you told me.” Too hostile, I tell myself. It’s hard not to meet aggression with aggression.

“At least you didn’t go into that bullshit about everyone can benefit from therapy, it’s always good to understand yourself better, etc., etc.”

Do I need this? I think to myself. We haven’t even said hello and we’re already adversaries. Actually that’s not a bad interpretation. “Mr. Harrison, I wonder why we’re already adversaries. As far as I know you voluntarily came into my office. I’m not forcing you to be here. There must be some reason you’re seeking the help of a therapist.”

“Ah ha. So you’re the try the gentle approach type of therapist.”

I am definitely getting pissed. Which must be what he wants. “I suspect it’s important for you to keep relationships on an adversarial basis. Perhaps that’s why you’re seeking therapy. Perhaps you have difficulty getting along with people.”

“Perhaps,” he says grudgingly.

Silence.

“OK. So now what?” he challenges.

I really do not need this. I want to tell this man that I don’t think we should work together, that I’m not the best person for him. Maybe that too would be a good interpretation. Or would it just be acting-out on my part?

“Why don’t you tell me a little about yourself?”

“Why would I want to do that if we’re not going to work together?”

“Have you decided that we’re not going to work together?” I ask.

“Have you?” is the rejoinder. 

“I don’t know,” I answer truthfully. “I do know that I’m not willing to spend every session fighting with you when I have no understanding of why you need to fight. And I’m also not prepared to convince you that you should be in therapy with me.”

“But you do think I should be in therapy?”

“Yes,” I reply definitively.

“Why?”

“Because you are clearly someone who needs to fight which means that you either have a lot of anger or need to keep people at a very far distance or both.”

“You see. You were able to tell me why I needed to be here.”

“And I suspect that you could have told me that yourself far more quickly.”

“But then I wouldn’t have known if you’re smart enough to handle me.”

“So I suppose I should assume that you’re going to be continually testing me?”

“Perhaps.”

“Mr. Harrison…”

“James.”

“James, I do know that how you are in the world, is how you are in here with me, but I want to again say that I think it is very unhelpful for us to be continually sparring and that one of my goals for you, is going to be to find the James Harrison behind your defensive posturing.”

“You don’t like me much, do you?”

“I would say that you insure that no one likes you much. But I would very much like to learn to like you. And I hope you’ll allow that to happen.”

“Touche!”

I groan internally and wonder why I didn’t refuse to take him on as a patient. “Can you tell me what you’re feeling, James?”

“Satisfied. I think you’re the right person for me.”

“Can you say how you felt when I said I thought you insured that no one liked you, but that I’d like to learn to like you?”

“I told you, satisfied.”       

“Did you feel anything else? Hurt? Relieved? Angry?”

“No. Just satisfied. I accomplished what I wanted to accomplish.”

“So you feel satisfied with yourself. Do you have any feelings about me?”

A slow smile spreads across his face. “I’ll tell you what came to mind. That’s what I’m supposed to do, right?”

I nod.

“I feel you’re a worthy opponent.”

Perhaps, I think to myself, this treatment will be about whether a worthy opponent can become a stalwart ally. If so, it’s going to be a slow slog through.   

Tuesday, September 6, 2016

Disaster

“I had a dream about all these disasters last night,” Jenny says. “It was frightening. There was one disaster after another. I mean I know there have been lots of disasters – floods, hurricanes, earthquakes, tornados – but it was strange for me to be dreaming of them. I don’t know if I was in the disaster or watching the disaster or helping at the disaster. It was weird.”

Jenny‘s a young medical student. I wonder if, at a surface level, she’s anxious about how she will handle her responsibilities as a physician. I remain silent, waiting to see where Jenny’s thoughts will take her.

“My mother called last night. She was complaining about my step-father for a change, about this step-father, just like she complained about all the others. I don’t know why she keeps marrying them, always sure this one will be her most perfect love. I think I’ve even lost count of what number she’s up to. Ugh. I don’t think I ever want to get married. Or not until I’m really, really sure. I guess I see her as a disaster. That’s sad to say about your own mother. I joke with my friends that she’s my negative role model. I want to be everything she’s not and not be anything she is. Sad.”

“Did you feel that way as a child?” I ask.

“Maybe not as a small child, but before I became a teen-ager for sure. Our house was a revolving door. At least she was smart enough not to have any more kids, except that there were always the so-called Dad’s kids who revolved through and then disappeared forever.”

“Was that hard? Forming an attachment to these father figures or siblings and then having them disappear?”

She shrugs. “I don’t know. Maybe. Or maybe I just learned to do my own thing, be involved with my schoolwork, with my friends. I liked being alone.”

Despite the matter-of-factness in Jenny’s tone, I find myself becoming sad. I wonder about her desire for aloneness as a defense against loss. And I think again about her dream, since disaster almost always involves loss.

“When did you last see your own Dad?”

“Who knows. He vanished a long time ago. Every so often he’ll make an appearance, but I certainly wouldn’t want to count on him.”

“I wonder if it’s possible for you not to feel sad about all these losses, Jenny?”

“I’m too busy.”

To avoid sadness, I think to myself. I ask, “What were the disaster survivors doing in your dream?”

“I was going to say they were doing what disaster survivors always do, dig through their houses looking for stuff, try to find things that are important to them. But I don’t think so. I don’t remember seeing people. It was like one of those apocalyptic novels. Maybe there were a few people, I don’t remember, but basically it was empty, barren.”

“Sounds really sad.”

Silence.

“I just had a weird thought. I wonder if it wasn’t me in all those disasters, but you. Like I was the observer, but you were the one who was there. I wonder what that would mean,” she muses. “I could get it if you’re the one who’s trying to help in the disaster. But would that mean I’m the disaster? I don’t feel like a disaster. So am I trying to reduce you, to make you like me, so I don’t feel like so much of a disaster?” Pause. “I guess that’s possible.”

“Are you saying, Jenny, that it feels like a disaster to need people, to need help, to not want to be all alone in the world?”

“It is a disaster to need people. No one is ever there. You can’t count on anyone. Not your mother, not your father …” Her voice trails off.

“Were you going to say, ‘not your therapist’?”

“Yes,” Jenny says looking down. “I mean I know you’ve been there for me, but you’re only my therapist. Eventually this relationship will end. And then what? Then I’ll be alone. Again. Just like always.”

“It’s hard for you to imagine that even when we do end – which we certainly don’t have to do until you’re ready – that you will take me with you, as part of you, just as a part of you will remain with me.”

“I don’t know if I believe that,” she says. A moment letter, Jenny is crying. “And I’m not sure I even want to believe it,” she says between sobs. “What would that mean, that I would stay with you when my parents could discard me so easily?”

“It would mean that you are loveable and that it was your parent’s great loss that they weren’t able to cherish you as you needed and deserved to be cherished.”

Tuesday, August 23, 2016

Always Worried


“I really appreciate your seeing me again,” Estelle Peterson says wringing her hands. I had previously seen Mrs. Peterson for a number of years. Although we made some progress in curbing her anxiety, she remained a constant worrier.

“My daughter’s pregnant,” she says.

“Congratulations. I remember you were afraid you’d never have a grandchild.”

“Yes, yes, that’s true,” she says dismissively. “But she lives in Florida.”

“And that means?”

“Zika!”

“Oh, you’re worried about her getting the Zika virus.” Concern about  Zika is certainly understandable, but I suspect it will only fuel Mrs. Peterson already considerable anxiety.

“And having a deformed child! I can’t imagine anything worse. I told her she has to leave Florida. Right now. Right away. She doesn’t have to worry about me, but she has to take care of her baby! I told her to go stay with her sister in Connecticut.”

“And she said?”

“That it wouldn’t be a practical. That she and Jonathon have jobs. That they just couldn’t pick up leave.”

“I told she could just quit her job and Jonathon can stay here, that she’d be all right with her sister. Then she got mad at me and told me to stop it. I told her I couldn’t stop it, that I couldn’t bear to spend the next six months worrying about her baby. They hadn’t even told me right away, so I’ll probably worry anyway, worry if one of those mosquitos got her early on. But she won’t listen to me. I don’t know what I’m going to do. How am I going to get through her pregnancy?”

 “How’s your daughter feeling about being pregnant?”

“What? Oh, she’s pretty good. She said that some of her morning sickness was pretty bad, but I told her not to worry about that, that was to be expected. I remember when I was pregnant with her and her sister. I thought I would die. But I didn’t. And she won’t die either. But I might die of a heart attack if I have to worry about the baby for six months.”   

I remember now. It wasn’t only Estelle’s constant worrying that was so difficult, but also her need to make everything about herself. Everyone’s pain becomes her pain. She sees herself as being constantly worried about others, but really she’s concerned about dealing with her own anxiety and discomfort.

“So how can we help you to survive the next six months?”

“No, you have to help me convince Diana. Tell me what I can say to her to make her leave?”

“Even if I could do that, which I can’t, it seems to me we both need to respect your daughter as an adult, to respect her decisions and to try to be as supportive of her as you can.”

“How can I respect her decision when it’s endangering her child, when it will leave me, her mother, a nervous wreck until the baby is born?”

“Do you generally respect your daughter’s decisions? Did you respect her decision to marry her husband, to become a teacher, to move to Florida?”

“I definitely wanted her to move to Florida. I wanted to keep an eye on her. Becoming a teacher was okay, although I wondered if she couldn’t do better. I guess that was true of Jonathon too, but he worked out pretty good.”

Knowing that I am most likely talking to myself, I continue on, “Mrs. Peterson, respecting your daughter’s decisions means recognizing that she’s an adult apart from you who has a right to make a decision even if it is different from the one you’d make.”

“Even if it endangers her child? No, I can’t respect her decision.”

And I don’t respect Mrs. Peterson’s way of being in the world, making it difficult for me to espouse respect when I don’t feel it myself. Perhaps I can try to accept Mrs. Peterson for who she is, and thereby move us both towards a more tolerant view of others. 

“Mrs. Peterson. I suspect that you’re not going to change your daughter’s mind about not leaving Florida. Perhaps I can help you to accept that fact and perhaps we can work on managing your anxiety.”

“You’re not being helpful.”

“Sorry. I can only do what I can do.”

“You used to say that to me all the time, that I had to accept my limitations, that I couldn’t control everything, that I could only do what I could do.”

“Yes, that’s true.”

“But maybe this time I can do more.”

“I guess we’ll continue this discussion next week.” 

Tuesday, August 9, 2016

Defeated


“What brings you here?” I ask Peter, a handsome young man I am seeing for the first time.

“My father.”

I wait for further elaboration. He offers none.

“Can you say more?” I ask.

“Nothing more to say. I’m here because of my father.” 

“So I gather you don’t want to be here.”

“You got that right.”

“And you don’t feel you need to be in therapy.”

“Right again.”

“And you’re angry that your father insisted you come.”

“You’re batting a thousand.”

Ignoring his sarcasm, I ask, “So why did you feel you had to do what your father wanted?”

He snickers. “You don’t know my father.”

“That’s true. Why don’t you tell me about him?”

He snickers again. “Sneaky. You’re going to get me to talk. Okay, might as well. My father’s paying for it. My father pays for everything. He’s rich. Developed his own company. Made a fortune. And never lets anyone forget it. He’s smart, a good businessman. My brother works with him. Me, I can’t imagine sitting in an office all day. Just like I can’t sit in class all day. I’m 24 and still bouncing from one college to another. I guess that’s why my father wants me in therapy. He wants you to motivate me.”

“Are you angry with your father?”

“Yeah, I guess you could say that. He’s always on my case. Always wants something more from me. Always bugging me to make something of my life.”

“And what do you want for your life, Peter?”

He shrugs.   “Don’t know. Don’t know why I have to want anything. I like hanging out with my friends, surfing, hand gliding, sitting around getting high. Why should I have to work? Daddy will leave me more than enough money.”

I find myself empathizing more with my patient’s father than with Peter himself, making me uncertain how to respond, concerned that I will sound critical, like his father. I decide further exploration is preferable to any comment about the patient’s current life. “Did you always feel this way, Peter? What about in grade school or even before?”


Peter sits silently, but exudes less defiance. “My Dad was my hero,” he finally says. “He played baseball with us, took us to games. And even when he stared making money, and wasn’t around as much, I knew that he was doing it for us. And then he started making more money. And there were stories about him, interviews with him, he was making a big name for himself. And there was me. My brother was a straight A student. I couldn’t measure up. I never liked to read. I was lousy in math. There was nothing I was good at. Except baseball. And I wasn’t good enough at that. My father climbed up and up and I went nowhere but down. So I gave up. Why bother.”

“Sounds pretty sad.”

“I guess,” he says, shrugging, his defensive tone returned.

“Where was your mother in all this?”

“That’s another story. Nothing was ever enough for my mother. She criticized all of us – especially my father. I never understood why he took it, why he didn’t get out. I thought he probably had women on the side – who could blame him – but I don’t know that for sure. I once asked him. He slapped me across the face.”

“Was that typical of him? To hit you?”

“I wouldn’t say that. He hit me a few times. But that time was a surprise. I didn’t get why my question made him so angry. But I never asked again. And I guess I stopped caring.”

“So when you feel angry, you turn yourself off, you ‘stop caring.’”

“I guess.”

“I wonder if the problem with that Peter is that without being able to tap into your anger, your aggression, it’s very hard to find your competitive spirit, your desire to win, perhaps even your desire to beat your father.” 

 “I could never beat my father. I could never even come close.”

“The problem, Peter, is that you gave up trying. You were so sure you’d lose, that you’d never come close, that you were defeated before you began.” 

“But I couldn’t come close.”

“Maybe. Maybe not. I wonder what you might be able to accomplish if you didn’t feel so defeated, so shut down. I hope you’ll give yourself and us the chance to find out.”

Tuesday, July 26, 2016

Unfaithful

“I have a confession,” Randy says. “I’ve been sleeping around.”

A snide, why am I not surprised, goes through my head. I say nothing.

“I know,” he continues, “I was supposed to try not to, to think about my feelings before doing anything. But all I can think about is that there’s this gorgeous woman over there who I’ve never seen before and will probably never see again and why the hell not.”

I have been seeing 36 year old Randy in therapy for about six months. His wife got tired of his constant affairs and gave him an ultimatum – therapy or divorce. Whether she would have gone through with her threat I have no idea, but he chose therapy. Randy is neither the easiest patient for me to work with nor the easiest patient to like. His narcissism and his presentation of himself as God’s gift to women are very off-putting to me, as is his difficulty in self-reflection and his impulsivity.

“Randy, when you say ‘why the hell not’ do you think you’re feeling angry, like perhaps I or your wife shouldn’t be telling you what to do?”

He laughs. “Never thought of it.”

“Well, can you think about it now?”

He rolls his eyes.

“What were you feeling right then when you rolled your eyes?”
“Geesh! You don’t cut a man any slack, do you?”

I remain silent.

“Okay. Okay. I’ll think about it. What was the question again?”

I feel my anger rising and wonder if I am feeling my anger, his, or both of ours.

“I think you are angry, Randy. Can you perhaps tell me what you’re feeling angry at?”

“I think this is a waste of time. I’m clearly not getting better. I’m still messing around. You haven’t fixed me.”

“Wait a second. ‘I haven’t fixed you’ meaning what?” I ask, thinking about neutering a dog and wondering if that’s what he’s symbolically hoping and/or fearing I might do.

“Getting me to stop wanting to mess around.”

“And how do you think I’d do that?”

“I don’t know, you’re the doctor.”

“Randy, do you want to be different? Do you want to stop ‘messing around,’ as you say?

“My wife wants me to.”

“But that’s not what I asked. What do you want?”

“I have to do something if I want to stay married to her.”

“And do you want to stay married to her?”

“Yeah, I guess.”

“Why?”

“I love her.”

“What about her do you love?”

“She’s a good person. She’s a good mother, a good wife.”

“Can you be more specific? What makes her a good wife?”

“I don’t know. She takes care of the kids, the house, she likes entertaining, she always makes a good impression.”

I’m ready to scream. He’s giving me one inane answer after another and telling me absolutely nothing. Is he doing it deliberately? Is he trying to thwart me? Frustrate me? A thought goes through my head. “Randy, do you like frustrating women?”

“What do you mean?”

“Do you like frustrating women? Perhaps tantalizing them? Perhaps never quite giving them what they want?”

Randy straightens himself in the chair. He stares at me. “What made you ask that?”

“You seemed to be enjoying not really answering my questions. Perhaps you enjoy not giving me what I want. Perhaps you enjoy not giving your wife what she wants. And what about sexually, do you enjoy withholding pleasure from women?”

“Whoa. We’re getting way too personal here.”

“That’s what therapy does, Randy, it gets personal. If you really want to change – which I don’t know if you do – we have to first understand why you do what you do, really understand it, not just play at understanding.”

“I don’t know if I can do that.”

“You don’t know if you can do what?”

“You’re saying you want into my world, my mind.”

“Yes, that’s exactly what I’m saying.”

He shakes his head. “I don’t know.”

“Well, at least you’re being honest right now. I appreciate that. I feel like at least I’m getting a glimpse into who you are.”

Pause.

“I was my mother’s doll. She played with me. Not sexually as far as I know, but she might as well as have. She owned me.” Pause. “I hate her. You ready to deal with all that, doc?”

“I’m definitely ready, Randy. The question is are you?”

“I don’t know. I’ll have to think about it.”


“Fair enough.”


Wednesday, July 13, 2016

Truth Revealed

Mrs. Cortez settles herself uncomfortably in the chair across from me, fidgeting nervously with her fingers. “I never expected to be in a therapist’s office,” she says. “Especially not for this.”

I smile at her. “Take your time. I can see you’re anxious,” I say reassuringly.

She sighs deeply. “My husband and I came from Mexico a long time ago. We wanted to have children in a place where they’d have more opportunity. We’ve done well. I’m the office manager of a large cardiologists’ office, my husband drives for FedEx. My daughter graduated from college. My son’s in college now.” She looks down at her hands. “It’s about my son,” she says, barely audible. “He…he told me he was gay.”

She glances up at me.

“It was after the Orlando killings, in the… the nightclub. He said he couldn’t stay silent. He couldn’t keep hiding who he was. He cried like a baby. I was shocked. I held him, told him I loved him, that I loved him whoever he was. But it’s so confusing to me. It’s against my religion. It’s against my culture. I know Pope Francis said who are we to judge and I’m trying not to, but it feels so unnatural to me. And he’s afraid to tell my husband, which I understand. But now I have this secret from my husband and I don’t like that either.”

“I can see how much pain you’re in, Mrs. Cortez.”

“Please call me Daniella. I just told you the biggest secret of my life, Mrs. Cortez is much too formal.”

“Of course, Daniella,” I respond. I like this woman. Although we come from vastly different backgrounds with vastly different values, I appreciate both her pain and her conflict. From a place of love, she’s struggling to take in a new reality, to expand her view of what’s acceptable, to integrate her new information about her son – her gay son – with who she always understood him to be.

“I know it’s hard,” I say, “But your son isn’t a different person from who he was before he told you he was gay.”

“It feels like he is. I look at him and I wonder…” Pause. “I imagine… I wonder who he’s been with and how. It kind of makes me sick. My son? How could my son kiss another man? Could he put another man’s… No, I can’t say it. I can’t even think it.” Pause. “I haven’t been to church since he told me.”

“Because?”

“I have all these impure thoughts, all these images. If I go to confession, what will I say? I don’t want to tell the priest.”

“I thought you said Pope Francis said who are we to judge.”

“That’s Pope Francis. Not all priests are like that.”

“So you’re afraid the priest will condemn your son, just like you’re afraid your husband will.”

“Yes. If I’m having all these problems, my husband is so much more traditional. And he’s a man. I know what men say about gays. All those jokes. And that’s something else. I worry about my son. He’ll have such a harder life. And Mexicans aren’t having such an easy time in this country right now. Then you add being gay. I’m scared for him.”

“Daniella, this may seem like an odd question, but can you say what you are hoping to get from therapy?

“I needed to tell somebody. It’s been such a burden.” Pause. “And I guess I want you to help me accept my son.” She cries silently. “He’s a good boy. I love him. I keep wishing this was a dream. That it will go away. But I know it won’t. I know I won’t change him. I want to accept him. And I want to figure out how to tell my husband.”

“Do you feel ashamed that your son is gay, Daniella?” I ask.

She nods. “I know you’re supposed to be born that way. But I keep wondering if it was something I did, something my husband did. Did I keep him too close, was my husband too strict?”

“There are no answers to those questions. But I wonder if we can understand how shame came to play such an important role in your life.”

She looks down. “I’ve always felt ashamed. Ashamed of my background, my poverty, my alcoholic father. Ashamed of being different, of not being born in this country. I always wanted to fit in. And now there’s my son. Another difference – for him and for me.”

“So hopefully as we talk about these issues and you find more peace, you’ll also be able to be more accepting of your son.”