Tuesday, March 26, 2013

The Volcano

Carl stares at me. He has said nothing since he threw himself into the chair opposite mine. His brow is furrowed, his head raised, his mouth pursed. 

I feel the rage emanating from him. Images flash through my mind: My father raging at a waiter for an unfilled water glass; raging at my mother for not waking him; raging at me for disputing his beliefs about dreams. 

It’s difficult for me to think clearly, although a continued silent stare-down does not seem at all helpful.

“You’re clearly angry, Carl, can you tell me what’s going on for you?”

He remains defiantly silent. 

“You look like you’re going to explode,” I say. “We know that sitting on your anger and then exploding is a problem for you,” I continue, wondering, not for the first time, if it had been a mistake for me to accept Carl as a patient. I knew about his difficulty with anger. And I certainly knew about my fear of angry outbursts. Was I again thinking that I could make a difference, that I could “tame” an angry man?

Still Carl sits there. I think about our last session. Was there anything about that session that might have made him angry? I come up blank.    

So I ask, “Did anything happen in our last session, Carl, that made you angry?”

“What do you think?” he spits at me.

“Well, I suspect there was since you’re obviously mad at me.”

“And I suppose you don’t know what it is?” he says, his voice raising.

Trying to defuse him, I say, “I’m sorry, Carl, I don’t. But if you tell me I’m sure we can talk about it.” As this sentence comes out of my mouth, I realize I too am becoming angry. I don’t like being in this conciliatory, placating position. I didn’t like it with my father and I don’t like it with Carl. I may be feeling some of his anger, but I’m also feeling my own.

He sneers at me. My anger increases. But I am, after all, the therapist here. “I wonder why you do this, Carl.” I say. “I wonder why you want to inflame this situation, why you want to be angry, why you want to turn it into a confrontation. It seems it would be better to tell me what you’re angry about and have us deal with it directly. I know when you reach a certain level of anger it’s hard for you to discuss it rather than exploding, but this is a good place to practice.”

“You cut me off,” he says glaring at me.

I have no idea what he’s talking about. 

“You don’t even know what I mean, do you?” he says, his voice again raising.

“No Carl, I’m sorry, I don’t.”

“I was in the middle of a sentence and you cut me off with your, ‘Our time is up for today,’” he says mimicking me.

I can’t imagine this to be true. Although I do maintain clear boundaries about time, I don’t cut patients off in the middle of a sentence. I know, however, that it is futile to engage Carl in an argument that can never be won one way or the other. Regardless of what actually occurred, Carl experienced the end of the session as a narcissistic injury, I was “cutting him off,” getting rid of him.

I weigh my response, trying to walk the tightrope between being falsely conciliatory and unnecessarily confronting. 

“I’m sorry, Carl,” I say. “I don’t remember cutting you off, but if that’s how you experienced it, I’m sorry. And I’m sorry that you had to carry all your hurt, angry feelings over the weekend. Did you feel angry right away? Did you know that you felt hurt as well as angry?”

“I didn’t say I was hurt,” Carl says, his anger still very much apparent.

“No, you didn’t. I assumed that you felt hurt since hurt and anger often go together and I also assumed you wouldn’t be so angry if you also didn’t feel hurt.”

“It’s not polite. It’s not polite to cut someone off in the middle of a session, I mean sentence.”

“Perhaps both are true, perhaps it never feels good to have the session end.”

“Don’t flatter yourself,” Carl replies, sarcastically, but perhaps a bit less angry.

Carl and I have a long, difficult road to travel. And I’ll probably ask myself many times if my familiarity with a man such as Carl helps or hinders me in my role as his therapist.


Unknown said...

I loved this blog and story that terrifically details some of the issues around the end of sessions. Great capture of dialogue and tension. Love the picture of the boy, too.

Linda Sherby PH.D., ABPP said...

Thanks. Yes, the end of a session always brings up lots of issues. Sometimes our patients will not tell us about them directly, sometimes not so directly.