Tuesday, May 21, 2013

A Difficult Patient

Why did I ever agree to see Paula? I didn’t have good feelings about her from the very beginning. She barely smiled as I greeted her in the waiting room, seemed to eye me warily, and held herself rigidly erect. My first impression was that she might be schizoid, someone who distances and keeps herself apart from others to protect herself from feeling her own vulnerability. She’s thirty-five, tall, a bit overweight, with short black hair cropped close to her face. She described herself as a computer nerd.

Today is only our fourth session, but it is not proceeding well. She sits across from me with a smirk on her face, her arms folded in front of her, staring fixedly at me.

“Paula,” I begin, too uncomfortable to let the silence continue, “It seems as though we’re back in the place we’ve been the last two sessions. I feel as though you’re daring me to say something brilliant and until I do you’re not saying anything.”

“That’s pretty good,” she says, her smirk increasing.

I want to slap her. “Do you want me to be angry with you?” I ask.

She shrugs.

I am not pleased. We sit in silence. Five minutes goes by. She uncrosses and crosses her arms, her legs. She says nothing. I flash on Kathryn the schizoid patient I wrote about in my book, one of my more unsuccessful treatments. But Kathryn was horribly anxious. She would never have been able to sit through this silence. She would have just gotten up and left. OK, does that mean I’m feeling Paula’s anxiety for her, that I need to help Paula take back her own feelings? I decide to give it a shot.

“I wonder, Paula, how you feel in this silence, whether it makes you at all anxious or whether I’m the only one in the room who’s feeling the anxiety?”

She raises an eyebrow at me. “You were doing better the first time around.”

I am ready to kill her. And then I remember another patient I wrote about and my reaction to him when he demanded that I be brilliant. He wanted me to be brilliant just as his father demanded that he be brilliant and just as my father demanded the same from me. And that demand always resulted in both my patient and I being frozen with anxiety. So my earlier patient was doing to me the same thing that had been done to him. He was acting out his childhood experience except now he was in the role of his father and I was the frightened child.    

I think about Paula and am a bit baffled. In our first session she described her father as a middle-level manager who didn’t seem particularly bright or demanding. What did she say about her mother? Not much actually. I guess I had the impression she was a housewife, but now I wonder. 

“Paula, I find myself wondering about your mother. What did she do?”

Paula’s smirk fades immediately. She glares at me. “You get a gold star,” she says sarcastically. “My mother was a Pulitzer Prize winning journalist who wrote novels on the side. She edited all my papers all through school. They were never good enough. I actually wanted to write. I became a computer technician instead.”

Sadness fills the room.

“I’m really sorry, Paula. I can feel how painful that was for you, never feeling good enough, never being able to freely express what you wanted to say.”

“Don’t get carried away. Just because you figured it out doesn’t mean you get a free ride.”

Although I can feel myself bristle, I remain determined to stay with the sadness. “So it’s easier for you to be a harsh taskmaster like your mother, than to feel the pain you felt as a not-good-enough little girl.”

I think I see Paula’s eyes fill with tears. But she draws herself back into her rigid self and closes down. 

This will be a very long treatment. All I can do is hope that my newfound understanding will help sustain me through the difficult times ahead.   

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