I try to keep my expression neutral while inside my stomach churns. Dealing with a patient whose values drastically conflict with my own is difficult, especially as I struggle with the question of where the therapeutic ends and the political begins. Earlier experiences with patients flash through my mind. While still a graduate student, one of my first patients extolled the virtues of Hitler, while I sat frozen, unable to respond. Another patient, shortly after 9/11 suggested incarcerating all Arabs in this country. I thought my face was neutral, but obviously not. “You don’t agree” she said. Impulsively I responded, “I’d rather be dead.” Although certainly not a therapeutic response, it did give us much to talk about. Or the patient who was convinced he knew my political leanings and baited me with statements he was sure I’d disagree with. The latter was less of a problem since I was able to address the reasons behind the patient’s wish to provoke me.
But so far Bob is only stating his opinion. So despite my strongly held beliefs to the contrary, I need to address this as any of the many arguments between my patient and his wife, remembering that my focus needs to remain on the patient. Right? Except it doesn’t feel right. Would I remain neutral if Bob told me he was beating his wife? Obviously not. But that’s an action, not a belief. Yet this man’s belief can also do harm. Here’s the question of whether the therapeutic and the political can or should be separated.
“So what do you think, am I right?” Bob continues, asking me the dreaded question.
I avoid answering. “You seem so certain of your position, why do you want my opinion?”
“I don’t know. Seems kind of normal to want to know the opinion of the person sitting across from you.”
“I suppose. Or does it speak to some uncertainty on your part or some desire to have me – perhaps an authority figure in your eyes – confirm your opinion?”
Bob shakes his head. “You can agree with me or not. It’s not going to change my mind.”
“I gather your wife didn’t agree with you and that didn’t change your mind either.”
“Damn right!”
“My kids are not going over to that house!” Bob says, his voice rising.
“And your wife feels how about that?”
“I don’t care how she feels!”
“What are you afraid of Bob? What do you imagine might happen if your kids go over to their house?”
Crossing his arms in front of his chest and scowling at me, Bob says, “They could put their hands on my little girls. They could play with them down there.”
“Do you worry that some of your friends, the heterosexual fathers of your children’s friends will abuse them?”
“Of course not!”
“And what’s your sense of the difference?”
“They’re lezzies, that’s the difference!” Bob says shouting. “You’re obviously one of those gay lovers too. I suppose you believe they should be allowed to marry!”
This hasn’t gone at all well. I suddenly realize that ever since I mentioned being an authority figure, Bob has been both defensive and provocative and I have engaged with him in a debate, rather than trying to understand what was going on between us. Time to change direction.
“Do you like to argue, Bob?”
“I guess,” he says, “I can hold my own.”
“Are you saying arguing makes you feel powerful?”
“I suppose you could say that.”
“How do you usually feel when you’re in this room with me? Do you feel powerful?”
Bob squirms in his chair. “No,” he says shaking his head. “You’re a lot smarter than me. You have a lot more answers. Lots of times I don’t even know the questions.”
“So you’re saying that you feel ‘less than’ me. But when you argue, when you ‘hold your own,’ you feel better about yourself.”
“I guess,” he says sheepishly.
“I wonder if you don’t often feel ‘less than.’ We’ll need to figure out why that is.”
“That won’t change my mind about those lezzies.”
“I hear you.”
I say nothing else. Bob needs to have the last word.
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