Tuesday, June 24, 2014

Black and White

“I was so depressed I didn’t go out of the house all weekend,” Liz says, her mouth pinched, her eyes downward, staring at her hands. 

“I’m so alone. No one cares about me. No one cares if I live or die.”

Rather than feeling compassion for my obviously unhappy patient, I’m aware of feeling immediately annoyed. There are reasons I could feel compassion. Liz’s husband Bob decided he wanted a divorce after almost 45 years of marriage, leaving her adrift at age 65, never having lived on her own, never having been involved with any man but her husband. Still, I feel annoyed. This tells me two things: one, I have a hard time with someone who remains stuck in the victim role because it’s a role I can’t tolerate myself and, two, underneath her depression, Liz is angry and is unconsciously communicating that anger to me.

I remain silent.

Liz continues. “Bobby went to see his father again this weekend. He was just there for Father’s Day. You’d think he could have stopped by.”

“So you’re angry that your son saw your husband again and not you.”

“I guess.”

“What do you mean, you guess?”

“I wouldn’t have called it anger, more like disappointment.”

“Can you feel both?”

“I suppose. I just don’t know why I don’t see more of him. He obviously has time for his father and for the girls he’s always chasing. I don’t see why he can’t squeeze a little time in for his mother. He’s all I have left in the world and I never see him.”

I consider and reject various responses: What about your daughter and her three children? What about your sisters? What about the friends you’ve been trying to develop? Although all these are all realities, they are irrelevant to Liz at this time. For the moment all that matters is that her son saw her husband instead of her.

“When was the last time you saw your son?” I ask although I fear that even that question veers too far from Liz’s feelings and her present state of mind. Still, her answer surprises me.

“He took me to dinner earlier last week.”

My unspoken response is, I thought you said you never see him, but I recognize the futility of going down that path. Instead I said, “I think you really are angry at Bobby, Liz, angry that he sees your husband despite how much Bob hurt you.”

“Well he did hurt me horribly. And he didn’t even leave for another woman. He left because he couldn’t stand me anymore. How do you think that makes me feel?”

“Of course it’s hurtful, Liz. Of course you feel lousy. But I wonder if you’re also feeling angry with me right now?”

“With you? Why should I be angry with you?”

“Perhaps because you don’t feel I’m being sufficiently understanding. Perhaps because when you get angry your anger gets bigger and bigger until it’s hard to find anything good or positive about anyone. It’s like you see the world in black and white with no shades of gray. It’s like when you’re angry at Bobby, you forget all the positive or caring or loving things he’s ever done. And then your anger keeps expanding until it encompasses everyone in your life and you’re left with only blackness, you’re left feeling all alone.”

“I definitely do feel all alone.”

“I know you do. But I wonder if you really are as alone as you feel or if it’s your anger that erases all goodness. It is possible – and I know this is very difficult for you – but it is possible to be angry with Bobby or with me or with anyone and still love them and care about them and know they care about you.”

“That’s really hard for me. I don’t even know that I’m angry until you point it out.”

“Well that’s a problem too. Instead of recognizing your anger, you tend to turn it on yourself and feel worthless and depressed. So, yes, first you have to recognize your anger as anger. And then we have to work on your being able to hold anger and more positive feelings at the same time.”

“So you’re not giving up on me?”

“Why would you think I’d be giving up on you?”

“I don’t know. Sometimes I think you’re impatient with me.”

“Maybe you’re right. Maybe sometimes I do feel impatient. But that would be a good example of my being able to feel something negative like impatience and still hold on to caring about you and being committed to our work together.”

“I understand. I just don’t know if I can do it.”

“That’s what we’re here for.”

Tuesday, June 17, 2014


“I really appreciate your seeing me again. I didn’t know who to turn to. I’m so scared, so, so scared.”

Across from me sits Jennifer, a patient I have not seen for over eight years. We’d worked intensively for a five year period, until Jennifer gave birth and decided that she’d like to try it on her own. I’d questioned her timing. The victim of childhood sexual abuse by an uncle she’d kept secret from everyone but me, I’d wondered what feelings might resurface with the birth of her daughter. But she was insistent and I had to respect her decision.

“I saw Samantha masturbating in the living room a couple of weeks ago. It freaked me out, but I talked to myself, said it didn’t mean anything happened to her, just a kid exploring her body. So I told her those were things we do in private. She seemed to accept that and I let it be. It still bothered me – I even started to have my scary dreams again – but I dropped it with Samantha. Then it happened again and I got more scared.

“So I tried to talk to her about it. I reminded her what I had said before about that kind of stuff being private, but this time I asked her if anyone else had touched her down there. She didn’t say anything, just looked away from me. I panicked. I told her I wouldn’t be mad at her, but she needed to tell me if anyone else was touching her. Then she nodded and I thought I would die. Not again I wanted to scream. This can’t be happening to my daughter too,” Jennifer says, crying, tearing at her hands. I feel my own anxiety rise along with hers. 

She continues. “I asked her if she could tell me who it was and she pointed to the house next door. That confused me because there’s no man next door, just a divorced Mom with kids. She has a daughter, Emma, who’s the same age as Samantha and they play together sometimes. Then I thought maybe the Mom was dating someone, or was it the Mom herself, all these thoughts racing through my head. Then she almost whispered, ‘Howie.’ For a second I didn’t even know who that was and then I realized that was Emma’s brother who’s probably ten. Is that abuse? He’s ten. What were they doing? Was anyone with them? Where was Emma? I asked the last question. Samantha just shrugged. So I stopped. And I called you.”

“I’m glad you called, Jennifer, I know how very difficult this is for you. It would be difficult for any Mom, but it sets off so many old terrors for you.”

Jennifer’s tears cascade down her face. Her agitation decreases. “I knew you’d understand. I talked to my husband, Bill. He said I was over-reacting that they were just kids, doing what all normal kids do. Maybe he’s right. I don’t want to terrify Samantha. I don’t want to give her the message that sex is bad and dirty. I’ve had more than enough of that to deal with myself. Please tell me what I should do.”

Thoughts have been swirling through my mind during Samantha’s panicky recitation. I always believed that her daughter’s sexuality would present problems for Jennifer, but the possibility of sexual abuse raises those issues a hundredfold. On the other hand, Jennifer comes in with a good deal of insight. She knows she has to rein in her fears to avoid terrorizing Samantha, although children easily intuit their parent’s underlying and unspoken feelings. And there are the practical questions. What should Jennifer do? What did actually happen? Although the facts do matter in a case such as this, how one understands those facts will vary greatly depending upon the lens through which they are viewed.   

“There a lot going on here, Jennifer. Are you asking me what you need to do about your feelings, about how to deal with Samantha, about what actually happened?”

Jennifer stares at me. “I don’t know. I can’t even think straight. All of the above, I guess.”

“You’re feeling overwhelmed by your feelings and you can’t think straight. Is it possible for you, for example, to talk with Bill again about your feelings, to talk with the Mom next door, have the two of you talk with the Mom?”

“I can’t,” Jennifer wails.

I remember that forlorn cry. “You still haven’t told anyone but me about your abuse, have you?” I ask.

Jennifer shakes her head sobbing.

“I’m sorry. I’m sorry you still feel so much shame you can’t speak. Let’s see if you can come in again tomorrow. I don’t want to leave you feeling so distraught.”

Tuesday, June 10, 2014

Losing Home

“I can’t believe I’m going to do it,” Paula says sobbing. “It feels impossible. It’s like I’m killing Robert. But I can’t be killing him because he’s already dead. Why? Why is he dead? Why am I doing this? Why is Karen moving? I can’t. I just can’t. Robert and I lived in that house almost our whole married life. How can I sell it? I just can’t.”

For those of you who read my book, you might remember Paula. She’s the depressed widow I treat during the winters when she leaves her home in Park Slope, Brooklyn to spend time in Florida. Depression has been with Paula most of her life; her husband’s death only made it worse. She hates leaving her home in Brooklyn, even for the winters, venturing south only at the insistence of her daughter, Karen, who, as Paula says, probably had enough of her, and sends her off to her other daughter in Florida. But Karen is now moving to Los Angeles. The plan is for Paula to return north this spring, to put her house on the market and to make a permanent move to south Florida.

“Maybe I shouldn’t,” Paula continues, still weeping. “Maybe I should just stay there by myself. I’ll just have to force myself to get out more, to make friends. I know I’m not very good at that, but I could try,” she says plaintively. “I know that’s not what my daughters want, but it’s my life. I get to do what I want.”

“It is indeed your life, Paula. This is a huge decision for you either way. But I’m glad to hear you say you get to decide for yourself what you want to do.”

“But I can’t. I couldn’t not do what my daughters want. They’d worry about me. I don’t want them to worry about me.”

“I wonder if that’s true, Paula. I suspect you’d kind of like your daughters to worry more about you.”

“That wouldn’t be nice.”

I sigh inwardly. Paula and I have covered this ground more times than I care to remember. “You don’t have to be nice all the time, Paula. And you don’t have to have only good thoughts and good feelings.”

“I guess.” She pauses. “But do you think it’s practical? Do you think I could stay in Brooklyn by myself?”

I smile. “So now you’re going to ask me rather than your daughters what you should do. As you said, you’re an adult. You can make your own decisions. You need to weigh how it would feel to stay in Brooklyn without one of your daughters, as opposed to how it will feel to sell your home.”

“I can’t. I can’t do either one.”

Sadness washes over me. Although Paula’s dependency, indecision and complaints often make working with her difficult for me, this time I feel Paula’s dilemma on a deeply personal level. I remember the tremendous pain I felt about leaving my Michigan home and relocating to south Florida. When my husband’s health tipped the scale in the direction of moving, I remember the questions I asked myself over and over: “How will I walk out of this house for the last time? How can I be making a decision that causes me such intolerable pain?”  

Remembering, I say, “With the exception of your husband’s death, leaving your home may well be the most painful loss you’ve ever experienced. It’s nothing to make light of. Home represents your and Robert’s relationship. Home represents a place of safety and security. It’s “home.” Whether home will be enough without Robert or your daughter, no one can decide but you. You often feel very alone. I don’t know if that aloneness will feel intolerable once Karen has moved. That’s something you’ll have to decide. But if you do decide to move, don’t minimize the pain you’ll feel and don’t get angry with yourself for feeling it.”

“I want Robert,” she says beseechingly. “I want Robert to be here and help me.”  

“I understand, Paula. I wish he could be here for you, but unfortunately that’s not possible.”

“I hate it when you say that. I know it’s true, of course, but I still hate it.”

“I know, Paula. It feels too real when I say it. But it is important for you to hold onto that reality because when you don’t, you’re surprised again and again that he’s dead and it’s like having to begin mourning for him all over again. And right now you have a huge decision to make and you need to make it knowing that Robert isn’t around to help you.”