Tuesday, July 29, 2014

In Motion

“Sorry I’m late,” Ryan says, lowering his tall, broad, smartly dressed body into my chair.

So what else is new, I think to myself, aware of the annoyance and sarcasm in my thought.

“The real estate market is really picking up. It’s great. But the customers are keeping me hopping. Have to be there when they want or the sales go elsewhere.” 

I remain silent.

“OK, so let me switch gears. What’s been going on? Well, Charlene is starting to drive me crazy. I think I’m going to have to break up with her. The sex is still great and she’s funny, but she’s so needy. I mean, I don’t mind sending her a quick text during the day, but I can’t be stopping to have some intense conversation. And just because I don’t have a 9 to 5 job, doesn’t mean I can see her whenever she wants. It’s not like that. My time isn’t my own. I have to be available to my customers.”

“Kind of like what you said to me about being late.”

“Yeah! Exactly! And you get it.”

“What is it that you think I get?”

“That I can’t help it. That I have to be available to my clients.”

Varying thoughts flood my mind. Lateness and commitment are big issues for Ryan. He came into treatment two years after his divorce saying that he was having difficulty keeping a relationship. At that point he was despondent, dejected, wondering what he was doing wrong. But he’s now lost himself in a flurry of activity, moving away from self-reflection, just as he moves away from commitment. 

Lateness can also be an issue for me, although my years of doing treatment have diminished its affect. Still, there’s the scared, abandoned little girl in me waiting in the darkened school for my almost always late mother to pick me up. But Ryan’s lateness has a more dismissive quality, like he’s saying “you’re not worth my time.” 

“You do get it, don’t you?” Ryan say, interrupting my thoughts.

“I think lateness and time and commitment is a far more complicated issue for you Ryan.”

“You don’t get it! You think I do it on purpose. Hey, I have to make a living! Remember all that child support I have to pay?”

“Can you say what your anger is about right now, Ryan?”

“Who says I’m angry?”

I feel a flash of annoyance and then, probably drawing on my own childhood experience, I feel sad for Ryan. It’s time to rein him in, to bring him back from his frantic busyness and avoidance. “I wonder if not feeling understood by me makes you feel alone and rejected,” I say.

“Whoa! That feels like a leap!”

“Ryan, let’s slow down here. You came into treatment feeling discouraged with the quality of your life, your relationships. But then you got yourself into a whirlwind – yes I know you have to make a living and that the real estate market is picking up – but I also think you’re trying to avoid yourself and your feelings and me and Charlene as well.”

He stares out the window. “It’s getting darker out there. Looks like it’s going to rain.”

“Sounds like that’s how you feel. If you stop for a minute, you can feel the darkness, the sadness come over you.”

“So what am I so sad about?”

“What are your thoughts?”

“My failed marriage. My not getting to see enough of my kids. I said I’d never get a divorce, never do to my kids what my parents did to me. Split between two homes, neither one having enough time for me, neither one knowing if I was going to school, doing my homework. It felt as though they didn’t give a shit. They probably did, but they were too busy trying to make ends meet.”

“It’s interesting, Ryan, when you just said it felt as though they didn’t give a shit, that’s exactly how it feels to me when you come in here and toss off a ‘sorry I’m late.’ It feels as though you don’t give a shit. So you’re behaving towards me as your parents behaved towards you and allowing me to feel what it felt like to be the kid you.”

“Wow! That’s deep. I’m not sure I’m smart enough to create that scenario.”

“It’s not something that you decide to do or figure out consciously. You act it out automatically so that in your relationships someone is always being the rejecting parent and the other person feels like the rejected child.”  

“That would be a good reason for relationships not to work out.”

“Yes, that’s definitely true.”

“And what do I do about it?”

“First step is being aware of it. And we’ll definitely keep it in mind in our work here.” 


Unknown said...

Well written and moving, this account speaks to both the therapist in me and the deflector in me and enabled me to feel my own sadness in a far too busy day today. I'm glad I paused to read and self reflect. Thank you.

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

Thank you, Miriam. I appreciate both your self-reflection and your feedback.

Unknown said...

Thank you! Your description of your interaction helped me sort through a "rejection" by a patient who wants to "take a break" from therapy in an email. I am reminded to look at my historical feelings of not being good enough so I can attend to what I know about her in the work we have done together. Linda Wayne

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

So glad to have been of help, Linda. Being able to look at ourselves and our own feelings is vital to our work as therapists.

And to add, I know I'd be angry if a patient emailed me to say she wanted to "take a break" and that I'd call and ask her to come in. Doesn't mean she would, but I'd want to be clear that it wasn't all right with me that a relationship based on verbal communication would be unilaterally terminated via email.

S.L.E.Meindl said...

I don't think that this behavior is what is actually called the "manic defense"... but I have always thought it should be!

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

No, it's not technically a manic defense, but can certainly be understood as being on that continuum.

DrT said...

Very nice Linda. I am sure this was a well thought out and well-timed interpretation helping your patient to slow down, and feel his feelings. And I take it as a given that you really know your client, so I am sure it was spot on. So many times it is really so that we can sense how our clients fear what lies under the stillness, so the chaos continues. Also your CT helped you understand your client even better.

I have a comment/concern on the topic of lateness in general however. The question I would have in the beginning as I get to know the patient is how much is this a defense (as you sensed in your patient), and how much is this a reflection of a dopamine deprived brain style, a true organic/neurochemical life long condition, that makes the person feel bad about themselves, as they sense they are living under their potential. They lead a life of disorganization, hurry, catching up, etc. When parents, spouses, teachers, and therapists (analysts) also do not understand, misunderstanding and misattribution can have really deleterious consequences. A person with ADHD struggling with the difficulties of this brain style, already feels "made wrong" in a 1000 ways. For most of his/her life. Sadly I have seen analytic interpretations compound this problem, when the therapist does not have the appropriate background to recognize the condition. And to complicate matters further, a patient's behaviors of hurry, overscheduling, etc., can have both deficit and defense aspects. So lateness is a complicated thorny issue.

Thanks so much for your post! Warmly, Teresa

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

Thanks for your feedback and input, DrT. It is always informative to have another perspective and to look at a patient's behavior from a different vantage point.