In an earlier blog, “A Dog’s Life,” I talked about Terri, a patient who became angry with me for canceling a trip because my dog was sick, while she had almost died as a child when her parents left her to go to Japan. Although her anger turned to sadness as she left my office, the anger soon returned.
“What do you mean you care about me? I’m just a patient to you. One of many patients. A patient who gives you money. I’m your livelihood. That’s why you care you me. Would you see me if I didn’t pay you? No, of course not,” Terri says crossing her arms in front of her, glaring at me.
“It’s true that you pay me, Terri, but you’re paying me for my time, not for my caring.”
“Huh!” Terri snorts, “Sounds like you’ve said that before!”
“Yes, I have said it before, but that doesn’t make it any less true.”
“So tell me how you care about me. Show me.”
Although I’m beginning to feel annoyed, I acquiesce to Terri’s demand.
“Well, I listen to you carefully and thoughtfully, I try to say and do what’s in your best interest, I worry about you if you’re having a hard time or if you’re being in any way self-destructive, I talk to you when you call …”
“Fine, if my calling bothers you, I won’t call any more.”
I feel a flash of anger, but recognize that Terri is trying to provoke me.
“Can I ask you something, Terri? Would it be possible for you to believe that I do care about you?”
“What do you mean?” she asks scowling.
“It feels like you’re trying not to take in any of the positive things I’m saying, that you’re turning them around so that you end up feeling rejected.”
“Right, so now it’s my fault that you don’t care about me!”
“Whoa,” I say, raising both hands. “Let’s stop a second here. It’s not a question of fault. What I’m suggesting is that it’s very difficult for you to allow in that anyone cares about you because you felt that neither of your parents loved you. That’s the lens through which you see the world. It’s a world where nobody loves you.”
“Yeah, I guess that’s true.”
“So the idea that I or someone could care about you is entirely foreign, a foreign concept that’s impossible to allow in.”
“I agree. Now I’m going to go a little further here but, again, I’m not talking about blame, I’m just trying to look at why you might do what you do. Okay?”
“I guess,” Terri says reluctantly.
“I think you also need to reject caring – just as you rejected my caring earlier - because what would it mean if I cared about you and your parents didn’t? It would mean that it wasn’t anything you did as a kid to make them not love you. It would mean that you were and are loveable and that your parents were incapable of loving you the way you needed and deserved to be loved. It wasn’t your deficiency, it was theirs and that means no matter what you do you can never, ever win their love. And that’s really painful.”
“You know what?” Terri says. “I think this is all a bunch of bullshit! We start out talking about you not caring about me and end up back on my parents. I think it’s you who are trying to turn things all around.”
“We’re kind of stymied here, Terri. I can say you’re turning things around to avoid taking in my caring and you can say I’m turning things round to avoid dealing with what you experience as my non-caring.”
“You’ve got a point there,” Terri says, almost smiling. ”I want to ask you something. You’re an analyst, right?”
“That means you’ve been in therapy, doesn’t it?”
I nod again.
“Did you feel your therapist cared about you?”
“Yes, I did.”
“How come? How come you did and I don’t?”
“For exactly the reasons I mentioned earlier, except in reverse. Although not everyone in my early life cherished me, there were enough people who did, that caring isn’t foreign to me. I expect people to care about me and I can take in that caring without having to give up on all my early caretakers.”
“Thanks for telling me. I think.”
I smile. “Nothing is ever uncomplicated, Terri. My telling you might feel like a gift, which you might also feel the need to reject. And now you might not only feel envious of my dog, but of me as well.”
“I’ve had it for today,” Terri says as she bolts for the door.
It is interesting that you feel your reality to be a fact and her reality as "what you experience as my non-caring" when you say "I can say you’re turning things around to avoid taking in my caring and you can say I’m turning things round to avoid dealing with what you experience as my non-caring.”
Just as the client has many parts, so do we as therapists (sigh, I am stating the obvious, excuse me.) Could it be possible that she picked up on something unconsciously from you other than care?
It sounded like she started of with anger yet I experienced your responses as you needing her to accept your care.
Obviously I dont know your relationship and all I write here is a reflection of my own inner world which I was either born with, which has been carefully planted or violently shitted into me.
But listening to Terri through you, I hear someone who unconsciously knows exactly what she needs....
By the way, care can cause catastrophic consequences in the internal world depending on the strength of the antilibidinal ego.... remember, the patient knows how fast she can go, perhaps the realisation of someone caring for her so suddenly could have devastating consequences and her 'defence' against your care is vital.
Just thinking about her the way you do is a deeply affectionate and loving act in my opinion....
I am completely confused by your saying that I assume my experience is reality, while assuming my patient's is not. The lines that you quote are meant to imply that there is no way we can figure out whose "reality" is real or a distortion and that therefore there does not seem to be any reason to continue to debate it.
I also don't think I agree that Terri unconsciously knows what she needs, but that is also an unanswerable question since it is impossible to know what anyone knows on an unconscious level.
Being an ardent fan of Fairbairn, I'm certainly familiar with the antilibidinal ego. However, I do believe that challenging patients to accept caring is one of the ways that the closed system can, over time, be breached.
I also agree that my thinking about her is indeed a loving act, but eventually Terri would need to know that as well in order for her to begin to take me in as a more positive object.
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