Inside/Outside

Tuesday, September 30, 2014

The Caretaker, Part 2


Today I return to Melinda whom I wrote about several months ago. She’s the woman whose 95 year old grandfather died and whose husband left her alone to deal with her grief. As we explored that experience, it became clear that Melinda needed to focus on others as a way to avoid her own feelings of anger and sadness. As the third girl in her family of origin, she had felt unwanted and unloved and carried around a reservoir of hurt, painful feelings.

“I feel as though I’m being torn in a dozen different directions,” Melinda begins. “The kids are a handful themselves – getting them ready for school, getting Elizabeth to tennis and dance and Mathew to softball and soccer, helping them with homework. But that’s all right. I expect that. But sometimes I think my husband is another kid. He’s so disorganized. I have to help him with our bills, get his clothes to and from the cleaners, do the laundry, remind him to take care of our cars and whatever chores he’s forgotten to do around the house. I even have to tidy the house before our cleaning woman comes. I know she’s supposed to be helping me and I guess she is, but I still have to tell her where to put things and straighten up before she comes. And my friends – I mean I love them all – but they’re always having crises – Bonnie broke up with her boyfriend, Charlotte’s mad at her husband again, Tina’s worried about her mother. And I have to get myself here as well.”

“Sounds like you’re feeling overwhelmed, Melinda, and not having any space for you.”

“Me? No, there’s no time for me. I’m too busy taking care of everyone else.”

“But I wonder if you also need to avoid you. Remember we talked about your treating yourself as you’d been treated and not allowing yourself and your feelings to matter?”

Melinda sighs. “I guess. I guess you’re right,” she says, her speech slowing.

“I notice you just slowed down a bit. That’s probably a good first step – giving yourself some time to think and feel.”

“It’s hard. I feel all this pressure, all these people making demands on me.”

“So who fills your needs, Melinda?”

“No one I guess. Makes me sad to realize that.”

“What about me, Melinda? I noticed before when you were listing all the people who were making demands on you, you said that you had to get yourself here as well. Sounds like you feel I’m another person who’s taking from you rather than giving to you.”   

“I suppose that’s true. You’re someone else I have to fit into my schedule.”

“But why is that, Melinda? Why is it that you can’t experience me as giving to you, why can’t you experience your time with me as nurturing?”

“I don’t know.” She pauses, thinking. “I don’t know why, but I suddenly thought of the time my mother forgot to pick me up from school and it felt like I waited for hours, although I’m sure I didn’t. Everyone in the family thought it was funny. It didn’t feel very funny to me.”

“I wonder if you’re saying, Melinda, that you’re afraid to allow yourself to need me because you’re afraid I’ll let you down like your mother and then laugh at you for needing me.”  

Melinda’s eyes fill with tears. “I was about to say, no, I know you wouldn’t do that, but obviously that really hit a chord in me.”

“Being needy makes you feel vulnerable.”

“That’s true. I hate feeling vulnerable. It’s scary. And weak.”

“So you run around taking care of everyone else so you don’t have to feel your own need to be cared for. You get to be the ‘strong one,’ the one who doesn’t having any needs.”

“Yup! That’s me.”

“And in the meantime, I suspect the feeling of neediness inside you gets bigger and bigger, making it even scarier for you to acknowledge, so that you have to try even harder to keep it hidden and stuffed safely away.”

“So what do I do about it?”

“Well, one thing we can do is keep a careful watch on what goes on between us. How you feel about being here, what you do or don’t do to keep me at bay and what happens if you begin to allow yourself to want or need from me.”

“That sounds hard. I can already feel myself wanting to head for the door.”

“I understand. But I will try to keep us focused on what’s going on between us, without making it too, too uncomfortable for you.” 

Tuesday, September 16, 2014

Cancellations

“What do you mean you’re going to charge me for last week’s session? I cancelled!” Carly says indigently. 

I’ve been working with 22 year old Carly for well over a year.  She knows that my cancellation policy is 48 hours’ notice or she gets charged for the session. There was a time that therapists allotted various time slots to their patients and that the patient paid for that time whether or not they came. It was as if someone paid a fee for a semester of classes. The person would pay that fee, regardless of how many classes were attended. Some therapists still follow that procedure, believing both that it increases the patient’s commitment to the process and insures that the therapist’s income is not subject to the whim of a particular patient. Still, that line of thought has been waning and I’m more comfortable with my 48 hour policy.

Except that I’m not always good at enforcing it. On the positive side, I could say that I’m flexible and willing to take my patients’ individual needs and circumstances into account. There can, however, be negative consequences as well. A patient might feel more unsafe about other boundaries in the treatment room – or in life in general - if I’m unable to be firm about my own policy. Or not standing firm, might lead a patient to feel increasingly entitled and therefore to become more demanding both in and out of the treatment room.

Either way, Carly knows that I won’t always stand firm. Her mother fell and had to go to the hospital. I didn’t charge her. Her car broke down on her way to the appointment. I didn’t charge her. She woke up with an attack of vertigo and was afraid to drive. I didn’t charge her. But this cancellation crossed my line. “My friend Charise came into town and needed someone to play tennis.”

“You know that my cancellation policy is 48 hours, Carly,” I say evenly.

“But you didn’t charge me when I got dizzy that time and couldn’t come!” she says.     

I sigh inwardly. The problem with not following my own rules is that I’m then in a position of having to pass individual judgments on what I deem worthy or not worthy of a forgiven cancellation.

“Does it seem to you Carly,” I ask, “that there’s a difference between being dizzy and unable to drive and going to play tennis with your friend?”

“But I see her so infrequently,” she exclaims.

“I understand that, but you could have played tennis with her later or earlier or on a different day,” I say. Even while speaking, I realize this is a ridiculous conversation. Although Carly is young and somewhat immature, she’s smart and clearly knows the difference between sickness and tennis.

I think about what might be going on here. Was there something that happened in our session before the cancellation? Is there something in Carly’s past that’s being repeated with me in this room? Nothing springs to mind, so I decide to ask Carly herself.

“How did you feel about us not meeting last week?”

”What do you mean?”

“How did you feel about cancelling last time?”

She glances out the window and down at her hands. “I liked it. I felt like I was playing hooky from school.”

Now we’re getting someplace, I think.

“And you wanted to play hooky because…?”

“Because I could. I never could as a kid. My parents would have killed me. And besides I would have felt way too guilty. Always have to be good, especially when it comes to school.”

I get that. I so internalized my family’s attitude towards education that I too could never have imagined playing hooky. But I rebelled in other ways, allowing me the separation from my parents that was necessary for my growth. Carly has been pretty much the consistently good kid. Now I’m in a bind – both wanting to support her need to pull away, while enforcing the consequences of her rebellion.

“I understand, Carly,” I say. “I understand that you’ve been the all-too-good kid and that playing hooky can be an important step for you towards independence. But I suspect if you were able to come in here and talk about your desire to play hooky with me, we could help to be your own person in relation to your family where it really counts.”

“You’re still going to charge me, aren’t you?”

“Yes, I’m still going to charge you. And I’m definitely going to want us to continue talking about how you feel about that and what it means to you.”

“It means I’m being punished for being my own person,” Carly says angrily.

“I hear you, Carly. It’s fine for you to be angry and we will continue to talk about it.”

Tuesday, September 9, 2014

In Search of Contentious Relationships

“Big surprise,” Tricia says, sighing, “Billy broke up with me. I told you he would. I told you he was nothing but a big baby who needed more and more reassuring and couldn’t tolerate arguing or sticking up for himself. Same old story again and again. I don’t know, don’t they make any 35 to 45 year old men who are men anymore?”

I’ve been thinking about Tricia and my relationship. I’ve been thinking about how quickly I find myself sucked into what is indeed her argumentative style. I’ve been thinking about why she needs to make all her relationships so contentious. And I’ve been thinking about why I’m so easily engaged in her argumentative style, as opposed to staying in my role as the therapist who seeks to analyze and understand.

My mind runs quickly through the responses that first come to me: Say nothing, which she’d experience as withholding and therefore maddening; Say, “Why do you think you keep finding men who are so wishy-washy?” which she’d hear as attacking; Say, “Why do you think you need to make your relationships so contentious?” probably the most important question which she would immediately dispute. For the moment, I settle for the most innocuous response possible, a typical therapist question.

“How do you feel about his breaking up with you?”

“Boy, there’s a typical therapist question if I ever heard one!”

I should have known she’d get me on that one, I think to myself.

“I felt like, well, I knew it.”

“But what did you feel?” I persist.

She shrugs. “Not much.”

“Tricia, can I ask you what you feel about our relationship?”

“Wow! That’s a change of topic. Where did that come from?”

“Well, we’re talking about relationships and you and I certainly have a relationship. We’ve been seeing each other for almost a year now.”

“Yeah, and I’m no further along than I was to begin with”


I’m beginning to feel dismissed and demeaned. Although I certainly take responsibility for the lack of progress in any treatment, Tricia’s inability to look at herself and her role in thwarting her own growth is more than annoying. Are my feelings similar to the ones I had with my father who knew everything, argued about everything and called me stupid if I ever dared to disagree with him?     

I persevere. “Tricia, have you ever felt close to anyone, ever?”

“You’re all over the map today,” she snaps back.

“Can you tell that you’re trying to bait me into an argument? It’s like you’re sparring with me as opposed to experiencing us on the same side, as trying to help you to better understand yourself and get to the place where you say you want to be, in a relationship with a man.”

“Where I say I want to be? What do you mean by that? Don’t you believe me? How can we be on the same side if you don’t even believe me?”

“Tricia, this is impossible,” I say clearly angry. “It’s as though you listen to everything I say looking to pick out the one thing that you can argue with me about and zoom right in on it.”

“Ah ha,” she replies, with a slight smile and a sparkle in her eyes, “I got you pissed off.”

“And why does that feel good to you?” I ask. “Does it give you a feeling of control over me? Does it keep a distance between us that’s more comfortable?”

“It shows you’re strong enough for me. That you can fight with me. That you can take what I have to dish out.”

“Who did that to you, Tricia? Who wanted to make you tough enough to fight back?”

In an instant, Tricia’s face becomes expressionless, frozen, her eyes staring blankly ahead. I’ve seen that look many times before, the look of an abused child.

“Who did that to you, Tricia?” I ask again, much more gently.

Tricia blinks and focuses back in on me. “My mother. I’ve never told anyone. I hate being a victim. She used to beat the shit out of me. She’d beat me and beat me until I stopped crying, until I was no longer a baby, until I could take it. She thought she was helping me. I thought she hated me. Except I think I have love and hate all mixed up.”

“I’m so sorry that happened to you, Tricia. You were a helpless child. A helpless child can’t be anything but a victim. There’s no shame in that, although I’m sure you do feel a lot of shame. And I’m sure you’re right, love and hate is all mixed up for you. We have lots to work on. But I’m really glad you told me Tricia. I know it wasn’t easy.”   

Tuesday, September 2, 2014

Death Looms

Seated in my waiting room is Tina and her frail, almost 90 year old mother.

“Would you like me to go in with you?” Tina asks. 

“Why, you think I can’t talk for myself?” she asks curtly. She holds onto the sides of her walker and struggles to get up. When Tina tries to help, she’s rewarded with a withering look.    

I wonder why I have agreed to see Mrs. Blumberg. Her daughter, Tina, has been my patient for years, many of those years devoted to dealing with her conflicts with her critical, guilt-inducing, withholding mother. I don’t usually see the relative of a patient, but Tina pleaded with me to do so. She described her mother as becoming increasingly morose and encouraged her to talk to a therapist. Mrs. Blumberg would have none of it. Then, suddenly, she announced she would see, “That woman you’ve been going to for all these years.”  No amount of explanation of the difficulties with this arrangement would dissuade her. It was me or no one. 

So Mrs. Blumberg is now walking into my office. Am I only doing my patient a favor? Do I just want to help a frail, old woman? Partially. But I’m also curious. I want to meet the woman who has caused my patient so much anguish, but whom she continues to love and care for.

“I know you people are real stingy with your time, so I better get right to the point. I’m almost 90 years old. I don’t have many years left and I’m scared of dying.”

I had planned to explain to Mrs. Blumberg  that I would keep both her and her daughter’s information confidential, that I couldn’t see her on an ongoing basis, and that I would be happy to refer her to other competent therapists, but she clearly has something important on her mind and has taken control of the session.

“Can you say exactly what you’re frightened of?”

“What do you mean? I’m frightened of dying. Of being dead.”

“I understand, but could you say what exactly frightens you; what are the specifics of your fear?”

“You’re ridiculous. Dying is dying. If you want me to be more specific, be more specific yourself.”

Aware of my annoyance and appreciating more fully Tina’s continuing struggle with this woman, I proceed as Mrs. Blumberg wishes.

“Well, some people might be afraid of dying because they’re afraid of what comes after death, as would they go to hell.”

“Now you’re being stupid. Jews don’t believe in hell, or heaven either.”

“Or some people might be afraid of leaving everything and everyone behind, of never again seeing the people they love.”

“Yes, that’s part of it. I wouldn’t like to never again see my children or grandchildren, never see my new great-grandson grow up,” she says thoughtfully. “But that’s not all of it. It’s just impossible to think of the world existing and my not being here.”

I’m taken aback by the narcissism behind Mrs. Blumberg’s response. It’s as if she’s saying I’m so important I can’t imagine the world without me. She continues.

“It’s like my new great-grandson. I won’t be here when he has his bar mitzvah. That frightens me. I’d like them to light a candle for me, but I know they won’t.”

The people I’ve loved and lost over the years – my grandparents, my mother, my husband – flash through my mind. They live on for me. I don’t need to light a candle for them to be with me.

“I wonder if when you say you’re afraid of dying, you’re saying you’re afraid that it will be as though you never existed, as though you were erased off the face of the earth.”

“That’s right. I’m afraid I’ll be poof, gone, as if I were never here.”

“Mrs. Blumberg, although it’s true that you will cease to exist in the flesh, it isn’t as though you were never here. You affected lots of people during the course of your life and you’ll live on in the memory of your children and grandchildren.”

“But not my great-grandson.”

“Well, we don’t know. We don’t know how long you’ll live, how old he’ll be when you die. But I’m sure Tina and her daughter will talk about you. Children love to hear stories about their grandparents and great-grandparents.”

“I can just imagine the stories Tina would tell,” she says snidely.

Unwilling to go down that path, I remain silent.

“Memories aren’t the same as being there,” Mrs. Blumberg says.

“No, they’re not,” I say, thinking immediately of my late husband. “But they’re better than nothing. And when you live in someone’s memory, you do live on.”