Tuesday, January 27, 2015

An Eye for an Eye

“I’ll never be able to have sex again,” sobs 22 year old Ashley, her face, buried in her hands with her long brown hair falling forwards, her voice barely audible. “I don’t know how I could have been so stupid. I know better. I’m not some dumb freshman, for God’s sake. I know you don’t get drunk at a frat party and go have unprotected sex with some guy you’ve never met before. My life is over!” she wails. 

It has been a month since Ashley confirmed that she has herpes. We have been dealing with nothing else since her diagnosis. She is understandably distraught, unable to move beyond the feeling that she has forever ruined her life.  

I think about some of the patients who have, over the years, told me about having herpes: The 60 year old woman who felt forever dirtied and punished by God. The session with a man who began by saying he needed to tell me his “secret,” and was then for so evasive, that I became afraid he was going to tell me he had committed murder. The young woman who said she contracted herpes after she had been drugged and raped, only to tell me months later that she had fabricated that story to hide her shame.  All tragic stories that forever cast a shadow over the person’s life. And now there is Ashley.

“I can’t believe I’ll never be able to have sex again. I’m only 22. I’ll never get married. Never have children.”

“Ashley, I’m by no means minimizing the pain and difficulty of having herpes, but it doesn’t mean you can’t have sex or get married or have children,” I say, trying to temper Ashley’s overwhelming feelings of despair.

“And risk doing to someone else what that asshole did to me! Never!!”

I think about the anger that almost invariably accompanies contracting herpes: the 60 year old who talked of being punished by God, my fantasy that my male patient might have committed murder, the young woman who fabricated a story of rape. Rage makes its way into the experience one way or another.

“I certainly understand your angry at that guy.”

“Yeah, I’m angry at him. Lot of good that will do me.”

“Well, it’s important that you’re aware of your anger, rather than being scared of it.”

“What are you talking about?”

“You’re angry. You’d love to get back as this guy, but there’s really no way to do that. So you feel powerless and that makes you even more angry.”

“So, yeah, and what does all that mean?”

“You notice, Ashley, that you’re also getting angry with me, which is perfectly all right, but I think it’s an indication of how angry you feel and how easy it is to direct your anger at me or someone else.”


“You have nothing to apologize for. It’s just important that we look at what’s happening and try to understand it because I think it’s related to why you think you can never have sex again or get married or have children. I think you’re afraid – not consciously, of course – that your anger would spill over to a new partner, that perhaps you’d want to give him herpes, just as it was given to you.”

“No way” Ashley says, shaking her head emphatically, her hair flying from side to side. “I’d never, ever want to do that to someone else.” 

“I know you’d consciously never WANT to harm someone else, but your unconscious desire for revenge is another matter. If you’re afraid of wanting to hurt, you might try to protect others from what you’re afraid is your dangerousness by depriving yourself of the pleasure of sex and marriage and children.” 

“But how could I possibly have sex with someone and know I could harm him - especially if you’re saying I want to harm him?”

Although Ashley’s question might sound as though she’s still stuck, I hear some hope for she’s at least considering the possibility of having sex again. I reply, “It’s not that you’d want to harm a new partner, it’s that you might be afraid your anger could be expressed in that way. And the more we can deal with your anger here, the more you know about your anger, the less afraid you would be of expressing it unconsciously.”

Tuesday, January 20, 2015

Parallel Process

“Roberta keeps saying that she has no life, that the only thing she does is run in circles doing her mother’s biding and that no matter what she does it’s never good enough for her mother anyway.”

So begins Dr. Kaitlyn Rose’s supervisory session. She is a 32 year old psychologist, licensed for two years, and struggling to establish a private practice. Like many young professionals she has discovered that her formal graduate school training, including her internship, has not adequately prepared her to deal with real patients in the real world. Recognizing that she could benefit from the expertise of a more seasoned professional and having heard me present at a seminar, she asked if I would supervise her. I readily agreed, both admiring her awareness of her own limitations and appreciating the chance to impact the clinical skills of a new generation of therapists.   

Dr. Rose continues: “I keep asking Roberta why she tries so hard when she knows that her mother will never be satisfied, but she just shrugs and tells me she has no choice. Besides, she says, she has nothing better to do anyway. So then we start talking about how she spends her days and how empty her life is and how come she never got married, and so on and so forth.”

“So how do you feel as you tell me this Kaitlyn or as you listen to Roberta?”

“Frustrated. I feel frustrated. I can’t do anything to help her.”

I smile. “Interesting, isn’t it, that you feel the same way in relation to Roberta as she feels towards her mother. Nothing you do can help; nothing is good enough. It’s a parallel process, you’re enacting the same experience with Roberta as she’s enacting with her mother.”

“That’s true,” Kaitlyn replies pensively. “I never thought of that.” She pauses. “But I have to do something!” she exclaims.

“Because…?” I ask, provocatively.

“Because that’s what therapists do, we help.”

“So you have no choice but to try and help, again, just like Roberta has no choice but to try and help her mother. Let me ask you this, why do you think Roberta keeps trying so hard with her mother?”

“I don’t know. She won’t tell me.”

“But what’s your guess?”

“I have no idea.”

I feel my own level of frustration rise. Is this yet another parallel process, my enacting with my supervisee what she enacts with her patient which the patient enacts with her mother? A never-ending series of mirrors that enables me to feel the frustration and powerlessness of desperately wanting to make someone different.  “Let me ask you this, Kaitlyn, why did you want to become a therapist?”

“So I could help people.”

“Yes, I’m sure that’s true, but why do you think it was important for you to help people?”

Kaitlyn blushes and averts her eyes. “I…I… My mother was very depressed. I know it’s childish but I think I believed if I became a psychologist I could help her.”

“No, Kaitlyn, it’s not at all childish. I don’t mean to intrude into your personal life. That’s not my place here. I was just trying to show you that we all have complex reasons for everything we do and, as you just said, your need to help people, to change people, was fueled at least partially by your desire to change your mother. And I’d venture to guess and you don’t have to tell me if I’m right because, as I said, I’m not your therapist, I suspect you felt the need to change your depressed mother so that she could be more available to you, be the mother you needed and deserved as a child.”

Kaitlyn’s eyes fill with tears. 

“So now what might be your guess about why Roberta keeps trying and trying to please her mother?”

“I get it,” Kaitlyn says, nodding sadly. “She keeps trying because she keeps hoping that her mother will approve of her, love her, give her what she always wanted.”

“That’s really well put, Kaitlyn. Roberta and you and me and the rest of the world, we keep trying and trying to win with the parent or parents we lost with, hoping to win in the present that which we lost in the past, hoping against hope that we will finally feel like the loved, valued little child. And the process of giving up that hope is a long and painful one.”     

Tuesday, January 6, 2015


“I just ended another relationship,” says Brittany settling herself into my chair for the first time. She’s an attractive enough woman probably in her early 40s, simply dressed in black pants and a gray sweater. She didn’t smile when I greeted her in the waiting room, just extended her hand.  Her eyes didn’t smile either. She continues.

“I told myself I’d give it a year and I did. We got together last New Year’s Eve and I broke up with him this January 1. He was a nice enough man. But I can’t do it. I can’t be in a relationship. It’s like torture to me.”

Torture, I think to myself. What a strong word.

“I know it’s not normal,” Brittany continues. “That’s why I promised myself I’d go into therapy if I couldn’t handle this relationship. I’ve been in therapy several times, but maybe I’m more ready now. I certainly know this is my problem. Way too many relationships to think it’s the men’s fault. I don’t usually last a year, but that’s what I said I’d do, so I did.”

Questions swirl through my mind: What makes a relationship feel like torture? Do you feel smothered? Are you so terrified of loss that you can’t allow yourself to connect? Did your relationship with your previous therapists feel like torture also? Will you need to escape our relationship as well? I decide on a far more innocuous statement.

“Sounds like when you make up your mind to do something you certainly follow through.”

Brittany’s mouth forms an almost-smile, while her eyes brighten slightly eyes as well. “That’s definitely not my problem. If I decide to do something, I do it. I wouldn’t be where I am today if it weren’t for my determination. I own a chain of yogurt stores and am about to start franchising nationwide. Not bad for an abandoned orphan left by the side of the road.”

“Literally?” I ask, surprised. 

“I’m exaggerating about that side of the road bit, but my parents were a piece of work. They were both drug addicts and definitely didn’t know what to do with a baby. At some point they just left me. Social services got involved and I went from one foster home to another until I was 10 when one family finally kept me until I was 16. Then I got myself declared an emancipated minor and went off on my own. And the rest is history.”

“That’s an amazing story, Brittany. A really sad story, but you tell it with no feeling at all.”

“I’ve repeated it a million times.”

“But you still must have feelings about it. About your parents abandoning you, about your going from one home to another, about the family you lived with for six years.”

“They were good-enough people. The family I lived with for six years. But it was the same problem. They wanted something from me I couldn’t give them. They wanted me to love them, to be a part of their family, to remember birthdays and care about Christmas. I don’t have it in me.”

The room feels heavy, steeped in despair, although I suspect I am the only one who feels it. Brittany is removed, protected by a suit of armor she constructed early on to shield her from repeated abandonment and neglect. How could she ever allow herself to care for another person who would likely, yet again, toss her aside? “Left on the side of the road.” That is her metaphor for her life. Brittany cannot allow herself to get any inkling of the scared, vulnerable, needy child who exists inside her. Instead, she prides herself on her truly amazing success, unaware of her underlying hunger for human connection. 

“How do you feel about not having it in you?” I ask.

She shrugs. “I know there’s something missing in me. And when I look around and see people, I can tell that relationships add something to their lives. So I guess I’d like to find out what’s missing.”

“I suspect, Brittany, that it’s not so much that something is missing, but that you’ve buried your hurt, neglected childhood feelings deep inside you and that when a potentially close relationship threatens to expose those feelings, you feel you’re being emotionally tortured. Then you bury the feelings even deeper and run away. It’s as though you’re saying, ‘I don’t need anyone and no one can hurt me ever again.’”

“I get the wanting no one to hurt me again, but I don’t know about my being afraid of needing anyone. I don’t think I do need anyone. That’s the problem.” 

“Well, I guess that’s something we’ll find out as we go forward,” I say optimistically. In my mind I add, assuming I’m able to keep you in therapy.