Paranoia

“I’m afraid I’m going to be fired,” Tricia says.

I’m surprised. I’ve worked with Tricia over a year and she has given me only glowing reports about her success as a graphic designer.

“They think I stole Charlotte’s idea.”

“Did you?” I ask. Tricia has never spoken well of Charlotte. My sense is that Tricia is envious of Charlotte - her senior status, her looks, her ease in social situations.    

“Of course not,” she replies indignantly. 

“Then why should they think you did?”

“I just do.”

I wait.

“What, you don’t believe me? You think I’m lying?”

I knit my brows and look at Tricia, both perplexed and concerned. There’s a paranoid feel to this discussion that is making me anxious. “What’s going on, Tricia?”

“What? What do you mean?” she asks, raising her voice.

“I don’t understand why you’d think I thought you were lying or why you’re afraid you’ll be accused of stealing Charlotte’s idea and be fired.”

She stares at me defiantly and then deflates before my ideas, dissolving into tears.

“I’m bad. I’m bad and I’m going to be punished.”

I feel as though I am in the room with a child who’s been caught … Caught doing what? What comes to mind is caught with her pants down.  I file away my internal meanderings and wait to hear what Tricia will say. But Tricia, looking frightened, says nothing. 

Very gently, I ask, “Can you say what makes you bad, Tricia?”

She shakes her head, still not speaking. 

Fantasies go through my head. She had sex with Charlotte. She beat Charlotte up.  She hit someone with her car. She molested a child. She … I bring myself back to reality. Tricia’s anxiety is obviously contagious, but these are fantasies, not realistic possibilities. 

“I had sex with Peter,” she blurts out.

Aha, I think, her boss - and Charlotte’s. She had sex with a male authority figure, a stand-in for her father and is afraid of the punishment from both inside her head and in the real world. Clearly she’s already punishing herself, branding herself as bad. She also fears retaliation from Charlotte, from me, from her mother, and from the powers that be at work.

Suddenly I flash on a patient I saw many years ago. She had been a teacher, but could no longer work. She had an affair with a married principal and felt so guilty that she became convinced everyone in the school system talked about her. She was tormented by her thoughts, but unable to move beyond them. I don’t work well with paranoid people. They remind me too much of my father, I’m too easily sucked into unfruitful and untherapeutic attempts to convince them of the wrongness of their thinking. I must tread lightly with Tricia.

“Sounds like you feel pretty guilty.”

“How could I be so stupid?” she asks, hitting her thigh with her fist. “Not only my boss, but Charlotte’s too. And I know Charlotte has a crush on him. Besides, he’s only toying with me. He tries to get in every woman’s pants. Now he’ll want to get rid of me.”   

“So you feel you ‘stole’ Charlotte’s ‘man’ and that now he’ll get rid of you and choose Charlotte instead. That, you feel, would be your just punishment.”

“I don’t know what you’re talking about,” Tricia says loudly.

“Tricia, why do you feel what you did was bad? And why are you so frightened?”

“I told you! It was stupid!!”

“Let’s say you decide it was stupid, that doesn’t seem enough of a reason to conclude that you’re bad and that you’re going to get fired. I do believe you do feel terribly guilty, but I suspect the origin of that guilt stems a lot further back.”

“You mean some dumb Oedipal thing? I never wanted to sleep with my father!”

“But I suspect you did want your father to prefer you to your sisters and perhaps even your mother.”

“He did prefer me,” Tricia says quietly looking down. “That’s why my mother hated me so much.” 

I don’t know if Tricia’s assessment is accurate, but I suspect it is why Tricia feels so guilty and also why she’s convinced retribution must follow. 

“It’s important that we try to understand your feelings about the relationship between you and your parents, but right now I wonder what you’re thinking about being fired.”

“It still think Peter might try and get rid of me and that Charlotte hates me, but I’m not feeling quite as scared as before.”

“Maybe that’s because you’re not beating up on yourself quite as much.”