Tuesday, May 26, 2015

Lost and Perhaps Found

I’ve been working with Marvin, a 72 year old depressed widower for nine months. His sessions – like his life - are boring and repetitive. He refuses to discuss the past – says he’s too old for that – and complains bitterly about the emptiness in his life. “Nothing’s better,” he says today. “I still sit alone in my apartment staring at the beautiful weather and wondering why I can’t get myself out there, even to take a walk. There’s no place to go. I’m just lost. When Esther was around, even if we did fight all the time, at least there was someone there. Now there’s nothing.”

I ask myself, not for the first time, why I don’t feel more empathy for this man. After all, I too am a widow. I know the pain of loss, the feeling of aloneness. It’s his passivity that I find difficult. I want to shake him, tell him to find some hobby, some activity, a friend, a girl-friend. But I do none of that, knowing full well that he would find reason to rebuff any suggestion I might make. Today, I take a different track.

“How do you feel about coming here?” I ask.

“I come,” he says, averting his eyes.

Although his answer is the typical passive, uninvolved response, I sense a certain discomfort and wonder if more is going on than he’s saying.

“But how do you feel about coming?” I ask again, more persistently.

“What do you mean?” he says, even more flustered.

“How does it feel for you to come here?” I repeat. “To see me?”

“I…I don’t know,” he says, squirming in the chair.

I remain silent.

“Maybe I shouldn’t come. Is that what you’re telling me?” he says petulantly.

“I didn’t hear myself say that.” 

He sighs. “Everyone gets tired of me. Even my children tell me if I don’t stop complaining they won’t call any more. Not that they call that much.” He pauses. “You think I complain too much, don’t you?” 

“Well,” I say, trying to be diplomatic, “I understand you’re feeling miserable and unhappy and wanting to talk about your feelings. But you don’t really talk about your feelings. Instead you present as a forlorn, helpless person stuck in your misery. Yes, Esther died and you’re alone and you can’t bring her back. But you can try, ever so slowly to make a life for yourself.”

“I love you,” he blurts out.

I’m stunned. And speechless. I flash on the story a well-known psychoanalyst, Dr. Glen Gabbard, told about himself when he was first starting out in the field. When a female patient told him she loved him, he responded first by saying, “No you don’t” and then by trying to convince her that what she felt was not “real” love, but transference from earlier loved figures in her life. I knew what not to do. What to do was more difficult.

“I’m flattered…” I say.

He interrupts, more animated than I’ve ever seen him. “You mean you love me too?” he asks hopefully.

Oh dear, I think. “I’m flattered that you think that much of me,” I continue. “And I’m really glad you’re able to feel so alive.”

“You don’t love me,” he says, immediately deflated.

“I care about you, but I don’t love you as you want and need to be loved.”

“Nobody ever loved me,” he says. “What a fool to think someone like you could love me.”

“I don’t think you’re a fool at all. I’m glad you’re able to engage in life sufficiently to feel love for me. Now we have to help you find someone who can love you back.”

He shakes his head. “That’s impossible. No one ever loved me, no one ever will.”

“I would really like to understand why you feel so unlovable.”

“Why don’t you love me?” he asks challengingly. 

“I’m impressed,” I say truthfully. “You can be assertive when you want to be. But by looking to me for love, which I suspect you know wouldn’t be appropriate, I’d guess that you tend to look for love from people who can’t love you back, probably like the people who couldn’t love you in the past.”

Marvin slumps further down in the chair.

“You know,” I say, “now that I know you can have that spark, I’m going to be more insistent that you engage with me in therapy. We need to talk about the past. We need to talk about how you feel right this minute. We need to reintroduce you to life or perhaps introduce you to life for the first time.”

“You think that’s possible?” he asks.

“I detected a bit a hope in that question. I say we go with that hope.”

Tuesday, May 5, 2015


This is the beginning of Marjorie’s fourth month of therapy. She’s a reserved 45 year old woman who finds little meaning in her life as the third wife of a rich, older man who was born into money. Her days are spent attending luncheons, galas, and fundraisers. 

She hands me a check for last month’s payment, then reaches into her Gucci purse and pulls out a small oblong package wrapped in stripped red and gold paper, tied with a gold bow. I groan inwardly.

“Marjorie …” I begin.

“I know, I know,” she interrupts. “I’m not supposed to give you gifts. I’m supposed to talk about why I want to give you gifts. But I know why I want to give you gifts. I don’t want to just give you your check. I want to give you more. You’re finally someone I can talk to, someone I can really talk to as opposed to all the ridiculous chatter I do every day.”

Marjorie and I have been discussing the issue of gifts since her second session. That day, when I went to greet her in the waiting room, she had placed a flowering plant in the middle of the coffee table, carefully rearranging the magazines to either side. I was taken aback and suggested we go to my office and discuss the plant.

“I just thought the waiting room needed a plant. I felt more alive after our first session than I had for years and thought a living plant was the perfect thank you.”

“That’s a lovely sentiment, Marjorie. And saying just that without actually bringing the plant would have been more than gift enough. That’s what we do here, we talk about our feelings, we don’t act on them.” 

Many thoughts and feelings went through my mind: What if I can’t keep the plant alive? I remembered years ago when I practiced in Ann Arbor a patient saw the plant in my office as one or the other of us and how that plant fared took on huge significance. I also felt intruded upon. Was that a feeling born from the present interaction with Marjorie or was the feeling tainted by my childhood feelings about my parent’s intrusiveness? What if I didn’t want a plant in my waiting room? 

For the moment, Marjorie and I agreed to disagree. 

Following a particularly difficult session when Marjorie told me her life-long secret, namely that she had been molested by her uncle as a child, she brought me a crystal blue paperweight. “I know I’m not supposed to give gifts, but there was no other way I could thank you for allowing me to unburden myself from my lifetime of shame, for your accepting me, when I was sure no one ever could.”

That time I felt more compassion for Marjorie, experiencing her gift as an expression of her feeling that she herself wasn’t enough, that she had to offer more than herself to express her gratitude. “I appreciate your kindness, Marjorie, but I want you to realize that you, yourself are enough. I don’t need a gift. Your presence, your trust in me, your thank you is gift enough.”

“But I don’t feel that,” Marjorie said.

“I understand that,” I said. “We’ll work on it. But no more gifts.”

So this time, when Marjorie extends the red and gold package towards me, I feel my anger rise. Shaking my head, I say, “I’m not taking the gift this time, Marjorie. My understanding was that we were going to work on you and your words being enough.”

Marjorie looks stricken. “You’re not going accept my gift?”

“I’m not rejecting you, Marjorie. I’m rejecting your insistence on devaluing yourself.” I hear my choice of the word ‘insistence’ and realize that I’m not being completely honest, I’m not dealing with my feeling of Marjorie thrusting her gifts on me. And then I understand.

“Marjorie, I’m going to say something that might be hard for you to hear, but I do think it’s important. I know you give me gifts because you don’t think enough of yourself. But I think there’s something else as well. Your uncle. He presented himself as if he was giving you a gift, giving you something pleasurable.”

Marjorie gasps, covers her mouth with her hands, “You think I’m molesting you?” she says in horror.

“What I think is that you’re helping me to feel how you felt as a little girl. Your uncle was literally intruding on you, abusing you, but he was also giving you pleasure and that’s always what’s most difficult for childhood sexual abuse victims.”

“I feel so dirty,” Marjorie says. “I never wanted it to feel good.”

“I know,” I say, compassionately, “but it’s hard not to crave the attention and your body can’t help but react.”

Barely audible, she adds, “And, each time, he brought me a gift.”