Tuesday, June 30, 2015

Saying Good-bye

“Well,” Arlene begins, “We have three sessions left including today.”

“How do you feel about that?” I ask.

“Good. I’m happy. I never thought I’d be able to say that. When I started with you three years ago I was totally miserable. I’m sure part of it is being on medication, but you’ve been so helpful to me.”

I’ve been seeing 65 year old Arlene in therapy for three years. And she’s right. She’s made excellent progress. She’s no longer depressed, can speak up for herself with her husband, and is more accepting of her grown children’s need for their own lives.

She continues. “Even last night, Larry took the remote and started flipping channels when I was right in the middle of watching ‘Madame Secretary.’ For a second I sat there and said nothing, but I could feel myself shutting down and I knew – because of you – that’s the first step to my becoming depressed. So I told him that wasn’t considerate of him and that I wanted to finish watching my program. I could see he wanted to give me an argument, but he didn’t and he did put my show back on.”

“And how did you feel about that?”


“Only good? Didn’t it feel like a victory, like you wanted to jump up and shout for joy?”

“I wouldn’t go that far. But I did give myself a kind of pat on the back.”

“Good for you!”


“I don’t know what else to talk about. I’m happy.”

“I glad you’re happy but can I ask you again how you feel about ending?”

“Like I said, good. I feel that I’ve accomplished a lot and that we’ve talked about my big issues - my fear of my father and my dependency on my mother - and that we’ve been mostly rehashing for months and that I don’t need to be here anymore.”

“I agree with you, Arlene, that you don’t need to be here, but I still wonder, we’ve had a long relationship. Do you feel any sadness about leaving?”

“No. I don’t feel I need to be here.”

I’m taken aback by Arlene’s response. I know that she has been quite attached to me during the time we’ve worked together. I also know that I almost always feel some sadness at the ending of a treatment. How is it possible she’d feel no sadness? I persevere.

“I agree you don’t need to be here. And you can feel a terrific sense of accomplishment and satisfaction about being ready to leave. But you can still feel sad about saying good-bye. I do. That doesn’t mean you shouldn’t leave. Let me ask you this, will you miss me?”

“No. I hope I’m not hurting your feelings, but I don’t think I’ll miss you and I don’t feel sad. I feel too happy to be depressed. Maybe the medicine keeps me from feeling sad.”

“I wonder if you’re saying you’re afraid to feel sad for fear of becoming depressed again.”

“I just don’t feel sad.”

Increasing confident that Arlene is defending against her sadness I ask, “What does make you sad?”


“I know that’s not true, Arlene. You were certainly sad when your granddaughter went into the hospital or when your friend Miriam died.”

“That’s different. That was about death. I was scared for Haley and Miriam’s death was a big loss.”

“You look a little sad now, thinking about Miriam’s death.”

She nods.


“Maybe we shouldn’t terminate,” she says suddenly.”

“You know, Arlene, it is all right to feel sad and still terminate.”

“There’s no reason we have to end.”

“I think what you’re saying, Arlene, is that you don’t want to feel sad. If you’re going to say good-bye you have to keep yourself from feeling sad and if you start to feel sad you have to keep yourself from leaving.”

Arlene shakes her head. “If I feel sad maybe it just means I’m not ready to leave.”

“I wonder, Arlene, if you’re feeling with me as you did with your mother. In order to be your own person you felt you had to cut off your feelings about her, to feel nothing, or separating from her would have been too painful. And that’s what you’re doing with me as well.”
“Well, if I’m still doing that maybe I’m not ready to terminate.”

“Or maybe in our two remaining sessions we need to deal with your allowing yourself to feel sad and still say good-bye.”

Tuesday, June 23, 2015

Near Death

I open the door to my waiting room and see Ben sitting there, perhaps a little thinner, perhaps a bit more gaunt, but basically looking like his old self. I blink back tears. He’s alive. He looks up and smiles at me. “I made it,” he says, echoing my own thoughts.

“I want to start by saying how much it meant to me that you came to see me at the hospital.”

A near fatal heart attack. Quadruple by-pass. Multiple infections and his first words are about my visiting him at the hospital. “Of course I’d come to see you.”

“It didn’t feel like an ‘of course’ to me. It felt like you cared about me. That I wasn’t just a patient.”
I think about Ben’s angry, rejecting mother and reflect on how difficult it is for people who weren’t cherished by a parent to take in that they’re cared about. “Ben, we’ve known each other for a long time. I’ve watched you become so much more of a feeling, related person, but it’s still hard for you to believe that I – or others - care about you.”

“This experience did show me how many people care about me. And my wife, she was amazing. I know it’s impossible, but it felt like she never left my side, that every time I opened my eyes she was there looking at me, squeezing my hand, smiling at me.”

Suddenly I’m besieged by images of my late husband lying in a hospital room with me sitting beside him. Many years, many images. Waiting for the results of his angiogram; the terror of his first angioplasties; the pain of a double knee replacement; the horror of discovering he had undiagnosed heart damage perhaps fatally complicating a minor heart attack after his first chemotherapy; his miraculous survival; his deterioration …  

My patient interrupts my reverie. “You look sad. I’m sorry. You must be thinking about your husband. “

Ben began working with me about a year before my husband’s death, now over seven years ago. It was an agonizing and vulnerable time for me, a time I revealed more about myself than was typical of me.

I say, “You’ve just demonstrated to yourself how much our patient-therapist relationship is a human relationship, how two people who have known year other for years, come to understand and care about each other. And you’re right, I was thinking about my husband, but I apologize for distracting you from your appreciation of your relationship with your wife.”

“Do you think being near death brings people closer?”

“What do you think?”

“I think it does. It makes you appreciate what you have when you see how it can all be gone in a second.  I actually thought about you when I saw how attentive and scared my wife was. I knew you would have been like that.”

“Ben, when you comment on your wife’s love and caring, when you reflect on your sense of me, I hope you can see how much you’ve changed, how much easier it is for you to genuinely connect to your wife, to me, and I’m sure to others as well.”

Ben nods his head, “Definitely. I feel like I’m a different person than the one who first came here.”

“And yet you’re still surprised by my coming to visit you in the hospital.”

“Yes. I don’t know. Is it because I feel I don’t deserve it?”

“Well, why wouldn’t you deserve it?”

“Because …,” he shakes his head. “I don’t know. I’m a pretty good person. And I do know …” Ben hesitates. “I do know you care about me.”

“Sounds like that was hard to say.”

“It was.”


“I suddenly feel sad. You’d think it would make me happy to feel you cared about me.”

I remain silent, giving him a chance to reflect.

He continues. “I just got this picture we’ve talked about many times, when my mother beat me in front of my friends because I didn’t take the garbage out the minute she asked. It’s like I don’t know how to reconcile the two. How could she treat me like that if you and my wife care about me?”

“I think what you’re saying, Ben, is that if you’re deserving of love and caring today, you were deserving of it then, but your mother couldn’t give it to you. And if you realize that was her shortcoming, not yours, you have to give up hope that you could ever have gotten her love, regardless of what you did.”

Ben rubs tears from his eyes. “I think that’s right. But I am grateful for the love I have today.”
“I’m really glad to hear that,” I say as the hour ends.


Tuesday, June 9, 2015

In Search of a Self

“I can’t believe it,” Janice says throwing her hands in the air. “Why does she feel she has the right to tell me what I should wear to my child’s graduation? I’m 42 years old. Shouldn’t I know what’s appropriate to wear and what isn’t?”

Janice is talking about her mother’s intrusiveness, a situation that has only worsened since her family moved to Florida a little over a year ago.

“Well,” I ask, “what does give her the impression that it’s all right for her to tell you what to do?”

“She’s always done it. That’s how she was when we were kids – especially with me as the only girl – and that’s how she is now. ”

“What did you say to her when she was telling you what to wear?”

“I said, ‘Ma, I’m a big girl now, remember?’”

“So you don’t confront her; you kind of make light of it.”

“I don’t scream at her if that’s what you mean.”

“No, I wasn’t talking about screaming at her. I was talking about having a genuine conversation about how you’re a grown woman who doesn’t need her mother to tell her what to wear and how it doesn’t feel good to have her invading every aspect of your life.”

Janice pauses and then asks, seemingly puzzled, “What’s the alternative?” 

Similarly confused, I say, “I’m sorry, I don’t know what you mean.”

“Well, when you just said it doesn’t feel good having her invade every aspect of my life, it suddenly felt scary to me, like if she wasn’t invading every aspect of my life would I feel, I don’t know, would I feel lost, abandoned?”

“That’s a very insightful question,” I say, thinking back on my own relationship with my intrusive mother. Early in my life I experienced her hovering as protective and safe, but I grew to chafe against it and needed to set my own boundaries. Perhaps Janice isn’t there yet. “So you’re saying that as much as you protest about your mother’s intrusiveness, perhaps there’s a part of you that still longs for it.” 

Janice looks at me, looks over at the clock, looks back at me and says, almost mournfully, “Ten minutes left.” 

So Janice longs for me as well, I think. I remain silent giving her the chance to pursue her own thoughts.  

“It’s so easy to me to feel lost, empty. Even when I’m with my kids, even when the house is bursting with noise, I often feel alone. I feel alone right now. You’re not saying anything and the session is almost over and I feel scared. And when I feel scared like this at home I call my mother. I sometimes fantasize calling you, but I wouldn’t do that – unless there was really some kind of emergency.”

I wonder how it is possible that I haven’t seen this side of Janice before today, how I accepted her protests against her mother’s intrusiveness at face value and didn’t see the scared little girl underneath. Was it because of my own experience with my mother? Perhaps. But I have an alternative thought. With her mother, Janice is the obedient child who accepts – and perhaps even welcomes - her mother’s intrusion into her life. With me, she is still the obedient child, but she knows – consciously or unconsciously - that I want her to be separate and independent, so she’s being as I want her to be. But as long as she’s being how I want her to be, she’s still not being her own separate person.

“I was just thinking, Janice, that you’re always trying to be the person the mothers in your life want you to be, whether that mother is your biological mother or me or perhaps other people as well. I think in the process of trying to please us all so you don’t have to feel scared and alone, you’ve kind of lost who you really are.”

“That feels really scary. Truthfully I’m not sure I’ve ever known who I am. I was my mother’s child and my husband’s wife and my children’s mother, and my brother’s sister, and your patient. I think all those people are different. I don’t think I have one me.”

“I can understand how that feels really scary, Janice. So I guess we know what we need to do. We need to find out who Janice really is.”

Tuesday, June 2, 2015


Emma is uncharacteristically late for her first session after my vacation. Usually a psychologically aware woman, she has now spent 20 minutes talking about the plans for her daughter’s high school graduation party, chatting about the guest list and the menu.

I interrupt her. “How did you feel coming today?” I ask.

“Oh,” she says. “Well, I didn’t want to come. I did very well in your absence. In fact, I was thinking that this should be our last session.”

I groan inwardly. I have seen Emma for four years and there is no question she has come a long way – more able to stand up for herself, more self-confident, less intimidated by her husband. But she is a patient who has been in therapy with several therapists over the years, a patient who knows that her more long-standing issues of desire for and fear of intimacy remain stubbornly unchanged. In fact, she is enacting that issue at this moment – feeling abandoned during my vacation she has closed off the needy part of herself and now seeks to reject me just as she felt rejected.

And, it’s worked. I do feel rejected. I feel hurt that she should want to leave me, hurt that she could discard me so easily after the relationship we’ve built up over time. And whose feelings are these?  Always a complicated question. Yes, I do believe that she is rejecting me just as she felt rejected by me and, earlier in her life, by a too-busy, self-involved mother. But I have my feelings too. I do go on vacation. I do have my own life. But my patients matter to me. I care about them. Besides, I don’t like good-byes. 

“So why do you think you would decide this today?” I ask.

“I told you. I did very well in your absence.”

“I’m sure you did. You’ve never been someone who can’t function without me. But you know yourself well enough to question what affect my vacation would have had on this sudden decision.”

“I knew you’d bring that up,” she says, sighing theatrically.

I remain silent.

“What?” she says.

I gesture with my hand for her to continue.

“Why is it that everything I do gets to be analyzed while nothing you do gets put on the table?”

Surprised by her question, I ask, “What don’t I put on the table?”

“Like how do you just get to go on vacation, entirely arbitrarily? You get to decide when you go, for how long, and regardless of what’s happening in my life or any of your patients’. You’ve always telling me I cut myself off from my feelings, well it seems you’d have to cut yourself from your feelings as well.”

Alternate responses flit through my mind. I could pursue her anger which is quite apparent and might well be fruitful. But I worry she would experience that as evasive and defensive. Or I could respond directly to the issue she raised.

“You make a good point, Emma,” I say thoughtfully. “I am the one who arbitrarily decides when I go on vacation and I do put my patients’ lives aside during that time – I put your life aside, just as you often experienced your mother doing. But it doesn’t mean I stop caring about you and it certainly doesn’t mean I feel closed off to you when I return. Quite the contrary, I’m eager to hear about you and what’s been going on in your life and in your mind. And just as you feel hurt and discarded when I go on vacation, I feel hurt and discarded when you announce that you’re unilaterally going to end our four year relationship in one session.”

“You do?” Emma asks incredulously.

“I’m sorry that surprise you so much, Emma. It’s so hard for you to take in my caring. I suspect you’re afraid that if you acknowledge you’re loveable, you’d have to give up hope that your mother would ever love you as you needed and wanted to be loved.”       

Emma’s eyes fill with tears. “This might sound silly, but right that moment when you said that, I felt my heart melt, like something opened in me; something opened, but something made me very sad too.”

“So maybe right at that moment you did feel my caring, but also felt the sadness of your mother’s inability to cherish you as the loveable child you were and are.”