Tuesday, August 25, 2015

If Looks Could Kill

Marlene glares at me as I open the door to the waiting room. My customary smile freezes on my face. I’ve been seeing Marlene for over three years now and her connection to me is quite intense. As we walk toward my office I ask myself if there was there anything notable about our last session. I didn’t announce an upcoming vacation. I don’t recall a therapeutic breach. We talked about her father, a man she has been loath to take off his pedestal. 

Marlene drops into the chair, crosses her arms and legs and pointedly looks out the window, avoiding my eyes. She’s a tall, blonde woman in her mid-thirties who came into treatment because of repeatedly failed relationships she described as filled with betrayal and abandonment.   

We sit in silence for several minutes as Marlene’s anger fills the room. I’m becoming increasingly uncomfortable. Is that because I want to avoid getting caught in a power struggle? Or does Marlene’s anger feel too big to me, triggering my own discomfort with intense rage? I can’t tell. But I know I’m going to break the silence.

“You’re obviously really angry with me, Marlene. Can you tell me why?”

“I hate you!” Marlene spits at me.

Over the years, I’ve certainly had patients tell me they hate me. But the venom behind Marlene’s words is frightening to me, especially since I have no idea what’s fueling it. I do know her anger is triggering me, reminding me of the irrational, explosive rage of my father, but that awareness doesn’t assuage my anxiety.
“You’re just like my fucking mother! All you want to do is take him away from me. I can’t say you want him all to yourself, you’re too much of an old bag for Daddy, but you probably just want me to be as miserable as you.”

I’m getting a glimmer of what’s going on. That helps. But the paranoia behind Marlene’s words is still discomforting. 

“So in our last session you felt I was trying to take your father away from you.”

“I didn’t ‘feel it,’ you were. Telling me he never loved me!”

I feel I’m walking through a land mine. If I dispute Marlene’s account of what I said, we’ll only end up arguing about who said what. Yet I’m not comfortable allowing what I see as Marlene’s distortion to exist as fact. I decide to try to go underneath the rage and paranoia. 

“So if I was trying to take your father away from you I can certainly understand your feeling enraged at me. But what if in the course of our discussion you found yourself having some doubts about your father …”

“Never, bitch! You see. You’re doing it again.”

My anxiety is moving towards anger, just as Marlene’s anger covers her fear and vulnerability.

“Marlene,” I say with more determination. “There’s a lot going on here today. Even the intensity of your rage and your unwillingness to hear me out, speaks to your covering over lots of feelings. Something clearly got triggered in our last session. I’ve become the enemy. I wasn’t your enemy before and I’m not your enemy today. If you feel I was too harsh about your father, I apologize. But no father is perfect, no father can be 100% available and loving. And I think you got scared about losing your perfect father. Perhaps having him be less than perfect feels like he’s not there at all, sort of like with me going from friend to enemy, he went from being 100% there to being 100% absent and that was too painful to bear.”

Once again there is silence, but this silence feels more tolerable.

“I don’t know,” Marlene finally says in barely a whisper. “If I believe you, I lose him. If I stay with him… I don’t know. Does that mean I lose you?”

“The world isn’t so black and white, Marlene. You don’t have to choose between us, even though I know that is how it often felt with your parents. Neither your father nor I are perfect, but our lack of perfection doesn’t mean that you’re abandoned and alone. It means you get to take what you can from each of us imperfect people and that you can also look beyond us for close, meaningful relationships.”

“I don’t know. I don’t know what to think.”

“What is it that you feel right now?


“Anything else?”

“Kind of empty. It’s like I was filled with rage when I came in and now that rage is gone, but I’m not sure what’s there in its place.”

“I understand. We’ll continue to talk about it next time.”

Tuesday, August 18, 2015

Taking a Break

“I know we only have a few minutes left in our session,” Martha says interrupting her complaints about her work and her marriage, “But I wanted to tell you I’m planning on taking a break from therapy.”

Feeling immediately angry at this sudden pronouncement with almost no time to discuss it, I ask, “What led you to that decision?”

“I’ve been thinking about it for a while. We just don’t seem to be getting anywhere. I come in every week and complain about either Mitchell or my boss, my boss or Mitchell. It doesn’t change anything.”

I happen to concur with Martha’s assessment, but my sense is that my attempts to engage Martha in greater self-reflection, as opposed to her litany of complaints, has been mostly unsuccessful. 

“Martha, could you at least come for one more session to talk about what you think hasn’t worked and why, as well as giving us a chance to say good-bye should you decide to end.”

“I’m not ending. Just taking a break. Besides, I’m on vacation the next two weeks.”

Another surprise. Martha obviously had planned her leave-taking for a while, even neglecting to mention her upcoming vacation.

Aware we have no time left this hour I say, “Well, what if you come in three weeks from today so that we have a chance to talk and in the meantime maybe we can both think about why you chose to tell me about your break at the very end of a session right before you were going on vacation?”

Martha sighs. “I guess. This seemed like a natural break point, but if you want me to come in once more I guess I can do that.”
“Thank you. I’ll see you in three weeks and have a good vacation.”

I am definitely annoyed, feeling dismissed and discarded. I have no idea whether Martha will show for her session in three weeks and whether or not she’ll continue. I feel obliged to keep Martha’s time available even though she’s made no commitment to the continuation of our relationship. 

Martha does show in three weeks. She is, however, uncharacteristically late, leaving me again off-balance and unsure of her intentions.

“Well, I’m here,” she says. “What do you want to talk about?”

“Maybe we should start by talking about your anger at me,” I suggest.

“I’m not angry at you. I just don’t think we’re getting anywhere.”

“You tell me the last few minutes of an hour that you’re leaving, you’re late to this session and you seem annoyed about being here.”

She shrugs.

Here I am again, angry. My anger. Her anger. My anger. Her anger. Maybe that’s what’s going on.

“You know, Martha, I think what you’ve been trying to do – unconsciously of course – is help me to feel your level of anger, dissatisfaction, and powerlessness, whether those feelings are directed towards me, your husband, or your boss. Things aren’t going the way you want them to in any aspect of your life and you feel powerless to change them.”

“That’s exactly right!” Martha says brightening.

“But I wonder if you’re really as powerless as you feel,” I continue. “Or if you don’t know how to ask for what you want or don’t know how to make it happen. For example, I want you to stay in treatment. I do understand that simply complaining about what’s not working in your life isn’t helpful; that we have to figure out ways in which you can get what you need here as well as in other parts of your life.”

“But how am I supposed to know what I need? You’re the doctor, you’re supposed to know.”

“There’s an awful lot in what you just said, Martha. First, there’s a request to be taken care of and anger at not being taken care of. But there’s also a lot of passivity in your statement which only increases your feelings of powerlessness and makes you less likely to get what you want.”

“But I don’t know what I want! I just know I’m not getting it.”

“That’s a great insight, Martha. And it makes a lot of sense. When you were a kid, no one cared what you wanted. They were too busy with what they wanted. You don’t know what you want. But you do know you feel dissatisfied. And when you’re dissatisfied you complain or leave. I’d say we know what we need to work on, assuming you’re willing to stay and work on it.”

“I was sure I was going to take a break. But, yeah, I’m willing to give it another try.”

“Good,” I say smiling. 

Tuesday, August 11, 2015


“I can’t understand,” says Jackie, tears trickling down her cheeks. “I thought it would be so wonderful to return home, to drive through Iowa on our way out west, to look at the old farmhouse, to show my kids where Mom used to live. But it was awful. It was all broken down, dilapidated. Nothing’s the same. I remember the huge trees we used to climb when we were young. They’ve all been cut down.” 

Jackie pauses. “One thing’s for sure. Our work together has changed me. I didn’t go numb. I definitely felt my sadness.” 

I feel Jackie’s sadness as well. And my own. Although I have no attachment to my childhood New York apartment, the home I lived in on a small lake outside of Ann Arbor, Michigan during my 30s and 40s was my idea of nirvana. Leaving that home was gut-wrenching for me; seeing it again was worse. I felt as though both the house and the landscape had been defiled. The atrium had been ripped out, replaced by a slab of wood covered by a carpet and a piano. And my beautiful weeping cherry tree was no more. I couldn’t stop crying. And that was when my husband was still alive. Now when I return to the Ann Arbor area I can barely tolerate driving by the highway exit to what was once my home.

“But it is a bit silly,” Jackie continues. “I hadn’t been home for over 30 years. What did I expect? It’s not like my family’s there anymore. In fact, my Mom and sister are right here in Florida. Why isn’t this home?”  

The question of where’s home. “Well, why isn’t it?”

“It is home. My kids were born here. I feel as though I’ve lived here forever. And, as I said, most of my family is here. And when I talk about Florida right here, right now it does feel like home.”

“And your sadness lifts.”

“Yes, that’s true. But when I think about standing in front of that old farmhouse I feel lost.”

“’Lost.’ That’s a good word. Sounds like you’re saying that you lost your past, lost your home, lost your foundation. As if you were untethered, floating in space.”

“That’s exactly right.”

“And when you think about being here in Florida, about your life being here, you feel reconnected. This is home.”

“Yes. Right.” Jackie pauses. “It feels weird though. Like I’m split. If I think of being here, I feel fine. If I think of being there, I’m overcome with sadness.”

I feel shrouded with sadness myself and worry that my sadness makes me less able to be helpful to Jackie. Our stories aren’t the same. She does feel a sense of home in Florida, she does experience a sense of connection. I try to get outside myself and focus on Jackie’s feelings. 

“What about if you think of your childhood memories of that home, of, for example, climbing the trees, playing in the yard?”

“Well, right now it just feels sad. All I feel is the absence. There are no more trees to climb. But I think before I went back to Iowa it used to make me happy to remember. Not that everything in my childhood was so great, but still, I remembered the good times and it made me smile.”

“Perhaps as the memory of your present visit fades, those positive childhood feelings with come back.”

Jackie frowns slightly. “This seems like an odd conversation we’re having. It’s almost like we’ve switched places. I’m the one who’s feeling my sadness and you’re the one who’s trying to get me to stop feeling it.” 

I immediately realize the truth of Jackie’s statement. It’s as if the sadness was too much for me, not too much for Jackie; as if I wanted to escape my own sadness, not that Jackie needed to flee hers. “You’re absolutely right, Jackie. I apologize. You were feeling your sadness and doing fine with it.”

“Did you think it would be too much for me? That I’d start going numb again?”

“No, Jackie, I didn’t. Truthfully, this was more about me than about you. I think I’m the one who wanted to get away from my own sadness, so I was thinking I was being helpful by trying to get you away from yours.”

“Wow! I’m sorry I made you sad.”

“You didn’t make me sad, Jackie. We all carry sadness inside us. And when it comes to the surface we need to do just what you’re doing, feel it and feel it until you don’t feel it any more. It’s part of living life.”   

Tuesday, August 4, 2015

Russian Roulette

Two women occupy my office chairs today. I have seen Georgia, a tall, stately, perfectly coifed 49 year old woman on and off for 14 years. When I first began treating her, her daughter Tricia was seven years old. Now a beautiful 21 year old sits across from me, a straight A pre-med junior at the University of Florida.

Tricia’s success has been Georgia’s obsession. Through the years we have worked at diminishing her anger at her accountant husband for not being sufficiently successful to send Tricia to an Ivy League College. Although I always thought I came from an overprotective family that relentlessly pushed me to succeed, working with Georgia introduced me to a whole new definition of relentless, coupled with a rule-bound, rigid household.

It’s unusual for me to agree to see a patient’s family member, but Georgia pleaded with me and I thought the situation sufficiently alarming to agree.

“It’s a pleasure to meet you, Tricia,” I say smiling. “I’ve certainly heard a lot about you over the years.”

“I bet!” she replies. “Sometimes I think I’m the only person my Mom ever thinks about.”

Good insight, I think to myself. “And how do you feel about that?” I ask.

“It gets old. I tell her I’m a big girl now. I can take care of myself.”

“Sounds like you’re getting right to the point of your mother’s concern, having unprotected sex.”

“I know the guys I’m sleeping with. It’s not like I’m hooking up with one-night stands. I know who they are, who they’ve slept with.”

“You don’t know, Tricia,” Georgia says, her voice tense and annoyed. “You can never know. I don’t understand why you’re being so reckless, playing Russian roulette with your life.” 

“Maybe that’s a good question. Why do you think you need to be reckless, Tricia?”

“I’m not being reckless. I told you I know who these boys are.”

I remember stories from Tricia’s early teen-age years when she would sneak boys into her room at home, often managing to get caught. I definitely understand her need to rebel, to break the shackles of her mother’s iron grip, but I don’t think Tricia is aware of the motivation behind her own behavior. 

“What were the messages you got from your mother regarding sex?” I ask.

“You’re kidding, right? No sex before marriage. Sex is holy. Only meant for a married man and woman. We’ll leave the same-sex part of that out completely.”

“What?” Georgia shrieks. “Have you had sex with a woman?”

“No comment,” Tricia replies snidely.

“That’s an interesting statement Tricia. Because it seems to me you’ve made many comments – directly and indirectly - about your sex life and I have wondered why that is. How does your mother know you’re having unprotected sex? How come she knew you were having sex as a teenager? And why did you just casually throw out the possibility of lesbian sex?”

“She asks me.”

“Tricia, I know you’re a very smart young woman. Yet you seem determined not to consider the meaning of either your statements or your behavior. For one, you already said you don’t think your mother thinks of anyone but you and that you don’t like that, but you manage to increase her thinking about you by being provocative. And, while you’re reeling her in on the one hand, you’re rebelling against her and everything she believes in on the other.”

“I don’t know what you mean.”

“I think you’re not sure how close you want to be to your mother. You tell her everything to stay close and then rebel against her to move away. I do understand, Tricia, that your Mom has held onto you very tightly and that makes the process of separating more difficult.”

“So now it’s my fault,” Georgia says angrily.

Always the problem with introducing a family member into an ongoing treatment, the patient ends up feeling dismissed and betrayed.

“It’s not a question of fault, Georgia. It’s a problem that exists for both of you today. I know you want Tricia to be healthy and happy and have a full life and in order to do that she needs to separate from you in a way that’s not destructive to her.”

“She always makes it about her,” Tricia says, exasperated. “Of course, you’re making it about her too.”

I smile. “You really are a very insightful person. There’s no way I as your mother’s therapist is going to be able to help you separate. But I do think it would be a good idea for you to go into your own therapy, with your own therapist. As you said, you’re a big girl now and you need to take care of yourself.”