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.”  

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