Thursday, December 15, 2016

We’re Pregnant

“I feel like such an idiot being here,” Harvey says. “Elise, my wife, has been in therapy forever and I’ve always made fun of her, never believed in it, thought you should be able to solve your own problems. But I throw in the towel. I can’t handle it. My wife is pregnant or, as she insists, we’re pregnant. That weirds me out in itself. I’m not pregnant. I get what she means, but it’s bad enough watching her body change. I sure wouldn’t want those kinds of changes happening to my body.”
Well, I think to myself, that’s an interesting beginning. Body issues for sure, but sounds like there’s a lot more going on.
“Elise’s therapist recommended you. Said you were the best. So I guess you know each other. Does that mean you’d talk to each other about us?”
“No, Harvey, what you say here is confidential. I wouldn’t share it with Elise’s therapist or anyone else.” With some paranoia thrown in, I suspect this man has pretty deep seeded problems.
“We wanted to get pregnant. We’ve been trying for a while. But now that it’s here, I have lots of second thoughts. But it’s not something you can change your mind about.”
“What’s freaking you out about the pregnancy?”
“Well, I worry whether I’ll be a good father, how much a baby will change our lives. We have a pretty good life. I make good money. I’m a financial planner. We travel a lot. We like to play. We…we have great sex. Or we used to.”
“You used to?”
“Yeah. I haven’t touched my wife for a while. Like pretty much as soon as we knew she was pregnant and she’s going on six months. First I was afraid I’d hurt the baby, although my wife and the doctor said that wasn’t possible. And now, now I don’t know… I feel bad saying this, but I guess I find her rather grotesque. You’re sure you won’t say anything to anyone, right?”
“Sounds like it’s hard for you to trust, Harvey.”
“Now that’s true. Hasn’t seemed to me there’s ever a reason to trust people. In my business people lie all the time. Out for the buck. Ready to say anything, stab anyone in the back.”
“And before you were in the business?”
“Yeah, I know, you want to know about my childhood. I could never understand how that’s relevant, but no question my childhood was awful. My mother was schizophrenic, in and out of hospitals. She died in one of those hospitals. My father, he was a sadistic bastard. I was the middle of three boys. It was called equal opportunity abuse. Probably worse for me and my younger brother. We were bed wetters. My father would beat us senseless. And then he devised this great humiliation technique. He’d make us sit on the stoop of our house, take out our penis and sit with a ribbon tied around it. Didn’t help the bedwetting.”
“That’s horrible, Harvey. What tremendous shame to inflict on a child.”
“Can’t argue with you there. By 17 I was gone. Never looked back. Didn’t do badly for myself. Until now.”
“How much younger than you is your younger brother?”
“Five, six years. We haven’t stayed in touch either. Probably don’t want to remind each other of what it was like.”
“Do you remember your mother’s pregnancy?”
“No. I don’t remember much of my mother. Probably wanted to put that away too.”
“Do you remember what any of her breaks were like?”
“I remember she’d be out of control, scared, screaming. She’d tear at her face, like she wanted it to be gone. Maybe like she wanted to be gone, but I just thought of that now. So can you help me, doc?”
“I think so. But I don’t think this is going to be an easy road for you. I’d say you have long standing issues about your body and lots of fears of bringing a child into a world you see as scary and unforgiving. And you might be scared of the child as well.”
“Of the child?”
“Not wanting to bring another person like either of your parents into the world.”
“I worried about that schizophrenic thing. But my wife said it was worth the risk.”
“So maybe it feels to you that your wife will bring another being like one of your parents into the world and maybe that makes your wife scary and untrustworthy as well.”
“That’s too deep for me.”
“That’s okay. We have lots of time.”
“No, we don’t. The baby’s not waiting for anyone.”

“That’s true. But you can’t put too much pressure on yourself. You can only do what you can do.”      

Tuesday, November 29, 2016

The Election

“I came here to gloat,” Diane says, grinning ear to ear.
I feel as though I’ve been slapped, rendered immediately shocked and speechless. I know exactly what Diane is referring to, the election.
“It was worth it for me to pay you for the session, just to say, ‘You see, I told you so.’ You were entirely out of touch. Thought you understood the little people, but the little people never wanted your elite Obama. Now you’ll see what they want.”
Finding it difficult to regain my composure, I struggle to remind myself that I am the therapist here, that although I haven’t seen Diane for over two years, we had a lengthy therapeutic relationship. It is my responsibility to understand the intensity of her anger. Although it is not my usual practice to discuss my politics with patients, Diane made it impossible to avoid. She scoured the internet looking for information about me and soon knew my political leanings, taking great pleasure in baiting me into arguments. She was definitely capable of raising my ire, like the time she said, “When was the last time you were hired by a poor person?” I experienced most of those interactions as Diane’s attempt to maintain distance between us, emphasizing our differences, rather than our shared connection. But this feels like unadulterated rage.   
“Diane, if you feel you won, which you obviously do, why are you so angry? And why are you so angry at me in particular.”
“’Anger Trumps Love,’ to rephrase an expression being thrown around these days.”
I remain silent.
“All your goody, goody peace, love and compassion. It’s bullshit. It’s about anger. It’s about taking what you want. It’s about being able to win, regardless.”
As with the rise of hate crimes across our country, I hear Diane saying that Trump has given her permission to express the rage she has long bottled up. Is she suggesting that I didn’t allow her access to that rage? Perhaps that’s true. Is she angry with me about that? Perhaps.
“Do you hate me, Diane?”
Now she looks startled. “No, why would I hate you? As you said, my side won.”
“You feel to me as though you hate me. You come here to gloat, as you said, very angry and clearly wanting to say, take this, bitch, suffer, I won, you get to crawl. Yes, that’s how it feels to me, it feels as though you’re wanting to dominate over me and have me submit.” As I say this, I think that perhaps all our arguments over the years were about this issue, that it wasn’t about maintaining distance, but rather trying to attain dominance. Only one person could win and she was determined that it would be her.
“I definitely feel I finally won over you. But I don’t hate you. I’m just enjoying my victory and I want you to admit defeat.”
In my mind I say, no way. I definitely admit losing this battle and suffering the sadness and grief that comes with it. But admit defeat, no way. “So what would my admitting defeat mean for you?”
“I’d have won.”
“I understand that, but what would that mean for you?”
“That I was right.”
“And what does being right get you?”  
“You can’t dismiss me and look down on me and see me as stupid.”
“Diane, are you sure that it’s me you’re reacting to now or is it more your feelings about your family, your parents and elder brothers who you experienced as dismissive and contemptuous of your opinions and intellect.”
“But they all agree with me politically.”
“I understand that. And I understand that it may feel when you and I disagree that I am being dismissive of you and your ideas. But from my perspective, you and I have very different world views. That doesn’t mean I question your right to your opinion or that I think less of you.”
“Are you sure about that?” she asks, challengingly.
That stops me. “That’s a very difficult question, Diane. I certainly don’t think less of your intelligence. But as I’m sure you very well know, we live in an extremely polarized society where people spend more and more time with people they agree with, they read material that supports the positions they already hold. So may I think less of the people who disagree with me, perhaps, perhaps it’s sometimes hard for me to understand how you or whoever holds the position you do. But, and this is a very big but, but that doesn’t mean I don’t care about you. My caring does – eh - override your politics.”
“You thought it didn’t you? You thought to say, ‘Love trumps hate,’ but decided against it.”
“Yes, I thought it, but decided against it. You see, you’re smart and insightful, as always.”

Monday, November 14, 2016

Alone Again

Cynthia collapses heavily in the chair across from me, as if she doesn’t have the strength to hold herself up. Sadness exudes from her every pore.

“My son told me yesterday he’s not coming for Thanksgiving,” she says, barely holding back tears.

Although I’m not surprised - Cynthia has been disappointed by her son many times before – I do feel badfor her. “I’m so sorry,” I say. “What happened?”

“He said it’s too expensive to bring the whole family.” Pause. “I know it is expensive to travel during the holidays. I wish I could help him, but I’m just not in a position to do so.” Pause. “I wonder if he was waiting for me to offer. But he should know my circumstances. He knows his father left me next to nothing. I’m not even 65. I have to be sure I have money to last my whole life.” Tears run down her cheeks. “I don’t want to spend Thanksgiving alone. It’s supposed to be a family holiday.”

I can feel myself wanting to go into “helper” mode – making suggestions, asking why she has to be
alone. It’s a place I have been many times before with Cynthia, usually ending in frustration for both of us. Her helplessness is hard for me. I want her to do something. She wants someone to do it for her, to take care of her.

“It is hard to be alone for the holidays,” I say, empathically.

“But what should I do?” she asks, crying harder. “What alternative do I have?”

Feeling as though she is unconsciously setting a trap for me I say, “It sounds, Cynthia, that you’re asking me for suggestions, but usually when I make suggestions you reject them, always finding a reason they’re undoable.”

“But there isn’t anything I can do. Paul isn’t coming. I can’t change that. I have no other family here. So I’m alone.”

“Sounds like you’re feeling angry at Paul.”

“Okay, so I’m angry. What does that get me?”

“Sounds like you’re angry with me too.”

“I just don’t see where this is getting me anyplace.”

I hear that almost as a positive statement, a desire for movement. “Where would you like to get, Cynthia?”

“Not alone again.”

“So what might you do to not be alone again?”

“You think I have control over this, don’t you?”

“You know, Cynthia, you feel more angry than sad to me right at this moment and I wonder if that’s
helpful to you. Maybe it can give you the push to figure out what you might do to not be alone again.”

“You sit there so smug. You’re probably surrounded by family – kids, grandkids – all getting together and having a great time. You don’t care that I’m alone,” she says crossing her arms in front of her.

Although this is definitely not my reality, it is clearly Cynthia’s fantasy about me. “So you’re envious of the life you see me as having.”

“Yes!” she practically spits at me, with venom. “You’re just like all of them. You have it all. You gloat while I suffer!”

“All of whom, Cynthia?”

“My sisters, my mother. They were prettier, smarter, able to get it all, while I was the shmuck who
married an even bigger schmuck who left me in the position I’m in today.”

“So you felt lousy about yourself, felt you couldn’t compete, couldn’t do as well. You gave up. Also, and I’d really like you to think about what I’m going to say, I think you now unconsciously punish them – and me – but remaining the “schmuck,” as you say. It’s as though you’re getting back at them by saying, see what you did to me, I’m miserable and it’s all your fault.”

“So what do you think I should I do?”

“You could fight back. You could do things that would make you feel better, make your life more fulfilling.”

“A little late, isn’t it?”

“I don’t think so. You said yourself you’re not yet 65. You still have a lot of living to do. And I’m not
talking about become a millionaire or discovering a cure for cancer, I’m talking about not needing to
keep yourself in a one down position.”

“What about Thanksgiving?” she asks.

“What about Thanksgiving?” I reply. “You still want me to make suggestions. But I know you can come up with your own suggestions, you could thrive, if you could allow yourself not to punish yourself as a way of getting back at the people who have hurt you.”

She shrugs. “We’ll see.”

“Yes,” I reply, “we’ll see.”

Wednesday, November 2, 2016


“I feel like such a loser. A loser and a whiner. I should be able to get over myself already. I’m reading Gloria Steinem’s “On the Road.” She’s 82 years old and still going strong. She’s made a huge contribution to women, to society. And her childhood was certainly no picnic.”

I’ve been seeing almost 60 year old Carol for several months now. She came into treatment because she was no longer able to paint, a creative outlet that had been important to her for many years. She said she was probably depressed, but could think of no particular reason to be depressed except that she was soon going to turn 60. “Old, old, old,” she said. “The big six zero.” 

“And me?” she continues. “My life has been a big nothing. Yes, I got married. I guess my marriage is okay, sort of so-so, maybe like all marriages. I have two children. They’ve had their own struggles but they’re decent people. And I used to paint. I’ve been wondering lately if I stopped painting because I really was never particularly good at it. How do I know if I’m good? Exhibiting every so often doesn’t mean you’re a good painter.” 

I’m aware of having conflicting feelings as I listen to Carol, vacillating between wanting to protect her from her own self-criticism to finding myself agreeing with her that she’s complaining about much of nothing. It’s as if I go from being the comforting parent to the critical parent and back again. I suspect Carol carries this critical parent inside her head, always ready to attack her.  

“You’re certainly very critical of yourself, Carol,” I say.

“That’s for sure. Always have been. I guess I figured if I was critical of myself I could make sure I did everything right and that way I’d ward off my father’s criticism. Never worked. He could always find something to be mad about, from not making my bed perfectly to having friends he, for some reason, didn’t like. It was impossible to please him.”  

“So now you carry your father around with you in your head.”

“Yup! You’d never know he was dead. It’s ironic you know. I thought I couldn’t wait for my father to die and now here I am keeping him alive inside my mind.”

“That’s a great insight.”


“My father used to paint too. Representational stuff. He was pretty good. Of course he hated what I painted. Said it looked like something a kindergartener would do. But that was the one place he couldn’t get at me. I painted what I wanted to paint. I would have liked his approval, but in my painting I accepted that I’d never get it.”

“And you felt how about that?”

“Sad, defeated.” Pause. “You know, I’m not sure that’s true. I feel sad and defeated when I talk about it now, but I’m not sure that’s how I used to feel. I think I felt a sense of pride that I could paint how and what I wanted to paint.”

“That’s interesting. I wonder if when you were able to give up seeking your father’s approval – at least as far as your painting went – you could paint. But now when you feel sad and defeated about not having his approval, you’re blocked, unable to paint.”

“That’s true.” 

“Any thoughts about what changed?”

“First thing that popped into my head is that I’m approaching 60.”

I remain silent, waiting to see where Carol’s thoughts will take her.

“My father had a heart attack at 60. Two years later his second heart attack killed him. I felt a lot worse about his death than I expected. Actually, I got depressed. I couldn’t paint then either.”

“When your father died you lost the chance of ever winning his approval.”


“So you felt helpless and defeated, like you feel now when you’re about to turn 60, the year he had his first heart attack.”

“So does turning 60 myself remind me of his mortality and therefore my mortality?”

“I’d say that’s a piece of it. But I wonder if it also brings you back to the time that you were so acutely aware that you had forever lost the chance of getting your father’s approval.”

“Makes sense.”

“And, when you were able to paint and not need your father’s approval, that was a victory for you. Now I wonder if you feel guilty about reclaiming that feeling of victory, of celebrating your being alive to still be able to paint and to paint as you wish. Perhaps it even feels as though you’re killing him off.”

“Wow! That’s pretty deep. I’ll have to give that some thought.”  

Tuesday, October 18, 2016

If You Loved Me

“I got a great idea after our last session,” 30 year old Melinda says enthusiastically.

I remain silent.

“You know how we’re always arguing about whether or not you care about me? Well, I figured out how you can prove it to me.”

Oh my, I think to myself. Whatever’s coming can’t be good.

“You can stop charging me for some period of time we agree on. That way I’d believe you cared about me and weren’t just in it for the money.”

I feel as though I’m going to be walking through a field full of land mines. Other than agreeing to Melinda’s request which I know I’m not going to do, whatever I say has the very likely potential of a large explosion. I’m also aware of feeling angry and put upon. Hmm, I think to myself, I bet at some level Melinda could have anticipated that would be my reaction. 

“When you came up with this idea, Melinda, how did you think I’d respond?”

“I don’t know. How should I know how you’d respond?”

“Well, we’ve worked together for about three years, you might have some thoughts about what I would or would not say or would or would not do.”

“You’re not going to do it, are you? You’re just stalling, playing games,” she says, her anger building. 

“Is that what you would have expected?” I ask.

Melinda crosses her arms over her chest and glares at me. “I’m not saying another work until you answer me directly.”

I sigh inwardly. Melinda and I have frequently found ourselves in these kinds of power struggles. I can refuse to say anything, at which point she will indeed not say another word until she storms out at the end of the session. Or I can submit to her demand that I answer her, which feels to me like an uncomfortable submission. Or perhaps, just perhaps, I can try and interpret what’s happening between us. Melinda’s mother died when she was nine, leaving her to be raised by her distant, authoritarian father, who she rebelled against while desperately wanting his love and approval. In her interaction with me, Melinda can take the role of her authoritarian father who tries to force me to be as she wants me to be. Or she can be the needy, demanding child who wants both to win her father’s love, while insuring that her mother will not abandon her.

“So I’m going to run a few assumptions by you and you can tell me what you think. First, I think you knew – if only unconsciously – that I would not agree to your request, that it would stretch the boundary of our relationship in a way that would not be acceptable to me. Second, the reason you find it so difficult to believe – and accept, I might add – my caring is that you felt abandoned by your mother and rejected and criticized by your father. It’s also easy for you to become your father in this room with me and just as you refused to bow to your father’s demands, at some level you know that I will not bow to your demands either.”

“It wasn’t a demand, it was a compromise, a negotiation.”

“I’m not sure about that Melinda. I think you came prepared to fight with me. And that’s probably the most interesting question. Why is it that you want to fight with me?”

“I don’t want to fight with you. I fight with you because you won’t give me what I want.”

“Which was exactly your relationship with your father.”

“I guess,” Melinda says reluctantly.

“But I think that as much as you say you want my caring, you often do things that prevents your getting exactly what you say you want, which leads me to wonder if you need to reject my caring.”

“That doesn’t make sense. Why would I do that? I think you’re just playing therapist tricks, trying to get away from your not caring about me.”

I choose to ignore Melinda’s last provocation. “Melinda, if you accepted my caring you would be saying that you were a person who deserved caring about. And if you allow that in, then you’re left with the realization that you are indeed loveable and that no matter what you did – or do – you couldn’t keep your mother from dying and you can’t keep your father from being a cold, critical person. And that leaves you feeling powerless and helpless and we know how awful those feelings are for you.”

“Is there any way you’d consider my suggestion?”

So much for interpretations, I think to myself. What I say is, “Now I know you know the answer to that question, so I guess you’re saying you’re mad at me.”

“Yeah. I think you should have to do something to prove your caring.”

“I guess we’ll continue talking about this next time.”   

Tuesday, October 4, 2016


“I never thought I’d be seeing a therapist. And certainly not for this! After all, it isn’t a problem. It’s what everyone does. Everyone my age, anyway. But here I am,” Samantha says, looking at me expectantly, brushing her straight blonde hair away from her face.  

She’s been speaking at me rapidly for several minutes although I still have no idea to what she’s referring. I look back at her and wait.

She sighs deeply. “This is harder than I thought. I guess it kind of feels like talking to my Nana. Don’t get me wrong, I love my Nana but …”

I smile inwardly. “But you wouldn’t want your Nana to know about whatever this is. ‘

“Exactly,” she says brightly.

“Well, I’m not your Nana, but it would be helpful if I knew what’s troubling you or, if it’s easier, you can tell me a little about yourself.” 

“I’m 20, a sophomore in college, actually born in Florida, from Daytona. I have two younger brothers. My parents are divorced. My Mom’s a nurse, my Dad owns a car dealership. I told them I wanted to go into therapy because school has me stressed. Which is kind of true.” Pause. “That’s about it. So I guess I better tell you.” She takes a deep breath. “I assume you know about hooking up, where you just go on your phone and make a date to meet for sex, no strings attached?”

“Certainly,” I say nodding.

“Well, I do it quite a bit. Started in high school, much more in college.  Like I said, no big deal, just lots of fun. Sometimes great sex, sometimes just so-so, but it’s a fantastic way to get lots of experience without having to worry about it getting messy.”

I now feel like Samantha’s Nana. It’s hard for me to imagine the pleasure involved in totally anonymous sex. But I hope to keep my judgment to myself. “So what about hooking up is becoming a problem for you?”

“I can’t not do it.”

“What do you mean?”

“Well, used to be I’d only do it on the weekend, sometimes with four or more guys, but still only Saturday and Sunday. Then it was also Friday night. And then maybe a couple of other nights during the week. But now I can’t not do it! I can’t sleep if I haven’t hooked up with at least one guy, sometimes more. Sometimes I try. I pace the floor, I drink some wine, I take a Xanax. Nothing works. Sometimes I end up hooking up at 3, 4 in the morning. I’m driven. And I know, it’s like being an addict and no kind of addict is good. My Dad’s an alcoholic and my Mom used to be addicted to pills. She’s clean now. But I know. It’s not good. Right?”

“No, Samantha, it’s not good.” Corroborating Samantha’s assessment doesn’t feel judgmental, but rather supportive of the stronger, less impulsive part of her. “But tell me what hooking up does for you? What about it makes you feel relaxed when nothing else works?”

“Like you said, it relaxes me. I guess part of it is just the physical release. Although I know that can’t be all of it, because it doesn’t work if I … uh … if I do it myself.” Pause. “I guess it fills me up, makes me feel less alone. And I like being wanted. Like the guy can’t have enough of me. Or the guys. They just all want me. It’s a high. Just talking about it makes me want to run out and do it.”

“And if you don’t. If you sit with your feelings right now?”

“I guess I feel blah. Yeah, blah. I feel ordinary, like a nobody, kind of lonely, like no one wants me. Yuk! I don’t like it. I don’t want to feel like that.”

“Can I ask you, Samantha, are the feelings you just described familiar? Did you feel them when you were a child?”

“For sure! First there were the two younger kids, boys at that. Then there was the booze and the pills and the screaming and the divorce and more screaming. I thought they might fight about who had to take us, but I guess that was the one non-issue. My Mom got us, no questions asked. Except they kept screaming because my Mom wanted more money, my Dad said no way. I don’t have much of a relationship with my Dad. He has lots of women. We kind of get in his way.”

There are so many interpretations to be made here, all related to Samantha’s feeling unimportant and insignificant, whether in relation to her brothers, her father, her father’s women or her parent’s involvement with their own lives and addictions. But there’s no rush. If she can tolerate her feelings, I suspect Samantha will be in treatment for some time.    

Tuesday, September 20, 2016

The Opponent

I open my waiting room door to meet James Harrison for the first time. He rises, hand outstretched to shake mine. I’d guess he’s in his mid-forties. A good-looking man, tall, thin, seemingly comfortable in his own skin. We make the brief walk to my office and I gesture him to the sage chair across from mine.

“So,” he says, “Why should I be here?”

I inadvertently jerk my head back while, at the same time, stifling the urge to laugh. He’s certainly wasted no time throwing down the gauntlet. Still, it’s so startling, that I find it almost funny. Perhaps that’s a defensive reaction on my part.

I think about commenting on his provocativeness, but decide that would only escalate what is already a fencing match between us.  “Well, since I’ve never laid eyes on you before,” I respond, “I have no idea why you should be here. Perhaps it would be helpful if you told me.” Too hostile, I tell myself. It’s hard not to meet aggression with aggression.

“At least you didn’t go into that bullshit about everyone can benefit from therapy, it’s always good to understand yourself better, etc., etc.”

Do I need this? I think to myself. We haven’t even said hello and we’re already adversaries. Actually that’s not a bad interpretation. “Mr. Harrison, I wonder why we’re already adversaries. As far as I know you voluntarily came into my office. I’m not forcing you to be here. There must be some reason you’re seeking the help of a therapist.”

“Ah ha. So you’re the try the gentle approach type of therapist.”

I am definitely getting pissed. Which must be what he wants. “I suspect it’s important for you to keep relationships on an adversarial basis. Perhaps that’s why you’re seeking therapy. Perhaps you have difficulty getting along with people.”

“Perhaps,” he says grudgingly.


“OK. So now what?” he challenges.

I really do not need this. I want to tell this man that I don’t think we should work together, that I’m not the best person for him. Maybe that too would be a good interpretation. Or would it just be acting-out on my part?

“Why don’t you tell me a little about yourself?”

“Why would I want to do that if we’re not going to work together?”

“Have you decided that we’re not going to work together?” I ask.

“Have you?” is the rejoinder. 

“I don’t know,” I answer truthfully. “I do know that I’m not willing to spend every session fighting with you when I have no understanding of why you need to fight. And I’m also not prepared to convince you that you should be in therapy with me.”

“But you do think I should be in therapy?”

“Yes,” I reply definitively.


“Because you are clearly someone who needs to fight which means that you either have a lot of anger or need to keep people at a very far distance or both.”

“You see. You were able to tell me why I needed to be here.”

“And I suspect that you could have told me that yourself far more quickly.”

“But then I wouldn’t have known if you’re smart enough to handle me.”

“So I suppose I should assume that you’re going to be continually testing me?”


“Mr. Harrison…”


“James, I do know that how you are in the world, is how you are in here with me, but I want to again say that I think it is very unhelpful for us to be continually sparring and that one of my goals for you, is going to be to find the James Harrison behind your defensive posturing.”

“You don’t like me much, do you?”

“I would say that you insure that no one likes you much. But I would very much like to learn to like you. And I hope you’ll allow that to happen.”


I groan internally and wonder why I didn’t refuse to take him on as a patient. “Can you tell me what you’re feeling, James?”

“Satisfied. I think you’re the right person for me.”

“Can you say how you felt when I said I thought you insured that no one liked you, but that I’d like to learn to like you?”

“I told you, satisfied.”       

“Did you feel anything else? Hurt? Relieved? Angry?”

“No. Just satisfied. I accomplished what I wanted to accomplish.”

“So you feel satisfied with yourself. Do you have any feelings about me?”

A slow smile spreads across his face. “I’ll tell you what came to mind. That’s what I’m supposed to do, right?”

I nod.

“I feel you’re a worthy opponent.”

Perhaps, I think to myself, this treatment will be about whether a worthy opponent can become a stalwart ally. If so, it’s going to be a slow slog through.   

Tuesday, September 6, 2016


“I had a dream about all these disasters last night,” Jenny says. “It was frightening. There was one disaster after another. I mean I know there have been lots of disasters – floods, hurricanes, earthquakes, tornados – but it was strange for me to be dreaming of them. I don’t know if I was in the disaster or watching the disaster or helping at the disaster. It was weird.”

Jenny‘s a young medical student. I wonder if, at a surface level, she’s anxious about how she will handle her responsibilities as a physician. I remain silent, waiting to see where Jenny’s thoughts will take her.

“My mother called last night. She was complaining about my step-father for a change, about this step-father, just like she complained about all the others. I don’t know why she keeps marrying them, always sure this one will be her most perfect love. I think I’ve even lost count of what number she’s up to. Ugh. I don’t think I ever want to get married. Or not until I’m really, really sure. I guess I see her as a disaster. That’s sad to say about your own mother. I joke with my friends that she’s my negative role model. I want to be everything she’s not and not be anything she is. Sad.”

“Did you feel that way as a child?” I ask.

“Maybe not as a small child, but before I became a teen-ager for sure. Our house was a revolving door. At least she was smart enough not to have any more kids, except that there were always the so-called Dad’s kids who revolved through and then disappeared forever.”

“Was that hard? Forming an attachment to these father figures or siblings and then having them disappear?”

She shrugs. “I don’t know. Maybe. Or maybe I just learned to do my own thing, be involved with my schoolwork, with my friends. I liked being alone.”

Despite the matter-of-factness in Jenny’s tone, I find myself becoming sad. I wonder about her desire for aloneness as a defense against loss. And I think again about her dream, since disaster almost always involves loss.

“When did you last see your own Dad?”

“Who knows. He vanished a long time ago. Every so often he’ll make an appearance, but I certainly wouldn’t want to count on him.”

“I wonder if it’s possible for you not to feel sad about all these losses, Jenny?”

“I’m too busy.”

To avoid sadness, I think to myself. I ask, “What were the disaster survivors doing in your dream?”

“I was going to say they were doing what disaster survivors always do, dig through their houses looking for stuff, try to find things that are important to them. But I don’t think so. I don’t remember seeing people. It was like one of those apocalyptic novels. Maybe there were a few people, I don’t remember, but basically it was empty, barren.”

“Sounds really sad.”


“I just had a weird thought. I wonder if it wasn’t me in all those disasters, but you. Like I was the observer, but you were the one who was there. I wonder what that would mean,” she muses. “I could get it if you’re the one who’s trying to help in the disaster. But would that mean I’m the disaster? I don’t feel like a disaster. So am I trying to reduce you, to make you like me, so I don’t feel like so much of a disaster?” Pause. “I guess that’s possible.”

“Are you saying, Jenny, that it feels like a disaster to need people, to need help, to not want to be all alone in the world?”

“It is a disaster to need people. No one is ever there. You can’t count on anyone. Not your mother, not your father …” Her voice trails off.

“Were you going to say, ‘not your therapist’?”

“Yes,” Jenny says looking down. “I mean I know you’ve been there for me, but you’re only my therapist. Eventually this relationship will end. And then what? Then I’ll be alone. Again. Just like always.”

“It’s hard for you to imagine that even when we do end – which we certainly don’t have to do until you’re ready – that you will take me with you, as part of you, just as a part of you will remain with me.”

“I don’t know if I believe that,” she says. A moment letter, Jenny is crying. “And I’m not sure I even want to believe it,” she says between sobs. “What would that mean, that I would stay with you when my parents could discard me so easily?”

“It would mean that you are loveable and that it was your parent’s great loss that they weren’t able to cherish you as you needed and deserved to be cherished.”

Tuesday, August 23, 2016

Always Worried

“I really appreciate your seeing me again,” Estelle Peterson says wringing her hands. I had previously seen Mrs. Peterson for a number of years. Although we made some progress in curbing her anxiety, she remained a constant worrier.

“My daughter’s pregnant,” she says.

“Congratulations. I remember you were afraid you’d never have a grandchild.”

“Yes, yes, that’s true,” she says dismissively. “But she lives in Florida.”

“And that means?”


“Oh, you’re worried about her getting the Zika virus.” Concern about  Zika is certainly understandable, but I suspect it will only fuel Mrs. Peterson already considerable anxiety.

“And having a deformed child! I can’t imagine anything worse. I told her she has to leave Florida. Right now. Right away. She doesn’t have to worry about me, but she has to take care of her baby! I told her to go stay with her sister in Connecticut.”

“And she said?”

“That it wouldn’t be a practical. That she and Jonathon have jobs. That they just couldn’t pick up leave.”

“I told she could just quit her job and Jonathon can stay here, that she’d be all right with her sister. Then she got mad at me and told me to stop it. I told her I couldn’t stop it, that I couldn’t bear to spend the next six months worrying about her baby. They hadn’t even told me right away, so I’ll probably worry anyway, worry if one of those mosquitos got her early on. But she won’t listen to me. I don’t know what I’m going to do. How am I going to get through her pregnancy?”

 “How’s your daughter feeling about being pregnant?”

“What? Oh, she’s pretty good. She said that some of her morning sickness was pretty bad, but I told her not to worry about that, that was to be expected. I remember when I was pregnant with her and her sister. I thought I would die. But I didn’t. And she won’t die either. But I might die of a heart attack if I have to worry about the baby for six months.”   

I remember now. It wasn’t only Estelle’s constant worrying that was so difficult, but also her need to make everything about herself. Everyone’s pain becomes her pain. She sees herself as being constantly worried about others, but really she’s concerned about dealing with her own anxiety and discomfort.

“So how can we help you to survive the next six months?”

“No, you have to help me convince Diana. Tell me what I can say to her to make her leave?”

“Even if I could do that, which I can’t, it seems to me we both need to respect your daughter as an adult, to respect her decisions and to try to be as supportive of her as you can.”

“How can I respect her decision when it’s endangering her child, when it will leave me, her mother, a nervous wreck until the baby is born?”

“Do you generally respect your daughter’s decisions? Did you respect her decision to marry her husband, to become a teacher, to move to Florida?”

“I definitely wanted her to move to Florida. I wanted to keep an eye on her. Becoming a teacher was okay, although I wondered if she couldn’t do better. I guess that was true of Jonathon too, but he worked out pretty good.”

Knowing that I am most likely talking to myself, I continue on, “Mrs. Peterson, respecting your daughter’s decisions means recognizing that she’s an adult apart from you who has a right to make a decision even if it is different from the one you’d make.”

“Even if it endangers her child? No, I can’t respect her decision.”

And I don’t respect Mrs. Peterson’s way of being in the world, making it difficult for me to espouse respect when I don’t feel it myself. Perhaps I can try to accept Mrs. Peterson for who she is, and thereby move us both towards a more tolerant view of others. 

“Mrs. Peterson. I suspect that you’re not going to change your daughter’s mind about not leaving Florida. Perhaps I can help you to accept that fact and perhaps we can work on managing your anxiety.”

“You’re not being helpful.”

“Sorry. I can only do what I can do.”

“You used to say that to me all the time, that I had to accept my limitations, that I couldn’t control everything, that I could only do what I could do.”

“Yes, that’s true.”

“But maybe this time I can do more.”

“I guess we’ll continue this discussion next week.” 

Tuesday, August 9, 2016


“What brings you here?” I ask Peter, a handsome young man I am seeing for the first time.

“My father.”

I wait for further elaboration. He offers none.

“Can you say more?” I ask.

“Nothing more to say. I’m here because of my father.” 

“So I gather you don’t want to be here.”

“You got that right.”

“And you don’t feel you need to be in therapy.”

“Right again.”

“And you’re angry that your father insisted you come.”

“You’re batting a thousand.”

Ignoring his sarcasm, I ask, “So why did you feel you had to do what your father wanted?”

He snickers. “You don’t know my father.”

“That’s true. Why don’t you tell me about him?”

He snickers again. “Sneaky. You’re going to get me to talk. Okay, might as well. My father’s paying for it. My father pays for everything. He’s rich. Developed his own company. Made a fortune. And never lets anyone forget it. He’s smart, a good businessman. My brother works with him. Me, I can’t imagine sitting in an office all day. Just like I can’t sit in class all day. I’m 24 and still bouncing from one college to another. I guess that’s why my father wants me in therapy. He wants you to motivate me.”

“Are you angry with your father?”

“Yeah, I guess you could say that. He’s always on my case. Always wants something more from me. Always bugging me to make something of my life.”

“And what do you want for your life, Peter?”

He shrugs.   “Don’t know. Don’t know why I have to want anything. I like hanging out with my friends, surfing, hand gliding, sitting around getting high. Why should I have to work? Daddy will leave me more than enough money.”

I find myself empathizing more with my patient’s father than with Peter himself, making me uncertain how to respond, concerned that I will sound critical, like his father. I decide further exploration is preferable to any comment about the patient’s current life. “Did you always feel this way, Peter? What about in grade school or even before?”

Peter sits silently, but exudes less defiance. “My Dad was my hero,” he finally says. “He played baseball with us, took us to games. And even when he stared making money, and wasn’t around as much, I knew that he was doing it for us. And then he started making more money. And there were stories about him, interviews with him, he was making a big name for himself. And there was me. My brother was a straight A student. I couldn’t measure up. I never liked to read. I was lousy in math. There was nothing I was good at. Except baseball. And I wasn’t good enough at that. My father climbed up and up and I went nowhere but down. So I gave up. Why bother.”

“Sounds pretty sad.”

“I guess,” he says, shrugging, his defensive tone returned.

“Where was your mother in all this?”

“That’s another story. Nothing was ever enough for my mother. She criticized all of us – especially my father. I never understood why he took it, why he didn’t get out. I thought he probably had women on the side – who could blame him – but I don’t know that for sure. I once asked him. He slapped me across the face.”

“Was that typical of him? To hit you?”

“I wouldn’t say that. He hit me a few times. But that time was a surprise. I didn’t get why my question made him so angry. But I never asked again. And I guess I stopped caring.”

“So when you feel angry, you turn yourself off, you ‘stop caring.’”

“I guess.”

“I wonder if the problem with that Peter is that without being able to tap into your anger, your aggression, it’s very hard to find your competitive spirit, your desire to win, perhaps even your desire to beat your father.” 

 “I could never beat my father. I could never even come close.”

“The problem, Peter, is that you gave up trying. You were so sure you’d lose, that you’d never come close, that you were defeated before you began.” 

“But I couldn’t come close.”

“Maybe. Maybe not. I wonder what you might be able to accomplish if you didn’t feel so defeated, so shut down. I hope you’ll give yourself and us the chance to find out.”