Monday, April 25, 2016


Belinda glares at me silently, arms crossed in front of her chest. “Look at you,” she says finally, “Sitting there so innocently, like you’re not about to shirk your responsibility and abandon us all.”

Finding myself more amused than angry, I wonder if Belinda is less distressed about my upcoming vacation than her words seem to imply. I’ve seen Belinda for a number of years now and watched her grow from a woman who was unable to feel much of anything, to someone who is more in touch with her emotions and more able to connect to others. But anger is her usual defense when she feels particularly vulnerable. “So you’re feeling angry about my being away for two weeks,” I say.

“Duh! Yeah, you could say that, great clinician that you are.”

I’m less amused. She may be angrier than I thought.

“This may seem like a silly question, but why? Why are you so angry?”

“That’s not silly, it’s stupid. Answer it yourself!”

“Belinda, what’s going on here? You’ve never liked when I’ve gone on vacation, but you seem particularly angry today.”

“All that talk about your being here for me, about my needing to take you with me, about my needing to rely on you. Great! So what happened to all that?”

“None of that has changed.”



“Say something,” she demands.

I consider remaining silent and decide that would only escalate the confrontation. “I think you’re trying to provoke me, Belinda, and I’m not sure why that is.”


“Do you feel anything besides anger about my being away for two weeks? Do you feel scared? Sad?”

“You’d like that wouldn’t you? You’d like me to be crying like a baby. Make you feel important. Like I couldn’t live without you.”

“You can live without me, Belinda, but that doesn’t mean you can’t have feelings about my being gone.”

“Why are you the one who decides when you get to leave? Why don’t I have a say in the matter? Why don’t your other patients?”

An image of my patients voting on when I should go on vacation floats through my mind and I again find myself amused. But then I wonder why I am being amused by Belinda’s anger today. Is it my defense? Is Belinda’s anger frightening me and am I trying to minimize it by finding it amusing? Or perhaps she’s the one who’s frightened of her anger.  

“Well?” she asks challengingly.

“Are you afraid of how angry you are, Belinda?” I ask.

“Are you?” is her retort.

“I don’t know,” I reply. “I didn’t think I was, but then I wondered if I was minimizing your anger and if that meant I was afraid of it. And then I wondered if you were afraid of your anger.”

Belinda’s face softens. She looks almost like she might cry. She shakes her head. “I can’t believe it. I was sure I’d never let you in today. I was sure I’d hold onto my anger. I was sure I wouldn’t tell you. I cut myself last night.”

My stomach turns over. “Why?” I asked, shocked. As far as I knew Belinda was never a cutter. 

“I just felt so angry you were leaving me. I didn’t know what to do with all the feelings. I tried screaming and hitting the wall but it didn’t help. So I took a knife and cut myself. Not much, truthfully. It was just a little nick. I don’t much like blood. I thought if I could really hurt myself, I’d probably feel better, but I couldn’t do it. And then I got even madder that you had that much power over me.”   

“I’m glad you didn’t really hurt yourself, but inflicting pain on you in any way is really scary, Belinda. I’m sorry you didn’t call me and try and talk about your feelings.”   

“That makes me mad too. Why would I call you and be even more dependent on you when there’s no way I’m going to be able to call you for two weeks?”

“It’s true, Belinda. I’m not going to be available for two weeks. But that doesn’t mean I stop existing for you or that you stop existing for me. We’re in each other’s lives; we’re in each other’s head. Our connection doesn’t vanish. And, yes, you can be angry that I’m going. And you can also feel sad and scared. And we can talk about all those feelings. But neither of us can or should try to take the feelings away or make light of them. You’re feelings always matter, because you matter.”

“I was about to say I wish you didn’t matter to me, but I guess that’s really not true.”

“I’m glad. We still have one more session before I leave, so let’s continue talking about this. And no cutting.”

Tuesday, April 12, 2016

When Silence Speaks

Emma settles into the chair across from me, takes a deep breath and speaks quietly, slowly, deliberately. She’s telling me about her week. Her son is excited about his softball team, her daughter is anxious about her upcoming school play, her husband is away on a business trip. “That makes it easier,” she says.

“It makes what easier?” I ask.

“His being gone. I know it’s terrible to feel like that and I know it’s not his fault, but it’s easier.”

“But what’s the ‘it’ that’s easier?”

There is a long, profound silence. Emma sits motionless. Although I’ve only seen Emma for a couple of months, I’ve become familiar with her stillness.  

“I’m trying to decide whether I should take the children out to dinner tonight,” she finally says. 

I’ve also become familiar with Emma’s tendency to avoid answering questions and to switch topics, often to something banal, almost as though there was nothing we had been discussing. 

“What just happened now, Emma?” I ask. “How did you get from it being easier when your husband’s gone to taking the kids out to dinner?”

“If I’m going to take the kids out to dinner, tonight would be a good night. Before he gets home.”

Yes, I think, but she still hasn’t addressed what makes it easier when he’s gone. I consider pushing, but find myself reluctant to do so.  

Another profound silence ensues. 

“Do you ever take vacations?” she asks suddenly.

“Yes, I do. Why do you ask? Do you feel anxious about my being gone?”

Another long silence. “No,” she says with a nervous laugh. “It would be easier. I wouldn’t have to think of what to say.”

“So it’s easier when your husband is gone and it would be easier when I’m gone.”


“Speaking is obviously very difficult for you, Emma. What happens when you sit in your silence? What are you thinking? What do you feel?” 


Emma’s silence, her non-responsiveness, her tendency to talk about apparently inane topics. None of it makes me angry. Sometimes bored, sometimes frustrated, but generally I hold myself still along with her. It’s like feeling frozen. Emma has told me a little about her background. She was the only child of a religious family who lived in the rural Midwest. Her father was extremely depressed, often unable to get himself to work for weeks at a time. Her mother was an angry, embittered woman who reached for the belt for any minor infraction.

“Emma, what about as a child? Was it difficult for you to speak then too?”

Another nervous laugh. And silence.

After a while I ask, “Can you say what you’ve been thinking during the last couple of minutes that you’ve been silent?”

After a while she responds, “They’re images.”

“Can you tell me what some of the images are?” I say gently.

“Cornfields. Sunflowers. My mother. It’s cold.”

I flash on a patient I saw years ago who, as a child, was punished by being left naked in the storm cellar. I wonder if Emma was similarly abused.

“Can you tell me about your mother, Emma?”

“She was mean. She hated me. She said I was the devil’s child, that she needed to beat the devil out of me.”

“What kinds of things did she beat you for?”

“Everything. Not getting up at exactly 6AM. Tracking mud in the house. Talking when she had one of her headaches. She always said her headaches were my fault. She never had headaches before I was born. That’s what she said.”

“You were terrified of her.”

She nods. 

“Did you ever feel angry with her?”


“You can feel angry with someone even if you don’t express it,” I say.

“She gets bigger.”

“I’m sorry?” I say, confused.

“The image. It gets bigger.”

“You’re saying that if you feel angry at your mother you see her image getting bigger?”

She nods.

“And you feel more frightened.”

She nods again.

“Is that what happens when you talk to me, Emma? Does the image of your mother get bigger, like you’re not supposed to be telling me things?”


“You know, Emma, you can always tell me to stop, that you’ve had enough. I’ll always respect your wishes. The last thing I want to do is be another abuser.”  

Silence. Then she says, “Maybe if it would be better if we didn’t go out to eat. It’s a school night. The children need to do homework.”

Although she can’t say it directly, Emma has clearly told me she’s had enough.