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?”
“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.”
Good piece! It highlights a common dynamic we all see and with which we cope.
I also have found it interesting when there is relief that I'm taking a break (vacation or conference, etc.). Saving money, time or not having to work hard at insight and improving one's self and life may be factors. Or not.
I think it's helpful and important to also be on the lookout for that dynamic. It's often "socially unacceptable" to express such a feeling and thought.
Thanks for your comment.
I've always been someone who has thoroughly enjoyed taking vacations so that guilt factor is pretty minimal for me. On the other hand, I have a great appreciation for how difficult it is for patients to have me leave and do try to address whatever feelings that come up for them.
Linda, Thanks for another wonderfully challenging clinical moment. Please pardon my huffy and arrogant reactions to follow.That's my teasing reference to the surge of my countertransference reactions. These include haughty and demeaning diagnostic labelling, my effort to ward off feeling demeaned and dismissed.To avert the sting, anxiety and fear that such an attack awakens in me I retreat to clinical theory and think of your patient as a prototypical borderline. One of my mentors wrote an intriguing paper on delicate cutting to avert feelings of emotional emptiness and depersonalization that occurs as the easily and exquisitely sensitive borderline retreats from the pain of rejection and abandonment. At some level she feels betrayed but also that she owns and controls and dominates you. These unrealistic, primitive and contradictory levels of self experience exist simultaneously. For her they are equally real rather than fantasies and memories of earlier traumatic abandonment. You are container so must not leave for she cannot metabolize her infantile abandonment rage and fragmentation alone. It's tough for you and really tough for her. She has no transitional object to which she can cling to stabilize herself nor stave off fragmentation and regression. At some point we all quietly retreat from this battlefield and admire those who continue the rescue mission.
Sorry it took me so long to post your comment, but as you probably guessed, I was on vacation.
As always, I find your comment astute and thought provoking and find that we are very much in agreement.
Thanks for taking the time to respond.
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