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.”


Chris Shorrock said...

As a fellow psychologist, I can very much relate through the session you have shared. I loved your intervention of being fully honest with the client, though it seems like it was very difficult, and actually brought focus directly onto the conflict that was present all along between the two of you (but not actually about you at all!).

Linda Sherby said...

Thanks so much for your comment, Chris, I really appreciate it.


Keith said...

While I am sure you wrote your item for the benefit of your fellow psychologists I hope you will indulge me, as a client, to express my opinion.
I do understand your frustration. It is extremely difficult to deal with mental illness and your profession is in the line of fire daily. Nevertheless, you chose your profession and made the decision to face this daily barrage. Your clients live mental illness 24 hours a day, 7 days a week, sometimes for years, not through their own choice but through the vagaries of fate. They pay you for your expertise, often at some (maybe great?) sacrifice to themselves and their families and have right to certain expectations by virtue of this contract.
They have the right to expect the proverbial “blank screen” when they are in session with you. I interpret this to mean there is no judgement, no bias and no pre-judgement of their actions or of the information they are providing to you at that session or any of the previous or future sessions. As I read phrases such as “collapses heavily …across from me”, “I am not surprised”, “setting a trap for me” I hear all of the above. It may be hard to keep your personal biases out of your sessions but that needs to be the fundamental basis for any therapeutic relationship. If you cannot separate your own beliefs from your treatment, you owe the client the honesty of telling him/her that. It is nothing short of exploitation to continue accept money when you know your beliefs/prejudices are affecting the quality of care he/she should expect.
They have the right to honesty. If you believe you are not helping the client you owe it to that client to be up front and suggest that another therapist might be a better match. I would much sooner be told to go elsewhere than to be used as cash flow for your business.
They have the right to respect. Your long diatribe gives absolutely no indication to me that you have any respect for this client. Your writing smacks of contempt and you can be sure that your client has sensed this in your sessions. It is small wonder to me that your relationship is as bad as it is.
Beyond your financial benefit there would seem to be no worth to this relationship. It would be easy to place the onus on the client to sever the relationship, however I remind you that you are the professional here. Many of us suffering mental illness have no ability or confidence to make the basic life choices so many of you take for granted. We are paralyzed in our illness and require reassurance at every step. That is why we are paying you – if you cannot deliver please do your client the favour of honesty and tell her you have nothing to offer.

Linda Sherby said...

Let me start, Keith, by saying that I appreciate your taking the time and effort to respond to my blog. And I have many things to say in response to it.

First, I do not see this patient as "mentally ill" and I think it is unhelpful to brand most anyone with that label, for it implies a hopelessness that I believe is both untrue and unhelpful. She could I suppose be labeled as depressed or masochistic or passive-aggressive, but even these labels seem unhelpful to me for they do not necessarily tell us how to deal with the patient therapeutically.

Second, I will tell you unequivocally that there is no such thing as a blank screen therapist. Yes, Freud introduced that term and presented it as the ideal, but much has happened in psychoanalysis since Freud's day, and we now know that every therapist is indeed a person with his her own history, conflicts, issues and present life circumstances that affect both the patient and the treatment.

In my blog, I attempt to demonstrate the complex relationship between patient and therapist, how each affects the other as they interact in the consulting room each with their own histories, conflicts, issues and present life circumstances.

There are patients I form instantaneous connections to, patients I come to love, patients I feel angry with, even patients I may dislike at various points in the treatment. Is it important that I attempt to understand my feelings? Yes. Might it be important to share my feelings with the patient? Perhaps, at times. But to think that I remain an impartial, unbiased observer, that is indeed impossible.

There are always two human beings in the treatment room. Any therapist who thinks he or she is a paragon of mental health is indeed doing his or her patient a grave injustice.

Linda Sherby

Keith said...

Thank you for having the courage to post my rather lengthy and admittedly critical response to your blog post. I do not want to engage in on-line debate with you and am more than content to let my words stand against yours with one clarification.
I did not “label” your client as mentally ill. I did suggest, and I believe, she is suffering from mental illness. Mental illness is a condition, as opposed the former which defines the individual by the condition. There is nothing hopeless in the condition of mental illness; it requires treatment with compassionate and non-judgmental care the same as any physical ailment. The use of euphemisms or refusal to use the term obscures the reality of the illness, trivializes the condition and allows the misconceptions and prejudice to continue.

Linda Sherby said...

I agree with you, Keith, that mental illness is not a hopeless condition and I stand corrected for implying that it is.

I also agree that it is unhelpful for us to have an online debate about these very complex issues so, as you said, we will let our words speak for themselves.

Linda Sherby