“Bill broke up with me Saturday night,” says 28 year old Chelsea in her Monday session, looking as though she may not have slept or bathed since then.
“I’m so sorry…” I begin.
“You didn’t call me back. I called and called and called.”
“I’m sorry, Chelsea, but when I called on Sunday I explained I was at a very long play, didn’t check my phone and got home way too late to call. Did you get my message?”
“It was too late,” Chelsea says, rolling up the left hand sleeve of her blouse.
Always a bit queasy, I resist the urge to look away, her left arm filled with red gashes from what I assume are self-inflicted cuts from a razor blade. “Oh, Chelsea,” I say, “It’s been years since you felt the need to cut yourself. I guess you were mad at both Bill and me.”
“You abandoned me. I couldn’t stand the pain.”
“What made the pain so unbearable?”
“What?” she asks, becoming angry. “That’s a stupid question. The two most important people in my life abandon me and you ask what made the pain so unbearable?”
“You’re definitely angry with me.”
“But why did you need to turn the anger on yourself, why cut yourself, why not be angry at me, at Bill?”
“What was I supposed to do, go to your house and kill your dog?”
“Was that a fantasy you had on Saturday night?” I ask, hoping I sound calmer than I feel internally.
“What if it was?”
“You know, Chelsea, it’s always all right to have whatever fantasy you have, as long as it stays a fantasy.”
“Hah! Scared you, didn’t I?”
“It’s a scary fantasy, but the pleasure you took in scaring me indicates just how angry you are at me. I guess what you’re saying is that you felt afraid you couldn’t contain your rage, so had to turn in on yourself.”
“I wanted to kill you! I wanted to kill Bill. I did start swinging at him, but he just pushed me away and told me that’s why he had to get away from me and literally ran out the door.”
“I am sorry, Chelsea. I know you loved Bill and really wanted this relationship to work out.”
“Why don’t they? Why don’t any of my relationships work out?” Chelsea says, starting to cry.
Although we have dealt with the responses to those questions many times over the years – because you’re demanding and needy, because one moment you love the person and the next you hate him, because you can’t tolerate even brief separations without feeling enraged or terrified or both - I also know this is not the time to revisit them.
“When I didn’t call you back on Saturday, what did you think? Why did you think I didn’t call? And what did you think when I called on Sunday?”
“I felt you were just like Bill. That you didn’t care about me, that you were sick of me just like him, that you wanted to be rid of me.”
“I understand that’s what you felt, Chelsea, but I was asking something a little different. I was asking what you thought. If you thought there might have been a reason I didn’t call you back that might have had nothing to do with you, like maybe I lost my phone or forgot it.”
“But you didn’t. You chose not to call me back.”
“So it would have felt better for you if I’d called after midnight?”
“It would have felt better, but it still would have been too late.”
Only Chelsea’s feelings exist for her at this moment. “You’re caught up in so many painful feelings, Chelsea - hurt, loss, rage, abandonment – that from this place it’s impossible for you to step outside your feelings and try to reflect on them. So maybe it would be better if we focused on helping you not to turn all those feelings on yourself and hurt yourself. Can we do that?”
“I kinda liked doing it, it was like going back to an old friend.”
“I’m sorry to hear that. So are you saying that you think you’re going to start cutting again?”
Chelsea smirks. “That made you angry, didn’t it?”
“You know, I wasn’t aware of feeling angry, but you’ve always been incredibly sensitive and now that you mention it, perhaps that’s true.”
“And that’s one thing I’ve always appreciated about you, your honesty and your willingness to own your own shit.”
“Thank you. So maybe from there we can work on repairing our relationship and move forward.”
“Maybe,” Chelsea says with considerable hesitation.
“I understand. Right now repair feels difficult.”
“Yes, it does.”
This is so sad. A complicated question for a blog post, I know, but I find myself wondering about what your client asked-- how does one "safely" manage destructive anger without turning it against the self in some way? How to approach this, aside from meds?
There are many ways to manage anger without turning it against the self. First, you can recognize your anger, acknowledge that you feel angry, perhaps feeling "justified" in your anger or perhaps being able to step outside yourself - as I suggested in the blog even thought the patient wasn't able to achieve that - and recognize that there may be other explanations than the one that seems absolutely "right" to you.
It's also possible to have aggressive fantasies, murdering the other or, in this case, killing my dog.
And eventually one has to realize that one isn't only feeling anger, but sadness as well and that that pain can be borne even thought it might feel intolerable.
And one has to recognize that no one is perfect, that one must be able to hold ambivalence, and know that you can love and hate the same person simultaneously.
This is very intense. I would find it hard to get past the remark about killing your dog. We're you able to continue your work with this lady?
Sounds like this patient clearly has BPD.
As long as a patient is talking about fantasies and not acting on them, the fantasy can be a good way of releasing anger.
Obviously if she was she was showing up at my house, that would be an entirely different set of circumstances.
I wouldn't disagree with your assessment, Hayley, but I wonder if and how the diagnosis would help you in treating the patient.
When I first read the recommendations for managing anger without turning it to oneself then I thought that these recommendations already seem to assume some basis that might not be existing. I don't cut myself but I find it very hard to just acknowledge the anger because it seems to do nothing. But then I realised that I do indeed discharge the anger via fantasies - I typically go to shower and conjure up all sorts of crazy fantasies and after I come out I am calmer.
I was also surprised to read that the fantasy of killing the therapist's dog would be something that in someone's mind would disable continuing the work with the patient. I must say that my youngest parts have similar fantasies regarding to my therapist (and not his dog), which he is well aware of. I think there is a large distance between a fantasy and an action and in order to be effective as a therapist (as Linda clearly is) one has to keep that in mind.
This is getting a little confusing because there is obviously more than one "Anonymous" leaving comments.
Regarding the last post, yes, I think that fantasies can be quite helpful in managing anger and that as long as they remain fantasies, there should be no problem working with them in the treatment.
Wow, Linda, what great work! It's so hard to access our own feelings, feel empathic, and tolerate the rageful attacks of the other, yet you managed to do so, and to repair the relationship at the same time.
I did want to remind you, however, that because of the issue of confidentiality, both the patients and the situations in my blogs are fictionalized. I try to present myself as true to my therapist self as I can possibly be, both in terms of what I imagine I'd be thinking and feeling and in how I imagine I'd actually respond to a real life patient.
Again, thanks for your comment.
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