Tuesday, July 25, 2017


Jeffery throws himself in the chair across from me looking more disheveled and distraught than his usually calm, poised presentation of a mid-forties successful financial advisor.  
“I couldn’t wait to get here. I almost called and asked if you had a double session available today or any more sessions available today at all. Do you?”
Thinking about how reluctant Jeffery has been to increase his therapy sessions to more than once a week, I say, “I’m sure I can see you later this afternoon, but first why don’t you tell me what’s going on.”
“My wife told me she wants us to have an open marriage.”
Many thoughts go through my mind, including the sarcastic, ‘so now the shoe’s on the other foot.’ Instead I say, “Her request obviously disturbed you.”
“Hardly difficult to figure that out. Can you imagine?! My wife! The prissy little woman who left me begging for sex.”
“Jeffery, what’s so disturbing about her asking for an open marriage?”
“That’s a dumb question.”
“You could look at her request as freeing you to see as many women as you wanted without having to sneak around.”
“But she could also see as many men! In fact, she already has. She told me at first she wanted to get back at me for all the women I saw on the side – even though I never admitted to seeing any other women. So she went online and started going out on dates when she knew I’d be out. And then she’d have sex with them. It almost made me throw up to hear that. And then she told me she’s come to enjoy it and wants to be able to do it openly. Ugh!”
“Jeffery, I know you might think these are dumb questions, but why is a man who never followed his marriage vows, so disturbed about his wife wanting the same freedom?”
“It’s not the same. She said she did it because she wanted to get back at me, meaning she must have been angry at me.”
“And does that give you an idea about your own motivation?”
“I wasn’t angry at my wife.”
“’A prissy little woman who left me begging for sex’ doesn’t sound not angry, but maybe it’s more than just your wife you’re angry at.”
“That theory again. I’m angry at my mother for dying and leaving me and therefore I’m angry with all women. I don’t buy it.”
“Can you think seriously for a moment why you might not buy that theory?”

“It’s just a cliché.”
That’s not a moment’s worth of thought, I think. Then I realize I’ve had several sarcastic thoughts this hour. Am I angry with Jeffery for being unfaithful? But I’m not angry with other unfaithful patients. Am I feeling Jeffery’s conscious or unconscious anger at me? Certainly a possibility. Am I angry with Jeffery for not accepting anything I offer be it a question, an interpretation or a request? Another possibility.
“Have you ever noticed Jeffery that you rarely take in anything I offer?”
“For heaven’s sake, my wife just told me she wants an open marriage and you want to talk about us.”
I think, ‘well, there’s an example,’ but I swallow that sarcastic response and say, “Perhaps there’s a connection between the two, Jeffery.”
“What!?” he says, roiling his eyes towards the ceiling.
“I wonder, Jeffery, if the reason you feel angry with women is that you’re afraid of being dependent on them, of needing them.”
“That’s ridiculous.”
“Again, I’m going to ask you to think about what I just said and to try and take it in.”
“It doesn’t make sense to me,” he responds immediately.
“Okay. Let me ask you something else. Do you still want that second session today?”
“What!? You’re more scattered than I am. If it’s going to be like this, no, no I don’t want it.”
“I think you’re afraid of having to rely on women – particularly your wife and me - because either you’re afraid you’ll lose us or become so dependent on us that you’ll feel the extent of your own neediness. And if you reject my idea without considering it you’ll have proven my point.”
Jeffery laughs. “I guess I can’t win.”
“It depends what you want to win,” I say very seriously. “If you want to get to the place where you can have close, meaningful relationships with women, you can definitely win.”
“And what would I need to do to make that happen?”
“I guess you could start by accepting that session later this afternoon.”
“That was a trick.”
“No, it wasn’t a trick. When you were extremely distressed you wanted to see me as much as possible, but once you were here, you had to reject your desire to rely on me by refusing the second session, just as you’ve rejected coming more than once a week.”
“Okay, okay. I’ll come in later this afternoon.”

“I’m glad.”   


Anonymous said...

Jeez that was fustrating just to read about... what a difficult man.

Linda Sherby PH.D., ABPP said...

But it's made easier when the therapist can realize how she's reacting to the "difficult man" and use that awareness to further the treatment.

Thanks for responding.


Unknown said...

Have you thought about making a book out of these small vignettes-- they are truly wonderful clinical anecdotes and you are a lovely writer!

Anonymous said...

A nice example of bringing a patient's hidden (or denied) motivations to the fore. The fear of dependency that can develop from early or otherwise significant loss can be so powerful and the avoidance behaviors that can play out between therapist and patient (or in the patient's relationships), as you show here, can be as hard for a patient to accept as they are to recognize. I'm wondering about other possible dynamics going on here for Jeffery. His chronic unfaithfulness masks anger at his mother dying and leaving him but maybe it also provides a "reason" or explanation as to why she left (in a child's mind) -- you left me because I'm "bad" or angry at you.

Thanks for another interesting piece.

Anonymous in Michigan

Linda Sherby PH.D., ABPP said...

Thank you, Coral, for your kind comments.

Yes, I have thought of putting these vignettes into a book. Unfortunately I have been advised by those you know the publishing world a lot better than I do, that unless you're famous - which I'm not - no publisher will print a book made up of stories that can be found for free online.

If you're interested, however, I can do a bit of self-promoting, and tell you that I have written a book - Love and Loss in Life and in Treatment - that has some of the same characteristics as my blogs. The book combines memoir with my work with patients and looks at how a therapist's current life circumstances effects the treatment.

Thanks again for your positive feedback.


Linda Sherby PH.D., ABPP said...

Thanks Anonymous in Michigan for your thoughtful comments. I agree with you completely. Jeffery could certainly experience his mother's death as his fault because he was bad or angry.

Glad you like my blogs.