Inside/Outside

Thursday, April 12, 2018

There’s Something Wrong With Me

Staring down, Cristina pulls at the fingers of her hands. She has been unable to say anything since entering my office.
As Cristina’s silence continues and her tears fall silently from her eyes, her pain becomes palpable. “I can see how much pain you’re in, Cristina. Can you tell me what’s wrong?”
She shakes me head. But then she practically whispers, “Me. I’m wrong. I’m all wrong.”
Although I have no idea what Cristina’s referring to, I feel the heaviness of her burden.
“I’m sorry you’re in so much pain, Cristina. Can you tell me what’s causing your pain?”
“There’s something wrong with me,” she replies, barely audible.
“Can you say what makes you feel there’s something wrong with you?”
Tears pour down her cheeks. She makes no attempt to wipe them away.  
“I can’t love her,” she says looking up at me beseechingly. “What normal mother can’t love her child?” She pulls harder at her fingers. “They said it was post-partum depression. And maybe it was. But no one has post-partum depression for two years. And, besides, I didn’t feel that way with my son. Peter was my precious baby. I couldn’t stop holding him and cooing at him. I loved him instantly. And I still do. But with her, it’s different. It was different from the start. And it hasn’t gotten any better.”
“So your daughter is two and your son is …?”
“Five.”
“And her name is …?” I ask, aware that she spoke her son’s name, but not her daughter’s.
“Caroline. I want to love her. I do. But it’s not there.” Pause. “Can you help me? Can you cure me? Can you make me normal again?”
“I can certainly help, but it isn’t like you have a disease, Cristina. I understand that you want to love Caroline, but perhaps first we have to understand why your feelings about Caroline are different from your feelings about Peter. And if you could try to understand what you feel rather than beating yourself up for your feelings, that would be really helpful.”
Cristina shakes her head empathically. “It’s not normal. I’m not normal.”
“Is anyone telling you you’re not normal?”
“Oh, yeah. My mother. She’s told me I’m not normal my whole life.”
“Because?”
“Because I’m not like her. My mother is one of these brash, strong, outdoorsy types who won’t take anything from anybody. And me, well today’s not a great example of how I usually look, but I’m usually pretty well put together. People tell me I’m pretty. I care about clothes and my nails, kind of a girlie girl. My mother couldn’t stand that about me.” Pause. “The truth is she wanted another boy, boy number four, but she got me instead. Unfortunately for both of us.”
“Do you think there’s a connection between how your mother felt about you and you feel about Cristina?” I ask.
Cristina looks at me blankly. “In what way?”
“Well, your mother didn’t like you because you were a girl and it sounds like you’re saying it’s much easier for you to love Peter, your boy, than Caroline, your girl.”
“You’d think I’d love Caroline all the more because I know how awful it feels not to be loved.”
“Well, rationally that may be true, but we humans don’t always act on the basis of rationality. There’s our unconscious to consider. There’s, for example, identifying with the parent who hurt us and then despite our best intentions behaving like them. I’m not saying that’s what’s going on for you, but it does sound as though your feelings about your daughter are similar to your mother’s feelings about you.”
“But I don’t know if Caroline is going to turn out to be a girlie girl.” Pause. “But she is tiny. And she seems so vulnerable.” Crying, Cristina adds, “My mother hated vulnerable. I think that’s what she hated more than anything. She hated when I cried. She hated that I cried. Said I wasn’t normal to cry so much. I guess I’m proving her right.”
“No, you’re not proving her right. You’re proving that you’re human. There’s nothing wrong with crying. And there’s nothing wrong with feeling vulnerable. We all feel vulnerable. And children feel most vulnerable of all.”
“You know, that is one of the things that bothers me about Caroline. She seems so fragile. And for some reason rather than being drawn to that fragility and wanting to protect her, I want her to get it together and be strong.” Pause. “You’re right! I sound like my mother. That’s awful. I never wanted to be like my mother. Now I have something else to hate myself for.”

“You’ve brought in a lot of material today, Cristina, and we’ll have plenty of time to work on it, but the more you could wonder why you do or feel what you do, rather than judging yourself, the easier it would be.”

Friday, March 23, 2018

Panic

“I couldn’t wait to get here,” Ray says, almost breathless. “Pamela asked me for a divorce. She said we’ve been working on our relationship for years and it just doesn’t get any better. She wants out. She wants a chance to find greater happiness with someone else.”
“I’m sorry, Ray,” I say empathically.
“I…I’m a mess. I don’t think I’ve slept two hours since she told me. I never thought she’d leave me. I don’t know what to do. I can’t think straight. I’m like beyond panicked.”
“What’s fueling your panic?”
“What? What do you mean?”
“I can certainly understand you’re feeling sad and scared and maybe even angry, but what’s underneath your panic?”
“I’ll be alone. She’ll leave and take the kids and I’ll be alone. Oh my God, I can hardly say that. I can’t breathe.”
“I’m here. You’re not alone now. Take a few deep breaths and then let’s try to look at what feels so terrifying to you about being alone.”
Ray looks at me incredulously. He buries his head in his hands and tries to slow his breathing. He bursts into tears.
I sit silently while Ray cries, hoping he has broken through some of the anxiety to feel his sadness underneath.
“Why? Why? Why did she do this?”
Ray’s shock about his wife’s decision is rather surprising to me since they have indeed been working on their relationship for years. Ray told me she had repeatedly said she was unhappy in the relationship, feeling him unable to give to her emotionally or sexually.   
“What did prompt her decision?” I ask.
“I don’t know. Maybe because we didn’t have sex?” he says questioningly.
“You’ve told me that has been one of Pamela’s consistent complaints. That you withhold from her.”
“Do you break up a 15 year relationship because of sex?”
Ray’s consistent disbelief feels incredibly na├»ve to me. I even wonder if it’s disingenuous. Then I have another thought.
“You feel very much like a scared, hurt child to me,” I say gently.
Crying again, Ray mumbles, “That’s exactly how I feel.”
“So perhaps that’s why you’re panicked. When a child is left he feels panicked because he can’t survive without his mother - or some caretaker.”
“So you think Pamela’s leaving me feels like my mother leaving me?”
I nod.
“But my mother never left me.”
“That’s not exactly true Ray. You’ve told me how she reacted after your father died.”
“Yeah, that’s true. Before I was seven – when my father died – we had a very close relationship. In fact, she was all over me. Sometimes I just wanted to get away from her. It was too much. But after he died, I don’t know, it was like she died too. She got so depressed and didn’t want me anywhere around. In fact she shipped me off to her sister’s for a while. It was awful. My cousins hated me. I’m sure they didn’t want another kid in the family. I had to change schools and that was awful. The whole thing was awful.” Pause. “And when I went back home, my mother still rejected me.” Pause. “And then she started dating. That was worse. All those men. And then my step-father. The whole thing was a nightmare.” Pause. “You know what just went through my mind? I wanted my Mommy back.”
Crying, Ray adds, “And that’s how I feel right now. I want my Mommy. Except it’s Pamela.”   
I remain silent, thinking this is not the time to explore the meaning behind Ray’s similar feelings about his mother and Pamela.
“I guess that helps explain my panic,” he continues. “But it doesn’t take it away,” he adds, looking at me beseechingly. “Can’t you take it away?”
“So perhaps now I’m the Mommy who you want to take away all your fears and sadness.”
“Can you?”
“That’s clearly your wish, but I’m afraid I have no magic wand.”
“No?”
“No, but we can look at your desire for that magic wand, for the all-powerful, all-perfect mother who can take away all your fears, all your sadness so that you feel nothing but perpetual bliss.”
“Sounds wonderful.”
“But I wonder if it would feel wonderful or, as you said before about your early mother, whether it would feel too much and you’d want to get away.”
“I don’t know. Right now it sounds wonderful.”
“When faced with abandonment you yearn for closeness, but when there’s closeness it can feel like too much and you yearn to get away.”
“I don’t know. I can’t deal with all that now.”

“I understand. We’ll have plenty of time.”

Friday, March 2, 2018

I'm Afraid

Jennifer sits in the chair across from me and cries. Tall and thin, with straight blonde hair, at 18 years old she is younger than most of the patients I see. I suspect her distress is about the school shooting at Marjory Stoneman Douglas High School on Valentine’s Day.
“Did you lose friends in the shooting, Jennifer?”
She shakes her head.
“Are you scared it will happen in your school?”
She shakes her head.
“You know, Jennifer, I saw your Mom a number of years ago and she called and asked that I see you. Does the fact that I saw your Mom feel all right to you?
She nods, then startles. “But what I say here is just between us, right?”
“Your Mom said you just turned 18, so yes, what we say here is confidential, unless I’m afraid you’re going to hurt yourself.”
“I won’t. I’m too much of a coward to do anything like that,” she adds sobbing.
“I lot of people are really scared right now, Jennifer. That doesn’t make you a coward.”
“No, they’re not. They’re marching. They’re going to Tallahassee. To Washington. They’re confronting the NRA, the President.”
“Yes, that’s true.”
“I can’t,” she says sobbing. “I can’t do it. I’m a coward. A coward!” she says with clenched teeth, her fists covering her tightly closed eyes. “Why can’t I do it? They can.”
I immediately flash on my younger self. I so admired my grandmother, willing to fight for what she believed, while I fearfully hung back. I don’t know that I saw myself as a coward, but I did feel disappointed in myself and wished I could be different. It was a wish that was at least partially fulfilled when I was able to confront my demons from the past. But none of this will help Jennifer right now.
“That’s actually a very good question, Jennifer,  especially if you could ask it without beating yourself up. What do you think makes it so frightening for you to think about protesting like some of the other students?”
Jennifer stops crying. She looks up at me like a deer caught in the headlights. She pauses then shakes her head and says, “I can’t. I can’t say.”
“Can you tell me why you can’t?”
“I’m scared. And… and I don’t want to make it a big deal.”
“Anything that scares you so much is a big deal.”
Silence.
“Can you tell me a little about your life, Jennifer? You’re an only child, right? Do you live with both your parents?”
“Yeah, it’s just me. My parents divorced. It must be a long time since you saw my Mom. They’ve been divorced since I’m nine. They had joint custody. But now that I’m 18 I’ll live with my Mom until I go to college.”
“So you prefer living with your Mom?”
“Oh yeah.”
“What’s your relationship like with each of your parents?”
“I’m real close with my Mom. My Dad, not so much.”
“Can you say why?”
“He always criticizes me. Nothing I do is ever good enough.” She hangs her head.
“Anything else?” I ask.
“He has PTSD. He was in Vietnam.”
I had forgotten that, but I remember now that Jennifer’s Mom said he could be explosive and erratic.
“Are you afraid of your Dad?” I ask gently.
“I didn’t say that!” she says, sounding panicked. “Besides, what does my Dad have to do with my being afraid to stand up for what I believe?”
“And what do you believe, Jennifer?”
“That guns kill. That we should have way more restrictions on who can get guns and what kind of guns are available.”
“What does your father believe?”
“He believes people have the right to have guns, but he doesn’t think a 19 year old should have an assault rifle.”
“What does he think about the protests?”
“He hates them. Reminds him of the Vietnam protests.”
“How would he feel if you participated?”   
“He wouldn’t allow it.”
“And what would he do if you participated anyway?”
Jennifer looks down and keeps shaking her head. “He’d scream and scream and scream. But not like normal people scream, like way, way out of control. He might also slap me or lock me in my room. He’s really scary,” she says, her words coming out in a rush.
“And you’ve been living with this all your life, Jennifer?”
“Yeah, although it got worse after the divorce. Before my mother could protect me a little. Afterwards he just got meaner. I never wanted my Mom to know. I didn’t want to upset her.”  
“Well, Jennifer, I think we know why you can’t protest as many of your friends do. But I don’t think it’s only because your father disapproves of the protests. He’s scared you your whole life, so to stand up to any authority is terrifying, just like standing up to him as a little girl was terrifying.”
“Really? You think that’s true?”

“Yes, I definitely think that’s true.”

Thursday, February 15, 2018

Disgruntled

“I had this unbelievably horrible day yesterday,” 76 year old Joan Green begins. With dyed red hair and raised eyebrows penciled to match, she challenges everyone around her and looks perpetually amazed by their response. She is my patient only because a psychologist colleague of mine begged that I see her. She had moved to Boca Raton, Florida a year ago after her daughter who lives in Phoenix could no longer tolerate her and feared her mother would destroy her marriage. Her son, my colleague, was not faring much better and told his mother that he would no longer have anything to do with her unless she went into therapy.
She continues. “I spent my whole afternoon in the pain doctor’s office and didn’t even get everything done. The pain is terrible. Everything hurts me – my back, my hips, my neck, even my feet. I can’t take it anymore.”
“Did anything go well yesterday?” I ask, perpetually trying to find something positive in Mrs. Green’s constant tales of woe. I doubt I’m the best therapist for this patient. Constant complaining is not my forte, especially when someone is so resistant to looking at her part in the interaction.
“I liked the doctor.”
My eyebrows shoot up in surprise. “Well that’s important. And positive.”
“Well, he was nice, but I don’t see why he couldn’t give me an injection yesterday and not make me come back.”
“Did he tell you why?”
“He needed me to get an MRI first. And he couldn’t do it in his office – I guess he doesn’t have the equipment. That wasn’t good either. And he said I had to call for an appointment. I don’t know why they couldn’t call for me. I don’t carry my phone with me. It’s way too heavy. I didn’t want to have to go all the way home and then go out for an MRI another day. I’m in pain! Obviously or I wouldn’t be in his office. I told them – I was in the waiting room by then, arguing with the office staff - I’d be willing to sit wherever and wait until they could take me.”
“Mrs. Green, does it seem to you that you have lots of expectations of other people, expectations that might be impossible to fulfill?”
“What! What expectations?”
“Well, what are your thoughts about that?”
“Why should I have any thoughts about that? You’re the one who brought it up. You should be the one telling me.”
Annoyed at this constantly demanding patient, I try to step back. “I wonder if you feel so un-given to, so lacking in nurturing that you have a profound need to be taken care of, whether that’s me answering your question rather than your thinking about it yourself or wanting a doctor to have every possible piece of machinery  available in his office, or needing others to make phone calls for you.”
“That’s just stupid psychobabble. Probably because you can’t answer your own dumb question.”
Feeling angry, I’m silent, trying to figure out what I want to say next.”
“What? Cat got your tongue?
“I wonder what you get out of being so difficult and demanding. I know that it can’t possibly get you what you want. Your daughter didn’t want you in the same city as her. Your son won’t deal with you unless you’re in therapy. But therapy is about looking at yourself. And if you’re not willing to look at yourself instead of blaming everyone else for their insufficiencies, we’re not going to get very far.”
“And that would be my fault?! How about your looking at you?”
“I’m happy to look at how I may be contributing to the difficulty we’re having, but that means you’ll need to look at how you might be contributing to the difficulty too.”
“Okay. So tell me. Both sides.”
“I’m going to answer that question, Mrs. Green, but I want to point out that you’ve again issued a demand and as a result of that demand I don’t really want to answer the question. I am going to answer the question, but I suspect that most people who aren’t therapists wouldn’t. They’d see you as an entitled, demanding, angry, embittered woman. And, from my perspective, that’s all true. But I do think there’s a reason you’re that way and I’m willing to work on us trying to figure out what that reason is which might help you to make some changes.”
“And what’s your part?”
“I think it may be particularly difficult for me to have people make demands on me without my wanting to resist their demands and that might make our work together more difficult.”
“So should I find someone else?”
“That’s certainly your choice. I’d be happy to give you some referrals if that’s what you decide.”
“You’re probably all alike. I’ll stick with you for a while and see what happens.”

“Okay. Fair enough.”

Thursday, January 18, 2018

The New Year – Part II

As I open the door, I am surprised to see a smiling Heather waiting for me. Quite a change from just three days ago, I think.
Once comfortably seated in the chair across from me, she says, “Not the person you expected to see today, right? Rob and I got back together.”
“How did that happen?” I ask, while silently thinking, oh no.
“He called. Said he made a mistake and wanted us to be together. Turned out that Brad was actually living with another man and Rob decided he couldn’t deal with the free-wheeling gay lifestyle.”   
I struggle with whether to remain silent or share my concern. While deliberating, Heather says, “You don’t approve.”
“It’s not a question of approval, Heather. I just wonder why you were so quick to take him back. He told you he wasn’t in love with you and you certainly know that you can’t choose who you’re attracted to.”
“We had great sex after the breakup. I remembered what you and I talked about and tried to be more aggressive. It was terrific. We didn’t tie each other up, but I tried to do more to him, like … umm …. doing oral sex and … I’m not sure I can say this …”
Silence.
“Like putting my finger up his ass. I thought I’d be grossed out, but it was okay.”
“So you’re saying that you tried to be what you consider more masculine.”
“I guess.”
“It’s like what you said last time, you thought if you could be more of a man you’d be good enough.”
“Why are you trying to take this away from me?” Heather asks plaintively. “I was so miserable; I felt so shitty. And you can see how much better I feel.”
“I know that breakups are horribly painful, but it seems to me that you’ve put yourself in the position to be hurt all over again. If Rob is gay, he’s going to find another man he’s attracted to and …”
“No, he told me he wouldn’t.”
“Okay,” I say, asking myself why I am pushing Heather so hard. Why am I trying to protect her, rather than looking at the underlying dynamics that have led Heather to return to this relationship? Am I re-enacting something in her family dynamics? Something in my own?  
Backing off I say, “What do you feel would be helpful for you today?”
“Oh!” she says, obviously surprised. “I don’t know.” Pause. “You just stopped. You didn’t keep badgering me. My mother never did that. She didn’t talk to me much, but when she did she was always trying to convince me to do what she thought I should, even if it made no sense.”
“So what do you want to do?”
“I want to stay with Rob, see what happens, and try to be more assertive.”
I think of all the rejoinders to her comment, but decide that confronting her directly will only feel like her old arguments with her mother. “And what would you like me to do?” I ask.
“Hmm. I’d like you to help me be more assertive.”
“So perhaps you’re being assertive right now, by telling me what you want me to do.”
“I guess, but it’s easy with women. Like I pretty much did what I wanted regardless of what my mother said. But with my father, there was no way. I toed his line.”
“So we’re talking about the power your father had and how being male was prized in your family.”
“Oh yeah.”
“And last week you talked about not feeling good enough to keep a man because you weren’t male enough.”    
“Yeah, weird as that is.” Pause. “So I guess I’m saying that I’m going to try to be more male.” Pause. “I guess that’s okay.” Pause. “What do you think?”
“It depends how much you’re twisting yourself into someone you’re not, vs. how it flows naturally.”
“It doesn’t flow naturally.”
Silence.
“So are you saying there’s no hope?”
“Depends what you’re hoping for. If you feel you to need to be a man, there’s certainly no hope for that. If you’re talking about keeping Rob, I’m dubious – although I could be wrong – because I think it’s about him, not you. But there’s certainly hope that you can give up feeling your womanness is inadequate and feel that you’re more than enough for a man.”
“Right now I just want to make it work with Rob.”

“I hear you. And I’ll be with you in any way I can.”

Thursday, January 4, 2018

The New Year

Heather blows her nose and rubs her very red eyes. “I feel as though all I’ve been doing since the New Year is crying,” she says. “I was sure Rob was it. I even thought he might propose on New Year’s Eve. Instead I just sat there waiting for him. Eventually I got panicked and started calling hospitals. He was always punctual. I don’t know why he couldn’t just call and tell me!”
“There you sound angry,” I say.
“I guess. But I can’t hold on to the anger. Mostly I just feel sad. And I think really stupid things like ‘it’s such a waste’ or ‘he was pretty good in bed.’ I know that’s ridiculous, he is who he is and that’s that.” Pause. “Except that I love him,” she exclaims, crying. “And I thought he loved me. When he finally got the nerve to call on New Year’s Day, he gave me that old line, he loves me but isn’t in love with me. Thought he could make it work until he met Brad and they just clicked. I had the sense they practically fell into bed two minutes after they met. And there I had one of those awful thoughts again. I was going to say, isn’t that what gay men do? I don’t want to be thinking that. That’s not who I am. I’m the most tolerant, liberal person around.”
“Perhaps that’s your anger speaking.”
“Maybe.” Pause. “This isn’t the first time,” she says softly.
“Isn’t the first time …?”
“I was involved with another man who realized he was gay. We weren’t quite as serious as Rob and I, but we’d been going together for a while.” Pause. “I’m not sure why I never told you. It was a pretty big deal to me, especially at the time. And now it’s happened again.”
“What are your thoughts about not telling me about the first man?”
“I’ve thought about it. I think I was ashamed. Ashamed that I wasn’t enough of a woman to hold onto a man. Or maybe ashamed of being a woman, that being a woman in and of itself isn’t enough.” Pause. “I think my mother thought that. I wasn’t enough and she wasn’t enough.”
“Enough for what?”
She shrugs. “Enough to be successful in the world, enough to be smart and educated and intellectual like my father. Enough to hold my father’s interest. He was never interested in her. He’d rather sit around with his fellow professors and have philosophical discussions. You know, I’ve told you, as a family we kind of weren’t. We all went our own way. My father paid attention to me when he wanted to impart some tidbit of knowledge, otherwise I was just kind of there. As for my Mom, we never talked, not even when we went on vacation. Just the two of us. My father never came.”
Heather continues. “You know. I wonder if there’s a connection between my not feeling like enough and choosing – unconsciously choosing – gay men. Almost like – this is ridiculous too – they’re less of a man and I’m less of a woman, so maybe I’d be able to hold onto them.”
“What was it like for you sexually, Heather? Did you feel like less of a woman in bed? Did you feel they were lesser men?”
“They weren’t lesser men. Rob was a very attentive lover, always wanting to please me. In fact, he embarrassed me. He wanted me to tell him what it felt like, what I felt when he’d do one thing or another. I didn’t like all that focus on my body. It embarrassed me, made me self-conscious. He’d always satisfy me, always. That made me uncomfortable too because he didn’t always … umm … ejaculate.”
“And the other man?”
“Now I’m really embarrassed.” Pause. “That was different. That was a lot rougher. Sometimes he’d tie my hands and like take me really hard and fast. It was a turn-on. For both of us. When he told me he was gay I asked him about our sex, about how exciting it seemed for both of us. He said it made him realize how much he wanted done to him what he did to me. That made me feel less than. I couldn’t do what he wanted, not only because I didn’t have a penis, but because I just couldn’t. I couldn’t be that aggressive.”
Heather pauses and then continues. “So what am I saying, that I’m not enough of a woman because I’m not a man? Wow! That’s wild. That’s messed up.”
“You’ve described your father as the source of power in the family, the person both you and your mother hoped to ‘interest,’ so it’s not surprising that only maleness feels like enough. How that relates to your choosing gay men isn’t clear – at least to me – and something we’ll have to continue talking about.”
“Definitely. I’m not interested in repeating this for a third time.”