Friday, November 30, 2018

Wanting to Flee

Trevor sits quietly in the chair across from me. After a few moments he says, “It was an okay week. Nothing special happened.”
I wait. There is silence. I’m puzzled. I have seen 26 year old Trevor for many years. I might even say I helped him grow up. When he first came to me he described himself as shy. During those years long silences were commonplace. But as he moved away from his fear and self-loathing he’s been far more engaged with me and, to a lesser extent, with the world outside my office. He acknowledged his gayness and was able to come out to his family and some of his friends. He’s still never been in a love relationship, a problem that we’ve been working on. But today his silence confuses me.
“Is something going on, Trevor?” I ask. “You seem particularly quiet, uncomfortable.”
He shakes his head and looks away from me.
I wait. I think about our last session. Did something happen that distressed him? We’d been talking about Thanksgiving with his family, but that had seemed to go fairly well despite his father’s usual blustering. Was there some tension between us? Nothing that comes to me. Don’t be impatient, I tell myself, just sit with him.
After a while he says, “I’ve been thinking maybe I should cut back to once a week. I’m doing pretty well and, like today, I don’t have much to say.”
I’m stunned. In all the years, Trevor has never asked to come less frequently and, in fact, has often asked for additional sessions. Something must have happened between us.
“Trevor, you need to tell me what’s going on. Did I say something last session that distressed you?”
“Why does something have to be wrong? Why can’t I just want to cut back?”
“Because you know as well as I do that there’s always a reason – usually more than one – for everything we do.”     
He sighs. “Why did that psychiatrist retire?”
“What psychiatrist?”
“The one next door.”
The light dawns. He asked me last time what had happened to my neighbor. When I told him he retired, he obviously became fearful that I might follow a similar path. “He retired because he wanted to travel, have more time to himself, pursue other interests. And, no, I have no plans to retire, ever. I love what I do and as long as my mind is still with me I plan to stay right where I am.”
“And why is the sign on your door different? What happened to the other therapists? The ones who’d worked here? Did they retire too?”
Now we’re in more difficult territory. I’ve been surprised by how few patients have asked me about the change of signage on the front door. “No, Trevor, they died.”
His already pale skin blanches further.
“Okay,” I say in a calm voice. “I understand that you’re frightened of losing me. First you were afraid I might retire and now you’re afraid that I’ll die. And of course I can’t make guarantees about my dying, but it’s certainly my hope to stick around for a long time.”
“I have to cut back to once a week. I have to become less dependent on you. Right now if something happened to you I don’t think I’d survive.”
“Trevor, the idea is that our work together will help you to be able to be more and more engaged with people other than me, but we can’t accomplish that by your cutting the frequency of your sessions. You’ve been doing very well lately, going out to lunch with people, meeting friends for dinner and a movie …”
“But that’s because of you!” he says. “I wouldn’t be able to do that without you.”
“Then we’ll have to understand why you feel you can’t do those things without me and help you to feel more comfortable being in the world.”
“Did they know they were going to die?”
Loathe to provide too many details, I say, “Yes, they both knew they were ill.”  
“So they could tell their patients?”
“Yes, their patients knew they were ill.”
Trevor starts to cry. “I couldn’t stand it! I couldn’t stand it if you died! I couldn’t watch you die.”
“I understand, Trevor, but I’m not ill and I’m not planning to die any time soon. Obviously none of us know when we’re going to die and it’s always sad to lose someone we love, but what we need to do is focus on helping you to be fully in the world, to embrace life and enjoy it.”
“Can we talk about this again next week?”

“Of course. I’ll see you Monday.”

Friday, November 16, 2018

The Invitation

“My neighbor invited me for Thanksgiving,” Marnie says without enthusiasm.
“You sound less than excited about the invitation.”
I remain silent.
“It’s her family.” Pause. “It’s not my family. I won’t know anyone. Except her husband and I don’t like him much.” Pause. “I don’t see why my sister couldn’t have invited me. Or my daughter.”

“I thought your sister was going on a cruise.”
“She is. But she didn’t have to. And I know, I told my daughter I didn’t want to travel all the way to Seattle, but she could have insisted.”
I find Marnie maddening. Nothing is ever good enough for her. I try, yet again, to provide some insight into her behavior.  
“You notice, Marnie, that you’ve again set up a situation where you can’t be satisfied. Your neighbor invites you to her house, but you’re unhappy because it’s not your family. You expect your sister to not go on her cruise because she should be here to invite you for Thanksgiving…”
“What’s so wrong about that?” she asks, interrupting me.
Responses flit through my mind from ‘you’ve got to be kidding’ to ‘would you have canceled your cruise for the sister you rarely speak well of?’ Instead I take a breath and pause. “Marnie, I know that you grew up in a hostile, unloving home. I know that your parents were too involved in their own battles to care about their young daughter who had the misfortune to be born just when they were considering divorce. I know you didn’t get enough love, enough nurturing, enough care. But by finding fault with everyone, by demanding that everyone always think of you first, you’re insuring that you will never feel as though anyone cares about you.”
Marnie’s head droops. Tears fall silently from her eyes. I can anticipate what’s coming next and, unfortunately, Marnie doesn’t disappoint me. “So you’ve turned against me too,” she says, whining.
I want to scream. I suspect my anger is not only mine, but also a projection of the anger Marnie keeps buried inside herself. “Marnie, can you tell me what you’d like from me right now?”
“I’d like you to understand how much pain I’m in and support me.”
“And your pain is about never feeling loved?”
She nods.
“And you feel angry about never being loved?”
“I guess.” Pause. “You know anger wasn’t allowed in my house. Not as a child. I don’t like to feel angry.”
“But it would make sense for you to feel angry about never being loved, right?”
“I guess,” Marcie responds reluctantly.
“So you weren’t allowed to feel anger as a child and you’re not comfortable feeling angry now.”
She nods.
“Would you consider the possibility that you bring all that stored up anger into the present and behave in ways that both expresses your anger and probably leads people to be angry with you?”
“I don’t understand. Why would anyone be angry with me?”
I consider whether I should answer that question in the here and now about Marnie and my relationship, and decide a bit more distance might be preferable. “Well, let’s consider the invitation from your neighbor. If in accepting the invitation…”
She interrupts me. “I didn’t accept, I told her I’d let her know.”
In my mind, I think, ‘well that certainly illustrates my point.’ I continue, “I wonder if your not immediately accepting the invitation is an expression of your anger. It’s like saying the invitation isn’t good enough.  It’s possible your neighbor might have felt hurt or insulted about your not accepting and might be less likely to invite you in the future which would lead you to again feeling rejected.”
“But I’m not sure I do want to go to someone else’s family.”
“I wonder if you realize, Marnie, that you do the same thing to others as was done to you – you’re not good enough so I won’t love you.”
“So do I have to accept whatever anyone offers me?”
“Good question.” I pause. “I guess I’d say it would be important for you to consider why you’re rejecting an offer. Like, would you really prefer to be alone for Thanksgiving? Do you want to be alone so that your sister feels bad for you? So that your daughter feels bad for you?”
“What’s wrong with wanting them to feel bad for me?”
“”Because you’re cutting off your nose to spite your face. And because you don’t realize that wanting them to feel bad for you is an expression of your anger.”
“I don’t understand that at all.”
“And you’re angry with me right now, correct?”
Pause. “I don’t think so. I’m just confused.”

‘Foiled again,’ I think. “Well, it’s time for us to stop, but we’ll continue next week.”

Thursday, November 1, 2018

Choose Me

“I don’t understand!” Marcy shrieks at me, continuing the stalemate we have been have been in for weeks. “Why won’t you just tell me I’m your most favorite patient? You know that I am. You know that you care about me more than anyone else, that you love me, so why don’t you just say it!”
Thoughts race through my mind as my patience runs thin: ‘You’re upping the ante. Now you want to be the person I care most about in my life, the person I love above all others. You’re certainly not being very loveable right now.’ I remain silent.
“Why don’t you say something?” Marcy yells.
I sigh. “Truthfully, I don’t know what to say. We’ve been arguing about this for weeks. We know that your mother abandoned you to the care of her sister. We know that your aunt clearly favored her own daughter over you, that you felt like a second class citizen, like Cinderella, as you say. And all these things are horribly sad and painful for a child, but there’s no way I or anyone else can make up for that. If I told you you were my favorite patient, that wouldn’t take away your pain about your mother or your aunt.”
“Then what good are you?”
“I’m here to help you mourn the past, to be sad and angry, sad and angry, sad and angry about what you didn’t get as a child and then to be able to accept what was and to move on, able to take in the good from others in the present.”
“Is that a script you read? You say the same stupid shit all the time,” Marcy responds, crossing her arms in front of her chest, chin raised, staring at me defiantly.
I’m pissed. I remain silent while I try to collect myself.
“What?” March says.
“You know, Marcy…” I begin before she interrupts me.
“Oh,” she says sarcastically, “here comes the lecture.”
I ignore the interruption. “It’s interesting to me how much your behavior is counterproductive.”
“What’s that supposed to mean?”
“You say you want to be my favorite patient, but you behave in a way that would make you anything but my favorite patient.”
“Oh! So now I’m supposed to be Miss Goody Two-Shoes. I thought you always told me – for years and years in fact – that I was supposed to say everything I was thinking, not censor anything.”
“I’m not suggesting that you censor what you say. I’m suggesting that what you say has consequences.”
“So now you’re threatening me?”
‘Stay calm’ I tell myself, knowing Marcy wants to provoke me. “The more you angrily demand that someone care about you, the less likely that person – me in this instance – is going to respond the way you want. So the question becomes why do you behave in a way that is least likely to get you what you want?”
“Don’t change the topic,” Marcy demands.
“I’m not…” I stop myself. “That last comment, for example. You know I’m not changing the topic. You’re just being provocative and trying to not consider what I’m saying.”
“OK, smarty pants, why don’t you tell me why I behave this way. I know you have some nice little theory floating around in your head.”
“Let me ask something else first. What would happen if I did tell you you were my favorite patient?”
“I’d ask if that meant you loved me.”
“And what would you feel if I told you I loved you?”
“I’d need you to prove it. Like, would you see me for free?”
“So you’re saying you’d add more and more demands until you got to a place where you could again feel unloved and unchosen.”
“Why would I do that?”
“Good question. Why would you?”
“I don’t know.”
“I suspect you unconsciously want to be rejected so that you can stay connected to your rejecting mother and aunt who walk around in your head. If you take in the good, the caring in the present, then – here’s my script again - you have to mourn what you didn’t get in the past. You have to give up the hope of getting the love you needed and deserved as a child from the people in your life who were supposed to care for you but never came through.”
“That sounds way too hard.”

“I wonder if it’s any harder than repeatedly demanding love from people in the present in such a way that you insure you’ll never get it.”