Inside/Outside

Friday, May 10, 2019

I'm Finished

“I don’t know why I have to keep talking about this,” Paulette says angrily. “I’m going to be 50 years old. I’m finished. I want out of my marriage! There’s nothing more to talk about.”
Keeping my voice calm, I say, “I certainly wasn’t suggesting you stay in your marriage, but I know every time you’ve left Derek before you’ve gone back, so I thought it would be helpful for us to look at what feels different this time.”

Paulette runs her hand through her hair and sighs. “The kids are gone, either in college or out on their own. They’re launched. I don’t have to worry about them any more.”
Treading carefully I say, “I wasn’t aware that you went back the last several times because of the kids.”
Paulette glares at me. She says nothing.
“Right this moment do you feel you want to leave me too?” I ask.
“That’s exactly what I was thinking. Maybe I should. Maybe I should leave you too. Maybe this has gone on way too long. And now you’re telling me I should stay married even though I’m so unhappy.”
I know that is not what I said, but arguing with Paulette is not helpful, especially when she’s incensed. “So you’d leave me and you’d leave Derek. What specifically would you do?”
“Are you daring me? You think I couldn’t do it. You think I couldn’t walk out of here right now, go home and pack up and leave?”
“I think you’re angry, Paulette. I think when you’re angry it’s a poor time for you – or anyone – to decide anything.”
“Are you trying to aggravate me? Because you’re doing a pretty damn good job of doing so.”
“No, Paulette, I’m not trying to aggravate you. As we’ve talked about, once you’re angry anything and everything can make you angrier.”
“You’re talking to me in that goddamn condescending voice, like I’m a child.”
“I’m sorry. You’re right. I am. But in some ways you feel like a child right now, Paulette. You know when you get angry the feeling just gets bigger and bigger until it wipes everything else away. So much so that you can forgot what you’re even angry about.”
“Did you just apologize to me?” Paulette asks, surprised.
“Yes. I have apologized before. Especially when I’ve let these interactions between us escalate to the point of us both just being angry.”
Paulette takes a deep breath. “That’s true. I remember,” she says, more calm now. She pauses. “Why can’t Derek do that?”
My thought - because he’s not your therapist - goes unsaid. Instead I say, “I imagine because he gets caught up in his own feelings.”
Silence.
“Can you say what you’re thinking?” I ask.
“I was thinking about what set off this whole argument over the weekend and that what I’m afraid of is exactly that, his getting caught up in his own feelings.”   
I wait.
She sighs. “He made plans to go see our youngest daughter at college. Didn’t invite me, didn’t ask me, didn’t tell me,” she says, her voice rising. “Why would he do that?” Paulette demands. “He’d know what my reaction would be.”
“So you see him as provoking you?”
“Well yeah!” she says sarcastically. “But you know that’s not the worst part. He wants to be alone with her. He doesn’t want me around messing it up. I know, she’s a big girl now – sort of – and she’s not going to let him do anything inappropriate. But what if he tries? What if his feelings get the better of him? He’s always wanted her. He always preferred her over me.”
“Paulette,” I say gently. “Your father started molesting you when you were 10. You’ve asked your daughters multiple times, cautioned them multiple times to not let anyone touch them inappropriately, to tell you if anyone ever made them feel even vaguely uncomfortable. Neither of them has ever said a word to you about their father.”
“But what if she likes it?”
Oh, oh, I think. Lots of issues there and we’re near the end of the hour. The thorniest question of whether she’s talking about herself will have to wait for our next session. For now I’ll take the easier path. “Well,” I say, “she may enjoy her father’s attention, the special relationship she feels they have.”
“They’re always excluding me. I feel I’m in competition with my own daughter! That’s sick.”

“Lots of issues came up here, Paulette. Why don’t we table them for the moment and talk about them at our next session.”

Monday, April 15, 2019

The Dream

“I had a dream last night,” Justin begins, squirming nervously in his chair. “I can’t remember any of it, but I feel haunted by it. I know that doesn’t make much sense, but it’s like I woke up scared, like something terrible is going to happen, like something or someone is going to get me. I kind of want to keep looking over my shoulder. Even here, I wonder if there’s someone else in the room, although I know that’s ridiculous.”
Justin, a 45 year old accountant, has been my patient for several years and, as far as I can remember, has never before spoken about a dream.
“Well,” I respond, “the dream obviously affected you, so maybe you can talk about your feelings and what those feelings bring to mind.”
“You’re charging your phone,” he says.
“Yes,” I say, surprised. It’s not unusual for me to charge my cell phone while patients are in the office.
“How do I know you’re not recording me?”
Justin can sometimes be a bit paranoid, but his question is beyond anything I would expect. “I guess you are feeling frightened, Justin. Your world suddenly feels very unsafe so even innocuous things can feel threatening."

"You didn’t answer my question.”
I’m taken aback, perhaps even a little frightened myself. Hmm, I imagine Justin is unconsciously inducing his feelings in me. “No, I’m not recording you. You’ve seen me charge my phone before, so I’m assuming that your concern is being triggered by your fear.”
Justin stares at me. My fear builds.
“Would you like me to unplug my phone?” I ask.
“I’d like you to turn it off,” he replies woodenly.
“Okay,” I say as I lean to my left, pick up my phone and turn it off.
The silence that ensues is deafening.

Finally, Justin drops his head in his hands, shakes his head and mumbles, “I’m sorry, I don’t know what’s wrong with me.
I breathe a sigh of relief. “So let’s see if we can figure out what’s going on, perhaps what triggered the dream, what might have led you to feel so frightened.”
“It’s such a terrible time of year. Tax time you know. Some days I’m working 5AM to 10PM at night. And everyone wants a piece of me. My ex-wife’s mad because I haven’t taken the kids. My older son says he needs money for college. My clients are driving me crazy. Everyone wants their taxes last week. I keep telling them it’s no big deal if we have to file an extension. But, no, that’s not good enough.”
“When you say everyone wants a piece of you, what comes to mind?”
“That’s it!” he says excitedly. “That’s what was happening in the dream. Everyone was pulling at my skin, like they were trying to rip me apart. I know there was more after that but …” He stops. “I think there was like a monster there. Maybe like a monster waiting to eat the pieces of me that they threw to it.”
I grimace internally. “That does sound terrifying.”
Silence.
After a few moments I ask, “What’s going on in your head?”
“I don’t know. I sort of feel I used to have that nightmare as a kid. A lot.”
“Any thoughts about it?”
Silence.
“I’m sorry,” he says after a few moments. “I suddenly felt frozen. Like I couldn’t move. And… I know this is ridiculous, but you seem menacing again.”     
“What is it that you’re afraid I’ll do?”
“I know this is crazy, but what jumped into my head was, eat me.”
“Like in the dream.”
He nods.
“Any thoughts?” I ask, although I have a pretty good idea of the answer.
He nods again. “Yeah, my mother. I used to say she loved me to death. But I guess I meant that literally. She wanted all of me. She didn’t want me to have anyone else in my life. She didn’t do that to my sisters, just me. They hated me, thought as the boy I got all of my mother. But I didn’t want all of her! And I sure didn’t want her to have all of me! Yuck! I feel beyond creeped out. I mean, I know we’ve talked about all this before, but having that dream made it so much more real.”
“The dream actually brought you back to the feelings you had as a child, the terror of being eaten, of being swallowed up.”
“Stop! I can’t deal with any more today.”
“Of course. Whatever feels comfortable for you.”
Justin looks at me with tears in his eyes. “I wish my mother could have been concerned about my comfort. And I’m sorry I thought you were recording me.”
“Nothing to apologize for. Totally understandable given what you were feeling.”

Friday, March 15, 2019

Guilt

“I feel so awful, I can’t believe that I had to disappoint my parents. I can’t believe I couldn’t handle college, that I had to come home. My parents have always been there for me, always wanted the best for and all I do is screw up.”
This is my first session with Tiffany, a slender, attractive young woman with blue eyes and long blonde hair. Her mother, sounding concerned, had called to make the appointment, saying that Tiffany was having difficulty at Duke and needed to come home.
“I hate myself!” Tiffany continues.
“Wow! That’s pretty strong. Can you say why you hate yourself?”
“All I’ve done is give my parents problems my whole life, even before I was born. My mother had to be in bed for two months before she had me! She’s a physician – so’s my father – she can’t just take two months off. But she had to because of me.”
“That hardly sounds like your fault, Tiffany. I assume it was some medical condition your mother had.”
“She never had that problem with my brother. My brother never gives them problems. He’s graduating from Yale and going on to medical school. Of course!”
Clearly hearing her sense of competition and failure in relationship to her brother, I decide, for the moment, to focus more on her current situation. “Can you tell me what was going on for you at college?”     
“All those science courses! I can’t handle them. I’m just not smart enough. I started crying at every little thing. And I think I pretty much stopped eating. And then I couldn’t even get myself out of bed to go to class. Especially Chemistry class.  I don’t understand it. It makes me feel stupider than I already feel.”
“Are there classes that you enjoy, that you do well in?”
“Oh yes,” she says, brightening. “I love anthropology and I’m…hmm…I’m a pretty good writer.”
“So you take science courses because…?”
“What do you mean? I have to take science courses to get into medical school.”
“And do you want to go to medical school?”
“I’ve always known I’d go to medical school.”
“That’s not the same thing as wanting to go.”
“Yes, I want to go to medical school. I put my parents through a lot when I was a kid. I got rheumatic fever and ended up in the hospital for quite a while. I could tell how scared they were.”
“You must have been pretty scared too.”
“I was, particularly when I was alone. But the doctors and nurses were great. And I kind of enjoyed watching all the machines and monitors. That’s the kind of doctor I want to be, a pediatrician, to help kids like me.”
“And do your parents want you to be a doctor?”
“Definitely. It’s like a given.”
“So what if it wasn’t a given? What if you could decide to do anything you wanted to do?”
“I’d go on archeological digs and write about them or even write made-up stuff about the digs, like mysteries. But that’s not at all practical. No way to make a living.”  
“Have you ever wondered, Tiffany, why you feel so guilty in relation to your parents?”
“I told you why, I’ve always given them problems.  Besides rheumatic fever I was a sickly kid. And I broke my arm doing gymnastics. They always had to worry about me.”
“It seems that a lot of the things you feel guilty about you had absolutely no control over, like your mother needing bed rest or your having rheumatic fever or breaking your arm.”
“I was fooling around on the bar, that’s how I broke my arm.”
“You sound determined to have things be your fault. Do you think, Tiffany, if you felt things weren’t your fault, you’d end up feeling powerless and scared?”
“I don’t know. I’m not sure I know what you mean.”
Too soon for that interpretation I tell myself. I decide to pursue a different path. “Do you ever feel angry at all the pressure you’re under?”
“Angry? I don’t think so. I feel mad at myself for not being able to keep up and, like I said, worrying my parents.”
“So, now that you’re home, do you think you’re going to be able to relax and take it easy for the rest of the semester?”
“Oh no. My parents are going to get me a chemistry tutor so I can go back to school more prepared.”
At this point I find myself feeling angry at Tiffany’s parents and wonder if I’m feeling Tiffany’s unacknowledged  anger. That could explain the tremendous guilt she feels – guilt for the anger she doesn’t even know she has. But those interpretations are also premature.  
“Our time is almost up for today. But I hope I’ll be able to get to know you more and I hope you’ll tell me more about your wishes and your dreams, even if they aren’t always practical.”
“I wish you could make me smarter.”

“I don’t know if I can do that, but perhaps I can help you to be more accepting of yourself.”


Friday, February 15, 2019

Being Checked Out

This is a first time I am seeing Maurice, a tall, thin, 22 year old African-American man. He looks uneasily around the room, settles himself in the chair across from me, still holding his phone and keys in his hands.
“How can I help you?” I ask.
“Dr. Hudson said I should come. He’s my English professor at the University. Says I have more potential than I show.”
“And do you agree with him?”
“About my potential, yeah, I do.” Pause. “But if you can help me, I don’t know.”
“Because…?”
“I don’t mean to be disrespectful, but you’re white. And you’re a lady.”
“You’re right. I am both white and a lady. And that makes you feel I couldn’t help you, couldn’t understand you?”
He nods.
“Well, we’d only know that as we got to know each other and, hopefully, learned to trust and respect each other.”
Silence.
Maurice sighs, shakes his head. “I don’t know. I don’t know if I can just do that, just start talking and hope that I can trust you.”
“Do you trust Dr. Hudson, since he’s the person who referred you to me?”
“I trust him as a teacher. I’m not telling him all kinds of shit about myself.”
“That’s true.”
Silence.
“You’re not trying to talk me into trusting you,” he says.
“I think that’s pretty hard to do. But I was about to ask what you thought might help you trust me enough to tell me about yourself.”
“I know shrinks don’t usually do this, but what if I ask the questions, ask you about yourself?”
“Well, I guess that would depend what the questions were. If you asked me to tell you about every person I ever dated and what our sex life was like, I’d probably want to know how that was relevant to your concerns about trusting me.”  
He laughs. “No, I wasn’t going to ask you that.” Pause. “Although now that you mention it, I did think of something kind of like that. Did you ever date a black man?”
I hesitate. “The answer happens to be yes, but I don’t think if the answer was no, that would mean you couldn’t trust me.”
“No. But, it’s a piece of information.” Pause. “Did you ever have a black friend?”
“Yes.”
“Did you ever live in the ghetto?”
“No.”
“Have you ever been inside a prison?”
“Yes.”
He looks surprised. “How come?”
“I worked as a group therapist in a men’s prison when I was in graduate school. I did my doctoral dissertation in that prison. I also worked in a forensic center and at a women’s prison.”  
Maurice nods his head. He places his phone and keys on the small table next to him.
I take those gestures as a sign I can take on my more traditional therapeutic role. “So I assume you or someone close to you has been in prison.”
“Yeah. Like all my brothers. I did a little time in juvie, but no hard time.”
“And you feel how about having been the only one of your brothers to avoid prison?”
“Bad. Lucky. Glad. Guilty. Like shit. Fortunate.”
“Lots of mixed feelings.”
“Yeah.”
“So can you tell me more about you?”
Silence.
“I can, but I wouldn’t want you to think that means I totally trust you.”
“Maurice, trust takes a long time to build. There’s no question, no hundred questions that you could ask me that would assure you that you can trust me. And besides, trust is a complicated word. What does trust mean to you?”
“First thing I thought, ‘That you’re not going to stab me in the back.’ And I guess I mean that both literally and figuratively.”
“I get it that young black men have to first be concerned for their lives. And after that, I guess you’re saying that you’re afraid I’ll somehow lure you in and then turn on you, betray you.”
Maurice nods. “I want to write. I think I have something to say. But I’m ignorant. I don’t know enough. I need to get my degree. So many of my people – both my family and black people in general – have sacrificed so much so that I can have this opportunity. I don’t want to let them down. I can’t let them down. But I can’t get out of my own way,” Maurice says with clenched teeth.
“Any idea why that is?”
Silence.
“I wish you were black. And I wish you were a man.”
“Well, I’m not,” I say shaking my head. “And it’s not like I have any black, male colleagues I can refer you to. So I guess you’ll have to decide if I’m good enough.”

“I like you, Doc. I guess that’s as good a place as any to start.”   

Friday, January 18, 2019

The Unexpected Affair

Judith is a tall, attractive 44 year old woman who carries herself as if she knows she will be noticed, clearly distinguished from those around her. Although she’s presently a stay at home Mom, today she is dressed as the lawyer she is, a perfectly fitting gray suit and black high heels.
“I’ve decided to have an affair,” she says matter-of-factly.
I’m startled. In the six or so months I’ve seen Judith, she talked about being dissatisfied in her marriage, but hadn’t mentioned the presence of another man.
“With whom?” I ask.
“I don’t know yet.”
Silence.
“I know,” she continues, “that’s a rather unusual way to go about it, but since my husband hardly gives me the time of day – I can’t even remember the last time we had sex or even had a real conversation  - I decided I might as well get my needs met elsewhere. I’m not going to leave him. The kids need their father and I need some male attention so, an affair’s the answer.”
During the course of my career I have seen many men and women who have been unfaithful to their partners with one or many other people.  I’ve always been comfortable talking with them about both their feelings and the meaning of these multiple relationships. But Judith’s cavalier manner, her impulsive decision, and her pronouncement to me without any apparent willingness to discuss her decision, is both off-putting and confusing.
“When did you make this decision? And how do you feel about it?”
“It feels like a good decision. Solves lots of problems. I guess I decided a couple of days ago. Hence my outfit today. I figure any time I’m out and about I need to be looking my best.”
“Did anything happen in the last couple of days? Anything happen since we last met?”
“No,” she replies flatly. “Nothing happened. Same old, same old, I guess that’s what happened.”    
“Do you plan to talk to your husband about your decision?”
“What!? Are you crazy? He’d divorce me in a minute.”
I knew she wouldn’t tell her husband. Why did I ask that question? Was I trying to make her feel guilty? Surprisingly, what Judith is contemplating does feel ‘wrong’ to me, it feels ‘wrong’ for a person in a committed relationship to decide in a calculated and apparently logical way to become involved with an unknown other person. I feel very differently if the person has an affair and wants to talk about it, understand it, and deal with the meaning it has for them. Hmm, I think. Her pronouncement felt as though she was throwing down a gauntlet. Perhaps that means her decision is about me, about our relationship. What was it we talked about in last week? Of course! She told me she read my book, the book in which I discuss both the intensely loving relationship I had with my late husband, as well as my strong emotional involvement with many of my patients.
“Judith, how did you feel about my book? I know we talked a little about it last week, but you seemed to skirt really looking at your feelings.”
“Now where are you going? I told you I thought you wrote very well and that the book was engaging.”
“But how did you feel about it? How did you feel about my relationship with my husband? About my relationship with my patients.”
She shrugs. “I guess I felt you were lucky. Here you had this shitty relationship with your father, but you found this adoring man to marry. I didn’t have that shitty a relationship with my father – not that he paid much attention to me, too focused on my mother – and I married a man who still doesn’t pay any attention to me.”

“So, perhaps you felt angry with me, that, in your words, I got lucky, while you got stuck.”
“Yeah, that’s about right.”
“So I came out ahead just as your mother came out ahead and that makes you doubly angry.”
“I hadn’t thought of that, but I guess that’s true.”
“So your ‘decision’ to have an affair is really based on your anger at both me and your mother for getting more than you, for leaving you feeling cheated.”
“You really don’t want me to have an affair, do you?”
“I think you’re saying I’m trying to keep you away from happiness, from your father.”
“That’s a bit too deep for me. I think you think having an affair is wrong.”
“I don’t necessarily think that having an affair is wrong. I think affairs have many meanings.  For you those meanings are clearly related to feelings about both your parents, that you bring into the present and into this room.”
“So you think I shouldn’t have an affair?”
“I think we should talk about it a lot more before you act.”
“I can’t promise that.”
“I understand. You don’t have to promise anything. You get to do what you do and we get to deal with it.”

“Okay. As long as that’s clear, I’ll see you next week.”