Inside/Outside

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.”   

Friday, January 4, 2019

Diminished

“I hope you had a better New Year than me,” Jeff says with a bitter edge as he settles into the chair across from me.
“I thought you were really looking forward to spending New Year’s with Eileen.”
“Yeah, me too. She broke up with me.”
“Oh, I’m sorry. You thought this relationship had real potential.”
“Them’s the breaks. I don’t seem to be able to find anyone since my divorce. Sometimes I wonder if I should have stayed with my ex, but I know we were both totally miserable.”
Forty-two year old Jeff is a good looking man with blonde curly hair, a dimple in his chin and intense blue eyes. He has, however, had little success in establishing a new relationship.
“Did Eileen say why she broke up with you?”
“Something about my being too sarcastic or too needy or some stuff like that.”
Silence.
“I guess you want to know what I think about what she said to me.”
“Jeff, your tone is pretty biting today. Are you angry with me?”
“I guess.”
Silence.
“I’ve been reading your blogs. And I was wondering why you never write about me. What makes the patients you write about more interesting than me?”
“Before I address that question directly, I’d like to look at the feelings that were brought up for you.”
“Makes me feel like I’m not as good as your other patients, not as important, not as interesting.”
“Sounds pretty much how you felt in relation to your two older brothers.”
“That’s for sure,” he says, smirking. “I was the pretty one, but not a girl. And my brothers had the smarts and the artistic talent which was way more important than looks in my family.”
“So you feel less than.”
“Yup! Guess you could say that.”
“And the fact that you’ve built a thriving accounting firm doesn’t undue the messages of ‘less than’ that you took in as a child.”
“Right again!” Pause. “I’m just a numbers man, not an intellectual, not an artist.”
“And the worse you feel about yourself, the angrier you are at the other – me, Eileen, whoever – for, in your eyes, not being valued.”
“So you’re saying Eileen was right about me. That’s great, real support, and from my therapist no less!”
“I don’t know if Eileen was right about you or not. What I do know is that when you feel diminished, less than, you’re so hurt by those feelings that you lash out and that doesn’t serve you well.”
“So why haven’t you written about me?”
Although Jeff’s demandingness makes me want to withhold from him, I feel it is more important to respond to his question and then deal with his reaction to what I have to say. “I don’t know, Jeff, how many of my blogs you read, but every so often I explain that the ‘patients’ in my blogs are fictionalized. I’m real – as real as I can imagine myself to be in a made up situation with a fictionalized patient. Otherwise I’d be concerned about patient confidentiality.”
“You’re kidding me?! Now I feel like a real ass. Competing with imaginary people! You must have been laughing your head off at me.”
“Not at all. This has been a very important session. We could see right in front of us how hurt you feel when you feel devalued and how quick you are to attack the person you experience as diminishing you. It clearly comes from how you felt as a child, but we need to work on helping you not to automatically assume that you are being devalued and, even if you are, not to bring to the current situation all the rage you felt as a child.”
“You know, I don’t even remember being enraged as a child.”
“Well, you might not have been allowed to show it.”
“That’s for sure. No one did anger in my family. We talked about issues like ‘civilized’ people. Anger was off the table.”
“So you’re probably sitting on years and years of anger.”
“You mean like when my mother would make me draw and draw and draw, despite the fact that I had no talent and that she would sit there criticizing everything I produced?”
“Yes, like that. I’m sure that made you plenty angry.”
“Holy shit! You know what I just realized. If the patients in your blogs are fictionalized, that means you’re one of those creative people. Does that make me feel less than? Yes, it does. But for whatever reason, right now that actually makes me feel more sad than angry. I guess I feel sad for the kid whose talents weren’t recognized and only found lacking for what he wasn’t.”

“That’s great, Jeff. I’m really glad you’re able to feel compassion for yourself as that child. That awareness will serve you well.”