Inside/Outside

Friday, September 10, 2021

An Apology

An Apology


“I’ve been depressed since our session this past Monday,” Paula begins. “I’m not exactly sure why.” Pause. “I guess it’s because we were talking about my mother’s death – for a change – and that always makes me depressed. It’s been almost 20 years for God’s sake, I don’t see why I can’t let it go.”


“I know you get depressed when we talk about your mother’s death, Paula, but I thought about our last session too. I feel as though I was pushing you too hard and I want to apologize for that.”

“That’s what you get to do. If you didn’t push me, I’d be even more stuck than I am already.”

“I don’t know. You were talking about your guilt about your mother’s death and although it’s true that from my perspective you have nothing to feel guilty about, what matters is your perspective. I don’t think I gave you enough of a chance to talk about your feelings, including your guilt feelings.”

“My mother died of cancer. I get that I was a teen-ager, more preoccupied with my own life. But I could have gone to the hospital more. I could have spent more time with her. I could have just sat holding her hand.” Pause. “Besides, why would I get depressed if you were pushing me to not feel guilty? You’d think I’d appreciate it.”


“Well, what is one of the big problems you had with your mother even before she got sick?”

“She was always in my face, always on top of me, telling me what to do, telling me what I should think, what I should feel … Oh! I get it! You think you were being like my mother, intrusive like my mother”

“Yes.”

“Hmm. I guess that’s a good point.” Pause. “But I still don’t know why that would get me depressed.”

“Well, what did you feel when I was pushing you to not feel guilty”

“I don’t know if I felt it then or whether I’m feeling it now that we’re talking about it, but right now I guess I do feel, hey, isn’t this where I get to talk about my feelings? How come you’re not letting me feel what I feel?  I thought that’s what I get to do here!” Paula pauses. On my video screen I watch as she drops her head, her straight brown hair falling forward over her face. “I’m sorry,” she mumbles, “I didn’t mean to get annoyed.”


“Paula, what just happened? You seemed to go from a person expressing her feelings and her right to be heard, to what seemed to be a scared, apologetic little girl?”

“I felt guilty for being ang… annoyed at you.”

“So you can’t even say you’re angry at me.”

“I’m afraid to be angry at you.”

“Because?”

“I don’t know,” she says in a barely audible voice.

Silence.

“Your anger feels dangerous?” I ask.

She nods. “I was angry at my Mom and look what happened to her. It’s much better to keep it tucked safely away.”

“Except it’s never ‘safely away.’ It’s turned inward on yourself so that you end up feeling depressed.”

“So you’re saying I was depressed after last session because I was angry at you and turned it on myself, not because my mother died? That makes me sound even more selfish and self-centered!”

I feel the urge to argue against Paula’s interpretation of her depressed feelings and wonder if her way of being self-deprecating, tends to elicit a reassuring, albeit intrusive, response from me. Do I feel a similar pull with other patients? Does Paula unconsciously set up this dynamic?” I’ll have to think about all that, but right now I need to respond to Paula.

“I think you can be depressed for more than one reason, but it sounds as though you’re saying you should feel depressed about your mother’s death.”

“Yes, of course I should feel depressed about my mother’s death. She’s dead!”

“You can certainly feel sad about your mother’s death, but I don’t know that carrying depression around as a heavy weight that burdens all aspects of your life is at all helpful.”

Paula sighs. “I guess after almost 20 years I should be able to cut myself some slack.”

I nod, smiling.

“But why is that so difficult for me?”

“I guess because you still feel the need to punish yourself.”

“I think you’re right.” Pause. “But what can I do about that?”

“I guess we’ll need to talk more about why you can’t forgive yourself for what you see as your adolescent ‘sins.’”



Friday, August 13, 2021

Good-bye Again

 Although it is not my norm, today I begin Laurie’s session. “I need to tell you, Laurie, that starting next week I’m going back to working from home.”

“What?!” she shrieks. “You’ve got to be shitting me! We just came back to your office! You know how much I need to see you. You can’t do this to me. You can’t, you can’t,” she says sobbing, her face buried in her hands.


“I knew this would be very difficult for you, Laurie, but you know how Covid cases are tearing through Florida. I can’t risk your health, mine or anyone else’s.”

“I hate you! I hate you!! You’re like a big tease. ‘Here I am and now I’m gone!’ I can never rely on you. I can’t rely on you any more than I could rely on anyone else.”

Although I know it’s very unlikely to help Laurie to feel better, I feel compelled to say, “Remember when you felt just seeing me once would be reassuring to you, would convince you that I was indeed alive and not a figure of your imaginings.”

Laurie looks at me scornfully. “You’re joking, right? What does it matter what I was feeling then? This is now and I feel like crap and it’s your fault.” Pause. “What if we wore masks?”

“You know the answer to that, Laurie. I wouldn’t be able to hear you and it’s impossible to do therapy if I can’t hear you. We can do therapy without seeing each other, but it’s impossible to do therapy without hearing each other.”

“So there’s no compromise?”

“I don’t know if it’s a compromise, but you now know that we will see each other at some point, we will be back in the office as soon as it’s safe.”

“As soon as YOU say it’s safe!”

“Yes, that’s true. It is my call. And that is part of what I do, Laurie, keep us both as safe as possible.”


“You’re talking about my mother, right?”

“Yes. She didn’t keep you as the six-year-old child safe when she killed herself and she certainly wasn’t keeping herself safe.”

“But I don’t see how that helps me now!”

“Well, I may be mistaken, but it seems to be that you are feeling a little calmer right this minute.”

“I’m feeling depressed. I’m feeling I have to deal with yet another loss, the loss of you. Makes me very sad.”

“Do you feel depressed or sad?”

“You always ask me that. I can never tell the difference.”

“Depression is more a feeling of numbness, of nothingness. And it’s often a result of anger turned inward, like turning your anger at me in on yourself. Sadness is more acute, more intense and is often about mourning.”

“I’m feeling both. I don’t want to be angry at you. It scares me. What if I’m angry at you and then you get Covid? I’d feel horrible, guilty. I wouldn’t want that to be the last thing you remembered of me. But I also feel this huge loss. I know, you’ll say I’m still mourning my mother, and maybe I am. But it’s also about you. I need you so much and it is so good to see you in person and it just feels like this huge emptiness, again.”

“I do understand, Laurie. It’s a loss for me too. It’s been wonderful seeing you in person, actually having you as a real, live person in my office. But it’s not forever, unlike with your mother.”

“I wish you wouldn’t keep bringing her up.”

“Because…?”

“Well, what first jumped in my head, is that it feels like you’re trying to pass the buck, trying to get me to talk about her rather than you.”

“That’s a really good point, Laurie. Maybe you’re right. Maybe I also was trying to move away from the sadness between us.”


“Really! Wow, I’m surprised. I’m surprised that you’d feel that and, truthfully, surprised that you’d admit it.”

I smile. “Therapy is a place I get to be truthful too, it’s a place I get to reflect on myself just as you do.”

Tears fall down Laurie’s cheeks. “You see, that’s why I love you so much, that’s why I miss you, you’re such an amazing special person. There’s no one in the whole world like you.”

“Remember how much you hated me at the beginning of the session? I’m neither a horrible, evil person nor a saintly one. I’m both. And it’s important that you try and hold onto both parts of me.”

“But now I have to say good-bye again and that makes me really, really sad.”

“Yes, it is sad, but we’ll talk to each other next week and we’ll both be very much real and alive.”


Friday, July 16, 2021

Too Close

 

“I went out with Charles again last night,” Ashley begins. “You know the guy I met on Match who I’ve been out with a few times.”

“I remember,” I say, nodding at the computer screen. “You kind of liked him.”

“I guess, but he was a little too much last night.”

“Meaning?”


“I don’t know. Like he started telling me all about his childhood, which was pretty terrible. He was physically abused by his mother, like really bad. And he wanted to know all about me. I’m not sure I was ready for that.”

“What made you uncomfortable?”

“What if we don’t work out? Why should I tell him all about me? Does he really need to know that my mother died of cancer when I was four and that my father wanted nothing to do with me?”

“I’d say there would be no reason for him not to know.”

“I never understand why you feel I should be blabbing my whole life to anyone and everyone.”

“Well, if you’re not presenting who you are to people it’s kind of impossible to get close to them and it takes a lot of energy to be play acting through a large part of your life.”

“Aren’t you play acting? Isn’t being a therapist all play acting?”

“In what way?”

“You could be in terrible pain right now, physical or emotional, and you wouldn’t tell me about it, right?”

“That’s true. We do all have roles that we inhabit in our lives and…”

“See, I told you! So I’m no different than you or anyone else!”

“We all have roles that we inhabit. Being a therapist is one


role, just as being an attorney is another. And, no, in our professional roles we’re not telling everyone everything about us. You’re not going to be in front of a judge and say, “Your Honor I can’t try this case today because I had to put my dog down yesterday and I’m a total basket case. But yesterday, when you put your dog down – obviously I’m just using that as an example – would you have been able to call a friend and say I need to talk?”

“I don’t have a dog,” Ashley says matter-of-factly. “I don’t want a dog.” Pause. “Actually, dogs are kind of like that guy last night. They want too much. They’re always there, always begging. I guess you’ll say that’s my need to keep my distance.”

“Yes, I would. And there’s the question of why that distance feels so necessary for you.”

“It just popped in my head that we’re back in your office next week. I don’t like that idea either. This is much more convenient. I don’t have to drive to and from your office. I don’t have to waste time sitting in your waiting room. I just turn on my computer screen and here you are.”

“So I assume by bringing that up right now, you’re making the connection that returning to my office feels closer – literally and figuratively - than virtual therapy.”

“Right. And I’d prefer continuing just as we are.”

“So do you have any thoughts about what makes closeness so uncomfortable?”

“It’s messy. People are just so needy. They want so much. Just like a dog.”

“Are you needy, Ashley? Do you want so much?”

“Me? No way! I can take care of myself.”

“I think you learnt that early on. If there’s no one really there for you, you learn that you have to take care of yourself.”

“Right!”

“But there’s a problem with that, Ashley. When you were four years old you couldn’t take care of yourself. You were a helpless, dependent little girl who just lost the most important person in your life. That little girl is still inside you. She still wants and needs and longs for someone to care for her…”

“Ugh! That’s disgusting. I hope that’s not true. And if it is true I want her gone, poof! Like she never existed.”

“I wonder, Ashley, if that’s exactly the reason you didn’t like the man you saw last night and the reason you don’t want to return to in office visits and the reason you don’t want a dog, all of that brings you closer to that dependent, childhood part of yourself.”


“So what should I do about it?”

“Well, first we’ll resume in office visits and we’ll talk about how that feels for you. And when you’re with someone and feel the need to get away, maybe you can try to pay attention to what you’re really trying to get away from. I suspect it might be the needy part of yourself.”

“What if I just avoided people?”

“Well, what do you feel when you avoid people? What did you feel when we were locked down in the pandemic?”

“Lonely. Like something was missing.”

“I guess that’s your answer.”


Friday, June 11, 2021

On Vacation

“I’m sorry I’m late calling,” Mia begins. “Lots of little things came up just as I was supposed to call.” Pause. “Of course, I’m sure you don’t care, just gives you 10 more minutes to do whatever you do.”

Silence.

“Aren’t you going to say anything?”

“Sounds like you’re angry at me,” I respond.


“Why? Because I’m late calling? Why should I be angry with you? Are you feeling guilty about something?”

“So I assume you’re feeling angry because I’m not going to be here for two weeks.”

Silence.

“It’s so stupid!” Mia says angrily. “I can’t believe you’d be dumb enough to actually go somewhere and risk getting Covid. Even I’m not ready to start traveling and I’m probably 50 years younger than you! I don’t really know how old you are, but you’re certainly not young!”

I realize Mia is goading me but, at least on this occasion, I don’t feel pulled into her provocation. “It sounds as though you’re feeling scared about losing me,” I say softly.

“So is that supposed to be the great interpretation that makes everything all right? That makes me understand, makes me less angry, makes me more accepting?”


“Why do you think you’re so angry, Mia?”

“I told you! You’re being stupid! And I can’t afford to have a stupid therapist! And not only that, you’ve been my therapist for years and I assume you’ve been secretly stupid the whole time. Maybe I’d be a lot further along if you were smarter.”

“Don’t you think it’s interesting, Mia, that you’re choosing to focus on my being ‘stupid’?”

“Why? Because my mother always told me I was stupid? One thing has nothing to do with the other. She’d accuse me of being stupid because she wanted to put me down. She was a bitch! And when my Dad was out of town there was no stopping her. She hated me and couldn’t stand for me to ever accomplish anything.”

“And you feel how about that Mia?”

“Don’t change the topic!”

Beginning to feel annoyed I say, “I’m not changing the topic. I’m trying to get underneath your anger, whether that’s your anger at me or at your mother. We know that anger is your first line of defense but that underneath you have lots of other feelings – fear, sadness, longing.”

“So I suppose now you want me to cry?”

“Mia, stop a moment. It’s not going to help you if you feel only pissed at me when I’m gone. You know …”

“You’re not going yet, right? I still have a couple of weeks, right?”

“That sounded almost like panic. Yes, you’re right, I’m not going for a couple of weeks.”

“So I still have time to change your mind.”

“Mia, you’re not going to change my mind. I’m going on vacation. I’ll be gone for two weeks. You know I’m fully vaccinated and I’ll be fine. Which doesn’t mean you can’t feel angry about my leaving, although I wouldn’t want you to worry that your anger could magically kill me. You can also feel scared and abandoned and alone. Sometimes you may even feel you won’t survive without me. But you will. You’re not a little girl any more. And even though it may feel like it, I’m not your Dad abandoning you to the uncontrollable rage of your mother.”

“Are you sure?” Mia asks, plaintively. “Right, here I go, just what you wanted, whining like a baby.”

“Mia, tell me what you’re feeling right now.”

“It’s just that I’ve gotten used to your always being here. It’s been a while since you’ve been away. It scares me. What if I need you? What if something terrible happens? What if my Dad dies? What if I’m sure you died?”

“So my being away increases your fear of something bad happening.”

“Yes.” Pause. “I can tell myself rationally that’s not the case, but that’s not how it feels.” Pause. “I guess it must be like when my Dad went away. Bad things did happen. Sometimes awful things.” Pause. “But my Mom can’t hurt me like that anymore, right?”

“Right.”

“’Cause I’m not a little girl, right?”

“Right.”


“And we still have time to work on this before you leave?”

“That’s right. And if you remember, Mia, I did tell you that I’ll be covering myself this time when I’m on vacation so if you have an emergency you can reach me.”

“That’s right! I totally forgot!” Pause. “You don’t usually do that.”

“No, I don’t usually, but I’m doing it for exactly the reason you mentioned. I’ve been here and available to all my patients for over 18 months - an unusual stretch for me - so I thought it might be hard for people to go cold turkey. I figured covering myself in an emergency is a sort of in between step.”

“I guess you really do care,” Mia says with a catch in her throat. “Thank you.”

“My pleasure.”

 

Friday, May 7, 2021

A Dream

 “I’m so glad I’m talking with you today,” Rose stays, starting immediately. “I had this awful dream last night and it’s haunting me. The specifics are kind of vague at this point, but the feeling it left me with is very clear - horror. And it was like a horror movie or something out of a scary sci-fi movie, neither of which I ever watch. So it was like this force, not sure what the force was – people, aliens, I don’t know. I don’t know that I ever saw any particular thing or person, I guess that’s why I call it a force - that was going around and doing something to people so that they looked like their whole body had been burned and like instantly turned to ash and dissolved. Ugh! It makes me shudder just to think about it. And I guess I was going around trying to avoid this thing, but also to warn people, people I knew and cared about, that they were in danger. I think I had a better idea when I first woke up who some of those people were, but now I’d just be making it up. I keep shaking my head wanting that image of people dissolving into ash to go away.” She takes a breath. “So what do you think?”


“I can certainly understand how disturbing a dream it was,” I say, impressed with how Rose has managed to convey her horror so well over the telephone. “What are your thoughts?”

“I don’t know. I was watching this TV show that had a cancer patient in it last night and it struck me how he seemed to be being eaten up from the inside out.”

Silence.

“I just keep feeling the horror.”

“Where does that feeling take you?”

“The horror? I guess the horror of the pandemic, of how many people have died. Oh! I guess that could be the force, the unseen virus, killing all these millions of people.” Pause. “But I wonder why I’d have the dream now. Things do seem to be getting better, at least for us. I’m vaccinated, most of the people I love and care about are vaccinated. Why now?”

“You said you thought there were specific people you were trying to save. Even if you have to make it up, who do you think some or one of those people were?”

“My mother comes to mind. She’s been dead for over 10 years now. She had a long life, almost 100 and she was pretty good until the last few years. She was ready to go. That made it easier for me, although it was still hard losing her. Painful, but not horrifying.”

Silence.

“What are you thinking about?”

“First I was thinking about this article I read about how deaths to overdose have skyrocketed during the past year. That feels like another force taking over people, especially young people. But then I ended up


someplace entirely different. I was thinking of the horror of growing up in my house, of my parents screaming and screaming at each other, of us cowering in the corner waiting for my father to start beating up on my mother or turning on one of us. He was definitely a force to be reckoned with, although he was a specific person, a tangible force, not a sci-fi character.”

“Maybe that made him even more scary. You couldn’t just turn off the TV.”

“That would explain why I was trying to save my mother. I was always trying to save my mother and feeling awful that I couldn’t.” Pause. “But still, I don’t know why I’d be dreaming about this now. This is an old story. Why now?”

Silence.

“Any thoughts about people being turned to ash and dissolving?”

“Cremation. Lots of cremations during the pandemic.” Pause. “The Holocaust. That was certainly a force of evil. Hitler, the gas chambers. But it doesn’t seem to be about that either. It felt more contemporary, like right now.”

“All right. Right now, what’s horrifying you, scaring you, threatening you?”

“Aging. I turn 65 next month. I know that’s not old these days, but I worry about aging, about who will take care of me if I’m ill or incapacitated in some way. And I suppose death itself feels frightening, the unknown, the aloneness. Death is a pretty scary, menacing figure. You think that’s what the dream’s about?”


“It’s certainly possible. And it’s also possible that it’s about all the things you’ve talked about today.”

“I suppose.”

“What are you feeling now?”

“Definitely not as horrified. Talking about it made it less scary. I feel more removed from it, like it’s something to look at and to figure out.”


Friday, April 9, 2021

Endless Despair

 “I don’t understand,” Amber wails over the phone. “I was doing fine. I had a good day. I took my dog for a long walk. And then with one phone call I’m a wreck. I can’t stop crying. I feel as though I want to beat my head against the wall,” she says sobbing.

“Can you tell me what happened during the phone call?”

“Nothing! I mean nothing that would lead me to feel awful. I don’t understand. Why doesn’t it stop? Why do I always, always feel so awful?”


Having seen Amber for several years, I realize nothing I say at this point is likely to be of help. Still, I reply, “You don’t always feel awful. You were just telling me you were having a really good day.”

“But it always comes back! Why does it always come back?”

“Part of the problem for you is that when you feel awful, the feeling takes you over completely and you can’t remember that you felt really good yesterday or the day before.”

“But why does it always come back?”

“What’s the ‘it’ that always comes back?”

“The bad feelings. They always come back.”

“You know, that’s a really good question. Why do your bad feelings always come back? Like today, you said you didn’t think the phone call should have triggered your bad feelings, but it did. And perhaps I should ask what specifically you mean by bad feelings.”

“Sad feelings. Depression. Feeling everything’s pointless.”

“Okay. So why do your sad, depressed feelings always come back?”

“I don’t know!”

“Well, what did happen on the phone call?”

“My boss told me I did a really good job on the marketing project. She had a few minor corrections, but basically complimented me on a job well done.”

“And you felt how about that?”

“While I was on the phone with her I felt good, pleased. But then, I don’t know. It just washed over me and I felt like shit.”

“What washed over you?”

“Despair. Like what does it matter anyway. It’s just a stupid marketing job, for some stupid liquor company that’s just going to turn people into alcoholics.”


“Whose voice is that, Amber?”

“It’s mine.”

“Yes, but isn’t it also someone else’s voice? You’ve certainly told me that your mother was always critical of you, always telling you what a failure you were, how you couldn’t do anything right.”

She sighs. “Yup. That’s my mother.”

“So when you were talking to your boss you could take in your her voice, you could take in the compliment. But when you got off the phone, your mother’s voice returned with a vengeance.”

“I guess so.” Pause. “But why?”

“What are your thoughts?”

“I certainly heard her voice a lot longer. It’s louder, telling me how stupid I was and that I’d never amount to anything. And she still does. Why did I go into marketing? Why couldn’t at least have been a teacher? Why aren’t I married? Why am I such a bad daughter, etc., etc.”

“Yes, her voice is louder. And I also wonder if you’re invested in staying attached to your mother’s negative voice.”

“Why?”

“If you move away from your mother’s voice, maybe it’s like moving away from her, leaving her behind. And she is, after all, the only mother you ever had.”

Amber starts sobbing. “I can’t leave her. I can’t. I’d feel way too guilty.”

“Plus, if you take in more positive voices and leave your mother behind, you’d also have to mourn never having the mother you wanted or deserved, not as a child and not as an adult.”

Amber continues sobbing. “I can’t! I can’t! You can’t make me! Oh my God, I’m being swallowed up by those bad feelings again!”

“No, Amber, I can’t make you. I neither could nor would force you to do anything. But I think you can see how terrifying the thought is for you, the thought of moving away from your mother, of mourning who she isn’t and wasn’t.”

More sobbing. “But maybe she’s right. Maybe I am bad and stupid and incompetent, maybe that’s why she couldn’t be nice to me.”


Softly I say, “I understand that it feels safer to take the badness inside you, to take it away from your mother, so that as long as it’s inside you you can hold onto the hope that if only you were different she would treat you differently, would love you more.”

“Wouldn’t she?”

“Only you can answer that, Amber, but from what you’ve said, it sounds as though your mother was rejecting of you from the moment you were born, for her own reasons, stemming from her own problems, but extraordinarily destructive and painful for you.”

“I can’t. I just can’t.”

“I understand. You can only do what you can do. And we’ll keep working, working at a pace that you can tolerate, that isn’t unbearable to you.”