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