I Can't Stand It!

 “I can’t stand this anymore!” Karen shrieks. On my video screen I watch a usually attractive 35 year old woman grimace and pull at her hair. “When, when is it going to end?”

“I don’t know the answer to that, Karen. It’s a pandemic and the virus will do what it’s going to do.”

“But we can’t plan anything. We don’t know from one moment to the next what’s going to be happening. How many times have we gone back and forth from being in the office and back on video? I can’t stand it! I feel as though I’m going crazy.”

“The uncertainty is difficult for everyone, Karen. And I do understand that going back on video after a few weeks in the office is very disconcerting.”

“And then there’s your vacation! How could you leave in the middle of all this?! What if you got sick? What if you died? Would I even know? Would anyone tell me?”

“I understand your feeling angry with me for abandoning you.”

“But answer my question. Would anyone tell me if you died or would I just be wondering forever?”

“Yes, a colleague would contact you if I died. But I wonder if your worrying about my dying came from your feeling so unsafe without me. My absence has always been understandably frightening to you and certainly with Covid raising everyone’s anxiety, it’s easy to see how you’d fear losing me forever.”

“You mean like when I was a kid and my mother went away leaving me with my insane father?” Pause. “Yes, that was terrifying. It was always terrifying, even when she was there, but when she was gone that was really, really terrifying. I never knew what to expect. Truthfully, my mother was useless at preventing my father’s explosions, but it still felt a bit safer when she was there. He was so unpredictable. You just never knew what would set him off: a book left on the kitchen table, the dog barking, my clattering a dish. It was so scary. And I could never understand why she had to go away. What was so much more important than me?!”

“The pandemic replicates your childhood experience in so many ways: you never know what’s going to happen next and, just like your mother, even when I’m here I’m pretty ‘useless’ to change the reality of the pandemic, just like she couldn’t prevent your father’s explosions.”

“But why did you have to go away? She went away for business, although as a kid I never knew what that meant. She went away to see her parents, but I didn’t understand why she couldn’t take me with her. I guess my Dad would say we couldn’t afford it, but I didn’t understand that either.”

“I don’t think, Karen, anything your Mom told you about why she went away would have felt like a good enough reason to you and I’m sure that’s true of me as well. You’d always feel you weren’t important enough, that you were being left for something more important than you.”

“You’re not going to tell me, are you? You’re not going to tell me why you went away.”

“I don’t think the reason I went away would make any difference to you. As I said, it wouldn’t make you feel any less left or abandoned.”

“But it might make me feel like I mattered enough for you to tell me.”

“Did you have any thoughts, ideas of why I went away?”

“Well that’s an obvious therapist trick! I won’t play!”

“What I think is happening now is that you’re finding something to fight with me about, as opposed to us dealing with your anger about my leaving, and perhaps also the fear and sadness you felt underneath.”

“Why won’t you tell me?!”

“Because no matter what I say, I will have left you for someone or something else and it’s those feelings we need to deal with, not the specifics of where I went or why. Your mother told you why she went away and it never made a difference to you.”

“Tell me.”

I struggle to decide how to respond. I’m beginning to feel angry, which I know is also what Karen feels. I don’t think an endless power struggle between us will be helpful. And I also don’t think my telling her will change her feelings. I finally say, “I went to attend a friend’s special birthday.”

“You told me! I won!”

I’m startled.

“Yay!! You didn’t expect me to react like that. This was great. I feel powerful! And way less scared.”

“That’s true, Karen, that’s not how I expected you to react. You feel as though you won and therefore you’re no longer the scared child, but rather the powerful adult.”

“Yes.” Pause. “And you’re right, I still feel you put someone else above me. But it doesn’t hurt nearly as much.”

“There’s a lot to process here. We’ll have to continue next session.”

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.”

 

If You Loved Me

“I got a great idea after our last session,” 30 year old Melinda says enthusiastically.

I remain silent.

“You know how we’re always arguing about whether or not you care about me? Well, I figured out how you can prove it to me.”

Oh my, I think to myself. Whatever’s coming can’t be good.

“You can stop charging me for some period of time we agree on. That way I’d believe you cared about me and weren’t just in it for the money.”

I feel as though I’m going to be walking through a field full of land mines. Other than agreeing to Melinda’s request which I know I’m not going to do, whatever I say has the very likely potential of a large explosion. I’m also aware of feeling angry and put upon. Hmm, I think to myself, I bet at some level Melinda could have anticipated that would be my reaction. 

“When you came up with this idea, Melinda, how did you think I’d respond?”

“I don’t know. How should I know how you’d respond?”

“Well, we’ve worked together for about three years, you might have some thoughts about what I would or would not say or would or would not do.”

“You’re not going to do it, are you? You’re just stalling, playing games,” she says, her anger building. 

“Is that what you would have expected?” I ask.

Melinda crosses her arms over her chest and glares at me. “I’m not saying another work until you answer me directly.”

I sigh inwardly. Melinda and I have frequently found ourselves in these kinds of power struggles. I can refuse to say anything, at which point she will indeed not say another word until she storms out at the end of the session. Or I can submit to her demand that I answer her, which feels to me like an uncomfortable submission. Or perhaps, just perhaps, I can try and interpret what’s happening between us. Melinda’s mother died when she was nine, leaving her to be raised by her distant, authoritarian father, who she rebelled against while desperately wanting his love and approval. In her interaction with me, Melinda can take the role of her authoritarian father who tries to force me to be as she wants me to be. Or she can be the needy, demanding child who wants both to win her father’s love, while insuring that her mother will not abandon her.

“So I’m going to run a few assumptions by you and you can tell me what you think. First, I think you knew – if only unconsciously – that I would not agree to your request, that it would stretch the boundary of our relationship in a way that would not be acceptable to me. Second, the reason you find it so difficult to believe – and accept, I might add – my caring is that you felt abandoned by your mother and rejected and criticized by your father. It’s also easy for you to become your father in this room with me and just as you refused to bow to your father’s demands, at some level you know that I will not bow to your demands either.”

“It wasn’t a demand, it was a compromise, a negotiation.”

“I’m not sure about that Melinda. I think you came prepared to fight with me. And that’s probably the most interesting question. Why is it that you want to fight with me?”

“I don’t want to fight with you. I fight with you because you won’t give me what I want.”

“Which was exactly your relationship with your father.”

“I guess,” Melinda says reluctantly.

“But I think that as much as you say you want my caring, you often do things that prevents your getting exactly what you say you want, which leads me to wonder if you need to reject my caring.”

“That doesn’t make sense. Why would I do that? I think you’re just playing therapist tricks, trying to get away from your not caring about me.”

I choose to ignore Melinda’s last provocation. “Melinda, if you accepted my caring you would be saying that you were a person who deserved caring about. And if you allow that in, then you’re left with the realization that you are indeed loveable and that no matter what you did – or do – you couldn’t keep your mother from dying and you can’t keep your father from being a cold, critical person. And that leaves you feeling powerless and helpless and we know how awful those feelings are for you.”

“Is there any way you’d consider my suggestion?”

So much for interpretations, I think to myself. What I say is, “Now I know you know the answer to that question, so I guess you’re saying you’re mad at me.”

“Yeah. I think you should have to do something to prove your caring.”

“I guess we’ll continue talking about this next time.”   

Back From the Dead

“I don’t know what to do,” Cynthia says plaintively, pulling at her hair. “I saw Phyllis for so long and I was so devastated when she just left her practice. When she left me! I mean I knew she was really sick, that she was probably going to die. But you know, I’ve hardly been able to talk about anything else since I started seeing you. And then here she is, calling me on the phone, saying she’s better and wondering if I’d like to come back into treatment with her. What am I supposed to do?”

I’ve been seeing forty year old Cynthia for a little less than two months and, she’s right, she’s been able to talk about little else then her feeling of abandonment when her therapist became seriously ill and had to precipitously end her practice. Fear of abandonment has always plagued Cynthia, having it come to pass with her therapist of many years has left her anxious, angry and distraught.

“Do you have any sense of what you’d like to do, Cynthia?” I ask. 

Cynthia fidgets in her chair. She looks warily at me, takes a deep breath and says, “I don’t see how I can talk with you about this.”

“Because…?”

“Well, it’s like I have to decide between you and Phyllis.”

“You don’t have to take care of me, Cynthia. You need to figure out what’s best for you. I’d certainly understand if you decided to go back to seeing Phyllis. You’ve had years of a relationship with her. And I’d be happy to continue seeing you if that’s what you decide.”

“It still makes me uncomfortable. Like I’d hurt your feelings. But I’d hurt Phyllis’ feelings if I decide to stay with you. That feels really terrible.”

“Can you say what feels terrible about hurting each of us?”

“Phyllis almost died! I wouldn’t want to do anything more to hurt her.”

“I understand that, Cynthia, but you’ve been really angry with Phyllis and if you do decide to go back with her that’s one of the things you’re going to have to discuss.”

Cynthia shakes her head empathically. “I could never do that. I’d just have to pretend it was like before she left.”

“From what you’ve told me, Cynthia, Phyllis sounds like a good therapist. I’m sure she’d encourage you to talk about how you felt about both her leaving and her return.”

“I’d say I felt sad, but that I understood and that I was really glad she was back.”

“So you’re saying you’d go back into therapy with Phyllis and be dishonest?”

“What else could I do?” she wails. 

I feel myself becoming annoyed by Cynthia’s passivity, clearly remembering how angry Cynthia has been with Phyllis these past months. She’s felt guilty about her anger, but angry nonetheless. “I wonder if being dishonest with Phyllis would be a way of expressing your anger at her, of pulling back from her just as she did from you.”

“So you think I should go back to Phyllis and tell her I wish she’d died?”

I feel myself flinch, aware of the rage that exists in Cynthia barely below the surface. “First, I didn’t say that you should go back to Phyllis. I said I’d be happy to continue seeing you. Second, I think you’re really, really angry and that you’re afraid your anger can be deadly. Whether you can go back to Phyllis and deal with her with your anger is something you’ll have to decide. But one way or another I don’t think you’re going to be able to avoid dealing with it.”  

Suddenly a thought comes to me. “What did you tell Phyllis when you spoke with her on the phone?”

Cynthia hangs her head. “I told her I’d see her next Monday,” she mumbles, barely audible.

“So has this session been a charade, Cynthia? Had you already made up your mind and only pretended to be unsure?”

“I thought it would be less hurtful,” she says avoiding my eyes. 

“I think, Cynthia, it will be very important for you to work on why you think deception is less hurtful than honesty, but in order to do that you’re going to need to be honest.”

“Are you mad at me?”

After talking about honesty I feel obliged to respond truthfully. “Yes, Cynthia, I’m mad at you for presenting a charade this session, rather than coming in and telling me what you decided and allowing us time to say good-bye.”

“I’m sorry,” she says quietly.

“I’m sorry too. But I want you to know that anger doesn’t have to be destructive and that I wish you the very best.”

Return

Emma is uncharacteristically late for her first session after my vacation. Usually a psychologically aware woman, she has now spent 20 minutes talking about the plans for her daughter’s high school graduation party, chatting about the guest list and the menu.

I interrupt her. “How did you feel coming today?” I ask.

“Oh,” she says. “Well, I didn’t want to come. I did very well in your absence. In fact, I was thinking that this should be our last session.”

I groan inwardly. I have seen Emma for four years and there is no question she has come a long way – more able to stand up for herself, more self-confident, less intimidated by her husband. But she is a patient who has been in therapy with several therapists over the years, a patient who knows that her more long-standing issues of desire for and fear of intimacy remain stubbornly unchanged. In fact, she is enacting that issue at this moment – feeling abandoned during my vacation she has closed off the needy part of herself and now seeks to reject me just as she felt rejected.

And, it’s worked. I do feel rejected. I feel hurt that she should want to leave me, hurt that she could discard me so easily after the relationship we’ve built up over time. And whose feelings are these?  Always a complicated question. Yes, I do believe that she is rejecting me just as she felt rejected by me and, earlier in her life, by a too-busy, self-involved mother. But I have my feelings too. I do go on vacation. I do have my own life. But my patients matter to me. I care about them. Besides, I don’t like good-byes. 

“So why do you think you would decide this today?” I ask.

“I told you. I did very well in your absence.”

“I’m sure you did. You’ve never been someone who can’t function without me. But you know yourself well enough to question what affect my vacation would have had on this sudden decision.”

“I knew you’d bring that up,” she says, sighing theatrically.

I remain silent.

“What?” she says.

I gesture with my hand for her to continue.

“Why is it that everything I do gets to be analyzed while nothing you do gets put on the table?”

Surprised by her question, I ask, “What don’t I put on the table?”

“Like how do you just get to go on vacation, entirely arbitrarily? You get to decide when you go, for how long, and regardless of what’s happening in my life or any of your patients’. You’ve always telling me I cut myself off from my feelings, well it seems you’d have to cut yourself from your feelings as well.”

Alternate responses flit through my mind. I could pursue her anger which is quite apparent and might well be fruitful. But I worry she would experience that as evasive and defensive. Or I could respond directly to the issue she raised.

“You make a good point, Emma,” I say thoughtfully. “I am the one who arbitrarily decides when I go on vacation and I do put my patients’ lives aside during that time – I put your life aside, just as you often experienced your mother doing. But it doesn’t mean I stop caring about you and it certainly doesn’t mean I feel closed off to you when I return. Quite the contrary, I’m eager to hear about you and what’s been going on in your life and in your mind. And just as you feel hurt and discarded when I go on vacation, I feel hurt and discarded when you announce that you’re unilaterally going to end our four year relationship in one session.”

“You do?” Emma asks incredulously.

“I’m sorry that surprise you so much, Emma. It’s so hard for you to take in my caring. I suspect you’re afraid that if you acknowledge you’re loveable, you’d have to give up hope that your mother would ever love you as you needed and wanted to be loved.”       

Emma’s eyes fill with tears. “This might sound silly, but right that moment when you said that, I felt my heart melt, like something opened in me; something opened, but something made me very sad too.”

“So maybe right at that moment you did feel my caring, but also felt the sadness of your mother’s inability to cherish you as the loveable child you were and are.”

The Mask

Elaine, burying her head in her hands, begins sobbing as soon as she sits down. Struggling to speak she says, “Baxter has cancer. That’s why he hasn’t been eating. I may have to put him down. I can’t believe I’m carrying on like this! I didn’t even shed a tear when my grandparents died.”

Sadness floods me as I feel for both Elaine and myself, thinking immediately of Pippin, the regal black and white cat my late husband and I adopted shortly after we moved to Florida. Putting her down two years after my husband’s death was beyond painful.  “I’m so sorry, Elaine, I know how attached you are to Baxter, how much he’s meant to you.” 

“And this is supposed to be good? Feeling like a wreck, feeling like my heart will break?” she says sarcastically.

I know what Elaine is referring to. I remember when she first walked into my office four years ago. Although attractive with tasteful make-up, Elaine looked like a doll, her face mask-like. Her mother died when she was three, her father when she was seven. She lived with her step-mother until their conflicts became unbearable, then moved to her paternal grandparents, who saw her as an unavoidable inconvenience. Listening to Elaine’s story I felt overwhelmed by sadness, while Elaine seemed devoid of feeling. 

Elaine came into therapy because she couldn’t maintain a relationship. She had no difficulty finding men but the relationships never lasted. The men said she was unconnected, unavailable, that there was no passion. Sex wasn’t the problem, it was something else, but she didn’t know what. I suspected I knew. It’s impossible to connect to a doll. Our job would be getting behind the mask. It wouldn’t be easy. She had spent years fending off the pain of all her losses. The mask would have to be peeled off slowly.

“I have no memory of my mother or my father,” she told me. “Just pictures I’ve seen and what my step-mother was willing to tell me, which wasn’t much since she preferred not to talk to me. Of course my grandparents didn’t like to talk to me much either. Besides, they were old, they didn’t want to be reminded of their son’s death. I can imagine that would be painful for them.”

“And you don’t think it would be painful for a three year old, for a six year old?”

“I can’t feel what I can’t remember.”

Finding Elaine’s memories would be crucial to her growth. 

While we focused mostly on Elaine’s difficulties with relationships in both her personal and professional life, over the years I asked questions about the past: “Do you remember your first day of school? Who took you? Do you have an image of the house you lived in with your father? Do you remember moving from your step-mother’s to your grandparent’s? Did you have to change schools? Leave friends?”

One session when Elaine came in she looked different. There was a crack in the mask. “I had a dream,” she began. “There was a child standing in an empty field. She was holding someone’s hand, a man’s. They were looking down. When I woke up I felt incredibly sad. I didn’t think the child was me. But then I wondered if it was me with my father standing at my mother’s grave. Could I possibly remember that? I was only three.”  

“Let’s stay with your feeling, Elaine,” I say softly. “What is it like to feel that sadness? What does it bring up for you?” 

“I don’t know,” she says starting to cry. “I guess I’m sad for that little girl. Standing by her mother’s grave, not knowing that in three more years her father will be dead too. It’s really awful. I guess I never thought of it like that. I guess I never thought about it at all.”

“You didn’t want to think of it, Elaine. You didn’t want to deal with your pent up sadness. But today you’ve taken a big step forward.”

Two years separates the session of Elaine’s dream and her telling me she might need to put down Baxter.   

Returning to the present session I say, “I know you’re feeling tremendous pain, Elaine, not only for your beloved Baxter, but for all the losses you’ve endured in your life.”

She sobs. “Please tell me this pain is worth it.”

“It’s worth it, Elaine. If you can’t allow yourself to feel your sadness, you can’t feel joy either and, most importantly, you can’t be truly alive.” 

Unconnected

“I just ended another relationship,” says Brittany settling herself into my chair for the first time. She’s an attractive enough woman probably in her early 40s, simply dressed in black pants and a gray sweater. She didn’t smile when I greeted her in the waiting room, just extended her hand.  Her eyes didn’t smile either. She continues.

“I told myself I’d give it a year and I did. We got together last New Year’s Eve and I broke up with him this January 1. He was a nice enough man. But I can’t do it. I can’t be in a relationship. It’s like torture to me.”

Torture, I think to myself. What a strong word.

“I know it’s not normal,” Brittany continues. “That’s why I promised myself I’d go into therapy if I couldn’t handle this relationship. I’ve been in therapy several times, but maybe I’m more ready now. I certainly know this is my problem. Way too many relationships to think it’s the men’s fault. I don’t usually last a year, but that’s what I said I’d do, so I did.”

Questions swirl through my mind: What makes a relationship feel like torture? Do you feel smothered? Are you so terrified of loss that you can’t allow yourself to connect? Did your relationship with your previous therapists feel like torture also? Will you need to escape our relationship as well? I decide on a far more innocuous statement.

“Sounds like when you make up your mind to do something you certainly follow through.”

Brittany’s mouth forms an almost-smile, while her eyes brighten slightly eyes as well. “That’s definitely not my problem. If I decide to do something, I do it. I wouldn’t be where I am today if it weren’t for my determination. I own a chain of yogurt stores and am about to start franchising nationwide. Not bad for an abandoned orphan left by the side of the road.”

“Literally?” I ask, surprised. 

“I’m exaggerating about that side of the road bit, but my parents were a piece of work. They were both drug addicts and definitely didn’t know what to do with a baby. At some point they just left me. Social services got involved and I went from one foster home to another until I was 10 when one family finally kept me until I was 16. Then I got myself declared an emancipated minor and went off on my own. And the rest is history.”

“That’s an amazing story, Brittany. A really sad story, but you tell it with no feeling at all.”

“I’ve repeated it a million times.”

“But you still must have feelings about it. About your parents abandoning you, about your going from one home to another, about the family you lived with for six years.”

“They were good-enough people. The family I lived with for six years. But it was the same problem. They wanted something from me I couldn’t give them. They wanted me to love them, to be a part of their family, to remember birthdays and care about Christmas. I don’t have it in me.”

The room feels heavy, steeped in despair, although I suspect I am the only one who feels it. Brittany is removed, protected by a suit of armor she constructed early on to shield her from repeated abandonment and neglect. How could she ever allow herself to care for another person who would likely, yet again, toss her aside? “Left on the side of the road.” That is her metaphor for her life. Brittany cannot allow herself to get any inkling of the scared, vulnerable, needy child who exists inside her. Instead, she prides herself on her truly amazing success, unaware of her underlying hunger for human connection. 

“How do you feel about not having it in you?” I ask.

She shrugs. “I know there’s something missing in me. And when I look around and see people, I can tell that relationships add something to their lives. So I guess I’d like to find out what’s missing.”

“I suspect, Brittany, that it’s not so much that something is missing, but that you’ve buried your hurt, neglected childhood feelings deep inside you and that when a potentially close relationship threatens to expose those feelings, you feel you’re being emotionally tortured. Then you bury the feelings even deeper and run away. It’s as though you’re saying, ‘I don’t need anyone and no one can hurt me ever again.’”

“I get the wanting no one to hurt me again, but I don’t know about my being afraid of needing anyone. I don’t think I do need anyone. That’s the problem.” 

“Well, I guess that’s something we’ll find out as we go forward,” I say optimistically. In my mind I add, assuming I’m able to keep you in therapy.

In Motion

“Sorry I’m late,” Ryan says, lowering his tall, broad, smartly dressed body into my chair.

So what else is new, I think to myself, aware of the annoyance and sarcasm in my thought.

“The real estate market is really picking up. It’s great. But the customers are keeping me hopping. Have to be there when they want or the sales go elsewhere.” 

I remain silent.

“OK, so let me switch gears. What’s been going on? Well, Charlene is starting to drive me crazy. I think I’m going to have to break up with her. The sex is still great and she’s funny, but she’s so needy. I mean, I don’t mind sending her a quick text during the day, but I can’t be stopping to have some intense conversation. And just because I don’t have a 9 to 5 job, doesn’t mean I can see her whenever she wants. It’s not like that. My time isn’t my own. I have to be available to my customers.”

“Kind of like what you said to me about being late.”

“Yeah! Exactly! And you get it.”

“What is it that you think I get?”

“That I can’t help it. That I have to be available to my clients.”

Varying thoughts flood my mind. Lateness and commitment are big issues for Ryan. He came into treatment two years after his divorce saying that he was having difficulty keeping a relationship. At that point he was despondent, dejected, wondering what he was doing wrong. But he’s now lost himself in a flurry of activity, moving away from self-reflection, just as he moves away from commitment. 

Lateness can also be an issue for me, although my years of doing treatment have diminished its affect. Still, there’s the scared, abandoned little girl in me waiting in the darkened school for my almost always late mother to pick me up. But Ryan’s lateness has a more dismissive quality, like he’s saying “you’re not worth my time.” 

“You do get it, don’t you?” Ryan say, interrupting my thoughts.

“I think lateness and time and commitment is a far more complicated issue for you Ryan.”

“You don’t get it! You think I do it on purpose. Hey, I have to make a living! Remember all that child support I have to pay?”

“Can you say what your anger is about right now, Ryan?”

“Who says I’m angry?”

I feel a flash of annoyance and then, probably drawing on my own childhood experience, I feel sad for Ryan. It’s time to rein him in, to bring him back from his frantic busyness and avoidance. “I wonder if not feeling understood by me makes you feel alone and rejected,” I say.

“Whoa! That feels like a leap!”

“Ryan, let’s slow down here. You came into treatment feeling discouraged with the quality of your life, your relationships. But then you got yourself into a whirlwind – yes I know you have to make a living and that the real estate market is picking up – but I also think you’re trying to avoid yourself and your feelings and me and Charlene as well.”

He stares out the window. “It’s getting darker out there. Looks like it’s going to rain.”

“Sounds like that’s how you feel. If you stop for a minute, you can feel the darkness, the sadness come over you.”

“So what am I so sad about?”

“What are your thoughts?”

“My failed marriage. My not getting to see enough of my kids. I said I’d never get a divorce, never do to my kids what my parents did to me. Split between two homes, neither one having enough time for me, neither one knowing if I was going to school, doing my homework. It felt as though they didn’t give a shit. They probably did, but they were too busy trying to make ends meet.”

“It’s interesting, Ryan, when you just said it felt as though they didn’t give a shit, that’s exactly how it feels to me when you come in here and toss off a ‘sorry I’m late.’ It feels as though you don’t give a shit. So you’re behaving towards me as your parents behaved towards you and allowing me to feel what it felt like to be the kid you.”

“Wow! That’s deep. I’m not sure I’m smart enough to create that scenario.”

“It’s not something that you decide to do or figure out consciously. You act it out automatically so that in your relationships someone is always being the rejecting parent and the other person feels like the rejected child.”  

“That would be a good reason for relationships not to work out.”

“Yes, that’s definitely true.”

“And what do I do about it?”

“First step is being aware of it. And we’ll definitely keep it in mind in our work here.” 

Ethical Dilemma

This is my third appointment with Brenda a slender, bubbly, curly-haired brunette who looks younger than her 45 years. She’s seen many therapists over the years, coming to me now because, “No matter what I do, I always find these losers. I think they’re Prince Charming in the beginning, but they turn out to be nothing but users.”   

It’s not a surprise that Brenda is attracted to men who are insufficiently giving. Abandoned by her biological father when she was an infant and reared by a reluctant single mother who was too busy struggling to survive to give Brenda much attention, Brenda chooses rejecting, self-involved men in an unconscious attempt to win in the present that which she was unable to win in the past, namely warm, loving parents.   

Brenda, who has quickly formed an attachment to me, seems especially upbeat as she enters my office. “I think I found him. I think I found the perfect guy.”

Oh, oh, I think to myself.

“He’s good looking, has a great job, seems warm, related, genuine. I think this is the one.”

I remain silent.

“You’re not saying anything.”

“Well, you’ve told me you often feel this way about men in the beginning, so I’m just listening, waiting to see what else you have to say.”

Brenda sighs. “I know. It does seem like my old pattern, falling for a guy in an instance and then finding out all these not so great things about him. But I already know the problem with Tom, he told me right away. He’s married.”

I want to groan; I want to roll my eyes. Instead I respond in acceptable therapeutic mode, “Well, that certainly fits your pattern for unavailable men.”

“Yes, but he has a horrible marriage and he’s leaving his wife.”

I say nothing.

“You don’t believe him.”

“Obviously I have no way of knowing whether to believe him or not. The more important question is if you believe him.”

“Tom’s a pilot. He and his wife married right out of high school, they had kids right away – the kids are grown now – and she hasn’t done anything with her life. He wanted her to pursue some career. He says she’s very bright, but all she does is sit at home and watch TV and he’s just not attracted to her any more.”

I feel sick. And blindsided. And at a loss at what to do. I know, without doubt, that Tom’s wife Natalie is my patient, someone I have seen for a number of years. What do I do? I can’t tell Brenda Natalie’s my patient. That would be a total breach of confidentiality. Previous situations flit through my mind: Two of my patients met in my waiting room and began dating each other. I reluctantly continued to see both of them. Both treatments became far more complicated, but there was no issue about secrecy.  Or the time a graduate student began treatment with me, one of her problems being dealing with her thesis advisor who, coincidentally, was also my patient. There again I couldn’t tell her her advisor was my patient so I saw both of them. It was uncomfortable at times, but not impossible. Or the time I unknowingly ended up seeing two friends who had a falling out and spent many sessions complaining about and belittling each other. Again, not the best way to do treatment, but not unmanageable.

But this situation feels impossible. To continue to see Brenda would be a betrayal of Natalie. In fact, even if Brenda leaves I’ll now have a secret from Natalie, never a good place to be with a patient. In addition, I cannot imagine myself remaining neutral regarding Brenda’s relationship with Tom. No, I have to end Brenda’s treatment. But this too is complicated. I can’t tell Brenda the reason without violating Natalie’s confidentiality. And no matter what I say, Brenda will experience my stopping the treatment as yet another in the long line of rejections and abandonments. But I see no other way.

“Brenda,” I say, “I’m really, really sorry and I know that this is going to make absolutely no sense to you, but I’m not going to be able to treat you.”

“What?” she shrieks.

“I know. I’m sorry. It has nothing to do with you, nothing to do with who you are as a person, although I’m sure that it will feel extremely hurtful and rejecting, but I can’t continue to see you. I’ll definitely refer you to some other good people and, again, I do appreciate how sudden and abrupt this is…”

“Is Tom your patient? No, it’s his wife. His wife is your patient, isn’t she?”

“You know I can’t answer that Brenda, just like I couldn’t answer that if someone asked me if you were my patient.”

“I know that’s it. I’ll ask Tom. I bet he’ll know.”

“Can you tell me how you feel about our ending like this, Brenda?”

“Shitty. It feels really shitty!”

“I’m sure it does. And, again, I apologize. I will give you some other names and I would recommend that you call as soon as possible so that you can deal with this rejection as well.”

 I feel awful – guilty, bad, incompetent, confused. Was there a better way to deal with this ethical dilemma?  Perhaps. But I can’t think of one.