I Feel Okay

 

“I realized the oddest thing this week,” Anne begins, her voice fairly upbeat as she speaks into the telephone. “I’ve been feeling okay.”

“That’s terrific, Anne,” I say excitedly.

“Yeah, I’ve been talking to you for how many years? And this is probably the first time I’ve ever said I feel okay. I can’t figure out why. Nothing has changed. I’m stuck indoors like everyone else. Our Covid numbers are spiking, I’m as terrified as ever of getting the virus and yet I’m okay.”

Anne is correct. I have been speaking with her for a number of years and this is probably the first time she has not described herself as depressed, anxious and isolated. We began working in person when she relocated to Florida to take care of her aging and always demanding mother, a long and arduous process that called upon all the strength Anne could muster and all the support I could give. After her mother died, Anne returned to New York, saying it felt like home, although she had neither friends nor career to return to. She did, however, now have sufficient money to live comfortably whether or not she could find a career path commensurate with her intelligence and education, leaving behind her unsuccessful attempts in retail or restaurants.

“What are your thoughts?” I ask.

“I don’t know. I’ve done the same thing these past several weeks as I’ve done for months, or even years, and I feel strangely content. No despair, no pressure. Of course I haven’t had any pressure for a while, not since my Mom died.”

“Except for the pressure you put on yourself.”

“That’s true.” Pause. “I still feel I should figure out what to do with the rest of my life. I should be looking at various career possibilities, seeing what piques my interest. But I guess I know what the reality is with Covid. New York is decimated. There are thousands and thousands of people unemployed, stores are boarded up. No one is going to hire a 52 year old woman who has probably never held a job for more than a year. I also feel I should go back to my painting. I was pretty good at it. Why don’t I spend my very excessive amount of free time painting again? I should. But I don’t.”

“So you’re still putting pressure on yourself.”

“Yes” Pause. “And I do still hear your voice telling me I should be spending more time with people. But of course everyone is told not to spend time with people these days. But I know you’d still be telling me I should at least reach out to my sort-of friends by phone.”

“You still feel pressure from both yourself and me, but you feel different, calmer, less despairing.”

“Yes.”

“And you don’t feel isolated?”

“Everyone feels isolated.

“Maybe that’s comforting.”

“What’s comforting?”

“That everyone feels isolated.”

“That’s a good point. I don’t have to feel like such a freak.” Pause. “Yeah, that’s right. Usually this time of year would be the worst. Thanksgiving in November, Christmas and New Year’s in December. Everyone running around buying food and presents and looking forward to seeing family and friends. And then there’s me. Sitting at home stuffing myself with junk food and wondering if I should kill myself. But not this year, this year everyone’s in the same boat as me. I know they still have these ridiculous TV commercials with people sitting around a big table together or drinking themselves sick at parties, but now they look exactly like that – ridiculous. No one should be doing that this year. Everyone should be doing exactly what I’m doing, sitting home alone, no one else there. Yes, it’s a tremendous relief. That’s exactly why I feel okay.”

“Where do I fit in?” I ask.

“You’re my one exception. You’re here. But of course you’re not here. You’re thousands of miles away.”

“And that means what for you?”

“Actually makes me feel a little sad. But not too much, because I know even if you were next door we’d be meeting just as we are now, on the telephone. Yes, that makes me feel better immediately. So I guess that’s another thing Covid has done for me – made me feel less like a freak and made our distance feel less significance. No wonder I feel better.”

Anne may feel better, but I’m left feeling sad, both for the sadness she likely feels underneath her “better,” as well as for the isolation she wears as a protective shield, unable to breach the chasm between herself and others. Covid will eventually end and unless we are able to breach that chasm she will return to feeling like a freak, the forever outsider longing to be part of the lives she only imagines.  

Tag words: Psychotherapy, mental health, patient-therapist relationship, projective identification, isolation, sadness, despair, aloneness, Covid19.

Starting Therapy Remotely

“Hello,” I say to an attractive, dark-haired woman who appears before me on FaceTime. “I’m glad to meet you.” And so begins my first experience beginning therapy remotely.

I practice in Florida, one of the states that is seeing a sharp uptick in Covid-19. Although I have toyed with the idea of returning to in-office sessions, I continue to find myself reluctant to do so. During the initial phase of the pandemic, I turned away new referrals, uncomfortable starting treatment with anyone I could not meet at least once in person. But as my time away from the office continues, I decide I need to go beyond my comfort zone.

“Hi,” Jennifer replies. “This already feels weird. I’ve been in a lot of therapy, but obviously in person. I kept thinking I’d wait until I could go to your office, but who knows when that will be, and I’m having a really hard time.”

“It feels strange to me too,” I say, “But why don’t you tell me how I can help you.”

I watch her take a deep breath. “I’m 49, I’m alone, I’m terrified of the virus and I just found out that my ex-husband has lung cancer. And that he hasn’t told our daughter yet. I’m so anxious I can’t stand myself.”

“That is a lot.”

“I’ve always been afraid of being alone and now I’m alone all the time. I mean, I talk to my daughter, but she’s in New York and she’s had a really hard time so I don’t want to lay all my stuff on her. And I worry about how she’ll respond to the news about Greg, that’s my ex.”

“Lots of people have been struggling with their aloneness during the pandemic, can you talk about what it’s like for you.”

“I’ve always hated being alone, ever since I was a little girl. I was the kid who was afraid of monsters under the bed, always had to have a light on, and would run into my parent’s room in the middle of the night. That’s why it took me so long to leave Greg, even though I knew about his affairs for years. And when he moved out I put way too much pressure on my daughter to be my companion, just as my Mom did to me. I mean, my parents stayed married, but they had a lousy relationship and I was my mother’s confidant. My Mom’s still alive. She remarried after my father died and she’s much happier now. We’re close, but not like it was when I was a kid.”

“Are you saying you miss your childhood relationship with your Mom or that you’re relieved?”

“I don’t know. Maybe both. When I’m happy, I’m relieved. But now that I’m so anxious, I guess I want my Mommy. I know that sounds silly.”

“Not at all. I totally understand.”

“I did tell my Mom about Greg, but she didn’t get it at all, thought I’d be happy that something really bad happened to him.”

“And is a part of you happy?”

“Oh no! I mean he certainly wasn’t a good husband but I could never be glad he got cancer.”

“So you’d feel guilty if you felt glad?”

“Definitely. I was brought up to be the good girl and the good girl I remain.”

“Can I ask you how this is feeling to you right now?”

“I guess it still feels weird. And I’m still anxious. I’m used to having my anxiety get better when I’m in

a therapist’s office. But I guess I’m not in your office. It’s like you’re here and not here. It’s similar to how I feel talking to my New York friends on the phone. They don’t feel really present to me so I’ve pretty much let most of those relationships kind of peter out.”

“Oh oh,” I say. “Does that mean you’re likely to do the same thing with us?”

She shrugs. “I don’t know.”

“Maybe you yearn for relationships that duplicate the early connection you felt with your mother, perhaps that’s the connection that reduces your anxiety, makes you feel safe, and that without that kind of connection you feel afraid.”

“I guess that’s true. But I thought I wanted to get away from my mother.”

“I suspect that a part of you does want to get away, but the scared little girl part of you still yearns for what you experience as safe.”

“I suppose.”

“I feel as though you’re less engaged with me right now.”

“Yeah. It’s not you. I just don’t know if this is going to work.”

“I suppose the question is whether you’re willing to give it a chance. We’ve actually talked about quite a bit today: anxiety, guilt, your need to be a good girl and, I suspect, although we haven’t talked about it, your difficulty allowing yourself to feel angry.”

Jennifer brightens. “That’s right! I feel really bad when I get angry.” Pause. “But right this minute I feel a little less anxious.”

“Maybe it helped that I figured something out about you, and that made you feel more connected, less alone.”

“Could be.”

“I can’t guarantee I’ll do that every session, but if you’re willing to give this a try, maybe our work together could be helpful, despite not being in person.”  

Alone Together

“I’m feeling so horribly sad,” Marion says, her sadness apparent from her voice which I hear remotely on my cell phone. “I feel sad for the country, sad for the world, sad for all the people who are losing their lives every day.”

Pause. “But mostly, I must admit, I feel sad for me. I mean, I’m grateful that everyone I know personally is well, that I haven’t had to deal with a loved one dying without being able to say good-bye… But I feel so alone, which is ridiculous. I know I’m not alone. Arnie is here with me as always. I get to FaceTime with my daughter and grandchildren almost every day – although how they’re all surviving in that apartment I have no idea. And with my son and his husband at least once a week. They’re actually doing very well, working from home and enjoying what they call a second honeymoon.”

Silence.

If I were I in my office with Marion I know I would wait for her to continue before I speak. But remotely I’m concerned that the silence will increase her feeling of aloneness. “And you feel sad because…?” I ask.

She sighs. “Arnie and I have no relationship. None. I mean I know we’ve been together for 30 years. I don’t expect us to be falling over each other like my son and his husband. But something, something…” Pause. “We sleep in the same bed. We get up in the morning, have breakfast, each of us focused on our iPads, barely speaking. Then he goes into the living room to watch endless news shows about the virus. I sometimes take a walk, then head for the bedroom to watch old movies or read or sometimes talk on the phone. I wish we at least had a dog, but of course they don’t allow them in our condo.”

Pause.

“Before at least I got to get out, had a change of scenery. I played cards, had lunch with my girlfriends, went to a movie. When I worked that was entirely different. You know, it’s sometimes hard to believe that Arnie and I were both teachers, that we had interesting lives, interesting things to say to each other. Now there’s nothing. Nothing. Emptiness.”

“And feeling alone with someone feels worse than being alone by yourself.”

“That’s definitely true.”

“You said that you and Arnie sleep in the same bed. Do you ever have sex?”

“I’d be hard pressed to remember the last time we had sex.”

“Do you miss it?”

“Sex has been so perfunctory for so many years it’s hard to say I miss it. I do miss cuddling. I miss the occasional kiss, holding hands, caring about each other. Now there’s literally nothing. The absence feels so bleak. And it’s mirrored in all those pictures of cities without people. Or even here – shuttered tennis courts, golf courses, emptiness.”

“Have you talked with Arnie about your feelings?”

“I’ve tried, maybe not enough, but I’ve tried. I tried sitting next to him on the couch, putting my hand on his knee, asking him something about what’s on the TV. Nothing.”

“But have you told him about your feeling of emptiness, of aloneness?”

“I can’t do that.”

“Why?” I ask.

Pause. “You know what I thought of? I thought of being a child, maybe 10, 11 I’m not sure. It was a rainy, dreary day. Must have been a weekend since I wasn’t in school. I was bored. I went to my mother to see if she wanted to play a game, but she was on the phone and put her finger on her lips and motioned me away. So I went to my father just to be with him. I knew he wouldn’t want to play a game. But he was reading the paper, looked at me annoyed and shooed me away. I learned never to ask, just to wait and see if someone will be there for me.”

“We’ve talked previously, Marion, about your unconsciously choosing a man like your father, but today I’m wondering about something else. What is it that you feel, you, the adult Marion, if you think about telling Arnie what you’re feeling?”

“I can’t.”

“But what is it that you feel?”

“Uncomfortable. Vulnerable. Maybe embarrassed. Like I’m not supposed to have feelings. Maybe like I shouldn’t need anything from anyone.”

“Like you shouldn’t need anything from anyone. I think that’s a very important statement, Marion. I think you’re saying that a long time ago you withdrew from your own needs, that you walled off those needs and locked them in a room somewhere deep inside you. And what you’re left with is a feeling of profound aloneness.”

“That feels right. But what do I do about it?”

“I think we have to start looking for the keys that will help us unlock that door, so we can find the sad, vulnerable child who reached out to her parents that dreary day.”

Alone Again

Cynthia collapses heavily in the chair across from me, as if she doesn’t have the strength to hold herself up. Sadness exudes from her every pore.

“My son told me yesterday he’s not coming for Thanksgiving,” she says, barely holding back tears.

Although I’m not surprised - Cynthia has been disappointed by her son many times before – I do feel badfor her. “I’m so sorry,” I say. “What happened?”

“He said it’s too expensive to bring the whole family.” Pause. “I know it is expensive to travel during the holidays. I wish I could help him, but I’m just not in a position to do so.” Pause. “I wonder if he was waiting for me to offer. But he should know my circumstances. He knows his father left me next to nothing. I’m not even 65. I have to be sure I have money to last my whole life.” Tears run down her cheeks. “I don’t want to spend Thanksgiving alone. It’s supposed to be a family holiday.”

I can feel myself wanting to go into “helper” mode – making suggestions, asking why she has to be

alone. It’s a place I have been many times before with Cynthia, usually ending in frustration for both of us. Her helplessness is hard for me. I want her to do something. She wants someone to do it for her, to take care of her.

“It is hard to be alone for the holidays,” I say, empathically.

“But what should I do?” she asks, crying harder. “What alternative do I have?”

Feeling as though she is unconsciously setting a trap for me I say, “It sounds, Cynthia, that you’re asking me for suggestions, but usually when I make suggestions you reject them, always finding a reason they’re undoable.”

“But there isn’t anything I can do. Paul isn’t coming. I can’t change that. I have no other family here. So I’m alone.”

“Sounds like you’re feeling angry at Paul.”

“Okay, so I’m angry. What does that get me?”

“Sounds like you’re angry with me too.”

“I just don’t see where this is getting me anyplace.”

I hear that almost as a positive statement, a desire for movement. “Where would you like to get, Cynthia?”

“Not alone again.”

“So what might you do to not be alone again?”

“You think I have control over this, don’t you?”

“You know, Cynthia, you feel more angry than sad to me right at this moment and I wonder if that’s
helpful to you. Maybe it can give you the push to figure out what you might do to not be alone again.”

“You sit there so smug. You’re probably surrounded by family – kids, grandkids – all getting together and having a great time. You don’t care that I’m alone,” she says crossing her arms in front of her.

Although this is definitely not my reality, it is clearly Cynthia’s fantasy about me. “So you’re envious of the life you see me as having.”

“Yes!” she practically spits at me, with venom. “You’re just like all of them. You have it all. You gloat while I suffer!”

“All of whom, Cynthia?”

“My sisters, my mother. They were prettier, smarter, able to get it all, while I was the shmuck who
married an even bigger schmuck who left me in the position I’m in today.”

“So you felt lousy about yourself, felt you couldn’t compete, couldn’t do as well. You gave up. Also, and I’d really like you to think about what I’m going to say, I think you now unconsciously punish them – and me – but remaining the “schmuck,” as you say. It’s as though you’re getting back at them by saying, see what you did to me, I’m miserable and it’s all your fault.”

“So what do you think I should I do?”

“You could fight back. You could do things that would make you feel better, make your life more fulfilling.”

“A little late, isn’t it?”

“I don’t think so. You said yourself you’re not yet 65. You still have a lot of living to do. And I’m not
talking about become a millionaire or discovering a cure for cancer, I’m talking about not needing to
keep yourself in a one down position.”

“What about Thanksgiving?” she asks.

“What about Thanksgiving?” I reply. “You still want me to make suggestions. But I know you can come up with your own suggestions, you could thrive, if you could allow yourself not to punish yourself as a way of getting back at the people who have hurt you.”

She shrugs. “We’ll see.”

“Yes,” I reply, “we’ll see.”

Disaster

“I had a dream about all these disasters last night,” Jenny says. “It was frightening. There was one disaster after another. I mean I know there have been lots of disasters – floods, hurricanes, earthquakes, tornados – but it was strange for me to be dreaming of them. I don’t know if I was in the disaster or watching the disaster or helping at the disaster. It was weird.”

Jenny‘s a young medical student. I wonder if, at a surface level, she’s anxious about how she will handle her responsibilities as a physician. I remain silent, waiting to see where Jenny’s thoughts will take her.

“My mother called last night. She was complaining about my step-father for a change, about this step-father, just like she complained about all the others. I don’t know why she keeps marrying them, always sure this one will be her most perfect love. I think I’ve even lost count of what number she’s up to. Ugh. I don’t think I ever want to get married. Or not until I’m really, really sure. I guess I see her as a disaster. That’s sad to say about your own mother. I joke with my friends that she’s my negative role model. I want to be everything she’s not and not be anything she is. Sad.”

“Did you feel that way as a child?” I ask.

“Maybe not as a small child, but before I became a teen-ager for sure. Our house was a revolving door. At least she was smart enough not to have any more kids, except that there were always the so-called Dad’s kids who revolved through and then disappeared forever.”

“Was that hard? Forming an attachment to these father figures or siblings and then having them disappear?”

She shrugs. “I don’t know. Maybe. Or maybe I just learned to do my own thing, be involved with my schoolwork, with my friends. I liked being alone.”

Despite the matter-of-factness in Jenny’s tone, I find myself becoming sad. I wonder about her desire for aloneness as a defense against loss. And I think again about her dream, since disaster almost always involves loss.

“When did you last see your own Dad?”

“Who knows. He vanished a long time ago. Every so often he’ll make an appearance, but I certainly wouldn’t want to count on him.”

“I wonder if it’s possible for you not to feel sad about all these losses, Jenny?”

“I’m too busy.”

To avoid sadness, I think to myself. I ask, “What were the disaster survivors doing in your dream?”

“I was going to say they were doing what disaster survivors always do, dig through their houses looking for stuff, try to find things that are important to them. But I don’t think so. I don’t remember seeing people. It was like one of those apocalyptic novels. Maybe there were a few people, I don’t remember, but basically it was empty, barren.”

“Sounds really sad.”

Silence.

“I just had a weird thought. I wonder if it wasn’t me in all those disasters, but you. Like I was the observer, but you were the one who was there. I wonder what that would mean,” she muses. “I could get it if you’re the one who’s trying to help in the disaster. But would that mean I’m the disaster? I don’t feel like a disaster. So am I trying to reduce you, to make you like me, so I don’t feel like so much of a disaster?” Pause. “I guess that’s possible.”

“Are you saying, Jenny, that it feels like a disaster to need people, to need help, to not want to be all alone in the world?”

“It is a disaster to need people. No one is ever there. You can’t count on anyone. Not your mother, not your father …” Her voice trails off.

“Were you going to say, ‘not your therapist’?”

“Yes,” Jenny says looking down. “I mean I know you’ve been there for me, but you’re only my therapist. Eventually this relationship will end. And then what? Then I’ll be alone. Again. Just like always.”

“It’s hard for you to imagine that even when we do end – which we certainly don’t have to do until you’re ready – that you will take me with you, as part of you, just as a part of you will remain with me.”

“I don’t know if I believe that,” she says. A moment letter, Jenny is crying. “And I’m not sure I even want to believe it,” she says between sobs. “What would that mean, that I would stay with you when my parents could discard me so easily?”

“It would mean that you are loveable and that it was your parent’s great loss that they weren’t able to cherish you as you needed and deserved to be cherished.”

Frustration

Jennifer Holland sighs deeply as she settles into the chair. “Well, another holiday season is upon us and I’m alone.”

“I thought both your sons were coming with their families,” I say too quickly and concretely.

She sighs again. “It’s not the same.”

“You mean your husband Dave isn’t here?”

Her eyes fill with tears as she nods. “It’s been five years since he passed. Five years of being alone.” 

“I understand that no one can replace Dave, but that doesn’t mean you’re alone.” 

“It’s not the same,” she repeats.

I’m back in a familiar place with Jennifer. I do understand her feelings. As a widow myself, I know all too well that the holidays bring one’s sense of loss and loneliness to the foreground. But Jennifer’s inability to appreciate what she does have, to take in anything positive from anyone – including me – leaves me feeling angry and frustrated.

“I know it’s not the same, but I wonder how your sons would feel if they heard you discounting their love and caring.”     

“They can’t understand. I know they lost their father, but they have their own families, their own lives.”

Feeling my anger rise, I wonder if I am feeling not only my own anger, but Jennifer’s as well. “Are you angry that your sons have their own lives, that they’re not here with you?”

“I’d prefer they were here. But boys don’t stay with their mothers. I have friends who are widows whose daughters live nearby. I get jealous whenever they bring up spending time with them. But me, I’m alone.”

“You just said you have friends,” I say, immediately aware that I am fruitlessly attempting to change Jennifer’s mind. 

“Yes. But they’re just friends.”

I try to get beyond my frustration and my wish for Jennifer to be different and say, “Do you hear yourself reject anything positive you might receive from anyone: friends, your sons, me?”

“But it doesn’t feel positive.”

Stymied again.

“What would be positive?” I ask.

“Having Dave back,” she says, crying.

From most patients, I would experience such a statement with great empathy. With Jennifer, I feel only anger. “I’m sure that’s true,” I say, trying to conceal my anger, “But you can’t have Dave back.”

“I hate when you say that!”

“Do you hate me?”

“No, I could never hate you. You’re trying to help me.”

“Are you saying you feel that you’re not allowed to hate me because I’m trying to help you?”

She nods.

“But you might hate me even if you feel you shouldn’t.”

“You’re confusing me. Besides, I don’t know why we’re talking about this. I want to know how to be less alone.”

I’m ready to scream. I try to step back and understand what’s going on between us. What I feel is that Jennifer is determined to spit me out. Well, I think, maybe that’s a starting place.

“Jennifer,” I say, “I know that your life has been unbearably sad and painful since Dave’s death, but my experience of the immediate right here and now, of this session right at this moment, is that you reject anything I offer that might help you to feel less alone, like you’re spitting me out.”

“But you haven’t said anything to make me feel less alone.”

“If you’re saying I haven’t said anything that’s going to bring Dave back, that’s true. If you’re saying you’re unwilling to take in anything that might make you feel better unless it’s bringing Dave back, I’d say you’re holding out for the impossible. And if you are saying you’re going to reject anything that isn’t going to bring Dave back, I’d say that’s what we need to work on.” Am I being too harsh, I wonder? Is my frustration turning into hostility?

“I don’t know what you want from me,” Jennifer says plaintively. 

Yes, I’m being too aggressive but Jennifer’s passivity and sense of entitlement is difficult for me to handle. I try to soften my tone. “Can you say what you’d like from me, Jennifer? Or what you think you might be able to do to help yourself to feel better.”

“I don’t know,” she laments. “I thought you were supposed to tell me that.”

“It’s so, so hard for you, Jennifer, to take in positives, to feel good about your sons coming, to feel pleased to have friends.”

“It’s not enough.”

“I understand they’re not Dave. But maybe you won’t be able to begin to take in the positives in your life until you’re able to accept that regardless of how much you might want it, Dave can’t come back.”

“I hate when you say that.”

“I know. It’s a reality you don’t want to accept.”

Alone

“What should I do?” Janet asks plaintively as tears stream down her cheeks. “I always hate this time of year, but this is the worst. I don’t know why they have to go visit his mother. She has two other kids who could have visited her. Me, I have no one. I’m all alone.”

Aware of many thoughts and feelings churning inside me, I opt for an empathic, but relatively neutral response. “I understand it feels awful to be alone during the holidays.”

Janet cries harder. “That doesn’t help me! What should I do?”

“What are your options?”

“I don’t have any,” she wails. “It’s all Harry’s fault. If he hadn’t left me at least I’d have him to be with.”

Remaining silent, I think: Harry left 10 years ago and you’ve said you were glad to be rid of him; you were invited to join your daughter and her family at her in-laws in Colorado; you could call some of your friends. I also think of my annual Christmas dinner, my house filled with friends and family. My husband has been dead for seven years now. His absence still weighs heavily, but unlike Janet I have acted to make sure I am not alone and miserable.  

“You’re not saying anything! Just like Kaitlyn. I keep calling her and crying and asking her what I should do while she’s having fun in Colorado and she doesn’t say anything either until she says she has to go.”

“It seems like you’re really angry at both me and Kaitlyn.”

“Angry?” Janet says, surprised.

“Angry,” I nod. “Neither of us is fixing your unhappiness and, in fact, you feel as though Kaitlyn is causing it.”

“She is.”

“Am I not remembering correctly? Weren’t you invited to join them in Colorado?” 

“They knew I’d never go. I don’t like to fly, I mean I will if I have to, but during the holidays it’s just awful and then there’s the weather and possibly getting stuck for days.”

“When was the last time you were happy, Janet, or at least content?”

“What? What does that have to do with anything?”

“It seems to me you’re almost determined to keep yourself miserable. I get that you’re angry. I also get that you feel mistreated and abandoned by others. But it’s very hard for you to take charge of your life and do what’s helpful for you.”

“So now it’s my own fault. Great!”

“I know you always say you don’t want to talk about the past, but did you feel cared for as a child, Janet?”

“Is this going help me not be alone at Christmas?”

“I don’t know about that, but it could help you to understand why you’re alone this Christmas and perhaps help you to make future Christmases different.”

“No. No one ever cared about me. There were five of us. I was smack in the middle. My father was always depressed and miserable and my mother spent all her time catering to him. And my brothers were always beating me up. Happy now?”

“No. I’m not happy for your pain. I’m sorry. And I certainly understand why you’re angry. I also understand that it’s hard for you to move beyond wanting someone to help you, to guide you, to care for you, since you never got the caring you needed and deserved as a child.” 

“So I get to talk about all that garbage and then I feel even more miserable.”

“That’s possible. For a while. And what I imagine is that in addition to your anger, we’d also find a very needy child who feels terribly sad and alone, just as you feel alone as an adult. Perhaps you even unconsciously create experiences of aloneness, hoping that this time someone will come along to make it different.”

“So you’re saying I should just live with being alone at Christmas and quit complaining.”

“I don’t think I said that, Janet. I said that we need to find you as the sad, needy child; that you need to have more empathy for her; and then hopefully at some point you’ll be able to move beyond her and be able to do what you need to do to take better care of yourself.”    

The Holidays

Arlene is feeling better today. She’s just coming out of a bout of depression, a depression that has plagued her throughout her life and about which she has little insight. Since her father was bipolar, she sees her depression as biological, something that comes over her, an external force that descends upon her and torments her. Although I don’t dispute the biological component of her depression, I do encourage her to try and understand the trigger for any given episode which seems to me related to her feelings of anger and guilt. These interpretations make sense to her, but they fade over time, leaving her again feeling like the helpless victim of her “curse.” 

Today, though, her mood has lifted. She feels “better,” describing herself as being in a holiday mood, excited about getting ready for the holidays. Although she feels somewhat overwhelmed by last minute shopping and wrapping for her three children, as well as preparations for Christmas dinner, she feels she can “handle” the stress and is generally upbeat.

“Do lots of people get depressed during the holidays?” she asks.

I’m surprised by the question. She’s not usually interested in people outside of herself or her family. “Some,” I reply. “Why do you ask?”

She ignores my question and perseveres. “What makes them feel depressed?”

I decide to see where this will take us. “Well, some miss their families or remember childhood Christmases or past Christmases that are no longer.” My mood begins to darken, as I remember the large, festive Christmas parties my husband and I used to give. 

“You mean like people who live alone?” she continues.       

Arlene is one of my patients who read my book. She knows I’m a widow. She knows I live alone. Is she needling me? Is she concerned about me? Is she trying to hurt me?

I proceed gingerly. “Yes,” I reply, “Some people who live alone have a hard time.”

“I can see how that would be depressing,” Arlene responds.

“Arlene, are you asking me whether I’m depressed, whether I’m going to be alone for the holidays?”

She’s immediately flustered. “Oh no, I would never get so personal. I would never ask you about your life.”

“But you read my book. Which was fine. I wrote it, you certainly have every right to read it. So you do know quite a bit about me. And now you’re asking these questions about people who are alone and depressed for the holidays. Are you sure you’re not asking about me?”

Arlene squirms in the chair, her eyes shift downward, then turn to look out the window. Silence fills the room. Arlene seems to be floating away. I find myself becoming anxious, concerned that she’s again moving towards feeling depressed.  

“Arlene,” I say, “I’m not your father and you don’t have to be either. He was a disturbed man who moved between very severe depression and flights into mania. When he was depressed he put a pall over your entire household. It was as though no sunshine could get through. I’m not depressed and I’m not going to be alone for Christmas. And you don’t have to be depressed either. But I think it would be helpful if we could look at why you started to drift towards depression when I asked you to consider whether you were asking about me.”

“You know,” she says, “I didn’t even know I was getting a little depressed right then, but you’re right, I was. I guess I felt I had done something wrong, that you were mad at me for asking questions about you that I shouldn’t be asking.”

“So you’re saying that you felt guilty?” I ask.

“Yes. As always.”

“I won’t dispute that you felt guilty, Arlene, but I also wonder if you felt angry with me, angry that you were being concerned about me, and that I was cross-examining you about your motives.”

“I wouldn’t say I felt angry at you. Maybe a little annoyed.”

I smile. “Anger is a difficult emotion for you. It was hard for you to feel angry at your father, hard to feel angry with me, hard to feel angry with pretty much everyone. But I’ll accept that you felt annoyed, as long as you try to recognize that annoyance and accept it without having to turn it against yourself and end up feeling depressed.”

“I’ll try,” Arlene says.

“Good deal! And have a very happy holiday.”