Anger: Repressed and Expressed

Thirty year old Jacquelyn looks unusually pensive as she settles herself into the chair across from me.

“A weird thing happened this week. Kind of disturbing ,” she begins. “You know how I tell you that I always watch those gruesome  shows like Criminal Minds or CSI, but that I have to cover my eyes during the particularly gory scenes?” she says grimacing.

I nod.

“Well, one of those gory scenes came on, and instead of covering my eyes I felt sort of compelled to watch it. And I – this is kind of embarrassing. I, umm, I actually felt kind of excited and found myself rooting for the serial killer. I wanted to watch him kill that, that, umm, that woman.”

“What did you first think of, Jacquelyn, before you said ‘woman?’”

Jacquelyn lowers her head. “First I thought to say ‘bitch,’ then ‘sniveling baby,’ or ‘coward’ or ‘idiot.’ But they sounded too negative, so I settled on woman.” Pause. “You know, you’re always telling me that I have lots of anger, but that I keep it buried inside me.” Pause. “I didn’t feel angry, not even when I was wanting him to kill her.” Pause. “That doesn’t make sense when I say it out loud.”

Jacquelyn’s last comment is encouraging. Although I’m sure she’s at least of average intelligence, she tends to be quite concrete, has difficulty with self-reflection, and is often unable to take in what seems to me the most obvious of connections.

“Was it that you wanted this particular man to kill the woman or did you want this particular woman dead?” I ask.

“Do you think I’m terrible for thinking about this?”

“Not at all. You weren’t killing anyone, you were watching a TV show.”

“I guess,” she replies dubiously.

Silence.

“You want me to answer your question.”

“Yes.”

“I wanted this woman dead.”

“And can you say more about that? Why did you want her dead? Who did she remind you of?”  

“I don’t know.”

“Well, how about thinking about it now.”

Silence. Jacquelyn squirms in her chair.

“Can’t she just be a woman?”

“If you think about a woman, what woman comes to mind?”

“She wasn’t like my mother.”

“Does that mean your mother was the first woman you thought of?”

She nods, looking down.

“And what’s the similarity between your mother and this woman in the TV show?”

Still not looking at me she says, “They were both housewives.” Pause. “They had children.” Pause. “Umm. Umm. They couldn’t stand up to their husbands.”

Thinking to myself, ‘now we’re getting somewhere,’ I ask, “How did the woman in the TV show not stand up to her husband?”

She looks up. I suspected that it would be easier for her to talk about the TV character than her mother.

“There’s this scene at the breakfast table where her husband is screaming his head off at both her and the kids. You know he’d be cursing in real life but of course they can’t show that on TV. He goes off on the little girl when she spills a glass of milk, calling her an idiot and worthless. The little girl starts to cry and the woman tells her husband to calm down and that does it, now he’s really off the wall, screaming at the woman and even looking as if he might hit her. She cowers and turns back to washing the dishes while the father starts screaming at the girl to stop crying and when she doesn’t he slaps her across the face. The woman doesn’t do anything.”

“Does that sound familiar, Jacquelyn?”

Tears roll down her face. “I didn’t want to kill my mother. Oh my God, I hope not. I hope I didn’t wish her gone, because then I would have been left with him.” Pause. “We were both such cowards,” she says now sobbing.

“What do you mean?” I ask.

“Both of us. Neither of us could stand up to him.”

“Jacquelyn, you were a little girl. How were you going to stand up to him?”

She shakes her head and continues sobbing. “Cowards. We were cowards. We should have done something.”

“You’re angry at both yourself and your mother for not being able to fight back.”

“We were cowards.”

“You can’t accept your own vulnerability, Jacquelyn.”

“No! I can’t!”

“So you wanted to kill the woman in the TV show because of her ‘weakness,’ because of her vulnerability.

“I didn’t want to kill her, I wanted her dead.”

I think Jacquelyn has had enough for today and decide to back off.

“You’ve done a lot of good work today,” I say. “I wonder how you’re feeling.”

“Scared.”

“Scared of?”

“I’m not sure. Being slapped across the face like the girl in the TV show. That’s silly. I feel bad, like I did something wrong and I’m going to be punished.”

“I understand, Jacquelyn. You’ve gotten closer to your anger than you’ve ever been and I think that’s frightening you.”

“You think so?”

“Yes, I do.”

“Okay. I’ll try to think about that.”

Ending

“So,” Philip begins, “There’s something I’ve been thinking about and after all these years I certainly know I’m supposed to talk about everything I’m thinking about. So, here goes,” he says, inhaling deeply. “We have two weeks, six sessions left and for our last session I’d like to take you out to dinner.”

Many thoughts and feelings flit through my mind. I’m surprised. Philip is a 55 year old obsessive man who despite years of therapy is still fairly rule-bound. Taking me out to dinner would definitely be bending those rules. So should I consider his request an indication of progress? Perhaps, perhaps not. Either way, I know I’m not going accept. To do so would be stepping way outside the bounds of our relationship. I have gone to lunch or dinner with patients who have been out of treatment for long time, but then I know that the treatment is definitely over and it’s more like catching up with an old friend. Last sessions and, in fact, the entire process of termination is fraught with many intense and conflicting feelings. A restaurant is definitely not the place to deal with them.

“What makes you ask? Why do you want to take me to dinner for our last session?”

He looks instantly deflated. “You’re not going to do it.”

I smile inwardly. My apparently neutral question wasn’t so neutral after all.  “No, Philip, I’m not going to accept. I’ll explain why, but first I’d be interested in knowing why you want to.”

“Is it because I’m a man? I mean I know we dealt with some of my, uhmm, feelings about you along the way, but this has nothing to do with that. I just want to say thank you for all you’ve done for me.”

“And when you say ‘thank you for all you’ve done for me,’ you’ve given me more than enough, a gift. You’ve been able to put your feelings into words. And your warm feelings at that. That’s a major accomplishment for you.”

“You didn’t answer my question.”

“I’m sorry. No, it’s not because you’re a man. Did I hear a hint of anger in there?”

“No one likes to be rejected.”

“Whoa. Let’s go back a minute. You say that you want to take me out to dinner to thank me for what I’ve done for you. What do you imagine you might be feelings that last day? Or the last week? Or what are you feeling today about ending?”

“Hard to separate out what I’m feeling about ending and what I’m feeling about your turning me down.”

“Okay. Just say what you feel right now.”

“Hmm. I feel disappointed. And hurt. And a little angry. And confused. I don’t understand why.”

“So let’s say we were at a restaurant right now. Would you like to be dealing with all those feelings at the restaurant?”

“I wouldn’t be having these feelings if we were at a restaurant.”

“Ah ha! So perhaps you’ve just told us another reason why you might want to take me to dinner for our last session. Maybe it’s so you won’t feel all the feelings you might be having during that session.”

“Oh.”

“Last sessions can be pretty emotional. I know there’s some excitement about leaving, a feeling of accomplishment. Some people describe it as feeling like graduation. But even graduation has sadness mixed with it, ending a chapter in your life, ending your relationship with me. We’re known each other a long time. It’s always sad to say good-bye. Sad for me too. I’m happy for you and your progress, but your leaving is a loss for me as well as for you.”

Philip stares at me. “You’re so dear to me,” he says softly. “You will always have a special place in my heart. You’ll be with me always and I’ll miss you more than I can say.”

“That’s so beautiful, Philip. Thank you. That means so much to me. I think about how you couldn’t even identify what you were feeling when we first started working together, let alone express it. And to be able to express such deep, caring feelings warms me all over.”  

He smiles. “I was just going to say, ‘So how about dinner?’ and then I realized I was just running from all the feelings in the room. I guess we’ll be meeting here for the remainder of our sessions. Five more to go. Makes me sad.”

Money Matters Again

I am aware of feeling annoyed as I go to the waiting room to greet Philip. It’s been five weeks since I’ve seen him. Each of the last four weeks he cancelled three or more days prior to our session – well within the time required by my 48 hour cancellation policy to avoid being charged – with various excuses, mostly related to business. Philip is a successful import/exporter. It’s not unusual for him to travel, but we’ve usually been able to reschedule during the week or arrange to talk by phone, even when he’s out of the country.

“It’s been a while,” he says greeting me with a broad smile that enhances his already handsome face. “I’ve been incredibly busy. Business has really picked up. Not that I’m complaining. I know lots of people are hurting, so I’m more than grateful. Other than that, not much is happening. Things are going okay with Serena, although she hasn’t been too pleased with all my traveling. I have been able to keep up with my kids, although I can find myself squeezed between time with Serena and time with the kids.” 

“And us?” I ask.

“Us?”

“We haven’t seen much of each other the past several weeks either and now you seem to be saying that there’s not much to talk about.”

“Truthfully, I haven’t had much time to think about myself. I just keep on truckin’.”

“Does that strike you as strange? You’re someone who usually spends a lot of time reflecting about yourself, trying to understand why you do what you do and now you’re being kind of flip and indifferent.”

“Maybe I’m just tired of spending all this time ruminating on myself. Maybe it’s time to just start living.”

“Philip, what’s going on?”

“What do you mean?”

“First you disappear for over a month …”

“I didn’t disappear,” he interrupts. “I called every time to say why I couldn’t come. Gave you enough advance notice too.”

I find myself confused, annoyed and stymied. When Philip kept cancelling, I thought about our last several sessions trying to understand what might have triggered his desire to keep away and hadn’t come up with anything. Now he’s being disinterested, dismissive and even hostile and I have no idea why. Was he feeling too close and needing to get away? And what was that comment about giving me advance notice? Philip is a wealthy man. Money never seemed to be an issue between us.

“Was it important that you gave me advance warning?” I ask.

“Yeah. Wouldn’t want you to be charging me for a session when I’m not here, especially since you just raised your fee.”

I try to keep my surprise from registering on my face. I raised Philip’s fee by $25, an amount I thought would be insignificant to him.

“Philip, what did it mean to you that I raised my fee?”

“Nothing. You’re entitled. This is your job. You deserve to make a living. And $25, it’s no big deal.”

“Seems like it is a big deal, Philip.”

“Don’t be silly. I can give $25 to the valet when I leave my car at the airport.”

“Except I’m not the valet,” I say quietly.

“I didn’t mean to insult you,” he says quickly.

“Philip, let’s stop a moment. I feel like we’ve been sparring all hour and I think I do understand what’s going on. I understand that the actual $25 an hour increase is inconsequential to you. But I think what it did is remind you that we have a professional relationship, that in addition to our human relationship, in addition to the caring interaction that goes on between us, you do pay me for my time. It reminded you, as you said, that this is my job. And I think that made you feel uncared about.”

“I never thought of that. At least not consciously. But now that you put it into words, I think you’re right.” He pauses. “Know what I just thought about? I thought about the time when I was a kid and my father and I had baseball tickets. I’d been looking forward to it for weeks. And then sometime before the game a delivery guy arrived with an electric guitar I’d been wanting and a note that said, ‘Sorry, kid, can’t make it. Enjoy. Love, Dad.’ I never did play that guitar. I realize it’s not the same thing …”

“But it felt that money, material things were taking the place of time and caring and that’s how it felt with me too.”

“I guess. I’m sorry. I know that’s not fair.”

“Nothing to apologize for. I’m glad our relationship matters to you. It matters to me too. And I’m glad we were able to figure out what was going on.”

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.” 

The Specter of Death as Ever-Present

I am returning in this blog to Leslie and Harvey, the couple who was dealing with Harvey’s diagnosis of lung cancer. They had never spoken about their fears of Harvey dying, leading to his pulling away in order to protect her from the pain of his possible death.

Before continuing, however, I would like to clarify that just as in my book, Love and Loss, most of the patients in my blogs are composites of individuals I have worked with over the years, although I do try to remain true to the patient or idea I am presenting. Similarly, the dialogue, which I use extensively to bring the patient/therapist relationship to life, flows from my mind, not from verbatim transcripts. 

I return now to the couple. Although Leslie is my patient, Harvey has asked to come in for another joint session, a request his wife Leslie is more than happy to accommodate.

“I appreciate you agreeing to see me, to see us again,” Harvey says, smiling a bit as he switches the “me” to “us.” “I guess you’d call that a Freudian slip, ‘cause I do think this session is more for me than for Leslie.” He looks pensive. “I’ve been thinking a lot about what you said last time I was here, how the awareness of death can provide an opportunity for greater closeness, for a chance to live life to the fullest.”

I nod.

“It’s never been like that for me. I mean not only since I’ve been diagnosed with lung cancer, but forever. I’ve always been terrified of loss, of death.”

“Really?” Leslie says, clearly surprised. “I never knew that.”

“I’m not sure I really knew it either until that last session. But then I realized it’s always been this way, even as a kid. I’d like go to the drug store to get some candy, there was this one guy behind the counter who was always nice to us kids, and I’d leave and wonder what would happen if I never saw him again and how terrible that would be. Or if one of my kids got sick, even like a cold or something, I’d wonder how I’d survive if they died, like I didn’t think I would survive. And then when I got sick, it’s like, wow! I’m going to lose everyone, everything, how horrible is that?”

The session is suffused with a heavy sadness.

“Harvey,” I begin tentatively, aware that he is not strictly my patient, “Hasn’t Leslie told me that your father died of cancer when you were quite young?”

“Yeah. I was seven. It was terrible. My mother was a wreck, depressed – not that I blame her – and us kids were pretty much left to fend for ourselves. I don’t know what we would have done without my grandmother, my father’s mother, although she wasn’t in such great shape either.”

“So your whole childhood became filled with sadness and loss and death.”

“Yeah, and my dog died right about then too.”

“I’m so sorry, Harvey. What a lot for a little boy to bear. You lost everyone who was dear to you, everyone who you needed to depend on, to rely on. And, not surprisingly, it’s still a sadness you carry with you.”

“But I guess that’s what I’ve been thinking about. Even though I’d constantly have these thoughts about loss or death almost whenever I met someone, even if they weren’t someone close to me, I’m not sure I felt the sadness.”

I look at him quizzically. “You certainly seem to be feeling the sadness now, right here in this room.”

“Yes, I definitely feel it now and I’ve been feeling it more, but I realize that I’ve protected myself from those feelings my whole life. I mean even though I really, really love Leslie and my kids and even though I think I’ve been a loving husband and father…”

“You have been!” Leslie interjects.

“But not completely,” Harvey continues, sadly shaking his head. “I think I’ve always kept a piece of myself back. And I don’t want to stay at this place. I don’t want to get to the end of my life and feel that I’ve cheated myself and the people I’ve loved because I haven’t been able to totally let myself go, let myself love to the fullest and get the very most out of life.”

Leslie is crying. “I’m so sorry, Harvey. I’m so sorry I didn’t know.”

“I didn’t know myself, Leslie, so it’s hardly your fault.”

Tears fill my eyes, as I think of the good-fortune of my intensely loving relationship with my husband and, of course, the pain of his loss.  

I’m not sure where Harvey will go from here, but he’s clearly taken a big step towards greater love and connection.