Unexpected Fear

 “I’m so terribly nervous I can’t stand myself,” Kaleigh begins wringing her hands, jiggling her right foot. “I thought I was going to be so excited about going back to Chicago after my first semester at school. But I’m not! I’m suddenly terrified of flying. I was never afraid of flying before. Maybe it’s because of the Israeli-Palestinian war and I’m afraid of terrorism, like of my plane being shot down. I don’t know.”

“Are you afraid of your plane being shot down?” I ask.

“I don’t know. It sounds ridiculous. But there was 9/11. Of course I wasn’t even born then, but still… It feels like anything can happen.”

“Anything can happen, but it is interesting to wonder why you suddenly developed a fear you never had before. Do you feel especially frightened because you’re Jewish?”

“I asked myself that. I guess someone could bomb the plane because they thought there’d be lots of Jews on it, but it’s not like I think someone’s specifically coming to get me because I’m Jewish.”

“Any other thoughts come to mind?”

“I just had a flash of my older sister. She’s not supposed to be there this holiday… But what if she is? That would be pretty scary.” Pause. “Oh God! It would be so terrible if she’s there. She ruins everything. She ruined my whole childhood! She ruined my family,” Kaleigh says crying. Pause. “I’m pretty sure my father told her not to come. But that doesn’t mean she won’t. And then everything would be ruined! All there would be is screaming and more screaming and tantrums and threats!! I can’t stand it.” Pause. “Do you think that’s why I developed a fear of flying? Like maybe I really don’t want to go home. Like maybe I’m afraid of what’s waiting for me.”

“Have you asked your parents if she’ll be there.”

“No, I haven’t. I feel scared about that too. Scared there will be this big scene about my even asking.”

“Why?”

“My mother will immediately get mad at me for being so afraid of my sister. And she’ll be mad that I might bring up the abuse again. She’s never believed me about the sexual abuse. She knows my sister used to beat the shit out of me, but she always dismissed the sexual abuse as two kids just playing around,” Kaleigh says crying. “I don’t know what’s more painful, the abuse or my mother just dismissing it. No, that’s not true. The sexual abuse was way more painful. I haven’t even told you all of it.” 

“Maybe it would be helpful if you did,” I say gently.

“She used to take things, mostly sticks, sometimes a vase or whatever else she found around and put it inside me. A few times she even threatened to use a knife, but she never did.” Pause. “Usually she put it in… in my vagina, but sometimes she’d put it in the other place. That really hurt,” she says crying.

“That’s so awful Kaleigh. I’m so sorry you had to endure that, it sounds like torture. No wonder you’re scared to go home. And I’m so sorry your mother doesn’t believe you. What your sister did is certainly not just ‘playing doctor.’ What about your Dad?”

“I’m so glad you believe me! I was afraid you wouldn’t. Afraid you’d think I was just making it up.”

“Of course I believe you Kaleigh. I can’t imagine why you’d want to make up something like that.”

“I’m so ashamed of it. I even lied to my boyfriend and said I’d had sex with one guy before him. It was better than telling him about what my sister did to me!”

“Shame is a very common in sexual abuse victims, but that doesn’t mean you have anything to be ashamed of. You were the victim. She was bigger and stronger and abused you.”

“I know. But that’s not how I feel.”

“I understand. And we’ll have lots of time to deal with those feelings. I notice you didn’t say anything about your Dad.”

“I’m pretty sure he believes me, but he’s not about to argue with my mother. It was hard enough for him to tell my sister that she wasn’t welcome in their house anymore after she hit him and trashed the entire living room.”

“I am so sorry, Kaleigh. Are you sure you do want to go home? Or maybe there’s someplace you can go where you can feel safe if your sister is there?”

“I can’t imagine announcing that I’m leaving to stay with Brad or even with one of my girlfriends. That would create an uproar in itself.”

“I know we don’t have time to discuss this further today, but we do need to work on you’re not being so afraid of your fear that you’re willing to sacrifice yourself. Obviously you have good reason to be afraid, but you do need to first and foremost take care of yourself.”

You’re Number Five

 “You’re number five,” Alex says upon sprawling languidly in the chair opposite me.

“Number five?” I ask. 

“Yes, you’re the fifth therapist I’ve seen. I liked your website, maybe a bit too sappy, but still pretty good.”

“What happened to the other four therapists?” I say, choosing to ignore his comment about my website.

“I fired them.”

“Because…?”

“Because they weren’t smart enough. Well, I guess that’s not completely true. I saw the first one for maybe a year. He was pretty good, but then I moved, so that was the end of him. The other three I saw here, but like everything else in Florida, they were just too stupid.”

“You certainly sound as though you’re angry, angry and hard to please, like nothing is good enough.”

“Okay, that’s not a bad comment. You’d get about a seven out of ten for that.”

Feeling myself becoming annoyed, I say, “Why don’t you tell me about yourself and about how I can help you.”

“That’s just it, I don’t know if you can help me.”

“Then tell me what brings you here.”

“I’m not happy.”

“Because…?”

 “Because the world is a shit place. Because people are stupid and insensitive and uncaring.”

I hesitate and then decide to say what came to mind for me. “And you see yourself as sensitive and caring?”

Alex laughs sarcastically. “I see you didn’t include smart in that and, yeah, I see myself as smart even though you didn’t ask. Sensitive and caring, not so much, but probably more than you think.”

“Alex, this isn’t a sparring contest. I imagine you are more sensitive and caring than you appear, and that your aggressive, confronting tone is more of a defense against whatever sad or scary feelings lie underneath. If I’m going to be your therapist, I need to have a sense of who you really are, so maybe you could tell me a little about those scary feelings.”

“Wow! You go right for the jugular, don’t you?”

I bite back my first impulse which is to say ‘Takes one to know one,’ assuming that would just continue the one upmanship. Instead I say, “How about telling me a story from your childhood.”

He smirks. “Yes, that’s right, you’re a psychoanalyst.”

Silence.

“Silence. Another tool.”

“I understand that change is hard, Alex, but there’s nothing to be gained by your being here, unless you’re willing to give us a chance as opposed to assuming I’m the enemy or a dueling partner.”

“You’re pretty good. I can’t rile you up.”

“There are lots of clever rejoinders I could give to your statements, Alex, but this isn’t supposed to be a debate. We’re supposed to be on the same side.”

“No one has ever has been on my side.”

“That’s sad,” I say, feeling a ray of hope. “Can you tell me who particularly you were thinking of?”

“My mother died of cancer a year after I was born – although obviously that wasn’t her choice – my father hated me because he was stuck with me, my older brother hated me because he blamed me for my mother’s death, my father’s mother thought I was a nuisance, my teachers all hated me because I was such a smartass – which I was – my wife divorced me and turned the kids against me, etc., etc. Get the picture?”

“Sounds like a pretty dismal picture. But it also seems, at least in some instances, that you’ve helped the picture stay dismal by, as you said, being a smartass which only ends up driving people away. I’m sure that ‘smartass’ way of being felt essential for your survival as a kid, but now it’s a hindrance that drives people away and leads to your being alone and unhappy.”

“I’m not unhappy. I’m just not happy.”

“Not happy and alone?”

“Yes.”

“And sad?”

Before Alex responds I rush to say, “Not a smartass response.”

He laughs. “Yes, and sad.”

“And you’ve been sad most of your life and you cover it over by being sarcastic and pretending you don’t need anyone.”

“Yes.”

“Thank you for giving me genuine responses.”

“You’re welcome. And thank you encouraging me to make that possible.”

“You’re welcome.” 

Pause.

“So are we deciding to work together?” I ask.

“Yeah, I guess I’ll give number five a chance,” he says smiling genuinely. “I promise I’ll be easier on you next time.”

“I don’t imagine you’ll be able to give up your defenses that readily, so I don’t think either one of us should expect you to be an entirely different person by next week. Maybe we’ll just be able to be lighter about your smartass responses, as opposed to thinking you won’t have any.”

“Sounds reasonable, Doc. Thanks.”

Family Visits

 

“I can’t believe my wife and I actually arranged to see both set of parents in the space of a month,” Harvey begins, a good-looking man in his forties. “Thanksgiving with her family was bad enough, people trying to be polite and pretend that they care about each other and that they care about our kids. I was surprised they even remembered the kids’ names. That’s how often they talk to them. I guess they do occasionally connect on Facebook, but of course my kids aren’t on Facebook that often – for old people they say. My 13 year old kept rolling her eyes when they tried to engage her around soccer.” He sighs. “And in a few weeks we go to my family. That will be different.”

“Different how?” I ask.

“Different in every way possible. I’ve told you about my family, screamers. No one is polite. No one cares about anything but hearing themselves talk. Except my mother. She’s different. Of course my brother will be there. If he and I don’t get into it I’d be shocked.”

“What do you imagine that looking like?”

“I wouldn’t rule out his throwing a swing at me.”

“Like when you were kids?”

“Yup.”

“You told me he was always jealous of you.”

“Definitely. Even though he was my father’s favorite. But that didn’t count for much since my father was such a loser. IS such a loser. In fact, it’s worse – if that’s possible – since he “retired.” Now he doesn’t even pretend he’s looking for work. Sits at home all day, drinking no doubt, getting into fights with my mother and watching Fox News all day.”

“You sound very contemptuous of your father.”

“You got that right.”

“How does it feel to be contemptuous of your father?”

“Familiar. I don’t think I was ever NOT contemptuous of him. Of course, I wouldn’t have said contemptuous as a kid.”

“What would you have said?”

“That he was … Wow! I was about to say that he was a scary jackass. I sort of forgot how scary he was. He was. He was big and blustery and would scream at the drop of a hat. And he was often screaming at me which would delight my brother to no end.”

“Where was your mother in all this?”

“Silent. I knew she felt bad for me, but she was totally cowed by him. She’d say she didn’t want to take ‘sides.’”

“Did you feel angry with her about that?”

“No. I guess I needed one good parent and she was definitely the good parent.” He smiles. “I still love her a lot. She wasn’t perfect but she’s a good person and she’s a great grandma. My kids love her to death even though we don’t visit very often for obvious reasons.”

“Do you ever invite her to visit you?” 

“All the time. But she won’t come without him and I’m not inviting that chaos into my home.”

“I wonder if you’re still afraid of your father.”

“Now? No, what could he do to me? I could knock him out in a heartbeat.”

“And how would you feel about that, about knocking him out?”

Harvey opens his mouth to respond and then closes it. “I was about to say great, but that’s not really true. I guess a part of me would feel great about it, but then he is my father. I guess I’d feel guilty. Yeah, you’re not supposed to be slugging your father.”

“I just had a thought. I wonder if you feel sad and disappointed that you don’t have a Dad you can look up to, one you’d enjoy visiting.”

“I never thought of that, but yes. Even as a kid I was disappointed that my Dad wasn’t more of… I guess that he wasn’t more. That he wasn’t more educated, smarter, more of a role model.”

“So maybe what else bothers you about visiting your parents is that every time you can’t escape feeling that disappointment. And maybe you’re disappointed in more than your Dad. Maybe you’re disappointed that your brother isn’t more of a friend and that your Mom wasn’t more actively on your side.”

“I don’t know about that part about my Mom, but I certainly agree with you about my father and brother. I wonder if knowing that will make the visit any easier.”

“Well, if you could accept that your father and brother are going to be the same as they’ve always been, maybe you can avoid having even the smallest of expectations and therefore be less hurt and less angry.”

“Maybe. I guess we’ll see if a few weeks.”

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.”

 

From Father to Son

 “My son’s home on Spring break,” Craig says, looking forlorn.

I wait.

“I know I should be happy, glad to see him. He’s a good kid, getting great grades in college, actually thinking about becoming a psychologist,” he says with a wry smile.

“But you’re not happy.”

He shakes his head. “And I hate myself for it!” Pause. “You know, I told you my father was an ass, always criticizing me, always telling me all the things I’d done wrong. He was the perfect one, I was the incompetent fool. Made me the anxious, insecure mess you see now.” Pause. “It’s not that I’m like that with my son Daniel. I’d kill myself if I was like that. I swore to myself I’d never be like that with my kids and I haven’t been. It’s more what I feel inside. And I’m so ashamed, how could I be such an awful person? It’s not like that with Britany, my daughter. We have a great relationship, so easy to spend time with, so easy to talk to.”

“So what is it that you feel about your son?” I ask.

“Jealous. Jesus, I hate that about me, what an awful thing to feel about your own son.”

“Beating yourself up for your feelings isn’t helpful to you. Or to your son for that matter. It would be better if we could understand your feelings. What do you feel jealous about?”

“It’s so embarrassing, but I’m jealous about everything. I’m jealous of his relationship with my wife. I’m jealous about his ease in the world. I’m jealous he has all these friends. I’m jealous that he already has a sense of purpose. I’m jealous, I’m jealous and I’m sick of myself.”

“It sounds like you’re saying you’re jealous of Daniel because he’s had a much easier time in himself and in the world than you had.”

“And what kind of father is that?! Fathers are supposed to want more for their children, want their kids to do better than them. And me, I’m a despicable jealous fool!”

“You certainly still carry your father’s critical voice with you inside your head, condemning yourself for who you are and what you feel.”

“But I should condemn myself. How else could I feel?”

“Well, you might feel compassion for yourself and, again, try to understand where your feelings come from.”

“It’s not only how I feel, it’s how I act! It’s not that I’m critical of Daniel but I’m – I’m not sure what to say – I’m distant, reserved and I worry how he interprets my coolness.”

“Do you think your father felt jealous of you?”

“What?! No. I told you, he thought I was an incompetent jerk.”

“But maybe he needed you to be a, quote, ‘incompetent jerk.’ Maybe he needed you to be less than him so he kept you down by being critical and demeaning. I don’t mean he knew all that consciously, but unconsciously he might have experienced you as a dangerous competitor.”

“I don’t know what to say to that. It’s like turning my world on its

head.” Pause. “And what would that mean in relation to Daniel?”

“Well first, as I said, you carry your father’s critical voice with you in your head. That critical voice certainly gets turned against you, but it sounds like you’ve also been afraid you’d turn it against Daniel and rather than do that, you’ve withdrawn from him.”

“Wow, that makes sense. I’m not sure what I do with it, but it makes sense.” Pause. “What about Barb, my wife?”

“What are your thoughts?”

“Barb always doted on Daniel. Britany was our first born, but I thought Barb always favored Daniel. I don’t know why, maybe because he was a boy and she lost her father shortly before Daniel was born. I guess I was jealous then, jealous of their bond and I worried that she was indulging the boy. Wow! I do sound like my father when I say that. My father was always telling my mother she was spoiling me, but unlike Barb my mother would immediately stop however she was being to me and side with my father.”

“So you lost your mother to your father. Are you saying you feel as though you lose Barb to your son?”

“I don’t know. Maybe. Especially since we’ve gotten older, you know, as the passion dims.” Pause. “I feel as though my heads spinning.”

“We have dealt with a lot today. Some of it might make sense intellectually, some not, but there are certainly a lot of feelings to work through on an emotional level. For sure, your relationship with your father has affected your being a father and that’s pretty much true for everyone.”

“So I’m not a freak?”

“That’s you father’s voice again, Craig. And, no, you’re definitely not a freak.”  

What's the Big Deal

 “I don’t get it,” Marlene begins, her face appearing tense and puzzled on my screen. “Every time I talk to one of my friends or even exchange an email, they’re talking about how devastated they still feel about the storming of the Capitol. I agree, go along with it, so they don’t think I’m some sort of a weirdo, but I don’t get it. It was a building for God’s sake. Yes, 5 people died and I’m sorry about that, but I see people dying of Covid every day in the hospital, people who are scared and alone and broken. We’ve lost way more than 300,000 people to Covid and people are so distressed about a building! What’s the big deal?”

I’ve had many patients who were very distressed by the events of January 6, others who, not surprisingly to me, didn’t even mention it. But I am surprised by Marlene’s lack of emotional response. As a nurse she has been on the front line of the pandemic, so perhaps, I think to myself, she can’t allow herself to feel any more pain. Still, politics matters to her. She usually has very definite opinions, often accompanied by intense affect.

“It sounds as though you’re uncomfortable with your not experiencing it as a big deal,” I suggest.

“I suppose. I don’t know, it just makes me feel different. Which is certainly not a new feeling for me.” She sighs. “Poor white trash, daring to want to make something different of myself. That got me beaten at home for thinking I was better than them and bullied at school because those kids sure as hell didn’t think I was as good as them. Shitty beginning.”

“And you’ve taken yourself far from those beginnings.”

“Yes. And I haven’t told you, but I’ve been thinking of applying to school to be a Physicians’ Assistant.”

 “That’s wonderful, Marlene. I’m so pleased for you.”

“You don’t think it’s crazy? I’m already over 40. And PA school is very competitive.”

“You know, Marlene, I think you just asked me if I think you’re being too uppity, going too far from ‘home,’” I say.

She chuckles. “I think you’re right.”

“So do you think it’s weird that I don’t feel more about the storming of the Capitol?”

“I don’t think it’s weird, Marlene, but I do think it’s unlike you.”

“So you had strong feelings about it.”

“I did. But I’m wondering right now why you are asking me all these questions rather than telling me more about what you’re thinking, what you’re feeling.”

“I guess I’m feeling weird, which takes me back to my childhood.”

“What specifically in your childhood?”

“All of us living in that three room house. All the screaming. All the violence. My Dad beating the shit out of me if he found me reading a book. All the kids at school circling me, jeering at my clothes.” Marlene’s eyes fill with tears. “Will those images ever go away? I want them to go away.”

“Let me ask you something, what brought those images back so vividly?”

Marlene’s eyes widen. “Oh my God, seeing those people storm the Capitol! That’s what brought those images back. Those were quote, unquote, ‘my people.’ Oh my God,” Marlene says sobbing. “Oh my God! It’s so awful! Of course I couldn’t take it in. It’s way too close, way too close. It makes me sick. I don’t want to be like them, I don’t, I don’t.”

“You’re not like them, Marlene. You’ve grown a long way from there.”

Marlene continues crying, tears streaming down her face as she stares at me on the screen. “I wish I was in your office right now. I wish I could feel your presence, like your presence would erase the awfulness of those images.”

“I wish that too, Marlene. But I do hope you can feel that I’m here for you.”

She nods. Grabbing a tissue, she blows her nose and wipes her eyes.

“So I couldn’t take in the horror of the mob attacking the Capitol because it brought me too close to my childhood experience? So I did what, I shut down, and didn’t allow the horror to penetrate?”

“I’d say that’s exactly what you did, Marlene. At first I thought you’d shut down because of all the months of dealing with the stress of Covid meant you couldn’t take in one more horror. But I’d say, you got way closer to the real reason you shut down, the need to distance yourself from the horrors of your childhood.”

Tag words: Psychotherapy, mental health, defense, patient-therapist relationship, childhood, violence, growth, ambition, numbness, shutting down.