Emma settles into the chair across from me, takes a deep breath and speaks quietly, slowly, deliberately. She’s telling me about her week. Her son is excited about his softball team, her daughter is anxious about her upcoming school play, her husband is away on a business trip. “That makes it easier,” she says.
“It makes what easier?” I ask.
“His being gone. I know it’s terrible to feel like that and I know it’s not his fault, but it’s easier.”
“But what’s the ‘it’ that’s easier?”
There is a long, profound silence. Emma sits motionless. Although I’ve only seen Emma for a couple of months, I’ve become familiar with her stillness.
“I’m trying to decide whether I should take the children out to dinner tonight,” she finally says.
I’ve also become familiar with Emma’s tendency to avoid answering questions and to switch topics, often to something banal, almost as though there was nothing we had been discussing.
“What just happened now, Emma?” I ask. “How did you get from it being easier when your husband’s gone to taking the kids out to dinner?”
“If I’m going to take the kids out to dinner, tonight would be a good night. Before he gets home.”
Yes, I think, but she still hasn’t addressed what makes it easier when he’s gone. I consider pushing, but find myself reluctant to do so.
Another profound silence ensues.
“Do you ever take vacations?” she asks suddenly.
“Yes, I do. Why do you ask? Do you feel anxious about my being gone?”
Another long silence. “No,” she says with a nervous laugh. “It would be easier. I wouldn’t have to think of what to say.”
“So it’s easier when your husband is gone and it would be easier when I’m gone.”
Silence.
“Speaking is obviously very difficult for you, Emma. What happens when you sit in your silence? What are you thinking? What do you feel?”
Silence.
Emma’s silence, her non-responsiveness, her tendency to talk about apparently inane topics. None of it makes me angry. Sometimes bored, sometimes frustrated, but generally I hold myself still along with her. It’s like feeling frozen. Emma has told me a little about her background. She was the only child of a religious family who lived in the rural Midwest. Her father was extremely depressed, often unable to get himself to work for weeks at a time. Her mother was an angry, embittered woman who reached for the belt for any minor infraction.
“Emma, what about as a child? Was it difficult for you to speak then too?”
Another nervous laugh. And silence.
After a while I ask, “Can you say what you’ve been thinking during the last couple of minutes that you’ve been silent?”
After a while she responds, “They’re images.”
“Can you tell me what some of the images are?” I say gently.
“Cornfields. Sunflowers. My mother. It’s cold.”
I flash on a patient I saw years ago who, as a child, was punished by being left naked in the storm cellar. I wonder if Emma was similarly abused.
“Can you tell me about your mother, Emma?”
“She was mean. She hated me. She said I was the devil’s child, that she needed to beat the devil out of me.”
“What kinds of things did she beat you for?”
“Everything. Not getting up at exactly 6AM. Tracking mud in the house. Talking when she had one of her headaches. She always said her headaches were my fault. She never had headaches before I was born. That’s what she said.”
“You were terrified of her.”
She nods.
“Did you ever feel angry with her?”
Silence.
“You can feel angry with someone even if you don’t express it,” I say.
“She gets bigger.”
“I’m sorry?” I say, confused.
“The image. It gets bigger.”
“You’re saying that if you feel angry at your mother you see her image getting bigger?”
She nods.
“And you feel more frightened.”
She nods again.
“Is that what happens when you talk to me, Emma? Does the image of your mother get bigger, like you’re not supposed to be telling me things?”
Silence.
“You know, Emma, you can always tell me to stop, that you’ve had enough. I’ll always respect your wishes. The last thing I want to do is be another abuser.”
Silence. Then she says, “Maybe if it would be better if we didn’t go out to eat. It’s a school night. The children need to do homework.”
Although she can’t say it directly, Emma has clearly told me she’s had enough.
I am waiting for Fran, a 38 year old successful interior designer, to arrive for her fourth, twice a week session. My clock says 11:03. She’s a few minutes late. I’m surprised since she seems like a responsible, conscientious person who goes out of her way to be “the good girl.” Still, she could have been held up by a client, or perhaps just the traffic.
11:08. I’m running through our sessions in my mind. We seemed to have a good connection. Although a relatively anxious person, Fran talked freely, telling me about her doubts about her competency despite her obvious success, her parent’s divorce when she was five, her mother’s unrelenting criticism, and the time her mother’s third husband came on to her.
11:15. I call and get Fran’s voice mail. I leave a message saying that I hope she’s all right and asking that she please call me. I spend the rest of her session trying to read, hoping the phone will ring, and replaying our last session in my mind.
That was the session she told me about her step-father’s advance. She was an adult and presented the incident as though she was disgusted by it, but not obviously traumatized. Had I minimized the trauma? Had I not looked deeply enough at her underlying feelings? Did I give her the impression that I didn’t want to hear about it?
Or was there something else that led to her not coming today or abruptly terminating? She mentioned wanting to write a book about her experiences as an interior decorator, especially some of the clients she’d worked with over the years. I was certainly supportive of the idea. But does she know about the book I wrote? Did she feel hurt, perhaps rejected, that I didn’t acknowledge it and talk with her as a possible fellow-author? But that’s ridiculous. What if she didn’t know about my book? Bringing it up would have seemed irrelevant or even competitive.
Time for my next patient. Time to put Fran in the background. At the end of each session I check my messages. Nothing from Fran.
Finally, at 4 there’s a message that says, “I’m really sorry. I got my schedule entirely confused today. I knew I was supposed to come and then it was just gone from my mind. I’ll see you on Thursday.”
I am incredibly relieved. Perhaps I didn’t do anything wrong after all. Perhaps there was something going on with Fran that had nothing to do with me. Well, that’s probably not true either. Perhaps her not coming was related in some way to our interaction, or her feelings about me or our relationship, but that doesn’t mean I did something “wrong.”
It’s actually noteworthy that I went so easily to feeling that I’d done something “wrong.” Perhaps that reflects not only my tendency to examine and take responsibility my own feelings and behavior, but also Fran’s feeling “bad” or “wrong” herself.
“I’m really, really sorry about Tuesday,” Fran begins. “I don’t know how I managed to forget my appointment. I never do things like that. I feel awful about it.”
“Do you have any thoughts, Fran, about why you might have forgotten the session? I ask not so that you’ll blame yourself or beat yourself up, but to see if there might have been something you were trying to communicate.”
“It’s interesting that you say I shouldn’t blame myself or beat myself up. I was doing that, but I think I was doing that after our last session anyway,” Fran says, blushing.
After a few seconds she continues. “You know that incident I told you about my mother’s husband coming on to me?”
I nod.
“Well, he did. But I kind of led him on. … I feel so awful telling you this. … He was always such an asshole, not that I ever lived with him or anything. And, I don’t know, I guess it made me feel powerful to be able to manipulate him in that way. I feel like such a piece of shit.”
I now understand why feelings of “wrong” had been floating around for both myself and Fran. I also think that Fran’s “leading him on,” was a way for her to get back at mother as well as her mother’s husband, but I decide that interpretation is best left for another day. Instead I take a more supportive approach. “We’ve all done things we’re not proud of Fran. What’s most important is to deal with our feelings of shame and guilt and to understand our behavior as best as we can. And that’s why you’re here.”
