Undecided Part II

 “It’s not good,” Stan says, shaking his head from side to side. “You have to tell me what to do! I can’t stand it! All I do is think about this day in and day out. Should I stay with Paulette and my family or should I throw it all up in the air and be with Frank?”

Silence.

“Tell me.”

“You know I can’t tell you Stan. No one can make that decision but you.”

He drops his head into his hands. “I can’t. I can’t make the decision.”

“If I told you what to do – which I wouldn’t – what would you hope I’d say? 

“That I should follow my heart and be with Frank.”

“So is that what you want?”

“Yes. Yes. It is what I want. But is what I want enough? Is what I want always what matters most? If I want to go murder my boss, should I go murder my boss? No, obviously not. Sometimes you can’t have what you want. Sometimes you shouldn’t hurt other people to get what you want.”

“That’s a very good point. Let me ask you something, why would my telling you to follow your heart and be with Frank, change what you just said about not hurting Paulette and your children?”

“And my parents. And the rest of my family”

“And why would my telling you to be with Frank change how you felt about hurting those people?”

“I guess because you’d be giving me permission. Because you’d be saying being gay isn’t bad, isn’t a perversion.”

“So now you’ve introduced something else. It’s not only about hurting people, it’s about whether you think being gay is bad.”

“Is it?”

“No. But it’s not about what I believe, it’s about what you feel. If you tell me you want to work on the negative feelings you have about homosexuality, I’m happy to do that, but you’ll still have to decide whether or not you want to leave your marriage. And I suppose there’s also the question of whether if you stay in your marriage and feel as though you’re accepting second best, are you making Paulette accept second best as well? Are you depriving her of feeling with someone else the same way you feel with Frank?”

“Oh no! You’ve just made this even more complicated!”  Stan stares at me intently. “Wait a minute, are you a lesbian? Do you feel I should be with Frank? That’s it’s better to be homosexual than heterosexual?”

I’m startled. “Now I’m confused,” I say. “I thought you wanted me to tell you to be with Frank which I certainly haven’t done, but now you wonder if I’m a lesbian because I raise the question of whether staying with Paulette is the only way to not hurt her?

“Wow!” Pause. “I guess it wouldn’t have been all right with me if you’d told me to be with Frank. Even giving me a possible reason to leave Paulette, like it would be kinder to leave her to find someone who was really into her, it… I don’t know. I guess it really scared me.” Pause. “I guess it’s that I don’t want to be gay. I don’t want to be rejected by my family. I don’t want all the hassles gay people have to go through. I just want to be normal, to have things be how they were.”

“And is that possible, Stan?”

“That scared me again. And again made me wonder if you really are gay.”

“I think you are very frightened. And when you feel as scared as you feel right now, it’s easy to think that there’s someone outside of you who’s frightening you, and right now that someone is me.”

“So you’re saying I’m being paranoid?”

“I’m saying right now you feel me as dangerous. And that’s okay. We can deal with that. We can explore what makes you so frightened both inside your head and outside in the world.”

“So you could think that homosexuality was okay and not be homosexual yourself?”

“Yes,” I say, concerned about how much less adult Stan feels to me right now. “Stan, you told me that you came from a Christian, conservative background. I assume the message was that homosexuality was bad, a sin?”

“Definitely.”

“And do you think that’s what’s scaring you now, that you’re afraid if you’re gay you’ll go to hell?”

“But maybe if I give up Frank and stay with Paulette I could go back to having a normal life and be redeemed.”

“I guess you’ve added a whole new dimension to your conflict. It’s not only figuring out what you want and not only trying not to hurt anyone, it’s also wrestling with a difficult religious question.”

“And can you help me with that?”

“Well, I can help you explore your thoughts and feelings, but I can’t answer the religious question for you any more than I could answer whether or not to be with Frank.”

“Thanks. I don’t know why, or how, but somehow I think this helped.”

“I’m not sure why either, but perhaps it was parsing out the different pieces of your conflict so that your feelings don’t seem so overwhelming.”

Undecided

“I appreciate your willingness to see me, even virtually,” Stan begins. He’s a nice looking man who seems anxious, unsure, fidgeting with his fingers, moving in his seat.

“How can I help you?” I ask.

“I just hope you can help me. I want to leave my wife. No, no, that’s not exactly true. I don’t want to leave my wife. I love Paulette. But I have to leave her. I love her and I love my two boys, but I just can’t go on like this. I’m sorry, I know I’m not making any sense.”

“You can say whatever you need to say, however you need to say it.”

“I’m in love with someone else. A man! I can’t believe it. I don’t even know how this happened. I’ve never been attracted to a man before. Or, or maybe I have. I don’t know. But all I know is that I love Frank. I never expected to love Frank, I mean I don’t know if I even liked Frank at first, but then, there it was, he kissed me and I don’t know if I ever felt anything so powerful in my life. So that’s it. I love Frank and I love Paulette. But I can’t keep lying to Paulette. I don’t even know how she hasn’t figured it out. I do everything I can to avoid having sex with her. Not that I mind having sex with her, but it feels like I’m being unfaithful to Frank! Which I know is completely crazy”’ Stan takes a breath. “So that’s the story. Do you think I’m awful?”

“No, of course not. I think you’re in a lot of pain. Can you to tell me a little more about yourself?”

“I’m 38. I’ve been married for 12 years. I have two boys, six and ten. I was supposed to be a physical therapist, but I ended up selling solar panels. I like it. Makes me feel I’m helping people. And the environment. That’s how I ended up in Florida. It’s a good place to sell solar panels. My wife and I are actually from a small town in Ohio west of Cleveland, conservative, Christian area. South Florida was an adjustment, but we’ve learned to love it.” Pause. “‘We’ve learned to love it.’ That’s the problem, ‘we’ has always meant me and my wife. I don’t know. I don’t know if I can leave that ‘we,’ break up my family, have to explain all this to my wife. And to my parents. I don’t even want to think about them.”

 “And if you do think about your parents…?”“They’ll never accept it. I don’t think they’d say they didn’t want to see me again, but I know my mother would cry hysterically and my father would preach endlessly about my going to hell.” Pause. “This whole thing is such a mess. What would I tell my kids? Would my wife keep me from seeing them? No, I don’t think she’d do that. You know, the more I talk about this the more I wonder if I should just leave things as they are, keep lying, keep seeing Frank on the side. Maybe this thing with Frank will just burn itself out. Maybe it’s not love, maybe it’s just lust.”

“Can we talk a little about your sexuality? You said Frank was the first man you’d been attracted to and then you didn’t seem sure of that.”

“I played football in high school. And you know, we’d all be in the locker room, showering, trying to see whose was bigger while pretending we weren’t looking. Sometimes there would be a guy and, I don’t know, I guess you could say I might have been attracted to him, but I didn’t think much about it. I dated girls. I had sex with girls. I met my wife in college, we had sex, we dated a while, we got married and here we are.”

“And how was the sex with girls? With your wife?”

“Good. Good. It was good.”

“But not as good as with Frank?”
“Nowhere near. I never had sex like with Frank. I can see with across the room and all I want to do is jump into bed with him. He was my customer, buying solar panels for his house. At first I thought he was stuck-up, arrogant. Seemed like an awfully big house for one person. When I came by he started asking me to have a glass a wine. And that led to lunch. And that led to sex and where I am today.” Pause. “What do you think I should do?”

“I can’t possibly answer that…”

“What would you say if I was your son?” Stan asks, interrupting.

“What makes you ask that?”

 

“I don’t know. I guess you’re probably about my parent’s age.”

“It sounds as though your concern about what others think makes it hard for you to sort out what you want for you.”

“That’s definitely true.”

“I know you feel a lot of pressure to try and make a decision right now, but I’d suggest that you give yourself some time and that you give us some time to figure out what you really want.”

Meeting the Family

“Well, I started World War III,” Patrick says sighing deeply, as he settles into the chair across from me. “I knew Vi wouldn’t go down easily with my parents, but I didn’t think it would be that bad. My mother literally gasped and my father’s rage permeated the entire dinner. He didn’t say a word to her the whole time, but he had a lot to say to me afterwards. I guess I shouldn’t have just sprung her on them, but she surprised me by coming down for the weekend and I was supposed to go to my parents for dinner so, I guess I just decided to bring her along.”

“Wait, Patrick. You mean you hadn’t told your parents that Vi is African American? And then you just showed up with her for dinner?”

“Yeah. You know, she teaches law at Columbia University in New York, I’m down here in Florida, I knew my parents, particularly my father is very prejudiced, so I guess I kind of avoided the whole thing until I couldn’t anymore. Vi wasn’t very happy with me either. Obviously the dinner was awkward for her.”

Internally I find myself yelling at Patrick, ‘Awkward? That’s an understatement! She must have been consumed by anger she had to swallow. How could you have allowed this to happen? To everyone.”

Wondering if I’m feeling not only my anger, but Patrick’s as well, I ask, “Who are you feeling angry at Patrick?”

“Angry? Well, I’m angry at my parents, particularly my father. He really let me have it. He guessed no nice white woman would want me since I was such a loser; had to go looking in the gutter for some black chick.”

“And you felt and said what?”

“I hung up on him.”

“And felt?”

“Angry. Disgusted. Vi is this incredibly accomplished, smart, beautiful woman. I’m honored that she’d want me. And all he can see is her black skin. Except I don’t know if she still wants me. She’s pretty angry with me too. She didn’t know I hadn’t told my parents she was African American. She kept saying we’re not children, we’re in our 30s, what gives them the right to think they can decide our lives.”

“And can they? Can they decide your lives?”

Patrick hesitates before saying, “No, not exactly.”

“What do you mean, not exactly?”

“Well, I couldn’t figure out the long distant part of Vi and my relationship anyway. I mean, it would hard for me to start all over again as a financial planner in New York and to say that there are no law schools down here equivalent to Columbia would be putting it mildly.”

“You’re confusing me Patrick. Are you thinking of breaking up with Vi? Were you thinking of breaking up before the dinner with your parents? Is your parent’s reaction influencing your decision about breaking up?”

“I don’t know. I love Vi, but I can’t figure out the logistics. I couldn’t figure out the logistics before the dinner and I can’t figure it out now.”

“Have you talked to Vi about your concerns? I know you hadn’t talked with me about it.”

“No.”

“Did you set Vi up, Patrick?” Realizing my anger is seeping through, I try to temper my question. “I mean, did a part of you think taking Vi to dinner with your parents would precipitate World War III, as you said, and might lead to her breaking up with you?”

“I hadn’t thought of that at the time, but now that you mention it … I mean, she’s such a perfect woman for me, I can’t see how I could break up with her. Except she lives in New York and I don’t see how that’s workable.”

Now I feel more sad for Patrick than angry. “You know, Patrick, it’s difficult for you to take charge of your life, to decide what you want for you and make it happen. You don’t talk with Vi about your concern about living in two different cities and whether that can be worked out. I suspect you haven’t even looked at the possibility of becoming a financial planner in New York. You don’t confront your father about your feelings about what he said to you.”

“I guess I always take the coward’s way out. I run.”

Now that I am no longer angry with Patrick, I realize that I had been reacting to him much as his father did. “I wonder, Patrick, if you’ve heard your father call you a loser your whole life and if you’ve come to identify yourself as a loser, despite your obvious success and accomplishments. You feel you can’t do it, whatever it is, and so you don’t, you opt out.”

“I think that’s true. But it’s a hard pattern to break.”

“Yes, it’s a hard pattern to break, but we’ll work on it.”  

The March

“I finally went to dinner at my parent’s,” 19 year old Bethany says dejectedly. “It was pretty bad. They just won’t let up. ‘I can’t believe you lied to us, going to the Women’s March on Washington without even telling us. If we hadn’t called and talked to your roommate we would never have known. What if something had happened to you? We didn’t even know you were gone.’ Blah, blah, blah. As if that was the issue. I bet if I went to the Trump Inaugural they would have been thrilled – even if I hadn’t told them. It’s such bullshit. They did do a bit of, ‘How could you be our child and believe those people have a right to marry.’ Or, ‘Didn’t we teach you that every life is sacred, especially the unborn, those most vulnerable?’ I thought I’d puke. I couldn’t wait to get out of there.” Pause. “I suppose you’re thinking, ‘I told you you should have told them.’”

“I don’t remember telling you you should have told them,” I say, surprised.

“You asked me why I didn’t tell them, didn’t you?”

“Yes, but that was a question meant to help you look at why you do or don’t do whatever.”

“Well, the answer’s pretty obvious. If I tell them I get all this shit. Just like I did.”

“And what did you say when you got all this shit?”

“Nothing.”

“Nothing?”

“Yeah. What am I going to say? You can’t argue with them. I just sit there, trying to tune them out, hoping they’ll stop sooner than later.”

“And why do you feel you can’t argue with them?”

She raises her eyebrows and snorts. “I don’t mean to be nasty, but how long has it been since you were 19?”

I smile inwardly. Although it’s been quite a while since I was 19, I do clearly remember the arguments I had with my parents, most especially my father. Not about politics. There are values were pretty similar, but often about psychology and science. My father was angry, dogmatic and unrelenting. For years, I argued and argued with him about dreams, about the cause of mental illness, about the unconscious, until I finally gave up. Then I was like Bethany, sitting at the table saying nothing, hoping he’d stop sooner than later. On the other hand, I never, ever stopped battling my father’s vicious temper, trying to put a clear limit how he could treat me. I bring myself back to my patient. “I get that it can be difficult to argue with your parents when you’re 19, but I’d like to understand specifically why YOU can’t argue with your parents, even at 19.”

She sighs. “First, they have the money. If they get mad enough, there goes college, plus whatever else.”

“Would they do that? They sound pretty determined for you to get an education, pretty invested in it.”

“They are.” Pause. “Especially my Dad. But sometimes I think my Mom believes I’m being corrupted by college, too liberal you know. And, I don’t know. This may sound weird, but I’m not sure that my Mom really wants me to succeed, like maybe she’s jealous or something. Like she never went to college, so why should I.”

“So are you saying you’re afraid your mother might undermine you?”

“I never thought of it that way, but I guess so. If I gave her any ammunition. Like the Women’s March.”

She pauses.

“I need to ask you something. What did you think about the Women’s March?”

“I’ll answer that in a minute, Bethany, but first I want to ask you something. Why did you ask that question right at this moment?”

She shrugs. “I don’t know. I’ve been thinking about it and just felt I had to ask.”

“Well, I have a thought as to why you had to ask right then. You were talking about your mother feeling threatening, dangerous and I wonder if you suddenly felt I might be dangerous too and had to check that out.”

“Are you?” she says quietly.

“No, Bethany, I’m not dangerous.” I could tell Bethany I was at the Women’s March too, but decide that might too greatly diminish the tension around the issue of whether difference between two people, perhaps especially two women, is inherently dangerous. “I suspect that our politics might be pretty similar, but even if it wasn’t, I’d still be on your side, still wanting you to have your own voice and make your own way in the world.”

When Values Clash

“I had another big fight with my wife,” Bob says throwing himself into the chair. “I don’t get it. I don’t understand how she could even argue with me about this one. It’s a no-brainer. Why would she want to expose the twins - seven year old girls I might add - to those two lezzie perverts living next door? I don’t care if they have kids my daughters’ age. I don’t want my girls exposed to that garbage. As far as I’m concerned women with women and men with men are just sick!”

I try to keep my expression neutral while inside my stomach churns. Dealing with a patient whose values drastically conflict with my own is difficult, especially as I struggle with the question of where the therapeutic ends and the political begins. Earlier experiences with patients flash through my mind. While still a graduate student, one of my first patients extolled the virtues of Hitler, while I sat frozen, unable to respond. Another patient, shortly after 9/11 suggested incarcerating all Arabs in this country. I thought my face was neutral, but obviously not. “You don’t agree” she said. Impulsively I responded, “I’d rather be dead.” Although certainly not a therapeutic response, it did give us much to talk about. Or the patient who was convinced he knew my political leanings and baited me with statements he was sure I’d disagree with. The latter was less of a problem since I was able to address the reasons behind the patient’s wish to provoke me.          

But so far Bob is only stating his opinion. So despite my strongly held beliefs to the contrary, I need to address this as any of the many arguments between my patient and his wife, remembering that my focus needs to remain on the patient. Right? Except it doesn’t feel right. Would I remain neutral if Bob told me he was beating his wife? Obviously not. But that’s an action, not a belief. Yet this man’s belief can also do harm. Here’s the question of whether the therapeutic and the political can or should be separated. 

“So what do you think, am I right?” Bob continues, asking me the dreaded question. 

I avoid answering. “You seem so certain of your position, why do you want my opinion?”

“I don’t know. Seems kind of normal to want to know the opinion of the person sitting across from you.”

“I suppose. Or does it speak to some uncertainty on your part or some desire to have me – perhaps an authority figure in your eyes – confirm your opinion?”

Bob shakes his head. “You can agree with me or not. It’s not going to change my mind.”

“I gather your wife didn’t agree with you and that didn’t change your mind either.”

“Damn right!”

“Clearly you and your wife have different ideas about this childrearing issue, how are you going to resolve the difference?”

“My kids are not going over to that house!” Bob says, his voice rising.

“And your wife feels how about that?”

“I don’t care how she feels!”

“What are you afraid of Bob? What do you imagine might happen if your kids go over to their house?”

Crossing his arms in front of his chest and scowling at me, Bob says, “They could put their hands on my little girls. They could play with them down there.”

“Do you worry that some of your friends, the heterosexual fathers of your children’s friends will abuse them?”

“Of course not!”

“And what’s your sense of the difference?”

“They’re lezzies, that’s the difference!” Bob says shouting. “You’re obviously one of those gay lovers too. I suppose you believe they should be allowed to marry!”

This hasn’t gone at all well. I suddenly realize that ever since I mentioned being an authority figure, Bob has been both defensive and provocative and I have engaged with him in a debate, rather than trying to understand what was going on between us. Time to change direction. 

 “Do you like to argue, Bob?”

 “I guess,” he says, “I can hold my own.”

“Are you saying arguing makes you feel powerful?”

“I suppose you could say that.”

“How do you usually feel when you’re in this room with me? Do you feel powerful?”

Bob squirms in his chair. “No,” he says shaking his head. “You’re a lot smarter than me. You have a lot more answers. Lots of times I don’t even know the questions.”

“So you’re saying that you feel ‘less than’ me. But when you argue, when you ‘hold your own,’ you feel better about yourself.”

“I guess,” he says sheepishly. 

“I wonder if you don’t often feel ‘less than.’ We’ll need to figure out why that is.”

“That won’t change my mind about those lezzies.”

“I hear you.” 

I say nothing else. Bob needs to have the last word.

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.