Father’s Day

“I have to decide today,” says 44 year old Brian, a patient who started seeing me last month because of overwhelming anxiety. Passing his hand through his brown, wavy hair he continues. “I’ve delayed and delayed, but if I’m driving to Pensacola tomorrow in time for Father’s Day, I have to make a decision today. No more procrastinating.” Pause. “It’s no secret that I don’t want to go. Even my mother who’s calling me every day to bug me about coming knows I dread the idea. And my wife is staying out of the whole thing. Which is kind of her. All I’d need is for her to be pulling me in the other direction and saying I need to stay for our boys.”

“I notice you’ve mentioned your mother, your wife and your boys, but not your father.”

Brian chuckles. “You’ve got that right. I realize it’s supposed to be his day, but if it were only for him I know I wouldn’t go. I mean, he was awful my whole life, but ever since he banished my brother because he’s gay and then Trump was elected, it’s impossible to have five minutes of a civil conversation. My father has always been a tyrant. He has an opinion about everything and for some reason he thinks he’s an expert on everything too. Which is ridiculous, since he barely finished high school and clearly isn’t very bright.”

I think of my father, definitely smart, politically like-minded, but most definitely a tyrant. “So why would you go?” I ask.

“My mother.” Pause. “And she’s right, they’re not getting any younger. But she’s pulled out every guilt inducing maneuver she can think of. ‘What if Dad dies and you never see him again?’ ‘Why does his relationship with Paul have to affect you?’ ‘Can you imagine how embarrassing it would be for him if not one of his children is present?’ ‘You can bring Janet and the boys; we’d love to have them; the whole family together’ As if I would subject my boys to whatever explosion is bound to happen.”

“And how do you feel about your mother pressuring you?”

“I don’t know. It’s what mothers do.”

My mind wanders to the many difficult years I had with my father, coupled with my mother’s constant inability to ever see my point of view. Regardless of the circumstances I was always the one who had to make things right.

“But that doesn’t tell us how you feel about your mother pressuring you,” I say.

Brian sighs. “It’s the same old, same old. My mother’s whole life revolves around my father. She has nothing else in her life. Except for us of course. But she’s followed my father’s lead as far as my brother. I wonder how she feels about being totally disconnected from Paul.” Pause. “It’s sad.”

“Sad for her? For Paul?”

“I was thinking sad for her. But it must be sad for Paul too.” Pause. “You know, I’m getting more anxious as we talk about this.” Pause. “And feeling like I should go.”

Silence.

“I, I need you to say something. My anxiety is going through the roof,” Brian says, clenching his hands and fidgeting in the chair.

“So the silence made you more anxious, just like thinking about the disconnect between Paul and your mother.”

“Yeah, I guess so, but I’m not sure how they’re related.”

“Nothing comes to mind?” I ask.

Brian shakes his head, looking puzzled.

Although I would prefer to wait to see what might emerge from Brian, his escalating anxiety pressures me to speak. “I wonder if one of the things that makes you anxious is the fear of being disconnected, not connected to your mother or to me.”

“I’m not sure I understand.”

“Well, you were talking about how your mother has no relationship with Paul. I think that scared you. You wouldn’t want to have no relationship with your mother, so I suspect when that thought went through your mind – consciously or unconsciously – you felt you’d better go for Father’s Day.”

“Wow! You think that’s what my anxiety is all about, being disconnected from my mother?”

“Your anxiety could be the result of many things, but the fear of separation could certainly be one of them.”

“And with you too?”

“Well, you were already feeling scared of being separated from your mother and when I wasn’t speaking I think you experienced that feeling of separation with me as well.”

“I’ll have to think about that. But meantime, what should I do about Father’s Day?”

“I can’t decide that for you Brian. There’s not a right or wrong decision, just your decision.”

“That scares me too.”  

“Because?”

“What if I make a mistake?”

“What if you do?”

“I think I’m going to go. It feels like the safest choice.”

“You need to do whatever you need to do. There was a lot that came up in this session today, too much for us to deal with it all. So I’m sure whatever you decide will be fine and we’ll have other times to work on your anxiety and your relationship with both your parents and with me.”

Wanting to Flee – Part II

“I can’t stop thinking about it,” Trevor begins. “Two therapists in this office died. Who’s to say you won’t be next? I’m having nightmares about your dying almost every night. What did they die of?”

Trevor’s speech is rapid, staccato, his anxiety palpable.

“I’m sorry you’re so distressed, Trevor, but I can’t see how knowing the details of other therapists’ deaths would help to calm you. What we need to do is deal with your fear of losing me.”

“More like terror.”

“Well let’s talk about that terror.”

“In my dreams I see you here in this office and as I’m talking to you, you start fading away, vanishing right in front of my eyes. And then you’re just gone and I’m here in an empty office. Sometimes I start screaming. Sometimes I wake myself up screaming.”

Listening to Trevor’s dream is difficult – his distress, the description of my death, plus the whole idea of fading away which actually taps into my own childhood nightmares. But I’m the therapist here and my patient needs me to act as one.

“Any idea, Trevor, why you’re dreaming this particular way of losing me, my fading away?”

“What difference does it make? Any way you’re gone.”

I’m surprised by what I hear as an angry tone to Trevor’s response. I remain silent.

“I really feel I should cut down on my sessions. I need to become less dependent on you. I need to prepare myself for your… for your leaving.”

“And how do you feel when you think about that?”

He pauses. “Not so good.”

“If you cut down on your sessions, would that be like your gradually fading away from me?”

“Oh! I never thought of that!” Pause. “But maybe that’s not a bad idea.”

“As in you’d leave me before I left you?”

“Yeah. Yeah. Something like that.”

“Would that feel like you’re getting back at me?”

“I don’t know. Feels more self-protective.”

“Trevor, it strikes me that a lot of how you’ve been in the world is self-protective, removing yourself from people, remaining distanced.”

“I suppose.”

“And we’ve always thought about that self-protection as stemming from your feeling the need to protect yourself from your father, and even more so when you realized you were gay.”

He nods.

I’m silent.

“What are you getting at?” he asks.

“Well, I was wondering two things, first how your mother fits into all this and second whether there isn’t some anger, some retaliation in your withdrawal.”

“Wow! I need to think about that.” Pause. “You know, Myra, my oldest sister, used to say that as my mother had more kids – 4 after me - she faded away more and more.” Pause. “I think that’s true. Early on Myra and I probably had the best of my mother, but then she kind of vanished.” Pause. “Just like you in my dreams.” Pause. “You think that’s why I’m so terrified of losing you, it’s like losing my mother all over again?”     

“I think it’s very possibly at least one of the reasons. And it’s certainly interesting that Myra talked about your mother vanishing and your nightmares are about my vanishing.”

“But that doesn’t change the terror.”

“Well, if we’re able to help you re-experience your childhood terrors and come to know – and feel – that you’re not the helpless, dependent child you once were, I suspect you’d have much less terror about losing me. And there’s still the question about your anger and retaliation.”

“But what if I don’t feel the anger? What makes you sure I’m angry?”

“I can never be sure, but when you talk about wanting to leave me before I leave you, it sounds like retaliation, it sounds like you want to punish me and that feels like retaliation.”

“Like you think I was angry at my mother?”

“Yes.”

“Myra was certainly angry at my mother. She had no doubt about it. Practically ruined her life. She was so busy rebelling she became a drug addict! But she came around.”

“So you’re saying that anger is dangerous.”

“You bet! Just try being angry around my father!”

“And what about your mother? How did she react to anger?”

“I can’t believe I’m saying this, but she faded away even more.”

“So being angry with your father is physically dangerous and being angry with your mother leads to abandonment. No wonder you don’t feel your anger.”

“This has been a heavy session. Feels like a lot going on.”

“I agree.”

He sighs. “So I guess I shouldn’t cut back on sessions.”

I smile. “Sounds like a wise choice.”

Disgruntled

“I had this unbelievably horrible day yesterday,” 76 year old Joan Green begins. With dyed red hair and raised eyebrows penciled to match, she challenges everyone around her and looks perpetually amazed by their response. She is my patient only because a psychologist colleague of mine begged that I see her. She had moved to Boca Raton, Florida a year ago after her daughter who lives in Phoenix could no longer tolerate her and feared her mother would destroy her marriage. Her son, my colleague, was not faring much better and told his mother that he would no longer have anything to do with her unless she went into therapy.

She continues. “I spent my whole afternoon in the pain doctor’s office and didn’t even get everything done. The pain is terrible. Everything hurts me – my back, my hips, my neck, even my feet. I can’t take it anymore.”

“Did anything go well yesterday?” I ask, perpetually trying to find something positive in Mrs. Green’s constant tales of woe. I doubt I’m the best therapist for this patient. Constant complaining is not my forte, especially when someone is so resistant to looking at her part in the interaction.

“I liked the doctor.”

My eyebrows shoot up in surprise. “Well that’s important. And positive.”

“Well, he was nice, but I don’t see why he couldn’t give me an injection yesterday and not make me come back.”

“Did he tell you why?”

“He needed me to get an MRI first. And he couldn’t do it in his office – I guess he doesn’t have the equipment. That wasn’t good either. And he said I had to call for an appointment. I don’t know why they couldn’t call for me. I don’t carry my phone with me. It’s way too heavy. I didn’t want to have to go all the way home and then go out for an MRI another day. I’m in pain! Obviously or I wouldn’t be in his office. I told them – I was in the waiting room by then, arguing with the office staff - I’d be willing to sit wherever and wait until they could take me.”

“Mrs. Green, does it seem to you that you have lots of expectations of other people, expectations that might be impossible to fulfill?”

“What! What expectations?”

“Well, what are your thoughts about that?”

“Why should I have any thoughts about that? You’re the one who brought it up. You should be the one telling me.”

Annoyed at this constantly demanding patient, I try to step back. “I wonder if you feel so un-given to, so lacking in nurturing that you have a profound need to be taken care of, whether that’s me answering your question rather than your thinking about it yourself or wanting a doctor to have every possible piece of machinery  available in his office, or needing others to make phone calls for you.”

“That’s just stupid psychobabble. Probably because you can’t answer your own dumb question.”

Feeling angry, I’m silent, trying to figure out what I want to say next.”

“What? Cat got your tongue?

“I wonder what you get out of being so difficult and demanding. I know that it can’t possibly get you what you want. Your daughter didn’t want you in the same city as her. Your son won’t deal with you unless you’re in therapy. But therapy is about looking at yourself. And if you’re not willing to look at yourself instead of blaming everyone else for their insufficiencies, we’re not going to get very far.”

“And that would be my fault?! How about your looking at you?”

“I’m happy to look at how I may be contributing to the difficulty we’re having, but that means you’ll need to look at how you might be contributing to the difficulty too.”

“Okay. So tell me. Both sides.”

“I’m going to answer that question, Mrs. Green, but I want to point out that you’ve again issued a demand and as a result of that demand I don’t really want to answer the question. I am going to answer the question, but I suspect that most people who aren’t therapists wouldn’t. They’d see you as an entitled, demanding, angry, embittered woman. And, from my perspective, that’s all true. But I do think there’s a reason you’re that way and I’m willing to work on us trying to figure out what that reason is which might help you to make some changes.”

“And what’s your part?”

“I think it may be particularly difficult for me to have people make demands on me without my wanting to resist their demands and that might make our work together more difficult.”

“So should I find someone else?”

“That’s certainly your choice. I’d be happy to give you some referrals if that’s what you decide.”

“You’re probably all alike. I’ll stick with you for a while and see what happens.”

“Okay. Fair enough.”

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.”  

Demands

Beverly rushes into my office and throws herself into the chair across from me. “You know,” she begins, “this is just too hard for me. All this running around. I have too many things on my schedule. I mean I know I don’t work – I have no idea how people who work ever manage to get here – but between golf and tennis and bridge and painting – it’s just too much. I need to come on a Saturday. That would work better for me.”

Although I am more than a little annoyed at both Beverly’s demand and at being relegated to the bottom of her list, I decide on an initial non-confrontational approach. “I’m sorry, but I don’t work on Saturdays.”

“You don’t work on Saturdays? How do the people who work get to see you? I suppose they just don’t, right?”

“You’ve been coming for almost a year, Beverly, and you never seemed to have difficulty getting here before. Why do suppose it’s suddenly become an issue for you?”

“I started taking painting lessons. I hadn’t been doing that before.”

“And since you knew you had such a busy schedule, why do you think you decided to add something that might make it harder for you to get here?”

“I didn’t think about it in terms of getting here. I just wanted to take painting lessons.”

“It feels to me, Beverly, that you’re wanting to dismiss the importance of our work together, that you’re saying it doesn’t matter.”

“That’s not fair. You’re the one who won’t see me on Saturday!”

“I think we need to take a step back here. Was there something that happened in our last session that made you feel uncared about? Were you angry with me?”

“You always do that. You always make it about you. It has nothing to do with you.”

“Okay. Then tell me what it does have to do with other than with your schedule.”

“My sister.”

“I remember we talked about your sister last week, about how I saw her as being competitive with you, but that you thought that wasn’t true, that she loved you and always wanted the best for you. And I said both could be true, that she could love you and want the best for you and still be competitive with you.”

“You took her away from me. No one in my family gave a damn about me except her. I was an extraneous being. But Joyce cared about me, looked out for me. And you just took her away.”

“So you are angry with me.”

“I guess. And at her. I’m furious at her. How could she take herself away from me when I relied on her so much? But I decided to show her. She’s the painter you see. I decided I’d become a better painter than her.”  

“So I guess you’re saying you feel competitive with her.”

“No. I’m just getting back at her.”

“Beverly, I want to point out that nothing out there in the real world happened or changed between you and your sister. This is all happening in your mind. You came to see your sister differently. And although you’re entitled to have your feelings, it would be helpful to you if you could hold onto the love and stability your sister provided for you in your chaotic childhood.”

“You’re taking it all back!”

“No. We’ve talked a lot about your living in a black/white world, with no shades of gray. Right now you want your sister to be the perfect sister – whatever that might mean to you – and you want me to be the perfect therapist who would see you whenever you want to be seen. But there is no such thing as a perfect person. You can get a lot of good from one person, but you can’t get everything and that doesn’t make either that person or you bad. And you can feel competitive towards your sister or towards me and that doesn’t make you bad either.”

“It doesn’t make sense to me. If she’s competitive with me how could she always be on my side? Sometimes she’d be on her side.”

“Well I suppose that’s true. But if she wanted, just let’s say, to be a better painter than you, that doesn’t mean she wouldn’t want you to be a better golfer or to find a loving husband or to take great joy from your children. Because there was so much cruelty and rejection in your childhood, it’s difficult for you to believe that someone can be in your corner and still take care of themselves. That’s like me saying I’m here for you, but I don’t work on Saturdays.”

“That makes me mad all over again.”

“I believe you. We’ll keep working on it.”

Echoes of the Past

“This has been a bad week,” says 44 year old Jennifer, her straight brown hair pulled into a bun, jeans and a pale yellow shirt covering her slim frame.

“Madison moved out,” she continues.

I’m surprised. Her daughter Madison is only 16. 

“She had one of her to-dos with her father. I don’t know why this happens again and again.”

Although I say nothing, I think: Because your husband is a narcissistic control freak who your daughter rebels against.

“Frank was driving Madison and her friend Amy back from the movies. He started to speed and she asked him to slow down. She says he just looked at her and went faster. She says she was getting scared and started to scream at him to stop. He says she was getting fresh and that if she wanted him to stop, he’d stop. So he screeched to a halt and told them to get out of the car. By this time I guess they were both crying, but they got out and stood there. Of course he came back for them and then he says that Madison called him an asshole and that he pulled over and slapped her across the mouth screaming telling her not to talk to him that way.

“When they got home Madison and Amy went straight to her room. Next thing I know she’s packed a suitcase and tells me she’s moving in with Amy, that Amy’s Mom said it was okay.  So now Frank is screaming that she’s not going anywhere and I’m trying to figure out what happened.”

As Jennifer relays her story, I feel my stomach tighten and realize that I’m clenching my hands, a familiar reaction for me when Jennifer describes these scenarios between Madison and her father. Although my father was never physical, he had a hair-trigger explosive temper. I was always afraid of him, but I always fought back. And I know what’s coming next in her story, the dynamics in my patient’s family being an uncanny duplicate of mine.    

“I told Madison she was too young to go anywhere and that she had to be more understanding of her father, that he was under a lot of pressure and that he just needed to let off steam, that he didn’t mean anything by it.”

I knew it, I think, just what my mother said to me. I feel my anger rise and wonder how I am going to respond to Jennifer as my patient, rather than as my mother.

She continues. “So she left. I’ve spoken to her each day, but she’s determined not to come home. I’m going to have to talk to Amy’s mother. It’s embarrassing. Meanwhile Frank’s being a bear. He says he doesn’t care and that she can stay where she is, but you can tell he’s hurting.

“How can you tell?” I ask, immediately regretting my question that’s coming from an angry place in me.

“Well, he’s angry, barely talking to me, going around slamming doors, grumbling around the house.”

“And how do you feel when he does that?” I ask, wondering if my question wasn’t so off base.

“I understand,” she says. “He’s upset.”

I want to scream. Instead I ask, “But how do you feel?”

She shrugs. “Nothing, I guess. I’m just worried about Madison.”

This isn’t getting us anywhere. “And how do you think Madison feels?”

She shrugs again, “I don’t know. She says she’s all right.”

“Do you think she might feel hurt or scared?”

“Yeah, I guess.”

Although my mother was an incredible denier, she wasn’t as out of touch with her feelings. My mother and Jennifer feel different now, making it easier for me to remain in my role as therapist. “You know, Jennifer, it occurs to me that it’s difficult for you to know much about feelings – your own or others – except for Frank’s. His feelings are so out there, although they’re usually expressed as anger, you can’t help but be aware of them.”

“Yeah, I guess that’s true.”

“Do you think that’s one of the reasons your relationship with Frank works for you. He expresses the feelings you can’t.”

“That makes sense,” she says nodding.

“I wonder what would happen, Jennifer, if you started to get more in touch with your own feelings, if you could know when you’re angry or scared or hurt.”  

She shakes her head. “I don’t know. That seems like I’d have to be a different person. And right now I have to figure out what to do about Madison.”  

“I understand, Jennifer,” I say, realizing both that she’s frightened and that the present crisis takes precedence. “Let’s talk more about the situation with Madison, but perhaps we can also keep in mind looking at how you feel.”  

Who Dislikes Whom and Why?

When I refer a person who is new to psychotherapy to a colleague, I always say that if for any reason he isn’t comfortable with the therapist, he should call me back and I will give him another name. My clear message is, never work with a therapist you don’t like.

But what about the other way around? Should a therapist work with a patient she doesn’t like? And what does it really mean to not like a patient? Is the dislike immediate or does it grow over time? Or does it lessen as the person becomes better known and, hopefully, more engaged in the process? Is the “not liking” about the patient? The therapist? Both?

In my 35+ plus years of doing therapy, there have been very few patients I have disliked and almost none I felt an immediate antipathy for or felt that I couldn’t work with. The exceptions have invariably been angry, paranoid men. One such man, in the middle of his second session, went on a tirade about the manipulative evils of women and demanded that I prove to him I was an exception. I felt instantly frightened and said that I wasn’t the best therapist for him and that perhaps he would work better with a man.  Would any female therapist have felt the way I did? I suspect not. This patient immediately brought forth memories of my paranoid, explosive father and I was back to being a frightened child rather than a competent adult therapist.

Less dramatic, as detailed in my book, Love and Loss, when I first moved to Boca Raton, Florida from Ann Arbor, Michigan, my experience of many of my early patients was not so much that I disliked them, but rather that I often didn’t like them. They seemed foreign to me; so much more superficial, concrete, narcissistic than my Ann Arbor patients. I didn’t know how to help them, almost as though I had forgotten how to be a therapist. They often didn’t remain in treatment for very long. I wondered at the time if they sensed my own feelings of ineptness or my too great need to build a practice and have them as patients. Years later, when I was writing my book, I realized that my difficulty had been more related to the fact that I hadn’t yet disconnected from my life in Ann Arbor - my friends, my home, my patients – making it impossible for me to really connect to my life in Boca Raton, including my patients.

There are also patients I like as patients, but doubt I’d like as a friend and, vice versa, patients I like as people, but don’t much enjoy as patients. In the first category there are patients like Pat who I discussed in last week’s blog – an angry, vengeful person who fought against mourning the loss of her unfaithful husband and her own sad, loving feelings. I like working with her. I can see a way to be helpful to her. In time I hope that she will be able to mourn and will become a more likeable person both in and out of the treatment room.

In the second category there is Betty, a bright, articulate, cultured woman who has an interesting job as a museum curator. I think we could have been friends if we had met before she became my patient. But as my patient I find her extremely frustrating. Despite her obvious intelligence, she is very concrete, not at all psychologically-minded and despite years of treatment, is unable to think about herself in a more introspective, psychological manner. She cannot wonder why she thinks or feels or behaves in a particular manner, she just does. I do understand that her concreteness stems from an overly rigid and strict background, but this does not help me experience her sessions more positively. I also understand that I am replaying the role of her parents in wanting her to be the way I want her to be, rather than accepting who she is. I hope I can come to accept Betty as she is, for she might then feel freer to explore and find her own mind.

So who dislikes whom and why? The answer, as always, is complex, determined by both people in the consulting room, by their experience of each other, by their past histories and by their present life circumstances.