Inching Forward

I return in this blog to Kevin, the man who had difficulty feeling much of anything and who angrily rejected my compassionate remark. Consciously he experienced my response as pitying, as an indication of my seeing him as weak. Unconsciously my positive voice threatened the angry, critical voice of the father he carries around in his head, a voice he would have to relinquish and mourn if he was able to take in more positive voices.    

Progress with Kevin has been slow. He remains unemotional, distanced, reserved, and quick to criticize. For my part, I am often overly cautious, carefully weighing what I say, trying to avoid his attack, an attack which expresses the critical voice of the internalized father that both he and I carry in our minds.     

Today, however, Kevin appears quite different. He is unshaven, dressed in shorts and a T-shirt and looks stricken. Even so, I’m reticent, reluctant to ask if he’s all right, preferring to wait to hear what he’ll say.

“I’ve had one hell of a night,” he begins. “My daughter’s appendix burst. She was screaming in pain. We had to rush her to the emergency room.”

“I’m so sorry, Kevin,” I say. “Is she all right?”

“Yeah, they operated on her and they say she’ll be fine.”

“It must have been terrifying,” I say, despite worrying that my expressing too many vulnerable feelings may result in a backlash from Kevin. But he feels so different today, so much more raw, that I’m willing to take the risk.     

I’m still surprised, however, when Kevin starts weeping. “My poor little girl. She was scared and hurting and I couldn’t do anything! I don’t think I’ve ever been so terrified in my entire life!”

Images go through my head: the trauma of my own childhood tonsillectomy, the terror of so many of my late husband’s hospitalizations, the pain of watching my elderly cat become sicker and sicker. All images associated with despair and powerlessness. This is what Kevin is also feeling. But they are feelings quite alien to him and I’m still unsure how far he’ll be willing to go with them. I wait.

“I bet you never expected me to be bawling in here,” Kevin says, his sarcastic edge returning.

Despite the sarcasm, his vulnerability has made me feel less tentative. “How do you feel about your crying in here or, for that matter, crying at all? And how do you feel about the feelings you obviously have for your daughter?”

“I don’t know about the crying in here part, but I’m actually glad that I could feel so much for Tracy,” Kevin says, more softly than usual. “I know I’ve talked about my feelings about my kids, about how I wasn’t sure that I really felt what I should feel about them. Well, last night did away with that concern. I don’t know what I would have done if anything had happened to Tracy. I felt like my heart would break for her last night. And I was glad to be able to feel.” 

“I’m glad you could allow yourself to feel and that the feelings were not only tolerable, but actually felt good.”

“I even felt closer to my wife last night. Beth was stronger than I thought. She didn’t fall apart even though I could see how scared she was and how much she loved Tracy. I don’t think it’ll fix everything between us, but it felt good, if only for last night. 

“I had some other thoughts, too,” Kevin continues. “I thought about my mother. We don’t talk about my mother much. My father always seems to be in the foreground. I remember when I’d get injured playing sports, especially football. Once I even broke my arm. She did what she was supposed to do. She took me to the hospital, gave me my medicine, asked if I was doing all right, but she wasn’t there emotionally. I could tell how different she was from Beth or even from me – if you can believe that! Yeah, I could tell that I felt more on an emotional level for my daughter than my mother felt for me. That was a revelation.”

“So you had an angry, attacking father and an unemotional, distant mother. It’s no wonder that emotional closeness is so difficult for you.”

“Yeah, I guess that’s true. So am I cured, Doc?”

“I’d say that last remark is an indication of your beginning to feel uncomfortable with the closeness between us and your need to pull back.”

“Come on, now. I didn’t mean anything by that.”

“Think about it. What does it sound like to you?”

“I guess you’re right. It’s sort of a smart-ass, off-hand remark.”

“And that’s fine. You can’t expect that one experience, no matter how terrifying, no matter how eye-opening can make everything different. But it obviously has affected you and it will affect you and us as we go forward.”

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.