Guilt

“I feel so awful, I can’t believe that I had to disappoint my parents. I can’t believe I couldn’t handle college, that I had to come home. My parents have always been there for me, always wanted the best for and all I do is screw up.”

This is my first session with Tiffany, a slender, attractive young woman with blue eyes and long blonde hair. Her mother, sounding concerned, had called to make the appointment, saying that Tiffany was having difficulty at Duke and needed to come home.

“I hate myself!” Tiffany continues.

“Wow! That’s pretty strong. Can you say why you hate yourself?”

“All I’ve done is give my parents problems my whole life, even before I was born. My mother had to be in bed for two months before she had me! She’s a physician – so’s my father – she can’t just take two months off. But she had to because of me.”

“That hardly sounds like your fault, Tiffany. I assume it was some medical condition your mother had.”

“She never had that problem with my brother. My brother never gives them problems. He’s graduating from Yale and going on to medical school. Of course!”

Clearly hearing her sense of competition and failure in relationship to her brother, I decide, for the moment, to focus more on her current situation. “Can you tell me what was going on for you at college?”     

“All those science courses! I can’t handle them. I’m just not smart enough. I started crying at every little thing. And I think I pretty much stopped eating. And then I couldn’t even get myself out of bed to go to class. Especially Chemistry class.  I don’t understand it. It makes me feel stupider than I already feel.”

“Are there classes that you enjoy, that you do well in?”

“Oh yes,” she says, brightening. “I love anthropology and I’m…hmm…I’m a pretty good writer.”

“So you take science courses because…?”

“What do you mean? I have to take science courses to get into medical school.”

“And do you want to go to medical school?”

“I’ve always known I’d go to medical school.”

“That’s not the same thing as wanting to go.”

“Yes, I want to go to medical school. I put my parents through a lot when I was a kid. I got rheumatic fever and ended up in the hospital for quite a while. I could tell how scared they were.”

“You must have been pretty scared too.”

“I was, particularly when I was alone. But the doctors and nurses were great. And I kind of enjoyed watching all the machines and monitors. That’s the kind of doctor I want to be, a pediatrician, to help kids like me.”

“And do your parents want you to be a doctor?”

“Definitely. It’s like a given.”

“So what if it wasn’t a given? What if you could decide to do anything you wanted to do?”

“I’d go on archeological digs and write about them or even write made-up stuff about the digs, like mysteries. But that’s not at all practical. No way to make a living.”  

“Have you ever wondered, Tiffany, why you feel so guilty in relation to your parents?”

“I told you why, I’ve always given them problems.  Besides rheumatic fever I was a sickly kid. And I broke my arm doing gymnastics. They always had to worry about me.”

“It seems that a lot of the things you feel guilty about you had absolutely no control over, like your mother needing bed rest or your having rheumatic fever or breaking your arm.”

“I was fooling around on the bar, that’s how I broke my arm.”

“You sound determined to have things be your fault. Do you think, Tiffany, if you felt things weren’t your fault, you’d end up feeling powerless and scared?”

“I don’t know. I’m not sure I know what you mean.”

Too soon for that interpretation I tell myself. I decide to pursue a different path. “Do you ever feel angry at all the pressure you’re under?”

“Angry? I don’t think so. I feel mad at myself for not being able to keep up and, like I said, worrying my parents.”

“So, now that you’re home, do you think you’re going to be able to relax and take it easy for the rest of the semester?”

“Oh no. My parents are going to get me a chemistry tutor so I can go back to school more prepared.”

At this point I find myself feeling angry at Tiffany’s parents and wonder if I’m feeling Tiffany’s unacknowledged  anger. That could explain the tremendous guilt she feels – guilt for the anger she doesn’t even know she has. But those interpretations are also premature.  

“Our time is almost up for today. But I hope I’ll be able to get to know you more and I hope you’ll tell me more about your wishes and your dreams, even if they aren’t always practical.”

“I wish you could make me smarter.”

“I don’t know if I can do that, but perhaps I can help you to be more accepting of yourself.”

Failure to Thrive

“I’ve decided to write a book,” Karen announces at the beginning of her of session. Dressed in casual jeans, no make-up with her hair pulled back in a ponytail, Karen looks younger than her 48 years.

Although her declaration leads me to think, ‘Oh no, not another idea that goes nowhere,’ I take a more supportive approach. “In art history?” I ask, Karen’s area of specialty.

“I don’t know. I haven’t decided yet. I have to do something. I can’t go on just being Dr. Thomas Hartfield’s wife. It’s too boring. I don’t want to have to get all dressed up and hang out at the club playing bridge, gossiping with the women.”

“Weren’t you recently talking about wanting to open an art gallery?”

“Yes. I still think that’s a good idea, but I don’t know, there’d have to be so many people involved, people I’d have to manage. It seems overwhelming. Writing is something I can do on my own, at my own time, in my own space.

“Of course, I haven’t written anything since I was in college. I was pretty good back then. I think I considered majoring in English. But then again I thought about majoring in lots of things. I’m not even sure how I ended up with a major in art history. I guess because I hung around college for so long and had so many credits, they told me it was time for me to graduate and art history was it.”

“So it seems, Karen, we’re back to talking about how difficult it is for you to make a decision and to carry a plan through to fruition.”

She sighs. “You don’t think I’d write that book do you?”

“Well, I don’t have a crystal ball, but when you say that you don’t  know what you want to write about, it seems you could get stuck right there. I’d be concerned you could think endlessly about what you did or didn’t want to write and never be able to move beyond that point.”

“How did you know what you wanted to write?” Karen asks me.

I don’t introduce my book into my therapy sessions, but many patients Google me and find it online. Now I wonder if there’s some relationship between my book and Karen’s sudden interest in writing. “Before I answer that question, Karen, can I ask you how you feel about my having written a book?”

“Envious. You were able to follow through and do it. But maybe also inspired, like if you can write a book maybe I can too.” She hesitates.

“What just happened there?”

“Nothing. I guess I got anxious. There are so many choices. I don’t know how anyone ever decides on one path over another. I don’t know how you pick. I don’t know how you pick one and give up the others. So how did you decide what to write about?”

I wonder about Karen’s anxiety. Does she worry I’d feel angry or vindictive if she wrote a book? Does making one choice over others bring up fear of loss? Keeping these questions in mind, I answer Karen. “I felt compelled to write about my relationship with my late husband. I think there’s often an emotional press in writing; you have something you have to say. It’s like being in therapy. It’s sharing a vital part of yourself that you want to be known.”    

“Do you think I don’t want to be known?”

“That’s a very interesting question. What do you think?”

“Well declaring myself, taking path A rather than path B would be a way of being more known.”

I’m silent, intrigued by Karen’s train of thought.

“But why wouldn’t I want to be known?”

“I was just asking myself the same thing.”

Silence.

“Weird. The words, ‘You’re a moving target’ just went through my head.” Pause. “Who did I think would shoot me?”

I wonder if it’s me, but I remain silent.

“My oldest sister for sure. She was horribly jealous of me. I was the pretty one, although I made myself as unattractive as possible until she left for college. She’d cut up my clothes, steal all my panties. One time she even cut off part of my hair in the middle of the night.”

“That’s called abuse, Karen,” I say, surprised by this revelation I had not previously heard.

“You think?”

“Definitely. What did your parents do?”

“I don’t know. I don’t remember telling them. Maybe I did. Maybe they said we had to work it out. That part of my childhood is a bit fuzzy.” Pause. “Do you think this is relevant?”

“I definitely think this is relevant, Karen. We have to stop now, but we definitely need to spend more time understanding how your sister affected your life.”

Defeated

“What brings you here?” I ask Peter, a handsome young man I am seeing for the first time.

“My father.”

I wait for further elaboration. He offers none.

“Can you say more?” I ask.

“Nothing more to say. I’m here because of my father.” 

“So I gather you don’t want to be here.”

“You got that right.”

“And you don’t feel you need to be in therapy.”

“Right again.”

“And you’re angry that your father insisted you come.”

“You’re batting a thousand.”

Ignoring his sarcasm, I ask, “So why did you feel you had to do what your father wanted?”

He snickers. “You don’t know my father.”

“That’s true. Why don’t you tell me about him?”

He snickers again. “Sneaky. You’re going to get me to talk. Okay, might as well. My father’s paying for it. My father pays for everything. He’s rich. Developed his own company. Made a fortune. And never lets anyone forget it. He’s smart, a good businessman. My brother works with him. Me, I can’t imagine sitting in an office all day. Just like I can’t sit in class all day. I’m 24 and still bouncing from one college to another. I guess that’s why my father wants me in therapy. He wants you to motivate me.”

“Are you angry with your father?”

“Yeah, I guess you could say that. He’s always on my case. Always wants something more from me. Always bugging me to make something of my life.”

“And what do you want for your life, Peter?”

He shrugs.   “Don’t know. Don’t know why I have to want anything. I like hanging out with my friends, surfing, hand gliding, sitting around getting high. Why should I have to work? Daddy will leave me more than enough money.”

I find myself empathizing more with my patient’s father than with Peter himself, making me uncertain how to respond, concerned that I will sound critical, like his father. I decide further exploration is preferable to any comment about the patient’s current life. “Did you always feel this way, Peter? What about in grade school or even before?”

Peter sits silently, but exudes less defiance. “My Dad was my hero,” he finally says. “He played baseball with us, took us to games. And even when he stared making money, and wasn’t around as much, I knew that he was doing it for us. And then he started making more money. And there were stories about him, interviews with him, he was making a big name for himself. And there was me. My brother was a straight A student. I couldn’t measure up. I never liked to read. I was lousy in math. There was nothing I was good at. Except baseball. And I wasn’t good enough at that. My father climbed up and up and I went nowhere but down. So I gave up. Why bother.”

“Sounds pretty sad.”

“I guess,” he says, shrugging, his defensive tone returned.

“Where was your mother in all this?”

“That’s another story. Nothing was ever enough for my mother. She criticized all of us – especially my father. I never understood why he took it, why he didn’t get out. I thought he probably had women on the side – who could blame him – but I don’t know that for sure. I once asked him. He slapped me across the face.”

“Was that typical of him? To hit you?”

“I wouldn’t say that. He hit me a few times. But that time was a surprise. I didn’t get why my question made him so angry. But I never asked again. And I guess I stopped caring.”

“So when you feel angry, you turn yourself off, you ‘stop caring.’”

“I guess.”

“I wonder if the problem with that Peter is that without being able to tap into your anger, your aggression, it’s very hard to find your competitive spirit, your desire to win, perhaps even your desire to beat your father.” 

 “I could never beat my father. I could never even come close.”

“The problem, Peter, is that you gave up trying. You were so sure you’d lose, that you’d never come close, that you were defeated before you began.” 

“But I couldn’t come close.”

“Maybe. Maybe not. I wonder what you might be able to accomplish if you didn’t feel so defeated, so shut down. I hope you’ll give yourself and us the chance to find out.”