In A Quandary

 “It’s kind of weird starting therapy on FaceTime,” my new patient, Leah, begins. “But I’m a therapist myself, getting used to working virtually, so I figured it was time to get myself back into treatment. I certainly could use the help.”

“And how can I help you?”

“I guess the big push for me to start treatment again is my father, but of course like everyone else in the world, I have problems and problems and more problems.” She sighs. “I’m 45. I’m married, my husband, Ed, is an IT guy working from home. I have two kids, girls, 12 and 14, who are in school virtually. So there we all are at home, each in a separate room, learning, seeing patients and solving computer problems. Sometimes it works, sometimes it doesn’t. It’s a problem if one of my girls doesn’t understand something she’s being taught and thinks she can just interrupt me in a middle of a session. I’ve tried to explain she can’t just do that, but if she goes to Ed, well, he just doesn’t have the patience, so she’ll end up interrupting me anyway. I’ve tried locking my door, but Elisa – she’s my youngest – gets really scared if I do that, so that doesn’t work either.”

“Sounds like you’re being pulled in every direction.”

“That’s for sure. And then there’s my father. My Mom died three years ago and at first I thought my Dad would be okay but now I can see he’s starting on the road to dementia – actually getting worse faster than I would have expected - and I’m worried about him being alone. Sometimes he calls again and again to ask the same question. He told me he’s burned a couple of pots forgetting he had the fire on. He’ll sometimes forget which apartment is his. And, of course, like many people during Covid, he’s lonely and, because he’s who he is, he’s angry. So I’m trying to decide if I should move him into the house with us.”

“Wow! Sounds like you have a tremendous amount on your plate.”

“Yeah. And the added problem is that I don’t like my Dad. I mean I love him – I guess – but I don’t like him. He’s angry, opinionated, narcissistic, dogmatic and intrusive. And that was all my life, not just since my Mom died or since the dementia.”

“So what was it like for you growing up?”

“Well, I’m a therapist, that should give you a big hint,” she says with a small smile. “It was hard. I was the oldest of three girls. My Mom was this really sweet person who didn’t have a backbone. She accepted anything and everything my father did, worshipped him really, and left us to fend for ourselves. Which usually meant I was the one arguing with him. My middle sister was the good girl, kind of like my mother, and my youngest sister just sort of floated through life, which is kind of what she’s still doing. I think she just ended marriage number three and career number … I don’t know. Too many to remember.”

“So what do you think it would be like with your father in the house?”

“Awful. I know it would. My youngest daughter is scared of him, always has been; and my oldest, at 14, she’d probably be arguing with him just like I used to. But I don’t know how they’d do with his dementia.”

“You haven’t said much about your husband.”

“I know,” Leah says sighing. “It’s hard. I mean I love Ed and I know he loves me, but even after all my previous therapy, I still think I married my father. No, that’s not really fair. Ed isn’t an angry bully like my father. But he is self-centered and not inclined to go out of his way to be patient or helpful, like I was saying before about his not helping my youngest with her schoolwork.”

“I notice you keep referring to your children as ‘yours’ rather than ‘ours.’

“That’s true. They’re very much my responsibility. I mean he loves them and he’s great about playing with them as long as it’s something he enjoys. But he’s definitely the fun parent and I’m the one who keeps after them to do their homework, pick of their rooms and so forth.”   

“So you always end up in the role of the responsible one. Any idea why?”

“First response, I was the oldest. Second, it’s the only way I’m sure things will get done.” Pause. “Maybe it’s the only way I feel safe.”

“There’s certainly a lot there for us to explore there.”

“I want to ask you before we stop if I should take my father in, but I know you can’t answer that.”

“Maybe we first need to look at why you only feel safe when you carry all the weight of responsibility.”

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.”

I’m Nothing

Loretta Fischer has come into my office for the first time. She is an impeccably dressed, slender woman, who sits primly across from me, fidgeting slightly in the chair, staring at me expectantly.

I oblige. “What brings you here?” I ask.

“I’m just not happy,” she replies. “I’m alone. My husband died five years ago, my children are scattered all over the country. They call fairly regularly, but they’re not going to be keeping me busy on Saturday night. You know, I do the usual things women my age do, I play cards three days a week, go to the gym, go out to dinner and to the movies with friends.” She sighs. “It’s boring. I used to be an administrative secretary. My boss really relied on me. I was important. Now I’m nothing.”

“Now you’re nothing?” I say. “That’s a pretty dismal assessment of yourself.”

She shrugs. “That’s how I feel. I’m not a wife, not a mother, not a worker. I’m nothing.”

“What about your friends? The women you go out with?”

“They’re just women to go out with. They’re not really friends. Women my age don’t make friends.”

“How old are you?” I inquire.

“That doesn’t matter. What matters is that I’m unhappy.”

I’m startled. Loretta alludes to her age twice in a brief period of time and then refuses to tell me her age when I ask. Is she provoking me? “Is there a reason your age is a secret?” I ask.

“You know it’s not polite to ask a woman her age. How would you like it if I asked you your age?” 

This is beginning to feel like a minefield. In a matter of minutes, what is usually the friendly getting to know you beginning of therapy has evolved into a confrontation. I suspect that Loretta is not only unhappy, but quite angry as well. “Well,” I respond gingerly, concerned that I’m moving too quickly, “I actually wouldn’t object if you asked me my age, but I think the more important question is whether your manner of responding reflects both your need to protect yourself and your anger at having to give anything of yourself.”

“What are you talking about?” Loretta says sternly, knitting her brows. Then she sighs and shakes her head. “They told me you were an excellent therapist, not like the others I’ve seen. They said you were more real. And here you are spouting the usual kind of nonsense. Your whole field is ridiculous.”

I feel scolded, diminished and angry. As these feelings wash over me, I realize that in very short order, Loretta has enabled me to feel exactly what she feels, “like nothing.” I’m torn about how to proceed. I wonder how many therapists she’s seen before me. I wonder if her age is a particularly sensitive issue or if she unconsciously needs to bate me. Regardless, I need to mend the breach in our relationship if this therapy is to have any chance of succeeding. “I’m sorry, Loretta,” I say. “I am getting way ahead of myself. But let me ask you something, you say you feel like nothing because you’re not a wife, a mother or a worker, what did you feel before you were wife, mother and worker? Did you feel like nothing then too?”

“Are you trying to get me to go back to my childhood? Another piece of nonsense. I suppose everything is my mother’s fault?”

I feel my anger rise. But maybe she does think everything is her mother’s fault. Her anger and criticalness and feeling like nothing have to come from somewhere. “Loretta, my sense is that you’re angry. I don’t know yet what or whom you’re angry at, but I do know that it took next to no time for us to be at odds with each other. I get that you’re unhappy and I’m sure it feels awful to feel like “nothing,” but I do think it’s important for you and for us to understand where that feeling comes from in both the past and the present.”   

“So you’re assuming I’m coming back?” she says smugly.

“I don’t know if you’re coming back, Loretta. That’s something you’ll have to decide. But I do know that most everything you say feels like a provocation to me and I can’t imagine that would be helpful to you in your life.”


“I’ll make another appointment and we’ll see.”

I bite back the answer that comes to mind, “We’ll both see,” and settle for, “Seems fair. We’ll meet again and see what develops.”