What's the Big Deal

 “I don’t get it,” Marlene begins, her face appearing tense and puzzled on my screen. “Every time I talk to one of my friends or even exchange an email, they’re talking about how devastated they still feel about the storming of the Capitol. I agree, go along with it, so they don’t think I’m some sort of a weirdo, but I don’t get it. It was a building for God’s sake. Yes, 5 people died and I’m sorry about that, but I see people dying of Covid every day in the hospital, people who are scared and alone and broken. We’ve lost way more than 300,000 people to Covid and people are so distressed about a building! What’s the big deal?”

I’ve had many patients who were very distressed by the events of January 6, others who, not surprisingly to me, didn’t even mention it. But I am surprised by Marlene’s lack of emotional response. As a nurse she has been on the front line of the pandemic, so perhaps, I think to myself, she can’t allow herself to feel any more pain. Still, politics matters to her. She usually has very definite opinions, often accompanied by intense affect.

“It sounds as though you’re uncomfortable with your not experiencing it as a big deal,” I suggest.

“I suppose. I don’t know, it just makes me feel different. Which is certainly not a new feeling for me.” She sighs. “Poor white trash, daring to want to make something different of myself. That got me beaten at home for thinking I was better than them and bullied at school because those kids sure as hell didn’t think I was as good as them. Shitty beginning.”

“And you’ve taken yourself far from those beginnings.”

“Yes. And I haven’t told you, but I’ve been thinking of applying to school to be a Physicians’ Assistant.”

 “That’s wonderful, Marlene. I’m so pleased for you.”

“You don’t think it’s crazy? I’m already over 40. And PA school is very competitive.”

“You know, Marlene, I think you just asked me if I think you’re being too uppity, going too far from ‘home,’” I say.

She chuckles. “I think you’re right.”

“So do you think it’s weird that I don’t feel more about the storming of the Capitol?”

“I don’t think it’s weird, Marlene, but I do think it’s unlike you.”

“So you had strong feelings about it.”

“I did. But I’m wondering right now why you are asking me all these questions rather than telling me more about what you’re thinking, what you’re feeling.”

“I guess I’m feeling weird, which takes me back to my childhood.”

“What specifically in your childhood?”

“All of us living in that three room house. All the screaming. All the violence. My Dad beating the shit out of me if he found me reading a book. All the kids at school circling me, jeering at my clothes.” Marlene’s eyes fill with tears. “Will those images ever go away? I want them to go away.”

“Let me ask you something, what brought those images back so vividly?”

Marlene’s eyes widen. “Oh my God, seeing those people storm the Capitol! That’s what brought those images back. Those were quote, unquote, ‘my people.’ Oh my God,” Marlene says sobbing. “Oh my God! It’s so awful! Of course I couldn’t take it in. It’s way too close, way too close. It makes me sick. I don’t want to be like them, I don’t, I don’t.”

“You’re not like them, Marlene. You’ve grown a long way from there.”

Marlene continues crying, tears streaming down her face as she stares at me on the screen. “I wish I was in your office right now. I wish I could feel your presence, like your presence would erase the awfulness of those images.”

“I wish that too, Marlene. But I do hope you can feel that I’m here for you.”

She nods. Grabbing a tissue, she blows her nose and wipes her eyes.

“So I couldn’t take in the horror of the mob attacking the Capitol because it brought me too close to my childhood experience? So I did what, I shut down, and didn’t allow the horror to penetrate?”

“I’d say that’s exactly what you did, Marlene. At first I thought you’d shut down because of all the months of dealing with the stress of Covid meant you couldn’t take in one more horror. But I’d say, you got way closer to the real reason you shut down, the need to distance yourself from the horrors of your childhood.”

Tag words: Psychotherapy, mental health, defense, patient-therapist relationship, childhood, violence, growth, ambition, numbness, shutting down.

Ending

“So,” Philip begins, “There’s something I’ve been thinking about and after all these years I certainly know I’m supposed to talk about everything I’m thinking about. So, here goes,” he says, inhaling deeply. “We have two weeks, six sessions left and for our last session I’d like to take you out to dinner.”

Many thoughts and feelings flit through my mind. I’m surprised. Philip is a 55 year old obsessive man who despite years of therapy is still fairly rule-bound. Taking me out to dinner would definitely be bending those rules. So should I consider his request an indication of progress? Perhaps, perhaps not. Either way, I know I’m not going accept. To do so would be stepping way outside the bounds of our relationship. I have gone to lunch or dinner with patients who have been out of treatment for long time, but then I know that the treatment is definitely over and it’s more like catching up with an old friend. Last sessions and, in fact, the entire process of termination is fraught with many intense and conflicting feelings. A restaurant is definitely not the place to deal with them.

“What makes you ask? Why do you want to take me to dinner for our last session?”

He looks instantly deflated. “You’re not going to do it.”

I smile inwardly. My apparently neutral question wasn’t so neutral after all.  “No, Philip, I’m not going to accept. I’ll explain why, but first I’d be interested in knowing why you want to.”

“Is it because I’m a man? I mean I know we dealt with some of my, uhmm, feelings about you along the way, but this has nothing to do with that. I just want to say thank you for all you’ve done for me.”

“And when you say ‘thank you for all you’ve done for me,’ you’ve given me more than enough, a gift. You’ve been able to put your feelings into words. And your warm feelings at that. That’s a major accomplishment for you.”

“You didn’t answer my question.”

“I’m sorry. No, it’s not because you’re a man. Did I hear a hint of anger in there?”

“No one likes to be rejected.”

“Whoa. Let’s go back a minute. You say that you want to take me out to dinner to thank me for what I’ve done for you. What do you imagine you might be feelings that last day? Or the last week? Or what are you feeling today about ending?”

“Hard to separate out what I’m feeling about ending and what I’m feeling about your turning me down.”

“Okay. Just say what you feel right now.”

“Hmm. I feel disappointed. And hurt. And a little angry. And confused. I don’t understand why.”

“So let’s say we were at a restaurant right now. Would you like to be dealing with all those feelings at the restaurant?”

“I wouldn’t be having these feelings if we were at a restaurant.”

“Ah ha! So perhaps you’ve just told us another reason why you might want to take me to dinner for our last session. Maybe it’s so you won’t feel all the feelings you might be having during that session.”

“Oh.”

“Last sessions can be pretty emotional. I know there’s some excitement about leaving, a feeling of accomplishment. Some people describe it as feeling like graduation. But even graduation has sadness mixed with it, ending a chapter in your life, ending your relationship with me. We’re known each other a long time. It’s always sad to say good-bye. Sad for me too. I’m happy for you and your progress, but your leaving is a loss for me as well as for you.”

Philip stares at me. “You’re so dear to me,” he says softly. “You will always have a special place in my heart. You’ll be with me always and I’ll miss you more than I can say.”

“That’s so beautiful, Philip. Thank you. That means so much to me. I think about how you couldn’t even identify what you were feeling when we first started working together, let alone express it. And to be able to express such deep, caring feelings warms me all over.”  

He smiles. “I was just going to say, ‘So how about dinner?’ and then I realized I was just running from all the feelings in the room. I guess we’ll be meeting here for the remainder of our sessions. Five more to go. Makes me sad.”

Moving Forward

Crystal greets me with a big smile as I open my waiting room door. A slender, 35 year old woman, dressed in casual black clothes, her hair pulled up in a bun, she looks like the yoga instructor she is.

“It’s been quite a week,” she begins. “We’re going into the New Year and, hopefully, I’m going into my new life.” She laughs. “Maybe that’s a bit dramatic. But I feel I’ve suddenly shed my old self. I was totally miserable when I left here last week. I couldn’t stop crying. I even canceled my classes. I know you’ve been saying it for years, but I never really got it, not really. But last week I really felt for me as that little girl, that little girl whose parents were so wrapped up in each other they didn’t even know I existed. It always felt so unfair. It was unfair. It’s not that they were struggling to make ends meet. It’s not that they couldn’t pay attention, they just couldn’t be bothered. And I kept hoping, hoping that I could make them be different. As a kid. As an adult. But I couldn’t. And I got angrier and angrier. And the angrier I got, the more I messed up my life. I was valedictorian of my high school class and I never even graduated from college. How sad is that? I guess I figured if they didn’t care, why should I?”

I’m pleased. This is one of those moments therapists wait a long time to experience. “Wow, Crystal. I’m impressed. It certainly sounds like something coalesced for you in a very different way last week.” 

“It’s what you said about mourning – not that you haven’t said that a million times before too. And you brought up that movie again, “Inside/Out.” So I watched it again. Especially that scene about the elephant. I sobbed my way through it and then I realized that letting go of the elephant as an imaginary friend was a metaphor for letting go of childhood, letting go of the past and that even though it’s very sad, there’s really no other choice if you want to move forward in your life. I can be mad at my parents forever. I can long for their love and attention, but it’s just never going happen. So I have to stop being a baby, let go and move on.”

“I was feeling so pleased for you, Crystal, but that last sentence raised a red flag for me. When you say ‘I have to stop being a baby,’ you’re now rejecting the hurt, vulnerable child in you just as your parents did.”

“Hmm,” she says thoughtfully. “What should I have said?”

“It’s not a question of what you should have said, but rather what you do feel for that child part of yourself.”

“I guess I don’t like her a lot. At least not this week. I want her gone.” She pauses. “You know, I don’t think I get how I could like that part of me and still move forward. I decided after my epiphany this week that I’m going to go back to college and then on to graduate school, although I don’t know if that would be in business or film or dance. I know, I’m covering the spectrum there.”

Although I wonder if Crystal is pushing herself into activity to get away from her internal sadness, I say, “That’s great, but you raise a very important issue when you say you’re not sure how to be kind to the sad, vulnerable part of yourself while going on with your life.” 
  
“I don’t.”

“Well, you sometimes talk about your neighbor’s little girl. Suppose one day you saw her crying because a friend of hers hurt her feelings or because someone pushed her and she fell. What would you do?”

“I guess I’d hold her and reassure her until she stopped crying and felt comfortable to go back to playing.”

I smile. “Well?” I say. 

Crystal smiles back at me. “I guess you’re saying I should treat myself like I’d treat her.” Pause. “You know, that’s not so easy. It’s like either I have to push myself forward and forget about the sadness or get stuck wallowing in it.” Another pause. “Well, I guess you don’t get rid of me yet. We still have work to do.”

I’m startled as I realize the meaning behind Crystal’s statement. “Crystal, allowing yourself to move forward, to do the things you want to do in your life, doesn’t mean you have to stop seeing me. There isn’t this strict demarcation between childhood and adulthood where adults don’t need love and caring and connection. You can go out into the world and see me for as long as you want or need.”

Crystal’s eyes fill with tears. “You’re amazing. I’m afraid I’ll never want to leave you.”

“That might be a fear of yours,” I say. “And we’ll deal with it.”    

The Mask

Elaine, burying her head in her hands, begins sobbing as soon as she sits down. Struggling to speak she says, “Baxter has cancer. That’s why he hasn’t been eating. I may have to put him down. I can’t believe I’m carrying on like this! I didn’t even shed a tear when my grandparents died.”

Sadness floods me as I feel for both Elaine and myself, thinking immediately of Pippin, the regal black and white cat my late husband and I adopted shortly after we moved to Florida. Putting her down two years after my husband’s death was beyond painful.  “I’m so sorry, Elaine, I know how attached you are to Baxter, how much he’s meant to you.” 

“And this is supposed to be good? Feeling like a wreck, feeling like my heart will break?” she says sarcastically.

I know what Elaine is referring to. I remember when she first walked into my office four years ago. Although attractive with tasteful make-up, Elaine looked like a doll, her face mask-like. Her mother died when she was three, her father when she was seven. She lived with her step-mother until their conflicts became unbearable, then moved to her paternal grandparents, who saw her as an unavoidable inconvenience. Listening to Elaine’s story I felt overwhelmed by sadness, while Elaine seemed devoid of feeling. 

Elaine came into therapy because she couldn’t maintain a relationship. She had no difficulty finding men but the relationships never lasted. The men said she was unconnected, unavailable, that there was no passion. Sex wasn’t the problem, it was something else, but she didn’t know what. I suspected I knew. It’s impossible to connect to a doll. Our job would be getting behind the mask. It wouldn’t be easy. She had spent years fending off the pain of all her losses. The mask would have to be peeled off slowly.

“I have no memory of my mother or my father,” she told me. “Just pictures I’ve seen and what my step-mother was willing to tell me, which wasn’t much since she preferred not to talk to me. Of course my grandparents didn’t like to talk to me much either. Besides, they were old, they didn’t want to be reminded of their son’s death. I can imagine that would be painful for them.”

“And you don’t think it would be painful for a three year old, for a six year old?”

“I can’t feel what I can’t remember.”

Finding Elaine’s memories would be crucial to her growth. 

While we focused mostly on Elaine’s difficulties with relationships in both her personal and professional life, over the years I asked questions about the past: “Do you remember your first day of school? Who took you? Do you have an image of the house you lived in with your father? Do you remember moving from your step-mother’s to your grandparent’s? Did you have to change schools? Leave friends?”

One session when Elaine came in she looked different. There was a crack in the mask. “I had a dream,” she began. “There was a child standing in an empty field. She was holding someone’s hand, a man’s. They were looking down. When I woke up I felt incredibly sad. I didn’t think the child was me. But then I wondered if it was me with my father standing at my mother’s grave. Could I possibly remember that? I was only three.”  

“Let’s stay with your feeling, Elaine,” I say softly. “What is it like to feel that sadness? What does it bring up for you?” 

“I don’t know,” she says starting to cry. “I guess I’m sad for that little girl. Standing by her mother’s grave, not knowing that in three more years her father will be dead too. It’s really awful. I guess I never thought of it like that. I guess I never thought about it at all.”

“You didn’t want to think of it, Elaine. You didn’t want to deal with your pent up sadness. But today you’ve taken a big step forward.”

Two years separates the session of Elaine’s dream and her telling me she might need to put down Baxter.   

Returning to the present session I say, “I know you’re feeling tremendous pain, Elaine, not only for your beloved Baxter, but for all the losses you’ve endured in your life.”

She sobs. “Please tell me this pain is worth it.”

“It’s worth it, Elaine. If you can’t allow yourself to feel your sadness, you can’t feel joy either and, most importantly, you can’t be truly alive.” 

From Endings to Beginnings

“So I assume my father already vetted you,” Chelsea says, sarcasm dripping from her every word. I’m taken a back, put off both by her words and her appearance, tattoos covering her arms and upper chest, multiple piercings in her ears, lip and nose.

I also had lots of feelings about that phone call. I immediately experienced Chelsea’s father as domineering, take-charge, arrogant and self-important, a combination that immediately called forth memories my father, leading me to feel intimidated, defensive and angry all at once.   

I respond to Chelsea, hopefully revealing none of my discomfort. “He did call me. I answered some of his questions about my credentials, but I told him what would be important is how you felt about me, if we felt we could work together, and that wasn’t anything he could decide.”

“Yeah, yeah, yeah. I’ve been through this many times. That’s what they all say. But he’s a bully. And he pays the bills.”

“I get that you’re angry at your father.”

Chelsea snorts. “That doesn’t take a genius!”

“No, it doesn’t. I also get that you’re angry, period. Are you angry about being here? Do you want to be in therapy?”

Silence.

I’m too old for this, I think to myself. An angry resistant patient and an intrusive father that is going to push all my buttons. Maybe I don’t want to do this.

“You don’t have to be here, Chelsea. You don’t have to work with me.”

“Giving up on me already?” Chelsea says, contemptuously.

She caught me! I feel both embarrassed and impressed by her insightfulness.

I take a deep breath. “Okay,” I say. “Let’s start again. What brings you here, Chelsea?”

For a second, Chelsea’s eyes fill with tears. Like a child, she rubs them violently away with her knuckles.

My heart melts. She’s another one, a wounded bird who covers her pain with anger; whose demeanor screams, “Keep away,” when what she means is, “Please love me.” I’m always hooked by this combination of fragility covered by determination and grit. I think of Alyce, the disturbed young woman I worked with over thirty years ago whose treatment constantly intruded into my life. But I was much younger then. I was in a warm, loving marriage with an incredibly supportive husband. I don’t know if I’d be up to that kind drama at this point in my life. But I’m way ahead of myself. I still know nothing about Chelsea.

“I’m an orphan again,” Chelsea says.

I wait.

“My asshole father divorced another one. I kind of liked this one. She was nice to me. It gets tiring, one house after another, mothers that come and go, brothers and sisters that come and go.”

“What about your biological mother?” I ask.

“She’s dead. She died when I was three. I hardly remember her. In fact, I don’t think I do remember her, just sort of from pictures.”

“Wow! You’ve had a lot of pain in your life.”

“I guess,” she says, shrugging.

“Sadness isn’t easy for you. You’re more comfortable with anger,” I say.

Silence.

“So where are you living now? What’s going on in your life?” I realize I’m asking these questions for me. I need to know how stable or disturbed Chelsea is before I commit to working with her.

“I’m living with asshole. On the beach. Money sure as shit isn’t a problem, not even with all the alimony he’s always paying. And I’m going to school. I know you can’t tell by looking at me, but I’m smart. And I like school. I want to be a doctor. And I will be.”

“I can tell you’re smart, Chelsea,” I say smiling. “And good at sizing people up. That should make you a good doctor.”

She brightens, surprised. “You think so?” she asks, suddenly more childlike.

“Yes, I think so,” I reply honestly.

“Thanks.” She pauses. I can see her struggling. “I think you’re okay,” she says. Then she immediately draws back, as if she’s revealed too much of herself, as if she’s taken too much of a risk. “I mean, I guess you’d be okay to work with.”

“It would be my pleasure to work with you, Chelsea,” I say honestly. I know this won’t be an easy treatment. I know her father will be a constant intrusion into both our work and my psyche. But this is a young woman who has known more than her share of pain and I think I can help her. I see her potential and I’m hoping to foster it.

For better or for worse, there’s always a new Chelsea. I’m fortunate that my life’s work brings fulfillment to me and, hopefully, growth for my patients.