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.”

So Much To Do!

“There’s just so much I have to do. Mom’s sister is coming from LA. Her best friend is coming from New York. I have to get food in the house. The house is such a mess, especially with Mom’s hospital bed in the living room. And there’s Melissa, getting her to school, to swimming, to play dates. I’ve tried to keep her life as normal as possible.”

These words rush from Chelsea the moment she enters my office. She continues:

“I’ve thought about asking Melissa’s father to take her for a while, but I don’t know, I don’t know how she’d feel about being sent away.”

“How do you feel, Chelsea? How do you feel about sending Melissa away? How do you feel about your Mom?” I ask, interrupting the flow.

“I don’t have time to feel. Except for stressed. I’m plenty stressed. There aren’t enough hours in the day. And I don’t want to leave Mom alone. I know the hospice nurse is there, but she’s a stranger. Mom doesn’t know her.”

“Chelsea, can you slow down a bit, can you …”

“I can’t slow down,” Chelsea interrupts. “I don’t have time as it is.”

I’m discomforted by Chelsea’s agitation. I know about anxiety taking over during times of impending loss, being propelled into action to escape the sick feeling in one’s stomach, hoping that doing something, anything will decrease feelings of helplessness.  But it’s possible – in fact, helpful – to remain aware of the ever-present sadness.  Chelsea is using her incessant activity in an attempt to rid herself of her feelings, an impossible task that only increases her anxiety – and mine.

“But you have time here, Chelsea,” I say. “You have time to feel. Your Mom is dying. She’s been living with you for several years. You’ve been her caretaker. You have feelings about losing your Mom.”

“Of course I have feelings,” she replies. “But what’s the point of dwelling on it. And her sister and best friend are coming. I can’t very well tell them not to.”

“Are you saying you’d rather they not come?”

“It doesn’t matter what I want. They want to come see Mom and they certainly have a right to.”

“But you can have a preference, a feeling about their coming, even though you understand their need to say good-bye to your Mom.”

“I guess I’d rather they not come. But they’re still coming.”

I feel myself becoming increasingly sad, although I don’t know why. Is Chelsea becoming more aware of her own sadness? Is she less aware and projecting her sadness onto me?

“Do you know why you’d rather they not come?” I ask.

“It’d be a lot less work.”

“Any other reason?” I persist.

Suddenly Chelsea is still. Her blue eyes fill with tears. “I know this is silly, but I’d rather have my Mom all to myself. I hadn’t thought of it, but I wonder if that’s why I considered sending Melissa to her father. I want it to be just Mom and me, just like it was when I was little. Oh God! I knew I didn’t want to go here! I can’t stand it! I’m not sure I’ll make it without Mom!” Tears stream down her cheeks. She buries her head in her hands, her body wracked with sobs.

My eyes well up. I remain silent, giving Chelsea her time.

After several minutes she reaches for the tissue box, blows her nose and wipes her eyes. “I’m sure I look like a mess.” She pauses. “But I actually feel calmer. Isn’t that weird?”

“No, Chelsea, not weird at all. You spend a lot of energy running in circles, trying to avoid your sadness. But when you stop and feel the sadness, although it’s very intense, you feel grounded again and you don’t have to be frantically worrying about things that don’t matter much at all.”

“But sometimes I’m not sure I will survive without Mommy,” she says in a whisper.

“I understand that’s your fear.”

“We were so close. It’s even been hard these last few months when she’s really not with me anymore. But I can pretend. I can pretend she knows who I am, that she hears me, that she responds to my voice. And maybe she does. But soon I won’t even have that. I don’t want to start crying again. I have to go soon anyway. Oh, I can begin to feel myself starting to rev up.”

“Good that you recognized that.”

“But better to be running around like a whirling dervish, than to be afraid I won’t survive without Mom.”

“Well, hopefully we can help you feel less like a helpless child who can’t survive without your mother. I’m sure you’ll miss her and grieve a lot. But you will survive.”   

In Search of a Self

“I can’t believe it,” Janice says throwing her hands in the air. “Why does she feel she has the right to tell me what I should wear to my child’s graduation? I’m 42 years old. Shouldn’t I know what’s appropriate to wear and what isn’t?”

Janice is talking about her mother’s intrusiveness, a situation that has only worsened since her family moved to Florida a little over a year ago.

“Well,” I ask, “what does give her the impression that it’s all right for her to tell you what to do?”

“She’s always done it. That’s how she was when we were kids – especially with me as the only girl – and that’s how she is now. ”

“What did you say to her when she was telling you what to wear?”

“I said, ‘Ma, I’m a big girl now, remember?’”

“So you don’t confront her; you kind of make light of it.”

“I don’t scream at her if that’s what you mean.”

“No, I wasn’t talking about screaming at her. I was talking about having a genuine conversation about how you’re a grown woman who doesn’t need her mother to tell her what to wear and how it doesn’t feel good to have her invading every aspect of your life.”

Janice pauses and then asks, seemingly puzzled, “What’s the alternative?” 

Similarly confused, I say, “I’m sorry, I don’t know what you mean.”

“Well, when you just said it doesn’t feel good having her invade every aspect of my life, it suddenly felt scary to me, like if she wasn’t invading every aspect of my life would I feel, I don’t know, would I feel lost, abandoned?”

“That’s a very insightful question,” I say, thinking back on my own relationship with my intrusive mother. Early in my life I experienced her hovering as protective and safe, but I grew to chafe against it and needed to set my own boundaries. Perhaps Janice isn’t there yet. “So you’re saying that as much as you protest about your mother’s intrusiveness, perhaps there’s a part of you that still longs for it.” 

Janice looks at me, looks over at the clock, looks back at me and says, almost mournfully, “Ten minutes left.” 

So Janice longs for me as well, I think. I remain silent giving her the chance to pursue her own thoughts.  

“It’s so easy to me to feel lost, empty. Even when I’m with my kids, even when the house is bursting with noise, I often feel alone. I feel alone right now. You’re not saying anything and the session is almost over and I feel scared. And when I feel scared like this at home I call my mother. I sometimes fantasize calling you, but I wouldn’t do that – unless there was really some kind of emergency.”

I wonder how it is possible that I haven’t seen this side of Janice before today, how I accepted her protests against her mother’s intrusiveness at face value and didn’t see the scared little girl underneath. Was it because of my own experience with my mother? Perhaps. But I have an alternative thought. With her mother, Janice is the obedient child who accepts – and perhaps even welcomes - her mother’s intrusion into her life. With me, she is still the obedient child, but she knows – consciously or unconsciously - that I want her to be separate and independent, so she’s being as I want her to be. But as long as she’s being how I want her to be, she’s still not being her own separate person.

“I was just thinking, Janice, that you’re always trying to be the person the mothers in your life want you to be, whether that mother is your biological mother or me or perhaps other people as well. I think in the process of trying to please us all so you don’t have to feel scared and alone, you’ve kind of lost who you really are.”

“That feels really scary. Truthfully I’m not sure I’ve ever known who I am. I was my mother’s child and my husband’s wife and my children’s mother, and my brother’s sister, and your patient. I think all those people are different. I don’t think I have one me.”

“I can understand how that feels really scary, Janice. So I guess we know what we need to do. We need to find out who Janice really is.”

To Know or Not to Know

“I have something I need to talk about, but I’m not sure I can,” begins Victoria, squirming in her seat. She is a smart, insightful, vivacious thirty-two year old woman who has been in therapy with me for a little under a year.  

Her words put me on immediate alert, concerned about what secret she might reveal. I remain silent as thoughts race through my mind: Was she raped? Is she an incest victim? Did she shoplift? 

She stares at me, takes a deep breath and says, “OK. I was at a dinner party on Saturday night. There were a couple of therapists there and your name came up. I was surprised. That’s the first time it’s happened. I didn’t know if I should immediately say that I was your patient, but I didn’t. I wasn’t sure I wanted my date to know I was in therapy and I guess I was afraid they might stop talking and I was kind of curious as to what they might say about you. But it was sort of scary too. Like what if they said something bad? I mean they didn’t, not at all. They started talking about the great blog you write. And that you wrote a book too.” Victoria stops and stares at me again.

Feeling as though I’m being scrutinized, I keep my face neutral as I wait for her to continue.

“So the next day I went on line and googled you and looked at your website. I don’t know if I should have done that.”     

“Because…? I ask.

“Because I don’t know if I’m supposed to. Because I don’t know if you’ll be mad at me. And I guess I’m not sure I want to know stuff about you.”

“Lots of reasons,” I say softly. “So what are your thoughts?”

“Have you noticed how I always stare at you? I’m always trying to figure out what you’re thinking, trying to read your body language, trying to know if you’re approving of me.”

“So you’re afraid I’ll disapprove of something you say or do and that I’ll withdraw my caring, just like your mother did.”

“Exactly. I was always trying to read her. She could be so cold. And when she got angry with me for anything – a look, an expression, never mind misbehaving – she was entirely gone, absent. It was awful.”

“And you bring that fear of rejection into this room and our relationship.”

“Definitely. And to other relationships too.”

“That’s why it’s so difficult for you to hold onto a sense of yourself. You too easily become a chameleon, trying to figure out what other people want of you and fulfilling their expectations rather than your own.” 

“So are you mad at me?”

“What do you think?”

“You don’t seem to be. But I still have the feeling it was bad of me to look, as though your life is off limits to me.”

“Was that true with your mother too?”

“Definitely! She was always telling me I should mind my own business, even if I asked her where she was going when she went out. And when she was pregnant with my younger sister I thought she’d kill me when I asked how the baby got there and what happened to her fat stomach.”

I laugh. “Sounds like a smart question to me. But I guess curiosity was forbidden, and sexual curiosity even more forbidden.”

Absolutely. I knew nothing about sex except what I learned from my friends, and you know how accurate all that stuff is.”

“Before we run out of time, I want to make sure we look at what you said about not being sure you wanted to know about me.”

“Yeah. I mean, I do want to know, but I’m not sure it would be good for me. Like what if I read your book and find out all these things about you. Then I could really be on my guard. Now I don’t know all that much about you, and I’m constantly looking at you trying to figure out what you think. But if I did know more, I might take all sorts of stuff off the table or really watch what I said or didn’t say.”

“Good insight. So I guess you’ll need to figure out what you do or don’t want to do.”

“Which means you’re not going to tell me what you think.”

“I think whatever decision you make, we’ll be able to deal with the feelings that come up as a result.”     

Suspicion

I have been seeing John for a little over a month. He is a reluctant patient: removed, distanced, openly skeptical that therapy can be of help. “I’ve tried it before. I can’t see how talking makes a difference. So what if I understand myself? It doesn’t mean that will make me different.”

John, now 60, grew up on a Midwestern farm with an alcoholic father and a depressed mother, neither of whom had the time nor inclination to pay attention to their son. John always knew he wanted out; always knew he wanted more. And he succeeded, at least financially. He started out acquiring small, undervalued properties and parlayed it into a now huge real estate fortune. Personally, however, John has been far less successful. He’s been married and divorced three times, has no relationship with any of his children, and spends most of his time alone, working or following the stock market. My sense of John is that he is protecting himself from knowing the extent of his own childhood neediness, erecting a fortress around him that neither he nor anyone else can penetrate.

At the end of today’s session John takes out his checkbook and says, “Let me pay you for last month.” He stops, looks at me and asks, “If I pay you in cash, will you reduce your fee?”

I’m startled. The session is over. No time to ask what this question means to him; what he’d think of me if I said, yes; what he’d think of me if I said, no. “I’m not comfortable with that,” I reply. He nods, writes out a check, hands it to me and leaves.

I am bothered and discomforted. Although I have other patients to see, John intrudes into my thoughts for much of my day. Why did he ask me that question? Is it just that he sees himself as a shrewd businessman, bargaining over his fee as he would a piece of property? Does he feel that everything and everyone is for sale? Was he testing me? And then a strange thought occurs to me, was this a set-up? Was he hired by someone to entrap me, to see if I’d be willing to take cash and not declare the income? What a crazy thought, I tell myself; a paranoid thought that’s completely out of character for me. 

At the end of my day, I’m finally free to explore the possible meanings of both my patient’s question and, more importantly, my own thoughts. It’s clear that my patient has profoundly affected me. He has intruded himself into my mind in a way that has resulted in my thinking inordinately about him, as well as thinking in an unusually suspicious manner.

So what might have happened here? My assessment of John is that he is consciously aware of his own distrust, but totally unaware of his own neediness. In therapy, the boundary between patient and therapist can be fluid, such that the patient can unconsciously prompt the therapist to experience feelings the patient himself may not be aware of. Today’s interaction with John left me feeling suspicious, like John himself, as well as preoccupied with him, raising the possibility that John may have unconsciously communicated to me his need to have me both think about him and feel as he does.    

But I’m not an empty shell that a patient can just put feelings into. What was my contribution to this interaction? Although I am not aware of being consciously tempted by John’s proposal, I also know that I too have an unconscious and, by definition, the unconscious is unconscious. Perhaps an unknown part of me was tempted, felt guilty and then needed to punish myself by imagining that I would be caught and punished for my transgression.   

In our next session, although I doubt John will gain much awareness from the discussion, I raise the issue of why he asked if I’d lower my fee for cash and how he felt about my declining.

He shrugs. “It never hurt to try. Thought it could be a good deal for both of us.”

“But is this about a deal, John, or is about a relationship?”

“I pay you, don’t I?”

“Yes, you pay me. And we’re still two people relating to each other, sometimes about really important and painful feelings and experiences.”

He shrugs again. “No big deal.”

Last week’s experience comes into my mind: John denying his need, while “taking over” my mind. “That’s where I’d disagree, John. I’d say you are a big deal, so that anything that pertains to you and anything that happens in this room is of utmost importance.”

John stares at me quizzically. I’d guess he’s not sure he believes me. I’d guess we have a long, long way to go. 

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.