Philip is a new, reluctant patient. He hasn’t been in therapy before, isn’t sure “how it works,” and doesn’t know for sure why he called. He’s getting into disagreements with people at work. He’s not sure why. Yes, he does tend to be a bit obsessive. Maybe his coworkers are put off by his insistence on perfection. And yes, he does worry about making a mistake. It makes him anxious. What if he did something “wrong” and “something bad” happened as a result?
In our first several sessions I’ve focused on the harsh voices that exist in Philip’s head telling him that danger lurks around every corner. I’ve also tried to explore what feelings exist underneath his anxiety and his need for perfection – anger, sadness, fear? He steps gingerly into those feelings – perhaps he is angrg that he was passed up for promotion – but scurries quickly away.
Today he knows exactly what he wants to talk about. “I had a huge fight with my wife. She got mad at how I punished our 10 year old daughter. Samantha opened up a mouth to me and I spanked her. I didn’t beat her, for heaven’s sake, I just gave her a spanking.”
“What did Samantha say to you?” I ask as neutrally as possible.
“She raised her voice and told me I was making her nervous and not helping her at all with her math homework.”
“And that’s why you spanked her?” I ask, the neutrality slipping from my tone.
“What? You don’t think that’s a smart-ass comment that needs to be nipped in the bud?”
“Is that what your father would have done to you?”
“You bet! That and more.”
“And you feel how about your father and what he did?”
“He was trying to teach me right from wrong.”
“But can you tell me how you feel?”
“I feel like he was being a father.”
“A particular type of father,” I say, ignoring that Philip has not told me how he felt.
“What do you mean by that?”
“Well, he’s the type of father who made you into the man you are today, someone who has a rigid sense of right and wrong and who is terrified of making a mistake.”
“So we’re on to blaming the parents. And I suppose I’m doing the same thing to my daughter?”
Throughout this interaction I’ve been thinking of my father. He never spanked me, but his explosive temper terrified me. He didn’t so much have a rigid sense of right and wrong, but an uncompromising conviction that only his ideas and beliefs were valid and that everyone else was “wrong” and “stupid.”
“I don’t know,” I reply. “It depends if your daughter capitulates to you or resists. It depends if you break her spirit like your father broke yours or if she’s able to fight back.” I fought back. And I’m routing for his daughter.
“You think I’m breaking my daughter’s spirit?”
“I think when you’re sure that you’re right and you try to foist that belief on someone else, yes, you’re trying to break their spirit.”
“That’s a lousy thing for a therapist to say.”
I stop. Philip is right. He’s my patient, not his daughter. I’ve gotten into a debate with him, trying to convince him of my way of thinking, rather than trying to understand his. I’m being just like him, his father and my father, trying to convince him of the correctness of my point of view. My past, my relationship with my father has affected my ability to be the good-enough therapist.
Not trying to minimize my contribution to this interaction, I also realize that I have re-enacted a scenario typical of patients with this harsh, rigid conception of right and wrong. They are often battling the voices in their head – is this right or wrong? am I right or wrong? – and those battles can get projected into interactions with others. The fight then becomes externalized and is played out with me, coworkers, wife, daughter, or whomever.
“You’re right, Philip. That was a lousy thing for me to say and I apologize. I should have been asking you what you felt when your daughter responded to you as she did, not trying to convince you to be different.”
Silence.
“What are you thinking?” I ask.
“I was wondering if I should be seeing you if you can make a mistake like that.”
I can feel the pull to try to persuade him, to ask him if he can’t forgive me, if he can’t allow me to be less than perfect. I resist. Besides, the hour is almost up. “I understand. But I hope you will come back next week so we can look at how you felt about my making a mistake and about my apologizing.”
I glance at the clock. It’s only a couple of minutes past two, but I wouldn’t have expected Emily to be even a couple of minutes late. I only saw her once before, a bright, articulate, 35 year old married woman with one child and a Ph.D. in Physical Therapy. Despite her obvious accomplishments and full, busy life, Emily described herself as a perfectionistic who always found herself lacking. In fact, she felt overwhelmed by feelings of inadequacy and shame. Not someone I would expect to be late.
By 2:05 I wonder if Emily forgot to press the buzzer in my waiting room. I go out to check. Sure enough, there she sits. Smiling, I say, “You forgot to press the button.”
Emily looks stricken. It is as though I have slapped her across the face.
“Please come in,” I say, in what I hope is a warm, welcoming voice.
Emily walks slowly into my office, glancing furtively at me out of the corner of her eyes.
“What just happened, Emily? You look terrified,” I begin as soon as we’re both seated.
“I…I… I made a mis…mistake,” she stammers. “I forgot to press the button.”
I vacillate between wanting to reassure her and wanting to understand what has created this degree of anxiety. “Yes, you made a mistake.” I say. “You’re human, like the rest of us. But you look so scared. In fact, you look like a scared little girl.”
Emily begins to cry. “I’m so stupid! I’m stupid for forgetting to push the button. I’m stupid for cheating myself of a full session. I’m just stupid!”
“Whose voice is that, Emily? Whose voice do you hear in your head telling you you’re stupid?” I ask.
“That’s easy, my mother’s. I think that’s all she ever said to me, along with you’re lazy, you won’t amount to anything, stuff like that. And that was before she got the strap.”
“So that’s why you looked so terrified, Emily. When you make what you see as a mistake, you’re afraid that both the other person - in this instance me – and that critical voice in your head will beat you mercilessly.”
“I guess that’s true.”
“Do you know, Emily, at least intellectually – I know you don’t feel it – but do you know intellectually that you didn’t do anything so terrible by forgetting to press the button?”
“Now that I hear you say it, I can kind of get there, but before, no, I’m convinced that I’m bad and stupid and deserving of whatever punishment comes my way. Like I thought you might decide not to see me anymore.”
“Wow! You have a really harsh, critical voice up there. We’re going to have to work on helping you to take in a kinder, gentler voice. Let me ask you, though, did you ever feel angry with your mother? Do you feel angry with her now?”
“Sometimes I feel angry now. After I had my son, I realized I would never, ever do the things to Aaron that she did to me. But then, I just believed I was bad and kept trying and trying to be better so my mother would love me.”
“And what do you feel right this minute, Emily.”
“Sad. I can see what a scared little kid I was.”
“I imagine you’ll feel lots of sadness during our work together: sadness for what you didn’t get as a child, sadness about having to give up hope that you can ever go back and get what you missed, even sadness about having to give up the critical voice in your head, the one that still maintains your tie to your mother. But sadness may well feel better than the terror you walk around with, and I’ll be here to help you through.”
