Too Close

 

“I went out with Charles again last night,” Ashley begins. “You know the guy I met on Match who I’ve been out with a few times.”

“I remember,” I say, nodding at the computer screen. “You kind of liked him.”

“I guess, but he was a little too much last night.”

“Meaning?”

“I don’t know. Like he started telling me all about his childhood, which was pretty terrible. He was physically abused by his mother, like really bad. And he wanted to know all about me. I’m not sure I was ready for that.”

“What made you uncomfortable?”

“What if we don’t work out? Why should I tell him all about me? Does he really need to know that my mother died of cancer when I was four and that my father wanted nothing to do with me?”

“I’d say there would be no reason for him not to know.”

“I never understand why you feel I should be blabbing my whole life to anyone and everyone.”

“Well, if you’re not presenting who you are to people it’s kind of impossible to get close to them and it takes a lot of energy to be play acting through a large part of your life.”

“Aren’t you play acting? Isn’t being a therapist all play acting?”

“In what way?”

“You could be in terrible pain right now, physical or emotional, and you wouldn’t tell me about it, right?”

“That’s true. We do all have roles that we inhabit in our lives and…”

“See, I told you! So I’m no different than you or anyone else!”

“We all have roles that we inhabit. Being a therapist is one

role, just as being an attorney is another. And, no, in our professional roles we’re not telling everyone everything about us. You’re not going to be in front of a judge and say, “Your Honor I can’t try this case today because I had to put my dog down yesterday and I’m a total basket case. But yesterday, when you put your dog down – obviously I’m just using that as an example – would you have been able to call a friend and say I need to talk?”

“I don’t have a dog,” Ashley says matter-of-factly. “I don’t want a dog.” Pause. “Actually, dogs are kind of like that guy last night. They want too much. They’re always there, always begging. I guess you’ll say that’s my need to keep my distance.”

“Yes, I would. And there’s the question of why that distance feels so necessary for you.”

“It just popped in my head that we’re back in your office next week. I don’t like that idea either. This is much more convenient. I don’t have to drive to and from your office. I don’t have to waste time sitting in your waiting room. I just turn on my computer screen and here you are.”

“So I assume by bringing that up right now, you’re making the connection that returning to my office feels closer – literally and figuratively - than virtual therapy.”

“Right. And I’d prefer continuing just as we are.”

“So do you have any thoughts about what makes closeness so uncomfortable?”

“It’s messy. People are just so needy. They want so much. Just like a dog.”

“Are you needy, Ashley? Do you want so much?”

“Me? No way! I can take care of myself.”

“I think you learnt that early on. If there’s no one really there for you, you learn that you have to take care of yourself.”

“Right!”

“But there’s a problem with that, Ashley. When you were four years old you couldn’t take care of yourself. You were a helpless, dependent little girl who just lost the most important person in your life. That little girl is still inside you. She still wants and needs and longs for someone to care for her…”

“Ugh! That’s disgusting. I hope that’s not true. And if it is true I want her gone, poof! Like she never existed.”

“I wonder, Ashley, if that’s exactly the reason you didn’t like the man you saw last night and the reason you don’t want to return to in office visits and the reason you don’t want a dog, all of that brings you closer to that dependent, childhood part of yourself.”

“So what should I do about it?”

“Well, first we’ll resume in office visits and we’ll talk about how that feels for you. And when you’re with someone and feel the need to get away, maybe you can try to pay attention to what you’re really trying to get away from. I suspect it might be the needy part of yourself.”

“What if I just avoided people?”

“Well, what do you feel when you avoid people? What did you feel when we were locked down in the pandemic?”

“Lonely. Like something was missing.”

“I guess that’s your answer.”

Alone Together

“I’m feeling so horribly sad,” Marion says, her sadness apparent from her voice which I hear remotely on my cell phone. “I feel sad for the country, sad for the world, sad for all the people who are losing their lives every day.”

Pause. “But mostly, I must admit, I feel sad for me. I mean, I’m grateful that everyone I know personally is well, that I haven’t had to deal with a loved one dying without being able to say good-bye… But I feel so alone, which is ridiculous. I know I’m not alone. Arnie is here with me as always. I get to FaceTime with my daughter and grandchildren almost every day – although how they’re all surviving in that apartment I have no idea. And with my son and his husband at least once a week. They’re actually doing very well, working from home and enjoying what they call a second honeymoon.”

Silence.

If I were I in my office with Marion I know I would wait for her to continue before I speak. But remotely I’m concerned that the silence will increase her feeling of aloneness. “And you feel sad because…?” I ask.

She sighs. “Arnie and I have no relationship. None. I mean I know we’ve been together for 30 years. I don’t expect us to be falling over each other like my son and his husband. But something, something…” Pause. “We sleep in the same bed. We get up in the morning, have breakfast, each of us focused on our iPads, barely speaking. Then he goes into the living room to watch endless news shows about the virus. I sometimes take a walk, then head for the bedroom to watch old movies or read or sometimes talk on the phone. I wish we at least had a dog, but of course they don’t allow them in our condo.”

Pause.

“Before at least I got to get out, had a change of scenery. I played cards, had lunch with my girlfriends, went to a movie. When I worked that was entirely different. You know, it’s sometimes hard to believe that Arnie and I were both teachers, that we had interesting lives, interesting things to say to each other. Now there’s nothing. Nothing. Emptiness.”

“And feeling alone with someone feels worse than being alone by yourself.”

“That’s definitely true.”

“You said that you and Arnie sleep in the same bed. Do you ever have sex?”

“I’d be hard pressed to remember the last time we had sex.”

“Do you miss it?”

“Sex has been so perfunctory for so many years it’s hard to say I miss it. I do miss cuddling. I miss the occasional kiss, holding hands, caring about each other. Now there’s literally nothing. The absence feels so bleak. And it’s mirrored in all those pictures of cities without people. Or even here – shuttered tennis courts, golf courses, emptiness.”

“Have you talked with Arnie about your feelings?”

“I’ve tried, maybe not enough, but I’ve tried. I tried sitting next to him on the couch, putting my hand on his knee, asking him something about what’s on the TV. Nothing.”

“But have you told him about your feeling of emptiness, of aloneness?”

“I can’t do that.”

“Why?” I ask.

Pause. “You know what I thought of? I thought of being a child, maybe 10, 11 I’m not sure. It was a rainy, dreary day. Must have been a weekend since I wasn’t in school. I was bored. I went to my mother to see if she wanted to play a game, but she was on the phone and put her finger on her lips and motioned me away. So I went to my father just to be with him. I knew he wouldn’t want to play a game. But he was reading the paper, looked at me annoyed and shooed me away. I learned never to ask, just to wait and see if someone will be there for me.”

“We’ve talked previously, Marion, about your unconsciously choosing a man like your father, but today I’m wondering about something else. What is it that you feel, you, the adult Marion, if you think about telling Arnie what you’re feeling?”

“I can’t.”

“But what is it that you feel?”

“Uncomfortable. Vulnerable. Maybe embarrassed. Like I’m not supposed to have feelings. Maybe like I shouldn’t need anything from anyone.”

“Like you shouldn’t need anything from anyone. I think that’s a very important statement, Marion. I think you’re saying that a long time ago you withdrew from your own needs, that you walled off those needs and locked them in a room somewhere deep inside you. And what you’re left with is a feeling of profound aloneness.”

“That feels right. But what do I do about it?”

“I think we have to start looking for the keys that will help us unlock that door, so we can find the sad, vulnerable child who reached out to her parents that dreary day.”

Removed

“I’m thinking of breaking up with the girl I’ve been dating,” Andrew begins. 

If I’m not mistaken, this is the third woman he’s broken up with in the several months I’ve been seeing him. Tall, with curly brown hair, 35 year old Andrew could be described as a handsome man, except that he feels too flat, too disengaged.  

“I know,” he continues, “I just said I thought she might be the one. I don’t know, we just don’t seem to click. I mean, we’re okay sexually, it’s not that. Maybe she’s too eager, too needy. I need her to back off. But that’s pretty crazy,” he says, half laughing at himself. “You’d think with my parents being so disconnected, I’d be dying to have a woman who’s really into me.”

“Can you say what she does that makes you feel she’s too needy and what goes on inside you?”

“I don’t know. Well, like she’s constantly texting me.” Pause. “But that’s not really true. She might text me in the morning and then once maybe after she’s done teaching for the day.”

“But it feels like a lot.”

“Yeah, that’s right. It feels like she’s always there.” 

“And when you’re actually with her?”

“I know this sounds bad, but I kind of want us to do whatever we’re going to do – go out to eat, go to the movies, whatever – go back to my place, have sex, and then have her leave. That’s enough for me.”

“While you’re with her, do you feel connected to her? You know, I just realized we’re both talking about ‘her,’ not using her name.”

“Her name’s Paula. And no, I don’t feel connected to her.” Pause. “I’m not sure I feel connected to anyone.”

“No one?”

“I don’t think so. I mean, I get along with people, I know what to say, how to act. But I wouldn’t say I feel connected. I tell my parents I love them. I hug my sister and my nieces. But it’s more that I know I’m supposed to do those things.” 

“Do you feel connected to me?”

“To you?” he asks, surprised.

I nod.

“No. We have a professional relationship. I pay you to listen to me and then I leave. I can’t imagine feeling connected to you.”

Kind of like what he wants from Paula, I think. What I say is, “Can you imagine feeling connected to anyone?”

“I guess my wife when I have one. And my kids, whenever that happens.”

“And not feeling connected, how does that make you feel?”

“I don’t know. Normal, I guess. Normal for me anyway. It’s how I’ve always felt.” 

“Do you ever feel lonely?”

“Lonely? I don’t know. I like being alone. I’ve always felt alone.”

“You know, Andrew, as I listen to you, I feel sad for you. You seem so alone, so cut off, so removed, both from others, as well as from your own feelings.”

He shrugs.

“And you did come into therapy. I think you said you wanted to figure out why you weren’t able to stay in a relationship with a woman. Sounds like we need to figure out why you can’t be in a relationship with anyone.”

“I guess.”

“Andrew, do you remember what you felt when you were little and your parents left you with one of your nannies and went away on business for months at a time.”

“That’s just how it was.”

“But how did you feel? How did you feel as that little boy?”

“I don’t remember.”

“Can you imagine doing that with your child some day?”

“Oh no! No, I couldn’t imagine ever doing that.”

“You seem to have more feelings about imagining leaving a child you still don’t have, leaving that imaginary child alone, than you’ve had about anything else we’ve talked about today.”

“I guess that’s true. But what does that mean?”

“That you’re that imaginary child; that buried deep inside you are lots of feelings about being left, sad feelings and scared feelings and angry feelings.”

“You think so?”

“Yes, I do.”

“So why don’t I feel them?”

“I imagine you locked those feelings away a long time ago and that opening that door feels overwhelmingly scary.”   

“And how’s that related to my not staying in relationships?”

“I think that when you start to get close to someone or if someone starts to get close to you, the possibility of needing or relying on that person brings you way too close to the scared, vulnerable, needy feelings you had as a child and you immediately close off and run away.”

“I guess that makes sense, but what do I do about it?”

“We start by carefully looking at your feelings as you go about relating to people in your life, including me, and seeing if we can find when you start to get scared and start pulling away.”

“Sounds like a long process.”

“I’m not planning on going anywhere.”

Demands

Beverly rushes into my office and throws herself into the chair across from me. “You know,” she begins, “this is just too hard for me. All this running around. I have too many things on my schedule. I mean I know I don’t work – I have no idea how people who work ever manage to get here – but between golf and tennis and bridge and painting – it’s just too much. I need to come on a Saturday. That would work better for me.”

Although I am more than a little annoyed at both Beverly’s demand and at being relegated to the bottom of her list, I decide on an initial non-confrontational approach. “I’m sorry, but I don’t work on Saturdays.”

“You don’t work on Saturdays? How do the people who work get to see you? I suppose they just don’t, right?”

“You’ve been coming for almost a year, Beverly, and you never seemed to have difficulty getting here before. Why do suppose it’s suddenly become an issue for you?”

“I started taking painting lessons. I hadn’t been doing that before.”

“And since you knew you had such a busy schedule, why do you think you decided to add something that might make it harder for you to get here?”

“I didn’t think about it in terms of getting here. I just wanted to take painting lessons.”

“It feels to me, Beverly, that you’re wanting to dismiss the importance of our work together, that you’re saying it doesn’t matter.”

“That’s not fair. You’re the one who won’t see me on Saturday!”

“I think we need to take a step back here. Was there something that happened in our last session that made you feel uncared about? Were you angry with me?”

“You always do that. You always make it about you. It has nothing to do with you.”

“Okay. Then tell me what it does have to do with other than with your schedule.”

“My sister.”

“I remember we talked about your sister last week, about how I saw her as being competitive with you, but that you thought that wasn’t true, that she loved you and always wanted the best for you. And I said both could be true, that she could love you and want the best for you and still be competitive with you.”

“You took her away from me. No one in my family gave a damn about me except her. I was an extraneous being. But Joyce cared about me, looked out for me. And you just took her away.”

“So you are angry with me.”

“I guess. And at her. I’m furious at her. How could she take herself away from me when I relied on her so much? But I decided to show her. She’s the painter you see. I decided I’d become a better painter than her.”  

“So I guess you’re saying you feel competitive with her.”

“No. I’m just getting back at her.”

“Beverly, I want to point out that nothing out there in the real world happened or changed between you and your sister. This is all happening in your mind. You came to see your sister differently. And although you’re entitled to have your feelings, it would be helpful to you if you could hold onto the love and stability your sister provided for you in your chaotic childhood.”

“You’re taking it all back!”

“No. We’ve talked a lot about your living in a black/white world, with no shades of gray. Right now you want your sister to be the perfect sister – whatever that might mean to you – and you want me to be the perfect therapist who would see you whenever you want to be seen. But there is no such thing as a perfect person. You can get a lot of good from one person, but you can’t get everything and that doesn’t make either that person or you bad. And you can feel competitive towards your sister or towards me and that doesn’t make you bad either.”

“It doesn’t make sense to me. If she’s competitive with me how could she always be on my side? Sometimes she’d be on her side.”

“Well I suppose that’s true. But if she wanted, just let’s say, to be a better painter than you, that doesn’t mean she wouldn’t want you to be a better golfer or to find a loving husband or to take great joy from your children. Because there was so much cruelty and rejection in your childhood, it’s difficult for you to believe that someone can be in your corner and still take care of themselves. That’s like me saying I’m here for you, but I don’t work on Saturdays.”

“That makes me mad all over again.”

“I believe you. We’ll keep working on it.”

Unconnected

“I just ended another relationship,” says Brittany settling herself into my chair for the first time. She’s an attractive enough woman probably in her early 40s, simply dressed in black pants and a gray sweater. She didn’t smile when I greeted her in the waiting room, just extended her hand.  Her eyes didn’t smile either. She continues.

“I told myself I’d give it a year and I did. We got together last New Year’s Eve and I broke up with him this January 1. He was a nice enough man. But I can’t do it. I can’t be in a relationship. It’s like torture to me.”

Torture, I think to myself. What a strong word.

“I know it’s not normal,” Brittany continues. “That’s why I promised myself I’d go into therapy if I couldn’t handle this relationship. I’ve been in therapy several times, but maybe I’m more ready now. I certainly know this is my problem. Way too many relationships to think it’s the men’s fault. I don’t usually last a year, but that’s what I said I’d do, so I did.”

Questions swirl through my mind: What makes a relationship feel like torture? Do you feel smothered? Are you so terrified of loss that you can’t allow yourself to connect? Did your relationship with your previous therapists feel like torture also? Will you need to escape our relationship as well? I decide on a far more innocuous statement.

“Sounds like when you make up your mind to do something you certainly follow through.”

Brittany’s mouth forms an almost-smile, while her eyes brighten slightly eyes as well. “That’s definitely not my problem. If I decide to do something, I do it. I wouldn’t be where I am today if it weren’t for my determination. I own a chain of yogurt stores and am about to start franchising nationwide. Not bad for an abandoned orphan left by the side of the road.”

“Literally?” I ask, surprised. 

“I’m exaggerating about that side of the road bit, but my parents were a piece of work. They were both drug addicts and definitely didn’t know what to do with a baby. At some point they just left me. Social services got involved and I went from one foster home to another until I was 10 when one family finally kept me until I was 16. Then I got myself declared an emancipated minor and went off on my own. And the rest is history.”

“That’s an amazing story, Brittany. A really sad story, but you tell it with no feeling at all.”

“I’ve repeated it a million times.”

“But you still must have feelings about it. About your parents abandoning you, about your going from one home to another, about the family you lived with for six years.”

“They were good-enough people. The family I lived with for six years. But it was the same problem. They wanted something from me I couldn’t give them. They wanted me to love them, to be a part of their family, to remember birthdays and care about Christmas. I don’t have it in me.”

The room feels heavy, steeped in despair, although I suspect I am the only one who feels it. Brittany is removed, protected by a suit of armor she constructed early on to shield her from repeated abandonment and neglect. How could she ever allow herself to care for another person who would likely, yet again, toss her aside? “Left on the side of the road.” That is her metaphor for her life. Brittany cannot allow herself to get any inkling of the scared, vulnerable, needy child who exists inside her. Instead, she prides herself on her truly amazing success, unaware of her underlying hunger for human connection. 

“How do you feel about not having it in you?” I ask.

She shrugs. “I know there’s something missing in me. And when I look around and see people, I can tell that relationships add something to their lives. So I guess I’d like to find out what’s missing.”

“I suspect, Brittany, that it’s not so much that something is missing, but that you’ve buried your hurt, neglected childhood feelings deep inside you and that when a potentially close relationship threatens to expose those feelings, you feel you’re being emotionally tortured. Then you bury the feelings even deeper and run away. It’s as though you’re saying, ‘I don’t need anyone and no one can hurt me ever again.’”

“I get the wanting no one to hurt me again, but I don’t know about my being afraid of needing anyone. I don’t think I do need anyone. That’s the problem.” 

“Well, I guess that’s something we’ll find out as we go forward,” I say optimistically. In my mind I add, assuming I’m able to keep you in therapy.

Alone

“What should I do?” Janet asks plaintively as tears stream down her cheeks. “I always hate this time of year, but this is the worst. I don’t know why they have to go visit his mother. She has two other kids who could have visited her. Me, I have no one. I’m all alone.”

Aware of many thoughts and feelings churning inside me, I opt for an empathic, but relatively neutral response. “I understand it feels awful to be alone during the holidays.”

Janet cries harder. “That doesn’t help me! What should I do?”

“What are your options?”

“I don’t have any,” she wails. “It’s all Harry’s fault. If he hadn’t left me at least I’d have him to be with.”

Remaining silent, I think: Harry left 10 years ago and you’ve said you were glad to be rid of him; you were invited to join your daughter and her family at her in-laws in Colorado; you could call some of your friends. I also think of my annual Christmas dinner, my house filled with friends and family. My husband has been dead for seven years now. His absence still weighs heavily, but unlike Janet I have acted to make sure I am not alone and miserable.  

“You’re not saying anything! Just like Kaitlyn. I keep calling her and crying and asking her what I should do while she’s having fun in Colorado and she doesn’t say anything either until she says she has to go.”

“It seems like you’re really angry at both me and Kaitlyn.”

“Angry?” Janet says, surprised.

“Angry,” I nod. “Neither of us is fixing your unhappiness and, in fact, you feel as though Kaitlyn is causing it.”

“She is.”

“Am I not remembering correctly? Weren’t you invited to join them in Colorado?” 

“They knew I’d never go. I don’t like to fly, I mean I will if I have to, but during the holidays it’s just awful and then there’s the weather and possibly getting stuck for days.”

“When was the last time you were happy, Janet, or at least content?”

“What? What does that have to do with anything?”

“It seems to me you’re almost determined to keep yourself miserable. I get that you’re angry. I also get that you feel mistreated and abandoned by others. But it’s very hard for you to take charge of your life and do what’s helpful for you.”

“So now it’s my own fault. Great!”

“I know you always say you don’t want to talk about the past, but did you feel cared for as a child, Janet?”

“Is this going help me not be alone at Christmas?”

“I don’t know about that, but it could help you to understand why you’re alone this Christmas and perhaps help you to make future Christmases different.”

“No. No one ever cared about me. There were five of us. I was smack in the middle. My father was always depressed and miserable and my mother spent all her time catering to him. And my brothers were always beating me up. Happy now?”

“No. I’m not happy for your pain. I’m sorry. And I certainly understand why you’re angry. I also understand that it’s hard for you to move beyond wanting someone to help you, to guide you, to care for you, since you never got the caring you needed and deserved as a child.” 

“So I get to talk about all that garbage and then I feel even more miserable.”

“That’s possible. For a while. And what I imagine is that in addition to your anger, we’d also find a very needy child who feels terribly sad and alone, just as you feel alone as an adult. Perhaps you even unconsciously create experiences of aloneness, hoping that this time someone will come along to make it different.”

“So you’re saying I should just live with being alone at Christmas and quit complaining.”

“I don’t think I said that, Janet. I said that we need to find you as the sad, needy child; that you need to have more empathy for her; and then hopefully at some point you’ll be able to move beyond her and be able to do what you need to do to take better care of yourself.”    

The Caretaker, Part 2

Today I return to Melinda whom I wrote about several months ago. She’s the woman whose 95 year old grandfather died and whose husband left her alone to deal with her grief. As we explored that experience, it became clear that Melinda needed to focus on others as a way to avoid her own feelings of anger and sadness. As the third girl in her family of origin, she had felt unwanted and unloved and carried around a reservoir of hurt, painful feelings.

“I feel as though I’m being torn in a dozen different directions,” Melinda begins. “The kids are a handful themselves – getting them ready for school, getting Elizabeth to tennis and dance and Mathew to softball and soccer, helping them with homework. But that’s all right. I expect that. But sometimes I think my husband is another kid. He’s so disorganized. I have to help him with our bills, get his clothes to and from the cleaners, do the laundry, remind him to take care of our cars and whatever chores he’s forgotten to do around the house. I even have to tidy the house before our cleaning woman comes. I know she’s supposed to be helping me and I guess she is, but I still have to tell her where to put things and straighten up before she comes. And my friends – I mean I love them all – but they’re always having crises – Bonnie broke up with her boyfriend, Charlotte’s mad at her husband again, Tina’s worried about her mother. And I have to get myself here as well.”

“Sounds like you’re feeling overwhelmed, Melinda, and not having any space for you.”

“Me? No, there’s no time for me. I’m too busy taking care of everyone else.”

“But I wonder if you also need to avoid you. Remember we talked about your treating yourself as you’d been treated and not allowing yourself and your feelings to matter?”

Melinda sighs. “I guess. I guess you’re right,” she says, her speech slowing.

“I notice you just slowed down a bit. That’s probably a good first step – giving yourself some time to think and feel.”

“It’s hard. I feel all this pressure, all these people making demands on me.”

“So who fills your needs, Melinda?”

“No one I guess. Makes me sad to realize that.”

“What about me, Melinda? I noticed before when you were listing all the people who were making demands on you, you said that you had to get yourself here as well. Sounds like you feel I’m another person who’s taking from you rather than giving to you.”   

“I suppose that’s true. You’re someone else I have to fit into my schedule.”

“But why is that, Melinda? Why is it that you can’t experience me as giving to you, why can’t you experience your time with me as nurturing?”

“I don’t know.” She pauses, thinking. “I don’t know why, but I suddenly thought of the time my mother forgot to pick me up from school and it felt like I waited for hours, although I’m sure I didn’t. Everyone in the family thought it was funny. It didn’t feel very funny to me.”

“I wonder if you’re saying, Melinda, that you’re afraid to allow yourself to need me because you’re afraid I’ll let you down like your mother and then laugh at you for needing me.”  

Melinda’s eyes fill with tears. “I was about to say, no, I know you wouldn’t do that, but obviously that really hit a chord in me.”

“Being needy makes you feel vulnerable.”

“That’s true. I hate feeling vulnerable. It’s scary. And weak.”

“So you run around taking care of everyone else so you don’t have to feel your own need to be cared for. You get to be the ‘strong one,’ the one who doesn’t having any needs.”

“Yup! That’s me.”

“And in the meantime, I suspect the feeling of neediness inside you gets bigger and bigger, making it even scarier for you to acknowledge, so that you have to try even harder to keep it hidden and stuffed safely away.”

“So what do I do about it?”

“Well, one thing we can do is keep a careful watch on what goes on between us. How you feel about being here, what you do or don’t do to keep me at bay and what happens if you begin to allow yourself to want or need from me.”

“That sounds hard. I can already feel myself wanting to head for the door.”

“I understand. But I will try to keep us focused on what’s going on between us, without making it too, too uncomfortable for you.” 

Escape!

A colleague told me that a patient of his had stopped treatment the previous day without any warning and that he felt hurt and angry. I both understood and commiserated. I also began thinking about some of the patients I’ve had over the years who quit without notice and how well I remember at least some of them, even those I saw over thirty years ago. 

There was a man I saw for several years who came in one day and said he wasn’t getting anywhere and was leaving. When he left, I started crying. Was I crying because I would miss him, because I had failed him, because I was narcissistically injured by my failure? Probably all of the above.  As I look back on that treatment today I know that he was a man who was terribly afraid of his own feelings of neediness and vulnerability and that he dealt with his fear by keeping everyone at bay.  He wasn’t going to get anywhere near me; he wasn’t going to let me in. I still remember that he told me that all he dreamed about was alternating screens of black and white. As a young clinician, although I understood the barrenness of his internal landscape, I had no idea that he was terrified of getting close. 

Another patient – perhaps even earlier in my career – was a woman who so feared closeness that she had sex only three times in her twenty year marriage. She wanted children so she thought she would try three times and take whatever she got. She had two children! When she announced one day that she was leaving, I tried to persuade her to come in through the end of the month so that we could both deal with our feelings about her leaving. Although she had no idea what feelings I was talking about, she agreed. During those final sessions she felt less anxious and uptight. Even then I knew that having a clear way out, an exit strategy, made it possible for her to be more relaxed and related. I didn’t then understand why. Today I get it. People who are afraid of their own dependency can never get too close for fear that they might be too greedy and want too much.

Probably my oddest termination occurred with a patient I saw only a few times. I was a more experienced clinician by then. I knew that this woman had difficulties with closeness and intimacy, but we were early in the treatment and I wasn’t making any grand interpretations. We had our session and she left. Under the chair I noticed a letter which I assumed she’d forgotten. When I retrieved it I saw that it was addressed to me. In it was a check and a letter that said today was our last session! I was stunned. We had spent an entire session and she gave not the slightest hint, at least not to my awareness, that she didn’t plan to continue. Seasoned clinician or not, she definitely got by me. I’d like to know why she left. I’d like to know why she chose to leave a letter as opposed to talking with me about her decision. But I’ll never know. Among the many things that remain unknowable to me forever.

So what’s the lesson here? Neither love nor caring nor empathy are, in and of themselves, enough.  And the therapist, despite all her knowledge and years of experience might still not understand what is going on with a patient.