“I really appreciate your seeing me again,” Estelle Peterson says wringing her hands. I had previously seen Mrs. Peterson for a number of years. Although we made some progress in curbing her anxiety, she remained a constant worrier.
“My daughter’s pregnant,” she says.
“Congratulations. I remember you were afraid you’d never have a grandchild.”
“Yes, yes, that’s true,” she says dismissively. “But she lives in Florida.”
“And that means?”
“Zika!”
“Oh, you’re worried about her getting the Zika virus.” Concern about Zika is certainly understandable, but I suspect it will only fuel Mrs. Peterson already considerable anxiety.
“And having a deformed child! I can’t imagine anything worse. I told her she has to leave Florida. Right now. Right away. She doesn’t have to worry about me, but she has to take care of her baby! I told her to go stay with her sister in Connecticut.”
“And she said?”
“That it wouldn’t be a practical. That she and Jonathon have jobs. That they just couldn’t pick up leave.”
“I told she could just quit her job and Jonathon can stay here, that she’d be all right with her sister. Then she got mad at me and told me to stop it. I told her I couldn’t stop it, that I couldn’t bear to spend the next six months worrying about her baby. They hadn’t even told me right away, so I’ll probably worry anyway, worry if one of those mosquitos got her early on. But she won’t listen to me. I don’t know what I’m going to do. How am I going to get through her pregnancy?”
“How’s your daughter feeling about being pregnant?”
“What? Oh, she’s pretty good. She said that some of her morning sickness was pretty bad, but I told her not to worry about that, that was to be expected. I remember when I was pregnant with her and her sister. I thought I would die. But I didn’t. And she won’t die either. But I might die of a heart attack if I have to worry about the baby for six months.”
I remember now. It wasn’t only Estelle’s constant worrying that was so difficult, but also her need to make everything about herself. Everyone’s pain becomes her pain. She sees herself as being constantly worried about others, but really she’s concerned about dealing with her own anxiety and discomfort.
“So how can we help you to survive the next six months?”
“No, you have to help me convince Diana. Tell me what I can say to her to make her leave?”
“Even if I could do that, which I can’t, it seems to me we both need to respect your daughter as an adult, to respect her decisions and to try to be as supportive of her as you can.”
“How can I respect her decision when it’s endangering her child, when it will leave me, her mother, a nervous wreck until the baby is born?”
“Do you generally respect your daughter’s decisions? Did you respect her decision to marry her husband, to become a teacher, to move to Florida?”
“I definitely wanted her to move to Florida. I wanted to keep an eye on her. Becoming a teacher was okay, although I wondered if she couldn’t do better. I guess that was true of Jonathon too, but he worked out pretty good.”
Knowing that I am most likely talking to myself, I continue on, “Mrs. Peterson, respecting your daughter’s decisions means recognizing that she’s an adult apart from you who has a right to make a decision even if it is different from the one you’d make.”
“Even if it endangers her child? No, I can’t respect her decision.”
And I don’t respect Mrs. Peterson’s way of being in the world, making it difficult for me to espouse respect when I don’t feel it myself. Perhaps I can try to accept Mrs. Peterson for who she is, and thereby move us both towards a more tolerant view of others.
“Mrs. Peterson. I suspect that you’re not going to change your daughter’s mind about not leaving Florida. Perhaps I can help you to accept that fact and perhaps we can work on managing your anxiety.”
“You’re not being helpful.”
“Sorry. I can only do what I can do.”
“You used to say that to me all the time, that I had to accept my limitations, that I couldn’t control everything, that I could only do what I could do.”
“Yes, that’s true.”
“But maybe this time I can do more.”
“I guess we’ll continue this discussion next week.”
I had seen Rhonda briefly six years ago when she first started her ophthalmology practice. She was anxious, unsure of whether she could handle either the patients or the necessary business responsibilities. She described herself as being an anxious person most of her life, but refused to focus much on her past, saying that she wanted to address present day concerns. Soon she found reasons not to come – she had to see a patient, go to a net-working luncheon, attend a meeting. Eventually she dropped out. I was surprised to hear from her again.
“Thanks for seeing me,” she says smiling. “A lot’s happened since I saw you. My practice is going very well, I got married and a little over six weeks ago I had a baby.”
“Congratulations. You’re right. A lot has happened.”
“My husband, Andy - he’s a physician too, an internist - he said I needed to come. He said it wasn’t normal that I haven’t named the baby yet.”
Inadvertently my eyes widen, my eyebrows raise.
“You don’t think it’s normal either,” she says, reading my surprised expression.
“I don’t know about normal, but I can see that it could be a problem. What do you call … Boy or girl?”
“Girl. You know, cutie pie, sweetie, lovey, baby.”
“And what’s your sense of why you haven’t named her?”
“I don’t want to make a mistake. I wouldn’t, for example, want to call her some sweet girlie name, only to have her be a tomboy. Or vice versa.”
“And how would you be able to know?”
“That’s the problem. I can’t. But I figure if I wait just a little longer, I’ll have more of an idea, more of a sense of her personality.”
“Does your husband get a vote?”
“He’s wanted to name her either Amanda or Kim right from the beginning. But I don’t know, they just don’t seem to fit.”
“How do you feel about your name, Rhonda?”
“I hate it!”
Aha, I think. Perhaps we’re getting someplace. “Because …?”
“My mother gave me the name. It was her mother’s. My father put the name Alexandra on my birth certificate but she crossed it out and put Rhonda. Alexandra is so much more … more regal sounding. I hate Rhonda. In fact, I go by Rho. Not regal sounding either, but not so clunky.”
“Did you know your grandmother, Rhonda, I mean Rho?”
“She was a witch. She lived with us. My mother waited on her hand and foot. In fact, I’d say Mom often neglected me and my sister because she was so busy catering to my Grandma.”
“Sounds like you feel pretty angry at both of them.”
“I guess that’s true.”
“And how do you feel about your baby?”
“My baby?! I love her, of course. Are you saying I don’t love my baby because I haven’t named her?”
“I’m not saying that, Rho …”
“Oh God! I hope I love my baby. What made you ask that?” Rhonda says interrupting me, giving me no chance to answer her question. “I wasn’t sure I wanted a baby right now, what with my practice and all. But my husband said it was time, that we weren’t getting any younger. Do you really think I don’t love my baby? I couldn’t bear that. It’s like I’d be passing it down the line, the indifference I experienced.”
“Rho, there’s a lot going on here, which doesn’t mean you don’t love your baby. You can love your baby and still have ambivalent feelings about being a mother. You can love your baby and be scared of repeating the experiences of your past in the present. It sounds like you’re aware of all that and that certainly puts way ahead of lots of people.”
Rhonda looks down at her clenched hands. “I can see how not naming my baby could make her feel unimportant. I don’t want to do that,” she says crying.
“I’m sure you don’t, Rho.”
“I’m going to tell Andy he can name her whatever he wants.”
That’s not being any more involved, I think to myself. “What do you want to name her, Rho?”
“I don’t know. I know from what we just said that there’s more to it, but when you ask me the question point blank, I go back to where we stated, I don’t want to make a mistake.”
“Sounds like naming your baby is so intertwined with your mother and grandmother, that it’s become impossible to separate them out.”
“I don’t know what to do. I feel I have to do something and I’m stuck. Do you have another session this week?”
“For sure.”
“Thanks. I guess I’ll go home and discuss it with Andy.”
“Sounds like a plan.”
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.”
