Undecided Part II

 “It’s not good,” Stan says, shaking his head from side to side. “You have to tell me what to do! I can’t stand it! All I do is think about this day in and day out. Should I stay with Paulette and my family or should I throw it all up in the air and be with Frank?”

Silence.

“Tell me.”

“You know I can’t tell you Stan. No one can make that decision but you.”

He drops his head into his hands. “I can’t. I can’t make the decision.”

“If I told you what to do – which I wouldn’t – what would you hope I’d say? 

“That I should follow my heart and be with Frank.”

“So is that what you want?”

“Yes. Yes. It is what I want. But is what I want enough? Is what I want always what matters most? If I want to go murder my boss, should I go murder my boss? No, obviously not. Sometimes you can’t have what you want. Sometimes you shouldn’t hurt other people to get what you want.”

“That’s a very good point. Let me ask you something, why would my telling you to follow your heart and be with Frank, change what you just said about not hurting Paulette and your children?”

“And my parents. And the rest of my family”

“And why would my telling you to be with Frank change how you felt about hurting those people?”

“I guess because you’d be giving me permission. Because you’d be saying being gay isn’t bad, isn’t a perversion.”

“So now you’ve introduced something else. It’s not only about hurting people, it’s about whether you think being gay is bad.”

“Is it?”

“No. But it’s not about what I believe, it’s about what you feel. If you tell me you want to work on the negative feelings you have about homosexuality, I’m happy to do that, but you’ll still have to decide whether or not you want to leave your marriage. And I suppose there’s also the question of whether if you stay in your marriage and feel as though you’re accepting second best, are you making Paulette accept second best as well? Are you depriving her of feeling with someone else the same way you feel with Frank?”

“Oh no! You’ve just made this even more complicated!”  Stan stares at me intently. “Wait a minute, are you a lesbian? Do you feel I should be with Frank? That’s it’s better to be homosexual than heterosexual?”

I’m startled. “Now I’m confused,” I say. “I thought you wanted me to tell you to be with Frank which I certainly haven’t done, but now you wonder if I’m a lesbian because I raise the question of whether staying with Paulette is the only way to not hurt her?

“Wow!” Pause. “I guess it wouldn’t have been all right with me if you’d told me to be with Frank. Even giving me a possible reason to leave Paulette, like it would be kinder to leave her to find someone who was really into her, it… I don’t know. I guess it really scared me.” Pause. “I guess it’s that I don’t want to be gay. I don’t want to be rejected by my family. I don’t want all the hassles gay people have to go through. I just want to be normal, to have things be how they were.”

“And is that possible, Stan?”

“That scared me again. And again made me wonder if you really are gay.”

“I think you are very frightened. And when you feel as scared as you feel right now, it’s easy to think that there’s someone outside of you who’s frightening you, and right now that someone is me.”

“So you’re saying I’m being paranoid?”

“I’m saying right now you feel me as dangerous. And that’s okay. We can deal with that. We can explore what makes you so frightened both inside your head and outside in the world.”

“So you could think that homosexuality was okay and not be homosexual yourself?”

“Yes,” I say, concerned about how much less adult Stan feels to me right now. “Stan, you told me that you came from a Christian, conservative background. I assume the message was that homosexuality was bad, a sin?”

“Definitely.”

“And do you think that’s what’s scaring you now, that you’re afraid if you’re gay you’ll go to hell?”

“But maybe if I give up Frank and stay with Paulette I could go back to having a normal life and be redeemed.”

“I guess you’ve added a whole new dimension to your conflict. It’s not only figuring out what you want and not only trying not to hurt anyone, it’s also wrestling with a difficult religious question.”

“And can you help me with that?”

“Well, I can help you explore your thoughts and feelings, but I can’t answer the religious question for you any more than I could answer whether or not to be with Frank.”

“Thanks. I don’t know why, or how, but somehow I think this helped.”

“I’m not sure why either, but perhaps it was parsing out the different pieces of your conflict so that your feelings don’t seem so overwhelming.”

The Dream

“I had a dream last night,” Justin begins, squirming nervously in his chair. “I can’t remember any of it, but I feel haunted by it. I know that doesn’t make much sense, but it’s like I woke up scared, like something terrible is going to happen, like something or someone is going to get me. I kind of want to keep looking over my shoulder. Even here, I wonder if there’s someone else in the room, although I know that’s ridiculous.”

Justin, a 45 year old accountant, has been my patient for several years and, as far as I can remember, has never before spoken about a dream.

“Well,” I respond, “the dream obviously affected you, so maybe you can talk about your feelings and what those feelings bring to mind.”

“You’re charging your phone,” he says.

“Yes,” I say, surprised. It’s not unusual for me to charge my cell phone while patients are in the office.

“How do I know you’re not recording me?”

Justin can sometimes be a bit paranoid, but his question is beyond anything I would expect. “I guess you are feeling frightened, Justin. Your world suddenly feels very unsafe so even innocuous things can feel threatening."

"You didn’t answer my question.”

I’m taken aback, perhaps even a little frightened myself. Hmm, I imagine Justin is unconsciously inducing his feelings in me. “No, I’m not recording you. You’ve seen me charge my phone before, so I’m assuming that your concern is being triggered by your fear.”

Justin stares at me. My fear builds.

“Would you like me to unplug my phone?” I ask.

“I’d like you to turn it off,” he replies woodenly.

“Okay,” I say as I lean to my left, pick up my phone and turn it off.

The silence that ensues is deafening.

Finally, Justin drops his head in his hands, shakes his head and mumbles, “I’m sorry, I don’t know what’s wrong with me.

I breathe a sigh of relief. “So let’s see if we can figure out what’s going on, perhaps what triggered the dream, what might have led you to feel so frightened.”

“It’s such a terrible time of year. Tax time you know. Some days I’m working 5AM to 10PM at night. And everyone wants a piece of me. My ex-wife’s mad because I haven’t taken the kids. My older son says he needs money for college. My clients are driving me crazy. Everyone wants their taxes last week. I keep telling them it’s no big deal if we have to file an extension. But, no, that’s not good enough.”

“When you say everyone wants a piece of you, what comes to mind?”

“That’s it!” he says excitedly. “That’s what was happening in the dream. Everyone was pulling at my skin, like they were trying to rip me apart. I know there was more after that but …” He stops. “I think there was like a monster there. Maybe like a monster waiting to eat the pieces of me that they threw to it.”

I grimace internally. “That does sound terrifying.”

Silence.

After a few moments I ask, “What’s going on in your head?”

“I don’t know. I sort of feel I used to have that nightmare as a kid. A lot.”

“Any thoughts about it?”

Silence.

“I’m sorry,” he says after a few moments. “I suddenly felt frozen. Like I couldn’t move. And… I know this is ridiculous, but you seem menacing again.”     

“What is it that you’re afraid I’ll do?”

“I know this is crazy, but what jumped into my head was, eat me.”

“Like in the dream.”

He nods.

“Any thoughts?” I ask, although I have a pretty good idea of the answer.

He nods again. “Yeah, my mother. I used to say she loved me to death. But I guess I meant that literally. She wanted all of me. She didn’t want me to have anyone else in my life. She didn’t do that to my sisters, just me. They hated me, thought as the boy I got all of my mother. But I didn’t want all of her! And I sure didn’t want her to have all of me! Yuck! I feel beyond creeped out. I mean, I know we’ve talked about all this before, but having that dream made it so much more real.”

“The dream actually brought you back to the feelings you had as a child, the terror of being eaten, of being swallowed up.”

“Stop! I can’t deal with any more today.”

“Of course. Whatever feels comfortable for you.”

Justin looks at me with tears in his eyes. “I wish my mother could have been concerned about my comfort. And I’m sorry I thought you were recording me.”

“Nothing to apologize for. Totally understandable given what you were feeling.”

We’re Pregnant

“I feel like such an idiot being here,” Harvey says. “Elise, my wife, has been in therapy forever and I’ve always made fun of her, never believed in it, thought you should be able to solve your own problems. But I throw in the towel. I can’t handle it. My wife is pregnant or, as she insists, we’re pregnant. That weirds me out in itself. I’m not pregnant. I get what she means, but it’s bad enough watching her body change. I sure wouldn’t want those kinds of changes happening to my body.”

Well, I think to myself, that’s an interesting beginning. Body issues for sure, but sounds like there’s a lot more going on.

“Elise’s therapist recommended you. Said you were the best. So I guess you know each other. Does that mean you’d talk to each other about us?”

“No, Harvey, what you say here is confidential. I wouldn’t share it with Elise’s therapist or anyone else.” With some paranoia thrown in, I suspect this man has pretty deep seeded problems.

“We wanted to get pregnant. We’ve been trying for a while. But now that it’s here, I have lots of second thoughts. But it’s not something you can change your mind about.”

“What’s freaking you out about the pregnancy?”

“Well, I worry whether I’ll be a good father, how much a baby will change our lives. We have a pretty good life. I make good money. I’m a financial planner. We travel a lot. We like to play. We…we have great sex. Or we used to.”

“You used to?”

“Yeah. I haven’t touched my wife for a while. Like pretty much as soon as we knew she was pregnant and she’s going on six months. First I was afraid I’d hurt the baby, although my wife and the doctor said that wasn’t possible. And now, now I don’t know… I feel bad saying this, but I guess I find her rather grotesque. You’re sure you won’t say anything to anyone, right?”

“Sounds like it’s hard for you to trust, Harvey.”

“Now that’s true. Hasn’t seemed to me there’s ever a reason to trust people. In my business people lie all the time. Out for the buck. Ready to say anything, stab anyone in the back.”

“And before you were in the business?”

“Yeah, I know, you want to know about my childhood. I could never understand how that’s relevant, but no question my childhood was awful. My mother was schizophrenic, in and out of hospitals. She died in one of those hospitals. My father, he was a sadistic bastard. I was the middle of three boys. It was called equal opportunity abuse. Probably worse for me and my younger brother. We were bed wetters. My father would beat us senseless. And then he devised this great humiliation technique. He’d make us sit on the stoop of our house, take out our penis and sit with a ribbon tied around it. Didn’t help the bedwetting.”

“That’s horrible, Harvey. What tremendous shame to inflict on a child.”

“Can’t argue with you there. By 17 I was gone. Never looked back. Didn’t do badly for myself. Until now.”

“How much younger than you is your younger brother?”

“Five, six years. We haven’t stayed in touch either. Probably don’t want to remind each other of what it was like.”

“Do you remember your mother’s pregnancy?”

“No. I don’t remember much of my mother. Probably wanted to put that away too.”

“Do you remember what any of her breaks were like?”

“I remember she’d be out of control, scared, screaming. She’d tear at her face, like she wanted it to be gone. Maybe like she wanted to be gone, but I just thought of that now. So can you help me, doc?”

“I think so. But I don’t think this is going to be an easy road for you. I’d say you have long standing issues about your body and lots of fears of bringing a child into a world you see as scary and unforgiving. And you might be scared of the child as well.”

“Of the child?”

“Not wanting to bring another person like either of your parents into the world.”

“I worried about that schizophrenic thing. But my wife said it was worth the risk.”

“So maybe it feels to you that your wife will bring another being like one of your parents into the world and maybe that makes your wife scary and untrustworthy as well.”

“That’s too deep for me.”

“That’s okay. We have lots of time.”

“No, we don’t. The baby’s not waiting for anyone.”

“That’s true. But you can’t put too much pressure on yourself. You can only do what you can do.”      

If Looks Could Kill

Marlene glares at me as I open the door to the waiting room. My customary smile freezes on my face. I’ve been seeing Marlene for over three years now and her connection to me is quite intense. As we walk toward my office I ask myself if there was there anything notable about our last session. I didn’t announce an upcoming vacation. I don’t recall a therapeutic breach. We talked about her father, a man she has been loath to take off his pedestal. 

Marlene drops into the chair, crosses her arms and legs and pointedly looks out the window, avoiding my eyes. She’s a tall, blonde woman in her mid-thirties who came into treatment because of repeatedly failed relationships she described as filled with betrayal and abandonment.   

We sit in silence for several minutes as Marlene’s anger fills the room. I’m becoming increasingly uncomfortable. Is that because I want to avoid getting caught in a power struggle? Or does Marlene’s anger feel too big to me, triggering my own discomfort with intense rage? I can’t tell. But I know I’m going to break the silence.

“You’re obviously really angry with me, Marlene. Can you tell me why?”

“I hate you!” Marlene spits at me.


Over the years, I’ve certainly had patients tell me they hate me. But the venom behind Marlene’s words is frightening to me, especially since I have no idea what’s fueling it. I do know her anger is triggering me, reminding me of the irrational, explosive rage of my father, but that awareness doesn’t assuage my anxiety.
  
“You’re just like my fucking mother! All you want to do is take him away from me. I can’t say you want him all to yourself, you’re too much of an old bag for Daddy, but you probably just want me to be as miserable as you.”

I’m getting a glimmer of what’s going on. That helps. But the paranoia behind Marlene’s words is still discomforting. 

“So in our last session you felt I was trying to take your father away from you.”

“I didn’t ‘feel it,’ you were. Telling me he never loved me!”

I feel I’m walking through a land mine. If I dispute Marlene’s account of what I said, we’ll only end up arguing about who said what. Yet I’m not comfortable allowing what I see as Marlene’s distortion to exist as fact. I decide to try to go underneath the rage and paranoia. 

“So if I was trying to take your father away from you I can certainly understand your feeling enraged at me. But what if in the course of our discussion you found yourself having some doubts about your father …”

“Never, bitch! You see. You’re doing it again.”

My anxiety is moving towards anger, just as Marlene’s anger covers her fear and vulnerability.

“Marlene,” I say with more determination. “There’s a lot going on here today. Even the intensity of your rage and your unwillingness to hear me out, speaks to your covering over lots of feelings. Something clearly got triggered in our last session. I’ve become the enemy. I wasn’t your enemy before and I’m not your enemy today. If you feel I was too harsh about your father, I apologize. But no father is perfect, no father can be 100% available and loving. And I think you got scared about losing your perfect father. Perhaps having him be less than perfect feels like he’s not there at all, sort of like with me going from friend to enemy, he went from being 100% there to being 100% absent and that was too painful to bear.”

Once again there is silence, but this silence feels more tolerable.

“I don’t know,” Marlene finally says in barely a whisper. “If I believe you, I lose him. If I stay with him… I don’t know. Does that mean I lose you?”

“The world isn’t so black and white, Marlene. You don’t have to choose between us, even though I know that is how it often felt with your parents. Neither your father nor I are perfect, but our lack of perfection doesn’t mean that you’re abandoned and alone. It means you get to take what you can from each of us imperfect people and that you can also look beyond us for close, meaningful relationships.”

“I don’t know. I don’t know what to think.”

“What is it that you feel right now?
”
“Confused.”

“Anything else?”

“Kind of empty. It’s like I was filled with rage when I came in and now that rage is gone, but I’m not sure what’s there in its place.”

“I understand. We’ll continue to talk about it next time.”

Paranoia

“I’m afraid I’m going to be fired,” Tricia says.

I’m surprised. I’ve worked with Tricia over a year and she has given me only glowing reports about her success as a graphic designer.

“They think I stole Charlotte’s idea.”

“Did you?” I ask. Tricia has never spoken well of Charlotte. My sense is that Tricia is envious of Charlotte - her senior status, her looks, her ease in social situations.    

“Of course not,” she replies indignantly. 

“Then why should they think you did?”

“I just do.”

I wait.

“What, you don’t believe me? You think I’m lying?”

I knit my brows and look at Tricia, both perplexed and concerned. There’s a paranoid feel to this discussion that is making me anxious. “What’s going on, Tricia?”

“What? What do you mean?” she asks, raising her voice.

“I don’t understand why you’d think I thought you were lying or why you’re afraid you’ll be accused of stealing Charlotte’s idea and be fired.”

She stares at me defiantly and then deflates before my ideas, dissolving into tears.

“I’m bad. I’m bad and I’m going to be punished.”

I feel as though I am in the room with a child who’s been caught … Caught doing what? What comes to mind is caught with her pants down.  I file away my internal meanderings and wait to hear what Tricia will say. But Tricia, looking frightened, says nothing. 

Very gently, I ask, “Can you say what makes you bad, Tricia?”

She shakes her head, still not speaking. 

Fantasies go through my head. She had sex with Charlotte. She beat Charlotte up.  She hit someone with her car. She molested a child. She … I bring myself back to reality. Tricia’s anxiety is obviously contagious, but these are fantasies, not realistic possibilities. 

“I had sex with Peter,” she blurts out.

Aha, I think, her boss - and Charlotte’s. She had sex with a male authority figure, a stand-in for her father and is afraid of the punishment from both inside her head and in the real world. Clearly she’s already punishing herself, branding herself as bad. She also fears retaliation from Charlotte, from me, from her mother, and from the powers that be at work.

Suddenly I flash on a patient I saw many years ago. She had been a teacher, but could no longer work. She had an affair with a married principal and felt so guilty that she became convinced everyone in the school system talked about her. She was tormented by her thoughts, but unable to move beyond them. I don’t work well with paranoid people. They remind me too much of my father, I’m too easily sucked into unfruitful and untherapeutic attempts to convince them of the wrongness of their thinking. I must tread lightly with Tricia.

“Sounds like you feel pretty guilty.”

“How could I be so stupid?” she asks, hitting her thigh with her fist. “Not only my boss, but Charlotte’s too. And I know Charlotte has a crush on him. Besides, he’s only toying with me. He tries to get in every woman’s pants. Now he’ll want to get rid of me.”   

“So you feel you ‘stole’ Charlotte’s ‘man’ and that now he’ll get rid of you and choose Charlotte instead. That, you feel, would be your just punishment.”

“I don’t know what you’re talking about,” Tricia says loudly.

“Tricia, why do you feel what you did was bad? And why are you so frightened?”

“I told you! It was stupid!!”

“Let’s say you decide it was stupid, that doesn’t seem enough of a reason to conclude that you’re bad and that you’re going to get fired. I do believe you do feel terribly guilty, but I suspect the origin of that guilt stems a lot further back.”

“You mean some dumb Oedipal thing? I never wanted to sleep with my father!”

“But I suspect you did want your father to prefer you to your sisters and perhaps even your mother.”

“He did prefer me,” Tricia says quietly looking down. “That’s why my mother hated me so much.” 

I don’t know if Tricia’s assessment is accurate, but I suspect it is why Tricia feels so guilty and also why she’s convinced retribution must follow. 

“It’s important that we try to understand your feelings about the relationship between you and your parents, but right now I wonder what you’re thinking about being fired.”

“It still think Peter might try and get rid of me and that Charlotte hates me, but I’m not feeling quite as scared as before.”

“Maybe that’s because you’re not beating up on yourself quite as much.” 

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.