Inside/Outside
Showing posts with label patient-therapist relationship. Show all posts
Showing posts with label patient-therapist relationship. Show all posts

Monday, February 26, 2024

Unrelenting Grief

“I just can’t get over this,” Scott says his head buried in his hands, a tall, dark-haired man who looks like he’s in his mid-thirties. “He was 98 years old. Did I expect him to live forever? I loved him so much. And he was always, always there for me. When he and my Grandma decided they couldn’t handle the Kansas farm anymore they moved right next door to us. Actually giving up the farm was pretty hard for me too. I guess I’ve always been a softie. My Dad made fun of me, called me a wuss, a ‘girl,’ too sensitive for my own good. He was always trying to toughen me up. But I loved that farm. It was my safe space. I spent summers there, got to be rid of my Dad and just be loved by my Gram and Gramps. I’m sorry, I’m just rambling all over the place”

“Not at all,” I say. “I can feel how much you’re grieving.” I am near tears myself, remembering the pain of losing first my grandmother and then, three years later, my grandfather. Remembering too, although my grandparents lived not on a farm but in a three room apartment in the Bronx, I knew what it was to have and lose a safe space. “You’re talking about loss. Most people have a terrible time with loss. Doesn’t mean you’re a wuss. Loss of the farm, loss of the days of feeling safe and protected, now the loss of your Grandpa. Is your Grandma still with you?”

“Yes, she’s only 90,” he says with a slight smile. “In my family that’s almost young. But the last month has been really hard on her,” he says sobbing. “I guess it’s been really hard on all of us, taking turns sitting by his bedside, holding his hand, first all those machines and tubes and God knows what else. Then, nothing. I don’t know which was worse, hoping for a miracle, or letting go of hope,” he says breaking down in gut-wrenching sobs. 

Several minutes pass.

“I can’t go on like this. It’s over a month. I have a wife, a precious daughter, a job. I can’t just keep crying.”

“A month isn’t a long time, but I understand you’re saying you’re feeling his death too intensely, like it’s entirely consuming you.”

“Exactly! And I keep asking the same thing my father did, ‘What’s wrong with me?’”   

“I suspect there’s nothing wrong with you, but perhaps we can try to understand the intensity of your feelings. Whose Dad was he, your mother or father’s?”

“My mother’s. I never really knew my father’s parents. They were very old and lived across the country so we almost never saw them. I don’t think I even went to their funerals – my Mom probably wouldn’t have wanted me to.”

“Because?”

“She was over protective like that, wouldn’t have wanted me to get too close to death.” Pause. “I had an older brother who died before I was born. I’m not sure my mother ever got over that loss. And she spent a lot of time making sure I wasn’t going to die like he did.”

“How did he die?”

“I guess he was a real dare-devil kid from the moment he was born. Putting things into electrical sockets when he was like two, riding his bike in traffic, climbing taller and taller trees. That’s how he died, fell out of a tree. My Mom was going to have none of that with me.” 

“Are you saying your Dad pushed you to be more like your brother and your Mom pushed you to be anything but?”

“I never thought about it that way, but that’s exactly right.”

“And your grandparents?”

“I was fine however I was.”

“Wow, that’s quite a contrast. Your grandparents loved and accepted you for just being you. You didn’t have to do or not do anything. That’s an amazing gift. No wonder your grief is so profound.”

Scott weeps. After a while he says, “But I have to stop crying. Why can’t I stop crying?”

“Because you’ve lost one of the two people who were most able to love you.”

Scott shakes his head. “I think there’s more.”

“I’m sure there is. None of our behavior is so simply explained. Do you have any thoughts?”

“I think I’m afraid. I’m afraid of my father. I’ve always been afraid of my father. My Grandpa kept me safe from my father. Now that he’s gone I don’t know if I’ll be safe. I don’t know if I can keep myself safe. And my Grandma’s too depleted. Anyway she wasn’t the one who kept me safe from my father. It was Gramps, Gramps,” Scott says sobbing. “I’m such a baby. I’m a 36 year old man, how can I be so afraid of my father?”

“I guess that is the question, Scott. What went on between you and your father when you were little that made you so afraid of him? We already know that he was very critical of what he saw as your ‘weakness.’ But perhaps there was more. Our time is up for today, but perhaps we can continue with this next time.” 


Saturday, January 13, 2024

Not Again

As Cynthia sits scowling from the chair diagonally across from me, I remember why I was both surprised and less than thrilled to have her call and ask to return to treatment.

After several minutes of us staring at each other I say, “What prompted your wanting to return to therapy with me?”

“The New Year,” she says curtly, as if that provides an adequate explanation.

“And…?” I ask, prodding.

“What the fuck! You know people make resolutions about what they’re going to do to improve their lives. As if January 1 was the magic date.”

“That would imply there were things in your life you wanted to improve.”

“Of course! You know anyone who doesn’t want to improve their life!”

“This all feels very familiar Cynthia. You say you want to improve your life, you asked to come back into therapy with me, yet you’re immediately attacking everything I say.”

“What? You can’t take somebody challenging you?”

“Okay,” I say, hoping I’m hiding my desire to strangle her. “Let’s look at that last comment: You can’t take somebody challenging you. What impelled you to make that particular statement?”

“What? How should I know. It seemed like a good response to your dumb ass comment.”

Silently counting to 10, I reflect on how uncomfortable it is to be angry and to have to contain it. “Okay,” I say. “We already know you’re angry. And we know you have good reason to be angry. But would I be making a wild guess to say that perhaps one of the ways you’d like to make your life better is to be less angry?”

She shrugs.

We again sit in silence, but this silence feels a bit more comfortable, not as raw, not as challenging.

She mumbles something.

“I’m sorry,” I say, “I didn’t hear you.”

“It’s not a good way to make friends,” she says, barely over a whisper.

“True. In fact I think that sometimes you use your anger to keep people away.”

“Why would I want to do that?” she asks, the edge back in her voice.

“I wasn’t criticizing you when I said you use your anger to keep people away. I was making a comment that, if correct, might help you to think about when and why you try to keep people away and when you you’d like a person to be closer.”

“I never know,” Cynthia says, again barely above a whisper. “I do want more people in my life. But when they come at me, I don’t know, I just can’t take it.”

“Interesting choice of words, Cynthia – when they come at me – like when your parents came at you to punish you, beat you, hurt you.”

She nods, dropping her head. “Yeah.” Pause. “People aren’t safe.”

“Some people are safe.”

“You can always get them mad.”

“I guess you’re saying YOU can always get them mad by prodding and poking and challenging. Or by running away.”

“Who says I run away?!”

“There’s that edge again, Cynthia. I say you run away. If you didn’t run away you’d have more people in your life. You’d be less lonely.”

“I never said I was lonely!”

“You didn’t imply it?” I ask gently.

She shrugs. Pause. “I guess.” Pause. “I don’t want people getting too close. I could get hurt.”

“I understand that, but I wonder if you’re also saying it feels really scary to want people, to need them. Like it feels really scary to need me, to say you want to be here, that you need to be here.”

“Go fu…” Pause. “I was just going to tell you to go fuck yourself, but then that seemed like exactly what you were saying, that I use my anger to keep people away and maybe it’s because I don’t want to need any of those fucking people who are just going to hurt me again and again.”

“I’m impressed, Cynthia, that you were able to catch that yourself, reflect on it and keep yourself from giving an automatic angry response.”

“Yeah. I guess that was pretty good.”

I smile. “I’m glad you were able to take in a positive comment about yourself and accept it.”

“I guess.”

“Now don’t get too enthusiastic,” I say teasingly.

“I… I’m glad I came back.”     

“Thank you, Cynthia,” I say. “I’m really, really glad you came back too.”


Saturday, November 11, 2023

Missed Sessions


 Jeremy, the prototype of a man who is tall, dark, and handsome, and just beginning to enter middle-age, begins his session by saying, “I won’t be here for the next three weeks. I’ll come back in December.” 

“Are you going out of town?” I ask, surprised. He hadn’t mentioned an upcoming vacation. And I don’t recall him making such an announcement in the two or so years we’ve worked together.

He squirms in his chair. “Umm, no. No, I just figured I could do with a little break.”

“Because?”

He crosses his legs, uncrosses them, then crosses them again. “It’s just beginning to be a bit too much.”

“What’s the ‘it?’”

“This,” he says, gesturing around my office.

“And what’s making it too much?”

“That,” he says brusquely, gesturing toward me with his chin.

“I’m too much.”

More squirming. “Not you exactly, just this, this questioning, probing, always searching for something more, something deeper.”

I try to think what might have occurred in our last few sessions that may have brought about Jeremy’s desire to flee. “Is there something that happened that made you feel I’m too overbearing, too intrusive?”

“I knew you’d say this was about my mother!” Jeremy says angrily.

Although I hadn’t been thinking about his mother, I remain silent, waiting to see what might develop.

“It’s not about my mother. I haven’t spoken to my mother in weeks. I decided to take a break from her too!” He pauses, taking in what he’s just said. “Shit!! I just agreed with you, didn’t I? This could come straight out of a Woody Allen movie!”

I smile. “And like in a Woody Allen movie, I’m going to continue digging. Is it that I’m feeling like your mother or have you experienced me as being more intrusive lately? Or did something happen with your mother?”

“I don’t want to. I don’t want to keep thinking and thinking and trying to figure things out. It’s enough already. I need a break!”

I feel frustrated and annoyed and find myself unable to stop. “Can you at least humor me and help me understand why this has come up right now?” As he is about to respond, I realize that I am indeed duplicating his relationship with his mother and say, “Wait! Let me pull back. First, I realize I am repeating exactly the relationship you have with your mother. I’m coming after you more and more. And the more I come after you the more you resist and the more you resist, the more I come after you. But, and maybe this is the piece you need to own. You’re the one who has put up an unbreakable wall. You’ve said ‘no matter what you say or do, I’m not telling you.’ You may have very good reasons for erecting that wall in the past, but now it feels more like a two-year-old who’s having a tantrum. Which doesn’t excuse my behavior of coming after you. I need to look at that myself and figure out why I couldn’t just pull back and let you tell me in your own time.”

“That’s a lot to take in.” Pause. “I do appreciate your saying that last part, that it’s not all me, that something got kicked up in you as well. It helps break the cycle you were referring to – chased after, run away; run away, get chased after.”

Long pause.

“I think I know what happened,” he continues. “I did have a
conversation with my mother. But before that I broke up with Charlene. I broke up with Charlene for exactly the reason we’re talking about. I told her I was going out with some friends and she asked where we were going. I wouldn’t tell her. We were only going out drinking, although Charlene did think I drank too much. Anyway, I wouldn’t tell her and she came up with more and more preposterous guesses – going to a strip club, hiring prostitutes, etc. It was ridiculous. The more she came at me, the more intransient I became until I finally said, ‘That’s it, we’re done!’ My mother called the next day and began right away bugging me about what had happened with Charlene and when was I going to settle down and give her grandchildren. I hung up on her.”

“So you were tired of all these pushy women, myself included.”

“Exactly!”

“I wonder if you’re so afraid of all these pushy women that you erect barriers to protect yourself or whether you erect those barriers so that women WILL come after you so that you can be ‘justified’ in rejecting them.”

“Why would I do that?”

“We’re almost out of time and you’ll need to tell me whether you’ll be here next week or not, but I think you might want to reject them so you never have to deal with the need for genuine connection that exists within you.”

“Wow! That’s a lot to digest”

“Yes, it is. And if you want to take some time to digest it, that’s fine and if you want to come in next week that’s also fine.”

“Can I think about it and call you?”

“Yes.” 


Friday, October 13, 2023

Risk Averse

 “I was talking to my friend Cindy last night,” Jenny begins. “She said she came across this quote from Eleanor Roosevelt ‘Do something every day that scares you.’ I was blown away. That’s just what we’ve been talking about, right?”

“Yes,” I agree nodding. “That’s a very profound quote.”

“But I thought you said you have to feel safe in order to take risks.”

“That’s also true. But if you wait until your last, last drop of fear and anxiety is gone you might stay stuck forever.”

“I know,” Jenny says dejectedly. “That’s why I’m here,”

“You’re 25 years old Jenny, I don’t think you can say you’re stuck forever.”

“I know. But we’ve been working for a while now and there are still so many things I’m terribly, terribly afraid of. Meeting new people is a total, complete trauma for me. I hate the first few weeks of school. There are so many new people, new faces, new expectations, new, new, new.” 

“And what is it that you’d say you’re afraid of?”

“That’s no secret. The wicked step-mother! What a cliché.”

“Except your step-mother was a little more wicked than most.”

Jenny seems to fade away and soon starts visibly shaking.

“Jenny, where are you? Can you come back?”

“I’m here. I didn’t dissociate. At least I don’t think I did. I knew I was here with you in your office.” Pause. “But perhaps part of me was back there, back in that basement,” she says starting to cry. “Why, why did she hate me so much? What did I do that was so terrible?”

“Jenny…”

“I know. You’re going to say I didn’t do anything. That she hated me because I took my Dad away from her, because she couldn’t have him every minute of his life. But maybe that means I was too demanding, wanted too much!” she adds sobbing.

“Is that how it feels, how it felt?”

“Yes, that I was just a greedy child who would suck her father dry unless Darlene stepped in to protect him! After all, I had killed my mother, why wouldn’t I kill him?!”

“Do you feel you killed your mother?”

“Of course!” Pause. “No, no I didn’t kill my mother, she died of cancer!”

“Jenny, it sounds like the rational you knows that you didn’t kill your mother, but perhaps there is a piece of you that feels you did.”

“She died so soon after I was born, before I was one. I don’t remember her at all,” she says sobbing. “Is that killing her? Not remembering her?” Pause. “Maybe I infected her when I was inside her. Maybe there was something so bad about me I contaminated her.” 

Although the rational me, yearns to counter Jenny’s assessment of her culpability, I wait to see what more primitive material Jenny may unearth. 

“Darlene would always tell me I was a bad seed, destined to do nothing but hurt and destroy. I fought her, screaming, yelling, thrashing, but she only hurt me more, left me starving in the freezing cold basement. It gets cold in Vermont in the winter. But, truthfully, I believed her. I believed I was a bad, bad person. I had killed my mother. She gave up her life for me. Even neighbors said that. ‘Your mother loved you so much. She gave up her life for you.’ She gave up her life for me and I was so, so angry with her. If she was going to have me, she should have stayed with me!! If she was going to leave me she should never have had me!” Jenny says, sobbing.

I want to go her and hold her and tell her nothing was her fault and that everything will be all right. Instead, I sit calmly in my chair. 

“I never said that out loud before,” Jenny says between sobs. “It feels good to say it out loud.”

“What feels good about saying it out loud?”

“I’m not sure. Sort of like I can examine it in the light of day.”

“And what do you see when you examine it in the light of day, in the light of an adult day?”

“Yes, that’s it. Saying it out loud brought it into the present, into me as an adult – sort of. It’s like a child fantasy that I’ve carried around my whole life and in the light of day – in the adult light – it doesn’t feel as real or as powerful.”


“It’s time for us to stop for today, Jenny, but you’ve done amazing work here today. I hope you’re able to be proud of yourself.”

Yes, yes I am,” she says smiling for the first time. “Thank you.”

“Thank you,” I say.


Wednesday, July 12, 2023

Considering

 “I wanted to let you know,” Tammy says immediately upon sitting down, “I’m considering changing therapists.”

I’m surprised and try to recall what if anything might have occurred in our last session that would have prompted her possible termination. “Because…?” I ask.

“We just don’t seem to be getting anywhere. It’s over two years. And, yeah, I know, therapy is a process, not a destination.”

“Is this something you’ve been considering for a while?”

“Uhm. No, not really.”

“Can you say what started your thinking along these lines?”

Tammy squirms in the chair. “Uhm, I guess I’d rather not.”

“Why would you rather not?” I ask bemused.

“This is why I want to change therapists! You question everything! You want answers to everything! Why? Why? Why? I’m sick of it.”

“And what would you prefer instead?”

“Somebody who just left me alone and let me live my life!”

“Then why would you want to be in therapy at all?”

“I considered that too. But not being in therapy feels too scary. I don’t trust myself enough to not be in therapy. Who knows what I might do.” 

“I realize that you’d rather not say what started your thinking about changing therapists, but I think it’s important that you do. You know if you decide to change therapists I certainly would support you in whatever way I could. But given what you just said about not trusting yourself, I suspect that means you know you can make impulsive decisions and that despite you’re not liking to be asked why, it is an important question for you.”

Tammy sighs deeply, rolls her eyes, looks at me and smirks. “I ran into Michael, my ex-boyfriend, Michael.”

“And?”

“What do you think?”

“He wanted to get back together.”

“Right. I told him I was engaged to Philip and he just laughed. Said he couldn’t believe I was still with that nerd. And that he bet I was still in therapy with you too. I told him yeah, I was. He says it figures, that you’d want me to be with a loser, always chasing my own tail.”

“Do you feel I want you to be with a loser?”

“No, not exactly, but you are always pointing out how good Philip is to me, how he cares for me and tries to take care of me.”

“And those are bad things?”

“No, of course not. But they can get kind of boring.”

“Did you have sex with Michael?”

“No, but I was tempted.”

“So it’s Philip or Michael and me or some other therapist?”

“I guess that’s about right.”

“And who’s the other therapist?”

“I don’t know. I haven’t gotten that far.” Pause. “But maybe he would be a man. That would be different; might make it more interesting.”

“Are you saying it might make it more dangerous or more sexual…”

“I’m not sleeping with any therapist!”

“I wasn’t suggesting you were, but wondering if having a male therapist would introduce the possibility of sex into the treatment and that might feel more tantalizing.”

“I chose a female therapist in the first place because I didn’t want that sexual element to be a part of it.”

“And now you think you might?”

“I don’t know. I guess that’s why I said I was considering changing therapists, not that I’d decided.”

“This is a big conflict for you, Tammy: safety and comfort on the one hand, or excitement and danger on the other. It gets played out with Michael and Philip, with me and a male therapist, and also in your work. Should you give up your job as a nurse and see if you could make it as a singer?”

“That’s just a dream, I’m not doing that. Too risky.”

“And are you comfortable, resolved saying that?”

“Makes me a little sad, but yeah. I’m 36, I’m not making it onto the charts. Too many of me out there.”

“So that’s one of the things you’ve come to accept.”

“Yeah, I guess.”

“You know, it actually might have been helpful for you to have seen a male therapist from the start…”

Tammy shakes her head adamantly from side to side.

“No?” I inquire.

“No. Then I really couldn’t have trusted myself and who knows what stupid thing I might have done, maybe even made an ass of myself and tried to seduce the guy.”

“So maybe now the question is do you want a break from the nice, caring me and/or Philip and add a bit of spice to your life in the way of Michael and/or a male therapist.”

“I guess so.” Pause. “I don’t know. I guess I’d like to continue considering it.”

“That sounds like an excellent decision. And we can continue to talk about it as well.”


Friday, May 19, 2023

You’re Number Five

 “You’re number five,” Alex says upon sprawling languidly in the chair opposite me.

“Number five?” I ask. 

“Yes, you’re the fifth therapist I’ve seen. I liked your website, maybe a bit too sappy, but still pretty good.”

“What happened to the other four therapists?” I say, choosing to ignore his comment about my website.

“I fired them.”

“Because…?”

“Because they weren’t smart enough. Well, I guess that’s not completely true. I saw the first one for maybe a year. He was pretty good, but then I moved, so that was the end of him. The other three I saw here, but like everything else in Florida, they were just too stupid.”

“You certainly sound as though you’re angry, angry and hard to please, like nothing is good enough.”

“Okay, that’s not a bad comment. You’d get about a seven out of ten for that.”

Feeling myself becoming annoyed, I say, “Why don’t you tell me about yourself and about how I can help you.”

“That’s just it, I don’t know if you can help me.”

“Then tell me what brings you here.”

“I’m not happy.”

“Because…?”

 “Because the world is a shit place. Because people are stupid and insensitive and uncaring.”

I hesitate and then decide to say what came to mind for me. “And you see yourself as sensitive and caring?”

Alex laughs sarcastically. “I see you didn’t include smart in that and, yeah, I see myself as smart even though you didn’t ask. Sensitive and caring, not so much, but probably more than you think.”

“Alex, this isn’t a sparring contest. I imagine you are more sensitive and caring than you appear, and that your aggressive, confronting tone is more of a defense against whatever sad or scary feelings lie underneath. If I’m going to be your therapist, I need to have a sense of who you really are, so maybe you could tell me a little about those scary feelings.”

“Wow! You go right for the jugular, don’t you?”

I bite back my first impulse which is to say ‘Takes one to know one,’ assuming that would just continue the one upmanship. Instead I say, “How about telling me a story from your childhood.”

He smirks. “Yes, that’s right, you’re a psychoanalyst.”

Silence.

“Silence. Another tool.”

“I understand that change is hard, Alex, but there’s nothing to be gained by your being here, unless you’re willing to give us a chance as opposed to assuming I’m the enemy or a dueling partner.”

“You’re pretty good. I can’t rile you up.”

“There are lots of clever rejoinders I could give to your statements, Alex, but this isn’t supposed to be a debate. We’re supposed to be on the same side.”

“No one has ever has been on my side.”

“That’s sad,” I say, feeling a ray of hope. “Can you tell me who particularly you were thinking of?”

“My mother died of cancer a year after I was born – although obviously that wasn’t her choice – my father hated me because he was stuck with me, my older brother hated me because he blamed me for my mother’s death, my father’s mother thought I was a nuisance, my teachers all hated me because I was such a smartass – which I was – my wife divorced me and turned the kids against me, etc., etc. Get the picture?”

“Sounds like a pretty dismal picture. But it also seems, at least in some instances, that you’ve helped the picture stay dismal by, as you said, being a smartass which only ends up driving people away. I’m sure that ‘smartass’ way of being felt essential for your survival as a kid, but now it’s a hindrance that drives people away and leads to your being alone and unhappy.”

“I’m not unhappy. I’m just not happy.”

“Not happy and alone?”

“Yes.”

“And sad?”

Before Alex responds I rush to say, “Not a smartass response.”

He laughs. “Yes, and sad.”

“And you’ve been sad most of your life and you cover it over by being sarcastic and pretending you don’t need anyone.”

“Yes.”

“Thank you for giving me genuine responses.”

“You’re welcome. And thank you encouraging me to make that possible.”

“You’re welcome.” 

Pause.

“So are we deciding to work together?” I ask.

“Yeah, I guess I’ll give number five a chance,” he says smiling genuinely. “I promise I’ll be easier on you next time.”

“I don’t imagine you’ll be able to give up your defenses that readily, so I don’t think either one of us should expect you to be an entirely different person by next week. Maybe we’ll just be able to be lighter about your smartass responses, as opposed to thinking you won’t have any.”

“Sounds reasonable, Doc. Thanks.”